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institution, will shortly be opened formally. The wards havefor the past three months been occupied by patients anddorts are being made to raise additional funds on behalf ofthe hospital.

AprU 19th. _________________

PARIS.

(FROM OUR OWN CORRESPONDENT.)

The Number of the Ticbcraulous in the Paris Hospitals.A MEDICAL journal has just carried through an inquiry

into the number of tuberculous patients under treatment inthe Paris hospitals. Of 4117 patients passed under review1685 were tuberculous-namely, 1146 men and 539 females,or a proportion of 40 per cent. A similar inquiry badalready been made by M. Mourier, formerly director of theAssistance Publique, who arrived at the result of 45 per cent.These figures are important at the present time when it hasbeen decided to reserve two or three of the Paris hospitalsexclusively for the use of tuberculous patients.l As a matterof fact, the number of tuberculous persons in Paris is fargreater than is indicated by the above figures. Even whenthe 2000 tuberculous patients who are to be treated in thehospitals are taken away from the general number there willeasily be 2000 others to take their place. Who can tellwhether the patients will go willingly into these "hospitalsof death" where they can be under no illusion as to thenature of their malady ? 7 In hospitals when the plan ofreserving certain wards for tuberculous patients has beentried as soon as those suffering from phthisis saw thatthey were to be in company with their fellow sufferers theyinsisted on leaving.

The Tlte’l’apeutio Uses of the Peroxides.M. Gilbert recently real a paper before the Society of

Biology on the Therapeutic Uses of the Peroxides and as asequel to this paper M. Albert Robin read another before theTherapeutical Society giving his experiences of this drugwhich he has for some time past employed. The peroxidesof calcium and of magnesium give up the whole of theiroxygen when they come in contact with the gastric juice.If, however, they are given in a capsule of keratine so thatthey can pass into the bowel before being decomposed theyhave a powerful antiseptic action. Under their influence theconjugate potassium indoxyl sulphate present in theurine in cases of septic absorption rapidly diminishes.Peroxides diminish the fcetor of the stools and are the bestmeans for overcoming diarrhoea due to a fermentative origin.On this account they may be made to serve as a diagnosticagent, for they have hardly any effect in diarrhoea due toserous, vaso-motor, bilious, nervous, or tuberculous causes.M. Robin quoted two typical cases which were under hiscare at the Beaujon Hospital. One was that of a patientin the third stage of phthisis who had profuse diar-rhoea, probably of tuberculous origin. The stools wereliquid, without marked foetor, very slightly coloured,and neutral or alkaline in reaction. Peroxide of mag-nesium in doses of one and a half grammes perdiem had no effect and reliance had to be placedupon astringents such as tannin, opium, and bismuth.IE these were given up the diarrhoea returned andoxide of zinc had to be given. The other case was

that of a patient suffering from pleurisy who duringconvalescence developed acute diarrhoea with very fcetidstools, giving a markedly acid reaction to litmus paper.This condition seemed to be due to gastric hyperacidity,the existence of which was confirmed by an analysisof the stomach contents and which in its turn was due tofermentation. Peroxide of magnesium was given at first indoses of one gramme per diem so as to act on the stomachcontents and afterwards in a keratine capsule so that it

might act directly on the intestinal contents. Within a fewdays the stools became less frequent and lost their foetor.As, however, they remained acid the stomach contents atthe end of a meal were saturated by a mixture of calciumcarbonate and calcined magnesia, two days after which thestools became absolutely normal. In the belief that oxygenliberated from the peroxides would be absorbed by theblood Hatch, Havald, Mon6, and Munstein have suggestedthat magnesium peroxide should be given in cases in which

1 THE LANCET, April 16th, p. 1085

the direct action of oxygen seemed advisable. Ttiey recom.mend its use in certain cases of ansemia and in certain casesof joint disease.April 19th.

___ ____

SWITZERLAND.(FROM OUR OWN CORRESPONDENT.)

The Midwives’ Petition.A QUESTION of practical importance is at present before

the legislative council of the canton of Ziirich. As the rulesand regulations for admission to the cantonal hospitals, boththose which receive paying patients as well as those whichprovide for the needs of the pauper population, are at presentunder consideration the midwives of the district havepetitioned asking that the fees charged to the paying classof patients should be raised. They plead that the presentcharges at the obstetric clinic should be raised as theinterests of both the ratepayers and the midwives are suffer-ing severely in consequence of the system now in force. Thenumber of women admitted at the obstetric clinic for thepurpose of their confinement has been rapidly increasingfrom year to year ; it has, in fact, more than doubled in tenyears, for there were 1344 admissions in 1902 as comparedwith 540 in 1891. Thus nearly one-fourth of all the confine-ments of the town of Zurich, which has a population of160,000, take place at the clinic and three-fourths are

