539ITALY.

and official permits cost more than they used to do, and at thesame time the mutual aid societies, the system of insuranceagainst sickness, and the giving of free advice at the hospitalshave materially reduced the incomes of practitioners. A

general increase in fees was therefore decided on, andthe practitioners of the Twelfth Arrondissement gavenotice that after Jan. 1st, 1910, their charges wouldbe raised by about one-third, the lowest rates beingas follows : advice at a medical man’s house duringhis usual consultation hours, 3 francs ; visit to a

patient on ordinary working days from 8 A.M. to 7 P4 francs; visit on Sundays and holidays from 8 A.M. to12 noon, 4 francs ; visit by request from 6 to 8 A.M. andfrom 7 to 10 P.M., 5 francs ; day visit of urgency, 5 francs ;day visit at a time specified by the patient, 5 francs ; visiton Sundays and holidays from 12 noon to 7 P.M., 5 francs ;night visit from 10 P.M. to 6 A M., 10 francs. When several

practitioners are summoned to an urgent case each is entitledto charge a fee. As hitherto, operations, examinations, andspecial treatment will be charged additional. The Practi-tioners’ Society of the well-known health station, Chatel-

Guyon, have adopted the following scale of charges. Thefees for the special treatment of patients requiring attend-ance in their homes are fixed at a minimum of 100 francsfor five visits or fewer. The fees for thermal treatment

including the first examination, the arrangement of the intro- ’

ductory stage, and four consultations at the medical man’srooms are fixed at a minimum of 60 francs. For extra con-sultations at the medical man’s rooms during his usualhours of attendance the minimum fee is 10 francs ; for con-sultations at the patient’s hotel or at the medical man’srooms by appointment the charge is 20 franca. For singlevisits or for making the introductory arrangements for acourse of treatment the minimum charge is 20 francs.Urgent visits and night visits from 9 P.M. to 7 A.M. are

charged double. These fees are payable for each patientunder treatment. The system of fees at half rates is no

longer in operation.Feb. 15th.

__________________

ITALY.

(FROM OUR OWN CORRESPONDENT.)

The Upper Chamber.

SUDDENLY the Prime Minister has recommended to theKing the names of 33 distinguished compatriots for Senatorialhonours-a step not merely of local but also of outlyinginterest, particularly in countries like Great Britain, where theconflict between the two Houses, Upper and Lower, has raisedthe question as to whether the former is needed at all, or, ifneeded, whether its membership should be hereditary or

elective. In Italy the aristocracy, with few exceptions,hold aloof from public life, the number of the reallypatrician families who court a political career being toldoff on the fingers of one hand. The young Italian kingdom,therefore, while averse from single-chamber parliaments,has had to choose the members of its Upper House from thegeneral body of citizens, selecting by preference those of theLower House who had shown an aptitude for affairs, andafter these those of the public, professional or lay, whosespecial knowledge and experience made them a desirableadjunct to such an assembly. Quite an exceptional numberof the latter have been men of medical training and achieve-ment, insomuch that few, if any, names of the highest dis-tinction in medicine, surgery, or hygiene, have failed to receiveSenatorial rank. In practical working, the system has morethan justified itself, and Italy owes much of her undoubtedprogress in sanitation and civic well-being to the counsels andenactments emanating from a professionally and, par excellence,a medically reinforced Senate.

The Senatur Camillo Bozzolo.

Universal satisfaction has followed the accession of thiseminent clinician and consultant to the Upper House,belonging, as he does, to the great subalpine school, whosecentre, Turin, has already contributed to the State such menas Moleschott, Concato, Bizzozero, Lessona, Giacomini, andLombroso-to mention only the dead. Born of a noble

family in the province of Como on May 30th, 1845, he studiedmedicine at Pavia, joined, while still an undergraduate, theGaribaldian contingent in the war of independence, returnedto the classes on the expulsion of the Austrians from UpperItaly, took the summos in medicinic honores at his Alma Mater,and entered on clinical work at the Ospedale Maggiore ofMilan. Transferred to the chair of medicine in Turin, he.wrought a beneficent change in the methods of study andteaching, replaced the traditional reliance on books by early,steady, systematic observation at the bedside, and succeededin making his pupils proficient in what Baccelli has called thephysician’s prima cura-diagnosis. As a preliminary to thishe insisted on a thorough drilling in what the older Englishschool called the " institutes of medicine," and was the firstto found in Italy a chair of ’’ propsedeutica medica," thebusiness of which was to train the perceptive and inductivepowers by contact with the living reality, responsive to hiswatchword, " facta, non verba."

