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Belfast Union Workhouse.Mr. F. J. McCarthy, Local Government Board

inspector, has just sent to the Belfast guardians acopy of his report consequent on his recent inspec- tion of the workhouse. From. it we find the

gratifying intelligence that there had been a reduc-tion of 30 per cent. in the number of workhouseinmates during the past five years, the number ofinmates on Saturday, Nov. 8th, 1913, in the work-house (including the sanatorium at Whiteabbey)being 2898, instead of 4139, on Nov. 14th, 1908. As

regards the management and cleanliness of theinstitution the inspector speaks very favourably.’’Due order was maintained among all classes,and care was taken that the workhouse rules

regarding classification were strictly observed."He found the sanatorium for consumptives at

Whiteabbey, "

as on previous occasions, a model ofneatness, cleanliness, and orderliness." The in-

spector draws special attention to the reduction ofcases treated in the maternity hospital in the work-house since the coming into operation of theNational Insurance Act, 1911. For the year ended

Sept. 30th, 1912, ;the total number of births in theunion maternity hospital was 405, while in the

following year it dropped to 281. The inspector, inconcluding his most complimentary report, bearstestimony to the " care and attention which theguardians, through their numerous committees,devoted to the work of administration. Ladymembers of the board took a deep interest in thework of the committees dealing with the sick andof the children under the guardians’ charge. Credit’was also due to the officers, and in particular to theclerk and master, for the efficient manner in whichthey discharged their duties."

, Certifying Factory Surgeon.Mr. W. McLorinan, L.R.C.P. & S. Irel., visiting

physician to Mater Infirmorum Hospital, Belfast, hasbeen appointed Certifying Factory Surgeon forNorth Belfast, in place of Dr. J. E. MacIlwaine,resigned.

PARIS.

The LeoM Bourgeois Dispensary.THE name of M. Leon Bourgeois, to whose efforts

much social legislation in France is due, and par-ticularly the antituberculosis laws, has been givento a new dispensary established in the gardens of ’,the Hopital Laennec. This dispensary has threedivisions-one devoted to the hospital care of

patients, another to consultation, and a third, theessential element of the institution, to a pre-ventorium. This last consists of rest and fresh airgalleries where poor people whose condition doesnot demand confinement to bed pass the day or partof it in rest and superalimentation, returning atnight to their homes, of which the sanitary con-dition is controlled by frequent visits fromthe dispensary officials. The plan has metwith enthusiastic support from the population,constituting, as it does, a middle course betweensanatorium and domiciliary treatment. It affordsthe necessary rest and alimentation to tuberculouspatients still able to work, while permitting themto earn something for the support of their families, !,for they spend only so much time as is necessary daily ’,in the preventorium. The inauguration of the dis-pensary was the occasion of an official ceremony at ’,which the President of the Republic, as well as ’’,-11. Leon Bourgeois, was present. The President i

seized the opportunity to explain the antitubcr-culosis programme of the Assistance Publique ofParis. This consists of dispensaries for out-

patient consultations; the distribution of aidin kind and money, and the inspection of

dwellings ; the provision of preventorium treat-

ment ; the reservation of special quarters s forthe tuberculous patients in certain of the Paris

hospitals, and the establishment of a suburban

hospital for the tuberculous, the construction ofwhich is about to be begun in the neighbourhoodof Paris.