attended by the midwives and the medical practitioners.I must here mention that the great majority of all the normalconfinements, perhaps over 90 per cent., are conducted bythe midwives and medical aid is only summoned in cases ofabnormal labour, this portion of the work is falling into thehands of the numerous medical specialists, male and female.I must also add that the midwives are well trained for theirduties as they have to spend six months at the clinic instudy in order to obtain a legal diploma. They also have toattend repetition courses at the hospital every three or fouryears as long as they continue in the profession. The rate-payers of the canton of Ziirich are put to considerableexpense owing to the fact that the middle-class patientsare undercharged at the clinic where they get the best ofadvice and attendance for nominal fees. The daily cost atthe clinic is 2s. 5d. per head ; the average amount paid inis only ls. 5d., and the deficit to be covered amounted in1891 to .61700 but has risen in 1902 to .E5100 for the obstetricclinic alone. The midwives argue that if this arrangementextended only to paupers nobody would have reason to com-plain but the middle classes have begun to use, or ratherto abuse, these charitable institutions to the detriment of themidwives who are under a legal obligation to attend normalpauper confinements for the meagre sum of 12s., whereas thepatients who could pay from .61 to E2 for a confinementmake use of the hospital. At present persons declaringtheir incomes at .E80 a year pay only 8d. a day whenin the hospital ; this sum should be increased to ls. 3d. perday. Persons declaring their incomes at amounts up to.E120 should pay 2s. a day instead of ls. as at present. Itmust also 0 be remembered that declared incomes are

notoriously some 20 to 50 per cent. short of the real income,owing to the high rate of income tax-namely, ls. 6d. inthe pound. It seems most necessary that the canton ofZiirich, which is hampered by a deficit now amounting to160.000, should do everything in its power to avoid useless,deficits as in the above case. This petition has caused thescale of charges for admission to the cantonal clinics tobe returned to the authorities for revision.

Ziirich, April 12th. __________________

EGYPT.(FROM OUR OWN CORRESPONDENT.)

Cattle Plague.THIS disease, also called rinderpest or bovine typhus, has

often been introduced into Egypt from Turkey or Syria,where it is endemic as in South Africa and India. One ofthe first duties of the newly formed sanitary department in1884 was to combat it and matters were then impossiblydifficult owing to the complete absence of veterinarysurgeons and all literature on the subject. In fact, theEgyptian Government of that day was 60 averse to in-

creasing the number of English officials that it actually

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sent back to England, without even interviewing him,the first civilian veterinary surgeon who was broughtout here to work for it. Now matters are happilyimproved, a large staff of English veterinary surgeonsinspect the country, and a flourishing college for nativestudents stands in the grounds of the sanitary department.In England and many other European countries cattlediseases are dealt with by the Agricultural Board but as thisis unhappily non-existent in Egypt all veterinary questionsare under the control of the sanitary department, so ablypresided over by Sir Horace Pinching. Cattle plague dieda lingering death in 1886 and Egypt remained free from ittill about a year ago, when it was re-imported from Syria.Attempts were made last summer to get serum from Oon-stantinople but inaccurate instructions which accompaniedthe supply caused the death of the cattle experimented onand the serum treatment became extremely unpopular. Nowthere is a well-appointed serum institute in the Abbassiyehdesert, near Cairo, where 100 bulls are kept immunisedagainst cattle plague. Each bull is bled every fortnightand gives seven litres of blood each time; these seven litresyield 65 per cent. of serum and a protective dose of serum is30 cubic centimetres per 600 pounds of the weight of theanimal. Roughly speaking, fully grown beasts weigh 1000pounds and bulls are chosen because they are strongerthan cows and yield more blood. In order to immunisea bull five cubic centimetres of virulent blood are in-jected subcutaneously over one shoulder and an appropriatedose of serum over the other shoulder, according tothe animal’s weight. This is practically the simultaneousmethod of Dr. G. Turner of South Africa, which hasbeen adopted in this country after experimenting withother methods. After the double injection the bull, thenormal temperature of which is from 101° to 1020 F.,has fever for from six to ten days, the temperaturerunning up to 105°. When the febrile reaction hassubsided the bull is injected subcutaneously at one

sitting with four litres of virulent blood which producesa second attack of fever lasting about a week, the tem-perature again rising as high as 105°. After the secondattack of fever is over and the bull has rested four or fivedays he is ready to be bled to furnish protective serum. Intwo months’ time, after four bleedings, he is reinforced withanother four litres of virulent blood when febrile reactionagain takes place. After another two months he is againreinforced and this may be repeated until he becomes" salted" - 1. e., incapable of becoming affected by the toxinand unable to yield antitoxin-when he can be safely sold tothe butcher. One’animal, however, has now been in con-stant use for seven months. Virulent blood is obtained

by bleeding at the height of the fever on the sixth

day, allowing three days for incubation and three daysfor the fever to rise. To obtain serum as soon as a bullis bled the blood is allowed to clot in tall cylindersand the expressed serum is then decanted and centrifugalisedin Cairo so as to get rid of any blood corpuscles whichmay be present, after which 0-5 per cent. of carbolic acidis added as a preservative. Every 100 litres of serum so

