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of the advantages secured. At the last general assembly ofthe Union of the Medical Syndicates of France it wasdecided to recommend that medical committees should be

appointed by the prefects from lists of candidates presentedby the local medical syndicates. The mission of these com-mittees would be to verify the charges made for medicalattendance and for medicaments. Dr. Deslandes, however,pointed out that the medical practitioners rarely visited theirpatients more frequently than necessary. There was a slightbut, on the whole, a justifiable increase, a little more atten-tion was paid to the patient than under the contract system,and this is no grievance but an advantage. The legitimategrievance is in regard to the drug bill. Dr. Deslandes saidthat he had studied a great number of accounts and he foundthat where in a department the fees for medical poor reliefhad augmented by 2000 francs the cost for drugs hadincreased by from 20,000 francs to 30,000 francs.The above proposal was approved but it was also suggested

that the committee of control, when appointed, might seethat there were no abuses committed by the authoritiesthemselves. If the medical man to increase his popularityvisited a patient once or twice more often than absolutelynecessary and was too lavish in prescribing drugs,bandages, &c., the municipal councillor in his anxietyto secure his re-election and to augment his popularitymight not be very careful as to the persons whom hecaused to be put down as entitled to medical relief at thepublic expense. Sometimes such persons were well able topay the usual medical fees and this would be more advan-tageous to the medical profession while saving the tax-

payers’ money. One district is mentioned where the entirefire brigade has been inscribed as entitled to gratuitousmedical relief. Some of the firemen are doubtless very poorbut this is certainly not the case with the entire brigade. Thenthere is a village consisting of 40 families and 35 of thesefamilies are entered on the list of indigent persons entitled tofree medical relief. In another place all the members of themunicipal council have enrolled themselves on the free listand as being poor enough to be treated when ill at the

public expense ; Dr. Gassot said he knew of a place where,out of about 6000 inhabitants, 5000 were inscribed as

indigent. Thus there have been some faults on all sides ;and if some of these defects are attributable to medicalpractitioners, it is satisfactory to see that the medical pro-fession in its collective and organised capacity, as representedby the national union of its syndicates, is determined to putdown all such shortcomings and thus to maintain its honourand integrity.

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SPENGLER’S INOCULATION TREATMENTOF TUBERCULOSIS.

(FROM OUR BUDAPEST CORRESPONDENT.)

Dr. Josef Hol]6s, chief physician of the Szeged CountyHospital, has been making an extensive investigation of

Spengler’s inoculation treatment of tuberculosis. Theexperiments were begun in February last and Dr. Holl6shas made public a full description of his observations, areszcmae of them being as follows. 1. The Spengler treatmentis not suitable for cases accompanied by high fever andimpaired heart action, neither is it suitable for patientswhose pulse-rate is persistently over 120, although the

physical signs may be slight. Those uncommon cases inwhich the so-called "hypersensitiveness" " is present may betreated in this manner only with the greatest caution. Inthese cases instead of the injection of the vaccine it isadvisable to rub in minimal doses of the substances con-tained in the culture bouillon, whereupon the hyper-sensitiveness ceases. 2. The most satisfactory results areobtained with the recent or subacute infections, for inthem recovery follows very quickly. The following is anexample out of the numerous successfully treated cases

quoted by Dr. Holl6s. The patient was a man, aged34 years. He had suffered from cough for the last six years.He was greatly emaciated and very weak and had beenunable to work for a year. The quantity of sputum broughtup in a day was from 80 to 100 cubic centimetres. From

July lst till August lst he was under Professor Spengler’streatment at Davos, in Switzerland. Before the treatment12 tubercle bacilli could be seen at one time in a microscopicfield. A second course of treatment was undertaken by Dr.Ho1l6s in October. At that time the patient was ill nourished

and in an unsatisfactory condition. There was dulness overthe upper lobes of the lungs and over the whole lungs therewas harsh breathing with vesicular rales. The daily amountof the sputum excreted was from 15 to 20 cubic centimetres.Some microscopic fields contained five tubercle bacilli, whilein others there were none. The sheath of the bacilli wasmostly injured. After the treatment the daily quantity ofthe sputum was from five to six cubic centimetres, it wasfree trom tubercle bacilli, and the patient felt well.Since that time (September) he has been able tofollow his employment continuously. Standing at hiswork does not fatigue him. He coughs very littleand can walk three or four hours every day withoutfeeling the least discomfort. 3. In severe chronic casesa system of treatment is needed in which the first series ofinoculations is succeeded by a second one after three months,but there is evident improvement even after the first courseof treatment. This is manifested in the diminution of thecough, the expectoration, and the respiratory difficulties.The patient’s weight increases and the number of bacillidecreases. 4. The toxic symptoms of tuberculosis dis-