The General Mortality in Frace.According to the recently published report of

M. Mirman, Directeur de 1’Assistance et de 1’HygiènePublique in the Ministry of the Interior, for theyear 1911-a particularly fatal year in nearly allEuropean countries-the total deaths in Francewere 775,088, equal to a death-rate of 19’59 per1000, a total increase of 70,318 over the pre-ceding year. The increase was mainly amongchildren under one year and people over 60,the excess in the former group being 30,172, in thelatter 26,410. Enteritis was the predominant factorin the first group, carrying off 46,769, or nearly halfof the total number (118,300) of deaths in childrenunder one year, an increase of 28,631 over the pre-ceding year. Typhoid fever showed an excess of1324 deaths in 1911 over the mean of the precedingyears, probably due to the excessive heat, whichdiminished the supply of pure drinking water andalso led to the consumption of impure ice. Epidemicdiseases showed a general decrease. Influenzathe most fatal, caused 9600 deaths. The totaldeaths from epidemic diseases were much thesame as for deaths from violence and suicide-viz., 29,470, as against 29,163. This indicates thateven when hygienic prophylaxis shall haveachieved its utmost, much will remain to be done.The epidemic diseases, against which the greatesteffort is being made in France to-day, contributeonly 4 per cent of the total number of deaths, andthis figure is declining with the measures that arebeing taken against typhoid fever by the provisionof an increased supply of’ drinking water and itsprotection against contamination, as well as byantityphoid inoculation. Cancer and tuberculosis

figures, however, remain disquieting. Cancer in1911 claimed more victims than all the epidemicdiseases put together-viz., 31,768. The conditioncalls for energetic action. Tuberculosis still claimsthe highest figure of all, notwithstanding itsdiminution from year to year. In 1911 it carriedoff 90,000 victims-that is to say, that between20 and 40 years 44 per cent. of deaths are due totuberculosis. An energetic struggle is being wagedagainst the disease, especially in certain large townsand in some of the departments, but initiative isstill greatly lacking. The Senate is occupying itselfwith a Bill introduced by M. Leon Bouxgeois, M. A.Ribot, and M. Paul Strauss for the establishmentof a central bureau of social hygiene and of an anti.tuberculosis office, the passing of which Bill is.

urgently required, as well as the law regarding cheapdwellings and for the expropriation of insanitary.property. M. Mirman, in closing his report, directsattention to the mortality due to alcoholism, still agreat scourge in France, and an active factor intuberculosis, as well as in deaths due to violenceand those of children caused by congenital debility.

The Centenary of Claude Bernard.The centenary of Claude Bernard, who was born

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on July 12th, 1813, was celebrated by a commemo-rative ceremony at the Collège de France on

Dec. 23rd, in the presence of the President of theRepublic and a numerous assembly of the scientificworld. M. M. Croiset spoke of the lustre thatClaude Bernard, who was professor of physiologythere, had reflected upon the college. ProfessorBergson told of the influence that the books of ClaudeBernard and his conception of life had had upon thespirit of his age. Professor Dastre described theworks and the numerous discoveries of Bernard, par-ticularly those relating to the physiology of digestion,and Professor d’Arsonval spoke in the name of theformer pupils of the master. The Minister ofPublic Instruction, in a striking address, describedFrance’s debt to the savant who began his illustriouscareer as the humble assistant in a pharmacy atLyons, came to Paris with a view to getting atragedy put upon the stage there, and entered thelaboratory of Magendie at the College de France,finally succeeding him in the chair in 1855. Hedied at Paris on Feb. 10th, 1878.Dec. 29th, 1913.

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BERLIN.

The Battle of the Clubs.THE possibility that a sick club may be unable to

obtain medical attendance for its members at theusual club rates has not been overlooked in thenew Workmen’s Insurance Act. It does not appearthat the patients need suffer any detriment, for analternative is indicated in a portion of theAct which provides that in such circumstances themembers may receive sick pay in excess of the

ordinary allowance for the purpose of enablingthem to consult practitioners unconnected with theclub. Before making these increased payments, how-ever, the club must obtain permission from thedistrict insurance office, which has also to decidehow a patient’s inability to follow his employmentmay be certified when an arrangement for thatpurpose cannot be made with a medical man.

