1
782 beds for cases of midwifery and thirty for diseases of women, and there are also three small special rooms for contagious diseases, which, however, were unoccupied at the time of my visit. It is a singular fact that puerperal fever broke out immediately after the opening of the hos- pital, and six patients died from it, while since that time there has not been a single case of the disease. The women are placed in a special room at the back of the hospital while delivery is going on, and as soon as they are confined are removed to wards in the vicinity, each of which contains four beds, and is so large and airy that the cubic space amounts to 8000 cubic feet. There is a magnificent ope- rating theatre, thirty-six feet in height, with large windows occupying the whole of one side, and offering a glorious view of the Rhine. On one side are a museum and instru- ment room, on the other a commodious lecture theatre. On the vast open space at the back of this women’s hospital it is proposed to build the new general hospital, and between the two buildings a suitable place for making pathological examinations and for keeping specimens will also be erected. In addition to the institutions already named, Bonn pos- sesses two special religious hospitals-one for Protestants and the other for Catholics, both of which are open to students for clinical purposes. They are not, however, so much frequented by the students as they might be; the men will go to the old clinical hospital, attracted no doubt by the reputation of its staff and by the fact that it is the University hospital. LIVERPOOL. (From our own Correspondent.) AT the last meeting of the Liverpool Medical Institution Dr. Nevins read a communication, founded on a report pre- pared by himself for the Home Secretary, on the results of the Contagious Diseases Acts. The paper was based upon statistics, and the conclusions arrived at by the author were as follows:-" That for several years before the first Act was passed great improvement had been taking place in the health of the army in this particular form of disease ; that immediately upon the introduction of the Acts there was a temporary rapid increase in these diseases ; that this increase generally ceased within twelve months in one form, but that in another form there has been a permanent increase throughout both army and navy, which continues to the present time ; that the improvement in health in one of these forms of diseases still continues upon the whole, but with a very diminished rate; that in the British navy throughout the world the health of the sailors occupies a more unfavourable position in these forms of disease in the Home and Mediterranean stations than in those stations which are not under laws similar to the Contagious Diseases Acts ; that the ratio of disease amongst the registered prostitutes had increased above 20 per cent. since the Act of 1866, and that the ratio of deaths amongst them had more than doubled since that date ; that the fluctuations of these diseases have been so great from year to year, both before and since the application of the Acts, that no opinion of any value can be formed from a short period or a limited number of men; and that the results now arrived at are a total ex- perience of the whole British army at home and the navy throughout the world, extending over a period of twelve years-the longest time that the official documents render possible." The discussion that followed was not of a satisfactory nature, inasmuch as the members, having no previous means of testing the accuracy of the mass of figures presented to them, were in a measure unprepared to criticise the de- ductions drawn. When it is considered how statistics may be twisted and distorted, it would be impossible to accept Dr. Nevin’s conclusions without a very close examina- tion of the sources from which they were derived, and the mode in which they were employed. To meet the great diminution in cases of syphilis occurring in the army since the application of the Acts, an ingenious table was compiled to show that this was traceable to the ordinary ups and downs of disease rather than to the efforts of preventive medicine. This very pleasant way of getting over a rather awkward fact was evidently much appreciated by those whose sympathies were not with the Acts. Amongst the speakers who in the course of the discussion opposed facts to figures, was Mr. Acton, of London, who appeared to watch with very considerable interest the proceedings of the evening. On the same day, it appears from a newspaper report, the Right Hon. J. Stansfeld was present at a meeting in Liver- pool, where the Acts were under consideration ; but as the audience included only those who, from their remarks, are regarded as opponents to the Acts, the nature of the speeches may be easily imagined. Liverpool, Nov. 9th, 1874. IRELAND. (From our own Correspondent.) THE attention of the medical profession of Ireland and the various medical associations has lately been principally de- voted towards the working of the Public Health Act, passed for this country during the last session of Parliament. Under this Act the duties are compulsorily imposed upon the members of the Poor-law Medical Service, and the re- muneration is to be fixed by the various boards of guardians as rural, and the corporations and town commissioners as urban authorities, subject to the approval of the Local Go. vernment Board. A great diversity of opinion appears to exist amongst both rural and urban authorities as to the sum to be paid their medical officers of health for perform- ing these duties, which have been described in a memorial presented to the chief secretary for Ireland, the Right Hon. Sir Michael Hicks Beach, who is the president of the Local Government Board, by the president and fellows of the Col- lege of Physicians, as being H numerous, significant, and novel." The scale of payment proposed by the various sanitary authorities clearly proves their disbelief in the necessity for the passing of such an Act, and their intention, if possible, to convert it into a farce. From X5 to .610 is the average remuneration proposed. In some of the more en- lightened neighbourhoods as high an amount as 30 has been suggested ; but, strange to say, the large towns and cities, where sanitation is most required, are the most nig- gardly in their offers. In Dublin City, for instance, the sanitary authority offers the medical officers but .810 per annum each. These gentlemen, of course, have declined to accept such a salary, and have presented a memorial to the Local Government Board to that effect. The medical officers of Cork and Limerick and other cities, and many of the unions of Ireland, have acted in a similar manner. The various medical associations, as the Irish Poor-law Medical Officers’ Association, the Irish Medical Association, and both the Colleges of Phy- sicians and Surgeons, have addressed the Chief Secretary upon the subject. In fact, " the back of the profession is up " in this country. The memorial of the College of Phy- sicians expresses a general approval of the provisions of the Public Health (Ireland) Act, and regards the appointment of the dispensary medical officers as sanitary officers, under section 10 of the Act, with much satisfaction, as a recogni- tion of the necessity of placing the medical profession in the foremost rank of an organisation for purposes of public health. It adds :—" That they [the memorialists] are fully conscious of the number, significance, and novelty of the duties which will have to be discharged by the sanitary officers under the Act-the most important of which duties can only be efficiently performed by medical men, in con- sequence of their education, qualifications, and training. That the responsibility of carrying into effect the principal of these duties-namely, the reporting upon nuisances, the investigation of outbreaks of preventable disease, the preven- tion of the spread of sickness, the examination of air, water, and food; the drawing up of periodical reports on the health of sanitary districts, and the compilation of statistics of disease, is especially imposed upon the medical sanitary officers. That the remuneration so far offered by the local sanitary authorities to the medical officers of health is quite inadequate, when regard is had to the multifarious and very responsible nature of the duties to be performed by them,