prepared are standardised by testing against virulent blood ina number of fresh bulls. The serum is then packed inbottles containing 220 cubic centimetres each and despatchedto the veterinary staff in the districts. The quantity nowprepared is 4000 doses a month, which is much less than theactual requirements, but it is hoped that shortly, owing tothe increased strength of the serum, about 10,000 doses amonth will be sent out. There are two methods of usingthe serum in the villages : (1) to give a dose of serum

to each animal of a suspected herd, thus conferringa passive immunity for a period of from three to five weeks(the great advantage of this temporary treatment is thatthe farmer at a busy time of the year can continueto work his cattle on the land for ploughing, &c.); and(2) to "vaccinate" by inoculating once by the simul-taneous method already mentioned and thereby secure

immunity for years. This second method is dangerousin the country districts because, owing to want of care

and imperfect knowledge on the part of the owners, from10 to 25 per cent. of the animals die. Tne chief causesof this high mortality, which has brought some discrediton the serum treatment, are that the ignorant owners

unless prevented continue to work the cattle in the fieldsand also expose them without protection to cold air at

nights even when the poor beasts are in the midst of theirfebrile reaction. However, at the Serum Institute, where the

bulls are treated with the care necessary for all sick animals,very few die. For instance, not one has succumbed out of thelast 80 immunised, though a slight mortality did occur earlyin the experiments before it was understood that sick nursingwas so all important. Every beast’s rectal temperature is takenby chart three times a day ; it is stabled by night in cleansheds made of wood and matting, it is exposed to the sunall day, and its food is carefully regulated, consisting chieflyof clover, beans, and chopped straw, while of course it doesno work. The institute since June has been under thecontrol of Dr. W. St. 0. Symmers, the professor of pathologyand bacteriology at the medical school, assisted by one

Englishman, two native veterinary surgeons, and a number ofservants. Professor Symmers is specially ntted for this workafter his long apprenticeship in the preparation of diphtheriaand other antitoxins in England. In addition to this institutehe is also controlling work at the slaughter-house inOld Cairo where a large number of animals are testedand partially immunised and whence suitable bulls are

after quarantine transferred to the Serum Institute. Theadvantage of this quarantine process is that the animalscan be carefully tested and if found to be suffering from anyother disease they can be discarded and so less risk is runof infecting the bulls at the institute. Quarantine is justnow of the highest importance because other diseases areprevalent, such as Texas fever (pyrosomiasis or hsemo.

globinuria), foot and mouth disease, and a but little under.stood complaint which is thought to be Rhodesian fever. Itis this last disease at which Professor Koch is now workingin South Africa and which is associated with a rod-shapedprotozoon in the red blood corpuscles, reminding one ofmalaria in the human subject. Professor Koch ha&been invited here in May by the Egyptian Governmentto give us the benefit of his knowledge on cattle diseases.Previous experience in Egypt and other countries tends toshow that rinderpest will temporarily die down during thehot summer months but will reappear in the autumn andthe Serum Institute must therefore continue to work at highpressure. Buffaloes also contract rinderpest but do notseem to be so susceptible as other cattle. Some gazelleswhich have recently died at the Zoological Gardens here hadsymptoms and post-mortem appearances closely resemblingthose of cattle plague. One of the best features of the SerumInstitute is that it is practically self-supporting ; over .&600(}have been expended but this sum has been repaid by cattleowners, though the serum is invariably given to those whocannot afford to buy it. H. H. the Khedive, who is a

considerable owner of cattle, has visited the instituteseveral times and has sent many of his cattle to beimmunised. This may encourage some of the disbelieverswho are fully persuaded when their herds are attacked byfood and mouth disease and Rhodesian fever that the serumis responsible. Already about 150,000 head of cattle havedied, representing, it is calculated, a loss to the country ofnearly f.2,000,OOO. Fortunately, about one-fourth of thesurvivors in Upper and Lower Egypt are already immuneafter recent attacks of cattle plague. Veterinary tropicalknowledge is quite in its infancy and experts cannot yetdifferentiate between some of the diseases I have mentionedeither by clinical symptoms or post-mortem signs. Dr.Bitter and Dr. Dreyer are working daily at blood filmsfrom the sick animals and may in the future be able tothrow some light on the problems which are of fascinatingperplexity.

Cairo, April 10th. __________________

AUSTRALIA.(FROM OUR OWN CORRESPONDENT.)

Quarantine.THE necessity of federal quarantine regulations was

alluded to in a former communication. Since then theTasmanian health authorities have written to the Board ofHealth of Victoria urging the necessity of making furtherefforts to secure federal quarantine. The board replied"that the time bad arrived when joint quarantine regula.tions for Australia should be framed." As is usually thecase, the passengers quarantined at Melbourne on arrivingfrom New Zealand, owing to the outbreak of small-pox there,have made protests. One complaint was, however, unusual-being a charge of favouritism owing to the use of undue

11 influence-" by a very influential personage. Mr. J.