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from enteric fever occurred in Belfast, and those frommeasles in Dublin and Belfast.The deaths referred to diseases of the respiratory system,

which had been 26, 40, and 26 in the three precedingweeks, rose to 34 in the week under notice. Of the 338deaths from all causes, 102, or 30 per cent., ’occurred inpublic institutions, and 3 resulted from different formsof violence. The causes of 8, or 2-4 per cent., of the totaldeaths were not certified either by a registered medicalpractitioner or by a coroner after inquest; in the 96 large.English towns the proportion of uncertified causes did notexceed 0-8 per cent.

In the 27 town districts of Ireland 586 births and 368 deathswere registered during the week ended Saturday, Sept. 4th.The annual rate of mortality in these towns, which had been14-6,13’6, and 14-5 per 1000 in the three preceding weeks, roseto 15’8 per 1000 in the week under notice. During the firstnine weeks of the current quarter the mean annual death-rate in these towns averaged 13’9, against correspondingrates of 11’6 and 13’4 per 1000 in the English and Scotchtowns respectively. The annual death-rate last week wasequal to 16’3 in Dublin (against 12’6 in London and12-2 in Glasgow), 15-4 in Belfast, 15-6 in Cork, 29-1 inLondonderry, 14-9 in Limerick, and 19 0 in Waterford,while in the 21 smaller towns the mean rate did notexceed 13-0 per 1000.The 368 deaths from all causes were 30 in excess of the

number in the previous week, and included 59 which werereferred to the principal epidemic diseases, against numbersincreasing from 24 to 49 in the four preceding weeks. Ofthese 59 deaths, 41 resulted from infantile diarrhoeal diseases,8 from whooping-cough, 5 from scarlet fever, 2 each fromenteric fever and diphtheria, and 1 from measles, but not onefrom small-pox. The mean annual death-rate from thesediseases was equal to 2-5, against 2-1 per 1000 in the Englishtowns. The deaths of infants (under 2 years) from diarrhoeaand enteritis, which had increased from 13 to 36 in the fourpreceding weeks, further rose to 41 last week, and included18 each in Dublin and Belfast, 3 in Londonderry, and 2 inCork. The deaths referred to whooping-cough, which hadbeen 10, 8, and 5 in the three preceding weeks, rose to 8 lastweek, and comprised 5 in Belfast, 2 in Londonderry, and 1 inKilkenny. The 5 fatal cases of scarlet fever, of which 3occurred in Belfast, were 2 in excess of the average in theearlier weeks of the quarter. The deaths from enteric feverand measles were registered in Belfast, and those from diph-theria in Belfast and Wexford.The deaths referred to diseases of the respiratory system,

which had been 40, 26, and 34 in the three preceding weeks,fell to 28 in the week under notice. Of the 368 deaths fromall causes 133, or 36 per cent., occurred in public institu-tions, and 6 resulted from violence. The causes of 13, or 3-5per cent., of the total deaths were uncertified, against0-8 per cent. in the large English towns.

ROYAL SANITARY INSTITUTE.-The provincialsessional meeting of the Royal Sanitary Institute was held atBrighton on Sept. 3rd and 4th. On the opening day a paperwas read by Major S. P. James, M.D., I.M.S., head of theKitchener Indian Hospital at Brighton, on Sanitary Problemsin Hospitals for Indian Troops in England, and interestedspectators of the proceedings were some 20 Indian soldiersof different castes and races who were present in order toillustrate the different types of Indians who are being cateredfor in Brighton. Major James’s paper gave a comprehensivesurvey of the arrargements that had to be made at both theEitchenf r and Royal Pavilion Hospitals to enable the patientsand staffs to live in accordance with the varying rulesenjoined by their religious sects. Major C. C. Murison,I.M.S., staff officer at the Kitchener Hospital, read a

paper dealing with the use of storm water drains toensure safe water-supplies being obtained from pollutedcatchment areas, and he exhibited and explained models ofa fly-proof meat-market and sweetmeat stall for the tropics.Lieutenant-Colonel H. R. Kenwood, M.B., R.A.M.C., intro-duced the subject of Camp Sanitation, giving results of theinspection of most of the great camps in the UnitedKingdom. Later in the day the members of the Instituteand friends visited either the Kitchener or the Royal PavilionHospital, and as ladies are not admitted to the Indian hos-pitals a special visit was arranged to the school clinic andsanatorium. On the second day Dr. P. Boobbyer, M.S.,initiated a discussion on Maternity and Child Welfare, andthere was also a debate on the Final Report of the RoyalCommission on Sewage Disposal, led by Dr. Samuel Rideal,D.Sc., F.I.C., and Mr. J. D. Watson, M.I.C E. Visits weremade to the Shoreham Camp and the Brighton ElectricityWorks.