The federal council has recently issued instructionsto the district insurance offices informing themunder what conditions they may allow the com-mittees of the sick clubs to pay the higher sick rateinstead of procuring free medical attendance. It isstated in the instructions that the above provisionmay only come into force when the local medicalmen have declined to accept the arrangements pro-posed by the clubs. When no medical man iswilling to give a certificate of illness to the clubmembers, such certificates may be given by non-medical managers of the club, employers, midwives,nurses, or other trustworthy persons. In referenceto this the Medical Reform rightly observes. Whatis the use of medical men devoting five years to pro-fessional study and passing several examinationswhen mayors, employers, and " other trustworthypersons not possessing any medical knowledgemay give certificates as to the condition of patients?

Eighteen Laparotomies on one Subject.Dr. Harzbecker lately showed before the Berlin

Surgical Society the case of a patient, 44 years of age,who in 1887 sustained a contusion of the abdomenin consequence of a fall from a horse. The sequelæof the injury were frequent attacks of ileus, and asmany as 18 laparotomies had been performed-thelast one five years ago-without a definite causefor the ileus being found. In 1903 colostomy wasperformed, and finally an anastomosis between thecæcum and the sigmoid flexure was made. Recently

he was treated only by electric light baths, enemata,physostigmine, and morphine. Dr. Harzbecker saidthat the symptoms were obviously due to chronicenterospasmus from a nervous cause, and that it wasdoubtful whether this condition was the result ofthe accident or not. The patient had been takingalcohol and morphine in excess since the accident.

Agitation respecting Degrees in Dentistry.The dental students of the University of Leipsic

have decided to engage in a so-called "

strike," thereason being that their request for the creation of adegree of Doctor of Dental Surgery has been refused.They have telegraphed to the dental students ofother universities to follow their example, andthose of the University of Berlin have held a

meeting of sympathy, at which it was decided tosend delegates to Leipsic for the purpose of takingjoint action. To understand the motives of thedental students it must be stated that a dental degreedoes not exist in Germany, although there is a Stateexamination by which the title of

" Zahnarzt" is

conferred. Dentists wishing to have a universitydegree could not be examined by the medicalfaculties by which the title of M.D. is granted. Thisdegree is obtained only after a regular study ofmedicine, but not of dental surgery, so the dentalstudents have had to apply to the philosophicalfaculties where the title of Doctor Philosophiæ]might be granted to them after an examination notincluding any reference whatever to dentistry. Thisundesirable state of things has led to repeatedpetitions being presented to the medical facultiesand the Government to create the title of doctor ofdental medicine or surgery, but these endeavourshave hitherto proved unavailing, and the studentshope to get by the " strike " what has been refusedto less heroic measures. The " strike " hasmeanwhile extended to nearly all the Germanuniversities.Dec.24th, 1913.

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ITALY.

Monument to Florence Nightingale in Florence.FLORENCE, the city of the great Englishwoman’s

birth, has paid a rare tribute to the memory ofFlorence Nightingale. The British Ambassador,Sir Rennell Rodd, has unveiled in the cloisterof Santa Croce, the church which representsto Italians what Westminster Abbey does to

Englishmen, a monument to her memory. Thisis the work of an English sculptor, Mr. F. W.

Sargant, brother of the learned judge and ofthe lady president of the Botanical Sectionof the British Association, and is a three-quarterlife-size symbolical figure representing the " Ladywith the Lamp," the name by which theheroine of the Crimea was known to the soldiersin the hospitals. The statue is a beautiful pieceof work in the classical style, and has won un-stinted praise. The idea of having a permanentrecord of Miss Nightingale in Florence originatedwith the British Consul-General in Tuscany at thetime of her death. Money was raised by a publicsubscription, in which citizens of many nationalities-joined, while the Deputazione dell’ Opera di SantaCroce readily agreed to the suggestion that theyshould find a site for the monument. The militaryauthorities and those of the province and city,with the Consular representatives, attended theunveiling ceremony, at which a large gather-ing of the foreign colony and of Italian societyassisted. The Croce Rossa was largely represented