LIVERPOOL

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beds for cases of midwifery and thirty for diseases ofwomen, and there are also three small special rooms forcontagious diseases, which, however, were unoccupied atthe time of my visit. It is a singular fact that puerperalfever broke out immediately after the opening of the hos-pital, and six patients died from it, while since that timethere has not been a single case of the disease. The womenare placed in a special room at the back of the hospitalwhile delivery is going on, and as soon as they are confinedare removed to wards in the vicinity, each of which containsfour beds, and is so large and airy that the cubic spaceamounts to 8000 cubic feet. There is a magnificent ope-rating theatre, thirty-six feet in height, with large windowsoccupying the whole of one side, and offering a gloriousview of the Rhine. On one side are a museum and instru-ment room, on the other a commodious lecture theatre. Onthe vast open space at the back of this women’s hospitalit is proposed to build the new general hospital, andbetween the two buildings a suitable place for makingpathological examinations and for keeping specimens willalso be erected.

In addition to the institutions already named, Bonn pos-sesses two special religious hospitals-one for Protestantsand the other for Catholics, both of which are open tostudents for clinical purposes. They are not, however, somuch frequented by the students as they might be; themen will go to the old clinical hospital, attracted no doubtby the reputation of its staff and by the fact that it is theUniversity hospital.

LIVERPOOL.

(From our own Correspondent.)

AT the last meeting of the Liverpool Medical InstitutionDr. Nevins read a communication, founded on a report pre-pared by himself for the Home Secretary, on the results ofthe Contagious Diseases Acts. The paper was based uponstatistics, and the conclusions arrived at by the author wereas follows:-" That for several years before the first Actwas passed great improvement had been taking place in thehealth of the army in this particular form of disease ; thatimmediately upon the introduction of the Acts there was atemporary rapid increase in these diseases ; that thisincrease generally ceased within twelve months in oneform, but that in another form there has been a permanentincrease throughout both army and navy, which continuesto the present time ; that the improvement in health in oneof these forms of diseases still continues upon the whole,but with a very diminished rate; that in the Britishnavy throughout the world the health of the sailors occupiesa more unfavourable position in these forms of disease inthe Home and Mediterranean stations than in those stationswhich are not under laws similar to the Contagious DiseasesActs ; that the ratio of disease amongst the registeredprostitutes had increased above 20 per cent. since the Act of1866, and that the ratio of deaths amongst them had morethan doubled since that date ; that the fluctuations of thesediseases have been so great from year to year, both beforeand since the application of the Acts, that no opinion of anyvalue can be formed from a short period or a limited numberof men; and that the results now arrived at are a total ex-perience of the whole British army at home and the navythroughout the world, extending over a period of twelveyears-the longest time that the official documents renderpossible."The discussion that followed was not of a satisfactorynature, inasmuch as the members, having no previous meansof testing the accuracy of the mass of figures presented tothem, were in a measure unprepared to criticise the de-ductions drawn. When it is considered how statistics maybe twisted and distorted, it would be impossible to acceptDr. Nevin’s conclusions without a very close examina-tion of the sources from which they were derived, and themode in which they were employed. To meet the greatdiminution in cases of syphilis occurring in the army sincethe application of the Acts, an ingenious table was compiledto show that this was traceable to the ordinary ups anddowns of disease rather than to the efforts of preventivemedicine. This very pleasant way of getting over a rather