" His published writings areall in keeping with his professorial work and are esteemedby the busy practitioner accordingly. I need only mentionsuch suggestive and serviceable treatises as his " BagnoFreddo e Raffredato nella Polmonite " (The Bath, Cold andCooled Down, in Pneumonia) ; on "Pericardite Latente" ;on "Necrosi del Pancreas"; and on "Febbri Cripto-genetiche." In hospital administration he has been a

pioneer and rehabilitator ; while in public hygiene he hascontributed to the solution of many vexed questions.Eleven years ago he opened the 7Jledicus annus of the subalpineschool with the masterly prolusion entitled : " Influenzadella Civilt à sulla Durata della Vita Umana " (The Influenceof Civilisation on the Duration of Human Life), whichbrought him congratulations from the chief seats of learningin Europe and, locally, gave him a place on the communal,council of Turin, where he sits as " assessore per l’igiene."

The Senator Tommaso De Amicis.

Another professor and consultant in the medical faculty isthe above-named Neapolitan physician, who, born in 1838 inthe province of Aquila, has held with much acceptance thechair of Dermosyphilopathy in the University of Naples.His promotion to Senatorial honours is recognised throughoutthe profession as a well-merited tribute to exceptional pro-ficiency in his special department-proficiency not onlysignalised at the bedside and in the lecture-room, but also innumerous publications and contributions to the "Atti" " ofmedico-chirurgical societies and congresses. He has trans-lated the well-known treatise of Belhomme on " Vénerio-logie," supplementing it with notes and excursus of which ithas been said, la sauce vaut mieux que levoisson.

The Senator Luigi Pastro.

This veteran, who takes his seat in the Upper Chamber inhis eighty-eighth year, having been born at Treviso in 1822;had, like Camillo Bozzolo, to suspend a brilliant period ofmedical study to serve in the war of independence. In 1849he was one of the heroic defenders of the Venetian Republicunder Daniel Manin, after which he was involved in trial forhigh treason with many other compatriots at Mantua.Condemned to 18 years’ imprisonment, he withstood therigours of an Austrian State fortress, heavily ironed andsometimes bastinadoed for his refusal to betray his con-federates, till 1856, when he entered the Sardinian army assurgeon and rose by rapid stages to ever higher grades onthe medico-military staff till in 1884 he retired on a pension.During his professional career he did splendid work on theoccasion of the cholera epidemics, which (especially that of1884) numbered many victims throughout Italy, and even inhis septuagenarian and octogenarian years he was called inconsultation at many Italian centres-Florence, Venice,Milan, and Rome. Just four years ago he published his" Ricordi di Prigione

"

(Prison Recollections), which willbear and reward perusal even after the classic work on thesame theme of Silvio Pellico, "Le Mie Prigioni."

Other men of science indirectly connected with medicinehave also been elevated to the Senate, of whom it will sufficeto mention Giacomo Ciamician, professor of biologicalchemistry in the University of Bologna, where his contributionsto his special subject have won him honourable recognitionfrom the leading scientific associations of Europe-Italianand Continental.

’

Feb. 5th.

540 VIENNA.-NEW YORK.

VIENNA.

(FROM OUR OWN CORRESPONDENT.)

An Unusual Case of Careinomcc of the Pharynx.AT a recent meeting of the Gesellschaft der Aerzte Dr.

Koschier showed a woman whom he has had under observa-tion for nearly ten years suffering all the time from carcinomaof the naso-pharyngeal space. At present the neoplasm fillsthe entire nose and the back of the pharyngeal space ; thenose itself is much thickened and the right eye is amauroticfrom retrobulbar neuritis ; some portions of the tumour aresuperficially ulcerated, but otherwise the patient makes littlecomplaint of her condition, no pain at all having been experi-enced since the beginning of the disease. An operation hadbeen refused when the neoplasm was small, and at the presenttime when an operation was hardly possible the patient wasstill not inclined to permit it. Repeated examinations bycompetent pathologists had confirmed the diagnosis. Dr.Koschier pointed out the fact that it was necessary to bevery careful as regards the prognosis of tumours of this

region, for this case, if operated upon even nine years ago,would have been made use of to swell the statistics of

cancer-operability, whilst its malignity was so small that itis doubtful whether an operation would not have lessenedthe chances of the patient’s survival.

Painless Childbirth.At the same meeting Dr. Eisenberg read a paper giving

the results of his attempts to make labour painless. Hesaid that the scopolamin-morphia method was not advisablebecause of its dangers and the prolongation of the period ofexpulsion of the foetus. He employed a partial chloroformanxsthesia produced by inhalation of the vapour from 10 or15 drops of that substance on a piece of gauze, which wasremoved every two or three minutes and only used duringthe intervals between the contractions of the uterus. Inthis way the pain was brought down to a minimum withoutthe woman’s consciousness being affected, and the power ofthe uterine contractions was not diminished. This sort ofchloroform anassthesia could be kept up for hours (in one casefor 31 hours) without any harm whatever; it had beencalled fractioned minimal narcosis," and at the surgicalclinic of Dr. Schnitzler extensive operations had beendone under it. A similar result might be obtainedwith ether, although its use is a little more difficult, becausewith it the induction of the slight but sufficient stage ofnarcosis requires more skill than with chloroform. Ether is

perhaps even the better of the two, for chloroform has some-times its dangers, as in the case of the idiosyncrasy, whena few drops may, it is said. prove fatal. The method

which Dr. Eisenberg recommended is much used in Franceand some other countries.