IRELAND.(FROM OUR OWN CORRESPONDENTS.)

Insanity in Ireland.THE annual report of the inspectors oft lunatics-

in Ireland, recently issued, states that there wereat the beginning of the present year 13,187 maleand 11,993 female insane under care in Ireland.The total, 25,180, is greater by 171 than at the-

beginning of the previous year. The increaseduring 1914 was 50 less than the average in--crease for the preceding ten years. Since 1880>the proportion of insane under care to the total

population has increased from 250 to 575 per100,000. During the year 1914 the pauper lunaticsin workhouses decreased by 1073, of whom 652were transferred to district asylums. The in-

spectors do not think that the war has been

responsible for any increase of insanity, thenumber of cases admitted which were due inwhole or in part to mental stress not showingany increase during 1914. On the other hand,the cases in which alcohol was assigned as a

principal cause showed a marked increase of alladmissions, as the following figures witness: 1910.10’48 per cent.; 1911, 8’83; 1912, 9’53; 1913, 8’62 ;and 1914, 11’01. This sudden increase in 1914 maybe due indirectly to the war producing a greaterconsumption of alcohol. The inspectors adduceevidence to show that venereal disease plays onlyan insignificant part in the causation of mental,

abnormality in Ireland. The great majority ofthe county asylums contain little or no generalparalysis, and inquiry has shown that the fewcases met with in them occur in persons who-have served with the forces of the Crown or havelived in seaports. The only asylums in which.the death-rate from general paralysis approaches-the similar rate in English and Scottish asylums.are Belfast, with 17’10 per cent., and the RichmondAsylum, Dublin, with 11’26 per cent. During theyear 1914 two deaths occurred by suicide, three bymisadventure, and one from injuries inflicted byanother patient. In Cork, Castlebar, and Sligo-asylums there were outbreaks of enteric fever duringthe year. In the Richmond Asylum there were30 cases of dysentery, with six deaths. The grossaverage cost per head varied from C21 18s. ld. in.

Killarney Asylum to C35 3s. 8d. in the RichmondAsylum. Further accommodation is required in

many asylums, notably in Castlebar, Mullingar,.Omagh, and Sligo.

Belfast and Pauperism.The Government returns for the month of July

show that Belfast can claim the distinction ofhaving the lowest pauperism record per 10,000 ofthe population of any city in the United Kingdom,the rate being 79, while in England and Walesthe rates ranged from 361 in the central districtof London to 96 for the Bolton and Oldham andHalifax and Huddersfield districts. The rates forScotland varied between 221 in the Glasgow and135 in the Dundee and Dunfermline districts.The record for the Dublin district was 258, forCork, Waterford, and Limerick 298, and the

Galway district 129. The total number of pauperson one day in the second week of July last inthe Belfast district was 3343, a reduction of 2 per10,000 compared with a month previously, and adecrease of 10 per 10,000 compared with last year.

Tyrone Medical Association.At a meeting of the County of Tyrone Medical

Association held on Sept. 3rd, Dr. E. C. Thompson

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presiding, the following resolution was passedunanimously :-That we, the Tyrone Medical Committee, condemn in

the strongest possible manner the unpatriotic action ofthe majority of the Clogher board of guardians in appoint-ing to the office of dispensary medical officer a youngmedical man qualified to serve his country at the front inthe Royal Army Medical Corps, and ignoring the longservices of the other candidate, Dr. R. H. Ross, whoalready for many years was permanently settled in the district,and had proved his ability to discharge the duties of this.office in addition to those of medical officer of the workhouse.

A resolution was also passed protesting againstthe appointment of whole-time referees under theInsurance Act, but advocating the procedurewhich has worked so well under the Workmen’sCompensation Act, of each society supplying itsown medical referee at its own expense. A furtherresolution was also passed in favour of amal-gamation of the British and Irish Medical Associa-tions, and of making the Tyrone Medical Associa-tion a branch. On the part of the dispensarymedical officers, resolutions were carried as tothe scale of consultation fees, the right to a

month’s holiday each year, fixing £4 4s. perweek as the remuneration for doctors of district

hospitals, and as to curtailing of the moderateholidays requested by Dr. H. B. Fleming, themedical officer of Omagh union workhouse.These proposals, regarding Poor-law medicalofficers, were placed before the Omagh guardiansat their meeting on Sept. 4th, but after some

discussion the board decided to take no action.