appear. These are very often present in latent tuberculosisand are so characteristic that the presence of tuberculosiscan be diagnosed from them. The subjective symptomsinclude chronic anemia, headache, fainting, loss of appetite,sleeplessness or restless sleep with unpleasant dreams, fre-quent palpitation, night sweats, and dysmenorrhoea. A con-siderable proportion of cases of anasmia, neurasthenia, anddysmenorrboea are nothing more than toxic symptoms oflatent or manifest tuberculosis. Among these dysmenorrhoeadeserves particular attention because in such circumstancesthe etiology of this condition has up to the present time beenquite unknown. Dr. Holl6s has now had under his care about20 such cases, in which the dysmenorrhoea ceased after theapplication of Spengler’s treatment. 5. Veiled latent tuber-culosis frequently occurs in families in which one of theparents is suffering from mild chronic tuberculosis. Thesepatients mostly cough during the winter. Their sputumcontains only few bacilli. They call their disease" catarrh,""asthma," or "cold." " The few bacilli give rise only to aslight infection in the children and the disease remainslatent, manifesting itself only in periods which may be aslong as ten years. Thorough examination of numerous

families is quite convincing as to the truth of thisstatement. In families where the children suffer fromthe different forms of the so-called surgical tuber-culosis the parents are not infrequently affected withbovine tuberculosis (PerlS1wht). This disease is not very un-common. The basmorrhagicforms are in the majority of casesperlsucht infections, in which the bacillus of bovine tuber-culosis is present either alone or in association with the bacillusof human tuberculosis. Not only Professor Spengler’s state-ments but also the experiences of Dr. Hollos agree on thepoint that the best remedy for pulmonary haemorrhage is theinjection of tuberculosis vaccine. In all the cases observedby Dr. Hollos the treatment was carried out whilst thepatient was continuing to follow his employment. Theresults have been very favourable, although the patients weredrawn from a section of the population to whom sanitarydwellings and hygienic living are quite an unknown con-ception. The results would probably have been even betterif the patients had belonged to the well-to-do classes whocan carry out all the instructions of their medical advisers.The treatment consisted only in the systematic administra-

tion of the injections. Dr. Holl6s expects that further expe.rience of the Spengler inoculation treatment will cause a greatchange in the method of dealing with tuberculous patients,for the severer cases will probably be admitted into thesanatoriums for the sake of isolation, while those whosesymptoms are mild will be treated at their own homes andwill continue to work for the support of their families.

BIRMINGHAM.(FROM OUR OWN CORRESPONDENT.)

i The Ha1nsteaà Collie’l’Y Disaster.THE serious accident which has caused so much sorrow and

; mental anguish in our immediate neighbourhood has cast agloom over the city and district and has made many people, ask how it is that so little effective succour is available when

colliery accidents occur. Around us are many mines inwhich accidents may occur at any moment, yet there is not

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in the whole district a rescue station such as that establishedin Yorkshire. Surely it might be possible to establish n bodyof volunteers willing to be trained in rescue work and avail- I

able at an instant’s call ? The University, which has alwaysshown itself ready to join in all plans advantageous for thedistrict, would no doubt be willing to play its part, and acorps established in association with it might be properlytrained in the use of, and equipped with, the necessary appa-ratus. It should not be difficult to familiarise the membersof such a corps with a sufficient knowledge of the surroundingmines, and if such a well-trained and properly equipped bodyexisted the life toll demanded by our mines might be muchreduced in future years.

The Ann2eccl Report of the General Hospital.The summary of the year’s work of this hospital shows

that the number of in-patients treated during the year 1907was 5568-that is, 364 more than in the previous year--andthe daily average was 305, as contrasted with 304 in 1906 andwith 291 in 1905. There were 62,102 out patients, thatnumber being 3305 less than in 1906 and 450 less than in1905, the diminution being mainly due to a reduction inthe number of out-patients accepted without tickets. In

submitting its report the board of management pointed outthat on the recommendation of the medical committee ithad instructed the visiting and resident medical and surgicalstaff to give first-aid to trivial cases and then refer themelsewhere, and also to refer chronic cases which do notrequire treatment by the hospital staff to practitioners, clubs,dispensaries, and the Poor-law authorities. During the yearthe staff has been rearranged by the transformation ofcasualty assistant surgeons into assistant surgeons and

surgical casualty officers are to be appointed to dealwith surgical casualty cases. The rearrangement andalteration of the operating theatres foreshadowed inlast year’s report has been carried out and the operatingwork has been facilitated. This was absolutely neces-

sary in view of the increasing number of operations,which in 1905 were 3326, in 1906 3344, and last year theyadvanced to 3853, an increase of over 500 in three years.The total expenditure for the year was .624,978 andthe deficit was .E3025, making a total deficit of .67698.The board admits that, recognising the increase of expensesnecessarily associated with increasing work, and particu-larly with increasing operative work, it views with concernthe continued falling off of subscriptions. In 1905 they felloff to the amount of £ 181, in 1906 .f:106, and last year therewas a further fall of .688.