awkward fact was evidently much appreciated by thosewhose sympathies were not with the Acts. Amongst thespeakers who in the course of the discussion opposed factsto figures, was Mr. Acton, of London, who appeared to watchwith very considerable interest the proceedings of theevening.On the same day, it appears from a newspaper report, the

Right Hon. J. Stansfeld was present at a meeting in Liver-pool, where the Acts were under consideration ; but as theaudience included only those who, from their remarks, areregarded as opponents to the Acts, the nature of the speechesmay be easily imagined.

Liverpool, Nov. 9th, 1874.

IRELAND.

(From our own Correspondent.)

THE attention of the medical profession of Ireland and thevarious medical associations has lately been principally de-voted towards the working of the Public Health Act, passedfor this country during the last session of Parliament.Under this Act the duties are compulsorily imposed uponthe members of the Poor-law Medical Service, and the re-muneration is to be fixed by the various boards of guardiansas rural, and the corporations and town commissioners asurban authorities, subject to the approval of the Local Go.vernment Board. A great diversity of opinion appears toexist amongst both rural and urban authorities as to thesum to be paid their medical officers of health for perform-ing these duties, which have been described in a memorialpresented to the chief secretary for Ireland, the Right Hon.Sir Michael Hicks Beach, who is the president of the LocalGovernment Board, by the president and fellows of the Col-lege of Physicians, as being H numerous, significant, andnovel." The scale of payment proposed by the varioussanitary authorities clearly proves their disbelief in thenecessity for the passing of such an Act, and their intention,if possible, to convert it into a farce. From X5 to .610 is theaverage remuneration proposed. In some of the more en-lightened neighbourhoods as high an amount as 30 hasbeen suggested ; but, strange to say, the large towns andcities, where sanitation is most required, are the most nig-gardly in their offers. In Dublin City, for instance, thesanitary authority offers the medical officers but .810 perannum each. These gentlemen, of course, have declined toaccept such a salary, and have presented a memorial tothe Local Government Board to that effect. The medicalofficers of Cork and Limerick and other cities, andmany of the unions of Ireland, have acted in a

similar manner. The various medical associations, as

the Irish Poor-law Medical Officers’ Association, theIrish Medical Association, and both the Colleges of Phy-sicians and Surgeons, have addressed the Chief Secretaryupon the subject. In fact, " the back of the profession isup

" in this country. The memorial of the College of Phy-sicians expresses a general approval of the provisions of thePublic Health (Ireland) Act, and regards the appointmentof the dispensary medical officers as sanitary officers, undersection 10 of the Act, with much satisfaction, as a recogni-tion of the necessity of placing the medical profession inthe foremost rank of an organisation for purposes of publichealth. It adds :—" That they [the memorialists] are fullyconscious of the number, significance, and novelty of theduties which will have to be discharged by the sanitaryofficers under the Act-the most important of which dutiescan only be efficiently performed by medical men, in con-sequence of their education, qualifications, and training.That the responsibility of carrying into effect the principalof these duties-namely, the reporting upon nuisances, theinvestigation of outbreaks of preventable disease, the preven-tion of the spread of sickness, the examination of air, water,and food; the drawing up of periodical reports on the healthof sanitary districts, and the compilation of statistics ofdisease, is especially imposed upon the medical sanitaryofficers. That the remuneration so far offered by the localsanitary authorities to the medical officers of health is quiteinadequate, when regard is had to the multifarious and veryresponsible nature of the duties to be performed by them,