PARIS.(FROM OUR OWN CORRESPONDENT.)

The Treatment of Gaseous Gangrene.SINCE the beginning of the war this serious com-

plication of wounds has been the object of muchwork and research. Quite recently, however, thesubject has been studied and discussed before theSociete de Chirurgie. M. Schwarz communicatedthe observations of M. Jacomet on 14 cases ofgaseous gangrene developing rapidly and accom-panied by serious general symptoms. In 3 ofthe patients no operation was possible and theyquickly succumbed. Four treated by amputationor by incisions (debridement) with the bistoury diedin a few days. In the other 7 cases M. Jacomet veryfreely incised and amputated with the thermo-

cautery and obtained success in 6 cases. He

recommends, as soon as possible after the arrivalof the wounded, parallel incisions with the

thermocautery 19-20 cm. in length, and distantfrom one another 6-7 cm., involving the wholecrepitating zone and reaching its upper limit.The incisions must comprise the skin and apo-neuroses. He then detaches with the finger thecellular tissue, leaving all the surfaces under theskin exposed. He washes all the detached partswith compresses of peroxide solution (12 volumes),places pledgets and drairs in the incisions, andcovers the whole limb with compresses soaked inLucas-Championnière’s dressing which is reneweddaily. When gas gangrene complicates a wound andcauses mortification of part of the limb he does notimmediately amputate the mortified part. He waitsafter having made the big incisions for a line ofelimination to appear. He then at this linedivides with the thermocautery all the soft

parts, and saws the bone. Ultimately, and onlywhen healing begins, he performs a regular amputa-tion. In the discussion Professor Pierre Delbet

reca,lled that gas gangrene varies. Sometimes cases

apparently very serious are not so in reality, andthen any treatment may give wonderful results.Pyoculture alone can give information whichallows of prognostication. As regards peroxide heconsidered injections of it into the tissues might bedangerous to them. M. Quenu thought that the kindof gas gangrene depends not only on the nature ofthe infecting agents but also on the resisting powerof the individual. He also drew attention to

tardy cases of gas gangrene developing roundold wounds of discharged patients who appearedto be on the way to recovery. He did not sharethe views of M. Jacomet in regard to therapeutics.In cases of total gangrene entailing the death ofthe limb the only treatment, according to M. Quenu,is amputation. M. Tuffier insisted on the capitalimportance of the variety of the gangrene, anindispensable distinction in order to appreciaterightly the value of the therapeutic means used.In the phlegmonous form he considered free incisionwith the bistoury to be sufficient. In the ascendingforms he recommended the galvano-cautery. As foroxygen in the form of gas, he had seen subcuta-neous gangrene cured by this means. With very deepgangrene he considered the method useless, sayingthat in such cases only amputation can provideagainst accidents. M. Broca reported a rare case ofembolic gas gangrene of the nates where there wasno wound. The patient, who was wounded in theforearm, succumbed in spite of large incisions.M. Tuffier drew attention to the fact that he hadnever seen a case of gas gangrene in the head, nor onthe face or thorax. M. Lenormand thought that onemust before all distinguish localised gas gangrenesfrom those of a diffuse and extensive variety. Inthe first form extensive incision of the focus, theopening of all its prolongations and of all its diver-ticula, and the removal of all foreign bodies were,he said, sufficient to prevent accidents. For thesecond variety the only resource was immediateamputation as high as possible. Finally M. Morestinprotested that the prognosis could not be basedon the nature of the gas-producing microbe, butdepended on its virulence and the organicresistance of the patient.Extraction of Projectiles with the Aid of the Camera

Obscura.The localisation of projectiles by radiological

examination saves the surgeon from many failuresand minimises the perils of operation, but that itis attended by various difficulties is proved by thefact that radiographers have instituted so manydifferent methods of obtaining the best result easily.Dr. Bouchacourt has described the procedure whichhe employs frequently in the district where hedirects a most important radiological establish-ment ; it was introduced by a Swiss medical man.The operation table can be replaced by an ordinarywooden table if necessary, a tube producing X raysbeing fixed underneath the table. Placed at theside or in front of the operator an observer issupplied with a small portable camera obscura,encased in aluminium, which renders it sterilisable-the manudiascope. This little camera obscura

possesses a screen on which the observer followsthe movements of the surgical instruments andindicates to the operator the direction to take andthe position of the surgical instruments in relation tothe foreign bodies to be extracted. The procedurepermits of the search for the projectile in everyposition of the operation, and in the opinion of Dr.Bouchacourt constitutes a notable improvement onthe ordinary procedures for radiographic localisation.