The Annual Report of the Qlteen’n Hospital.That portion of the annual report of the Queen’s Hospital

which deals with the number of patients shows that during1907 the number of in-patients was 2485 and out-patients35,413, the former having increased by 178 and the latter by200 as contrasted with the numbers of 1906. Naturallyassociated with the increased work there was increasedexpenditure which reached a total of 12.788, or

& 1.031 more than last year, whilst the income was only.E395 more than in the previous year. Before the newbuildings can be opened free from debt a further sum ofabout .S 1.5,000 is necessary, and when the new block is atwork it is estimated that an additional income of L2500 willbe required. When it is remembered that the chitdren’shospital is going to appeal for a large sum, that many otherpublic institutions are calling for monetary aid, that trade isdeclining, that expenses are increasing, and that there aredoubt and fear in financial circles and in many trades andindustries, the outlook of charities which require increasedfinancial aid is not for the moment particularly hopeful.

The Walsall and -District Hospital.It is obvious from the annual report that the Walsall

Hospital has before it a difficult period and the utmost effortsof its friends will be needed to enable it to continue steadilyon its path of continually increasing usefulness. Daring thepast year the increased accommodation has enabled the

average daily number of patients to be raised from 45 to 53,with a consequent increased expenditure of .E1190. whilstthe income unfortunately has only increased by 250. Thecommittee holds out no hope of a reduction in expenditure solong as advantage is taken of the new accommodation, andit has decided to restrict the number of beds in use, buteven with the restrictions imposed the cost of the increasednumber of patients can only be met by an additional incomeof 600. The committee hopes that now the facts are clearly

before the public the necessary response will be made, butf it is not then the scope of the work will have to beliminished.March 17th.

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MANCHESTER.(FROM OUR OWN CORRESPONDENT.)

The Infirmary ;Site.JUST as the public mind was settling down to the idea

that the infirmary site should be devoted to an art galleryand free library another proposition has been brought forwardwhich seems to have aroused some interest. The Exchangehere has become too small and unless removed to anothersite will have to be greatly enlarged by absorbing, as itmay be called, a street or two and other property. The

suggestion is that the Exchange and the Art Gallery andLibrary should change sites and if necessary that the lattershould be enlarged as much as necessary. No doubt thePiccadilly site would be excellent for the Exchange but asregards the Library and Art Gallery there would be lesslight, as there would be buildings all round instead of afairly open space.

Ladies’ Health Soaiety.The Eccles town council came to the very sensible

decision the other day to appoint a second woman visitor inconnexion with the Ladies’ Health Society and to increaseits subscription to the society from f:50 to E100 a year.Reference was made to the business-like way in which theoperations of the society were carried out. The visitors areto receive their instructions from the medical officer ofhealth, Dr. W. M. Hamilton, as is the case in Manchester,where the work is done in cooperation with Dr. J. Niven.

Coroner, Druggist, and Patient.At an inquest held about a week ago a conversation took

place between Mr. Gibson, the coroner, and the witness, adruggist, on the duties of the latter. Mr. Gibson said that theboy who died was suffering from pneumonia, "but you (thedruggist) could not tell that. If you had not given a powdera doctor would in all probability have been seen and the childmight have been saved." To this the druggist replied that acustomer comes and says she wants a powder as the child’sstomach is upset. " If I don’t serve her she would think mechurlish and go somewhere else and she would be served."The coroner said that he was strictly within his rights inselling what was asked for and he did not consider thatthere had been a breach of duty in any way. This no doubtis perfectly good law, but the present case is only oneillustrative of a widespread but bad practice. The druggistis in a dilemma : he cannot be sure of the accuracy of themother’s diagnosis and must be conscious that his powder,so far as he can tell, may be inefficient and useless, or it maybe actively injurious. On the other hand, he may think thatto keep his customers and to make a living is a duty owingto himself and he does not trouble about his own responsi-bility directly by selling something which may do harm, orindirectly by preventing the calling in of the medical man.The dividing line between what is safe and therefore allow-able and what is dangerous is often faint and indistinct, butit would seem desirable that all acute cases should be seenby a medical man, rather than be left to the haphazard effectof a powder on an unknown patient in an unknown condi-tion. Though evidently knowing the risks of this counterprescribing the coroner had to guide his course by the law asit stands.

Health of Widnes.Widnes is not an attractive-looking place, for chemical

works and the dwellings of the workpeople seem to havepresented difficulties that the architects have not overcomein their attempts at making them things of beauty and joysfor ever. It is interesting to notice, however, in the annualreport of the medical officer of health, that 1907 was, so far asenteric fever was concerned, a comparatively healthy year, 15’cases only being notified, as compared with 67 in 1906. Heattributes it to the wet cold summer and the consequentimmunity from flies. The rainfall at Widnes may have beenheavier than the average over the country generally, whichwas lower than usual. The summer was, no doubt, cold andcheerless and a large proportion of the rain fell in the day,which, of course, made what fell more noticeable than if a