Distribution of the Medical Profession in Austria.The distribution of practitioners in Austria is, as every-

where, dictated by expectation rather than by actual need ;it is, therefore, no wonder that in some districts medicalmen are relatively scarce. In a very interesting contri-bution to the Klinische Wochenschrift Professor Fraenkelmentions the difference of care taken by the State for thespiritual needs and for the bodily needs of the population.Whilst in every village there is a church, or at leasta chapel, where a priest offers religious teaching and con-solation to the peasantry, there are, on the other hand,many places inhabited by several hundreds of personswhere medical help cannot be had, and from which itis a journey of several hours to reach the nearest medicalman. In the cities the ratio of the medical men to the

population is decidedly high, as, for instance, in Prague,where it is 1 to 300 ; in Vienna, where it is 1 to 750 ;and in Graz, where it is 1 to 560. In the country districts,however, there is an average of 1 medical practitioner to2500 inhabitants, but with wide local variations, for inGalicia in the eastern part of the empire the proportion is 1 to16,000, and in Gorz in the south it is 1 to 17,000. If the dis-tricts are considered as regards their size it is found that theinner or central counties are better off. In Lower Austria, forinstance, an area of about two square miles is provided withone medical man ; in the north about eight square miles areexpected to be served by one medical man, but in the southern coast districts there is only one medical man for a I

population distributed over 36 square miles. Naturally, suchconditions must be explained by the inadequate remunerationof the public appointments or the unsatisfactory conditionsof private practice. A few figures will be useful. In 1908there were altogether in Austria proper, which has a

population of 28,000,000, a total number of 12,070 doctorsof medicine entitled to practise. Of these, 7510 held publicappointments, of which 1800 were State appointments, 3910were municipal appointments, and the remainder were in theservice of other public corporations. The State appointmentsare whole-time appointments, no private practice being per-mitted ; the rate of their remuneration is only moderate, and theother appointments are worth less in proportion. There is,therefore, little inducement for a young medical man toseek them. Various medical associations have repeatedlyurged the public authorities to increase both the number ofappointed practitioners and their remuneration in accordancewith modern requirements as the only means of obtaining asufficient influx of medical men into country practice.

Premiums for the Breast Nursing of Infants.The establishment of the so-called Stillkassen (funds from

which weekly payments are made to mothers nursing theirinfants at the breast) has had a very beneficial influence onthe nutrition, and consequently on the welfare, of infants. InVienna the enterprise is quite a private affair, but still ithas been able to show that 210 women, who have beenassisted in this manner, have not had a single death tolament amongst their infants. There is, however, one factorwhich must be improved, and that is the duration of breast-feeding amongst these assisted mothers. It is intended toraise the premium for each consecutive month, so as toinduce longer nursing. At present the premium amounts to21 kronen (about 1 guinea) per month. The number of

primiparæ was 164, the rest had from two to five childreneach, and it is interesting to note that only 27 of the re-maining multiparæ had suckled either their first or their

subsequent infants, the others being induced to do so by thepremium paid to them.

Feb. 14th. ___________________

NEW YORK.(FROM OUR OWN CORRESPONDENT.)

The Federal Controi of Serzcnzs and Vaccines.MENTION has been made in this correspondence of the

Government control of serums manufactured for sale in theUnited States. When this Federal law was adopted there wasa large traffic in serums prepared by speculating firms, andthe quality of the articles which they placed on the marketwas very variable. At the first inspection it was found thatirresponsible persons were making and marketing biologicalproducts without sufficient care or knowledge to ensure

safety and reliability. The law provides for a completesystem of Governmental supervision over the establishmentsproducing vaccines, viruses, serums, toxins, antitoxins, andanalogous products. This surveillance consists of inspections,licences, and methods of control or check-testing in the

Hygienic Laboratory of the Public Health Service at

Washington. The law requires that each package of virus,serum, toxin, antitoxin, or other product be plainly markedwith the proper name of the article contained therein ; thename, address, and licence number of the manufacturer, andthe date beyond which the contents cannot be expectedbeyond reasonable doubt to yield their specific results. Sincethe operation of the law a marked improvement has takenplace in vaccine virus ; standards for measuring the strengthof diphtheria and tetanus antitoxins have been established ;both the diphtheria and tetanus antitoxins found on themarket have a decidedly increased potency ; weak serumsare forbidden and those discovered have been withdrawnfrom the market ; false or misleading labels have beenchanged, and in general the licensed manufacturers havereached a high state of efficiency. The result to the

practising physician has been most satisfactory, for he is nolonger liable to get negative results in the use of the serumson the market in any part of the United States.

Vaccine Virus in the Pharmacopœia.Dr. M. J. Rosenau, Director of the Hygienic Laboratoryof the United States Public Health Service, advises that