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into the large intestine in cases of ectopia of thebladder, but in most of the cases sepsis hasspread upwards to the kidney. Maydl, by care-fully preserving the ureteric sphincter, was ablein great part to prevent this ascending sepsis.Makkas devised an ingenious operation by whichthe caecum was excluded from the rest of thebowel and into it he implanted the ureters,providing by an appendicostomy this new bladderwith an exit. Cuneo and Hovelacque have also

employed portions of the bowel separated fromthe rest to form new bladders. Dr. Blair Bellsecures by irrigation the asepticity of the sepa-rated portion of bowel before it receives theureters, and so far as we are aware it hasnever previously been shown that it is possible torender free from germs such a separated piece ofbowel. There appear to be great and promisingpossibilities in this new operation.

THE LANCET, VOL. I., 1918:THE INDEX.

THE Index and Title-page to the volume ofTHE LANCET completed with the issue of June 29this in preparation. Owing to the increasing shortagein the paper-supply, the Index will not be issuedwith all copies of THE LANCET, as was the customprior to the War. Subscribers who bind up theirnumbers are requested to send a post-card (whichis more convenient for filing purposes than a letter)to the Manager, THE LANCET Office, 423, Strand,London, W.C. 2, when a copy of the Index and Title-page will be supplied free of charge.

THE BELGIAN DOCTORS’ ANDPHARMACISTS’ RELIEF FUND.

SUBSCRIPTIONS TO THE SECOND APPEAL.THE following subscriptions and donations to the Fund

have been received during the week ending June 8th :-:E s. d. :e s. d.

Dr. T. Rouse ......... 1 1 0 Anonymous* ......... 1 1 0Mr. J. H. Jacobs ...... 1010 0 Mr. E. Spencer Evans(m) 0 10 0Dr. H. J. Mackenzie ... 1 1 0 Dr. Albert Lucas...... 2 2 0Drs. Forsyth & Norman 1 1 0 Dr. Alfred Cox (m) ... 1 1 0Sir A. Pearce Gould (m) 5 0 0 Lady Cooper’’’......... 10 0 0Dr. W. A. Milne ...... 3 0 0 1 Mr. G. S. Albright* ... 50 0 0

* Per Sir Rickman Godlee.. m, monthly.

Subscriptions to the Fund should be sent to the treasurerof the Fund, Dr. H. A. Des Vceux, at 14, Buckingham Gate,London, S.W. 1, and should be made payable to the BelgianDoctors’ and Pharmacists’ Relief Fund, crossed LloydsBank, Limited.

Up to date the Hospital Saturday collection inBelfast amounts to JE1640 10s.

BRITISH SCIENCE GUILD.-The twelfth annualmeeting of the Guild will be held at the Mansion House at4 P.M. on June 19th, when Lord Sydenham will give anaddress on Education, Science, and Leadership. Cards ofinvitation may be obtained from the Secretary, 199,Piccadilly, W.l.WEST LONDON MEDICO-CHIRURGICAL SOCIETY.-A

meeting of this society was held at the West LondonHospital on June 7th, Dr. J. A. Rice-Oxley, the President, inthe chair, when Captain D. McCrae Aitken gave an address,illustrated by lantern slides and casts, on the Correction ofGross Bony Deformities of the Lower Limbs Resulting fromWar Injuries, based upon results obtained at the Shepherd’sBush Orthopaedic Hospital. He described his reversed bone-

wedge method of dealing with injuries in the neighbourhoodof joints, whereby shortening of the limb was obviated. Mr.Tyrrell Gray, Major Jocelyn Swan, Dr. James Mennell, andothers took part in the discussion.

IRELAND.

(FROM OUR OWN CORRESPONDENTS.)

Organisation of the Irish Medical Profession.A MEETING of delegates of the Irish medical profession

was held on May 29th in the Royal College of Surgeons forthe purpose of reconstituting the Irish Medical Committee.This representative body is elected on a democratic basis andwas first formed in July, 1913, to act for the profession inmatters arising out of the Insurance Act. It managed itsbusiness satisfactorily and has held the confidence of theprofession. In view of the likelihood of future legislationwhich would affect the interests of the medical profession inIreland, it has been thought necessary to continue thecommittee and to give it wider powers. At the meeting ofdelegates it was declared that the Irish Medical Committee wasto be regarded as the authoritative body" for the purpose ofrecording the views of the medical profession in Ireland inconnexion with Irish medical affairs, and, when necessary,promoting legislation whereupon.

" There are two medicalassociations operating in Ireland, the Irish and the British,and it is unfortunate that neither of them is in a position tospeak for the entire profession. However, their presentmemberships are not strong enough to give them that

authority. It appears necessary, therefore, to havea third organisation with greater authority. The chief

difficulty of the Irish Medical Committee has alwaysbeen the question of finance, and for the past few

years it has been in the anomalous position of beingdependent on contributions from the two associations whoseactivities it supersedes. Having re-established the IrishMedical Committee, the meeting of delegates proceeded tadiscuss questions concerning the status and interests of thePoor-law medical officer. There is at the present momentgrave dissatisfaction in the service. Salaries were even innormal times inadequate, and at present barely pay workingexpenses. Many unions have as yet refused to establishgraded scales of salaries for their medical officers, and thescales agreed on a few years ago are now found unsatis-factory. So grave is the discontent that some talk washeard of the advisability of a " general strike " in order tocompel the Local Government Board to use their powers tofix salaries.

Sanatorium Benefit in Belfast.The new Central Tuberculosis Institute was formally

opened on June 6th, the ceremony being followed by a visitto the Whiteabbey Sanatorium. Dr. Andrew Trimble,who is chief tuberculosis officer for the city as well asmedical adviser to the Belfast Insurance Committee, hasjust issued his report to the Committee on the workdone for the year 1917. Out of a total of 3578 cases

examined, 1492 (41’6 per cent.) were insured and exempt,and 2086 (584 per cent.) were non-insured. Of the 3578examined, 2807 (78’4 per cent.) were either tuberculous orsuspect, and 771 (21-6 per cent.) were non-tuberculous;of the types of the disease, the largest number were

in the pulmonary class, then came the glandular group,but of the osseous and abdominal type, the non-insured hada much larger proportion owing to the fact that the non-insured class include patients under the age of 16. Theunfortunate part of the report is, that despite the great costof the Belfast corporation scheme, the tuberculosis death-roll of Belfast rose from 2-1 per 1000 in 1916 to 24 in 1917.The reasons given for this deplorable feature in this reportare a keener search for tuberculosis, more accurate diagnosis,the war (due to reduction of the healthy civilian population,and the return of the tuberculous), the increasing scarcityand cost of food, the wear-and-tear of warfare and munitionwork, and the succession of severe climatic conditions forthree consecutive years. The tuberculosis officer thinksthe old view that tuberculosis is a house disease ishardly tenable. He says : "More probably it is not the

occupation but the wages paid in the occupation is thedominant cause"; he also lays stress on the influence ofthe topographical and climatic conditions of the city on theincidence and mortality of the disease. I am afraid a

great deal can be said in support of the view that the

housing question-rather than poverty-is at the root of thetuberculosis problem, especially the pulmonary variety.Why is it that the death-rate from tuberculosis has risen in