1074 KING EDWARD’S HOSPITAL FUND FOR LONDON.

VIENNA.

(FROM OUR OWN CORRESPONDENT.)

Reappearance of Ir2fluenza. ACCORDING to the October reports of the Board of !,

Health a new wave of influenza threatens the city.Hitherto cases have been few and the course of thedisease is mild, with a prevalence of intestinal sym-ptoms, but with the recent sudden change of weathercatarrhal manifestations appeared ; cerebral cases

have also been reported and practitioners have beenwarned. This time the younger part of the populationis more affected, perhaps because older people havebeen immunised by almost universal epidemicsduring recent years.

The Rat Plague. ’,For some months the difficulties of everyday life in

Vienna have been complicated by the appearance ofswarms of rats and mice, apparently imported inconsignments of wheat and grain from abroad. Theconsiderable trade carried on with the Balkan States,and Eastern Europe generally, gives rise to dangerof diseases communicable by these animals, andstringent precautions have been taken to avertdisaster. Sanitary authorities have been instructedto pay special attention to the conditions of drainsand sewers. It may be mentioned that the spread ofinfluenza has also been attributed by some investi-gators to the spread of mice and rats.

The Problem of Doctors’ Fees.Owing to constant depreciation of the currency the

medical profession is faced by a serious and hithertounsolved problem. In a very instructive leaflet,published by the Medical Organisation, it is pointedout that the daily wages of carpenters, bricklayers,engineers, and shoemakers have increased from 100to 120 times as compared with 1913, whilst theirdaily working hours have been cut down to eight.A number of other workers earn between 70 and 90times their pre-war wages, whilst the prices of foodand other necessaries have risen 120 to 200 times.These people can therefore obtain from 50 to 90 percent. of the commodities they were accustomed to buybefore the war. Doctors’ fees, however, have notincreased pari passu, and only quite lately have thepublic been asked to pay as much as 50 times thepre-war fee for medical attention. The MedicalOrganisation has now demanded a hundredfoldincrease of the original fees, and also stipulates thatforeign patients shall be charged fees in their nativecurrency. An English, Swiss, or Dutch patientcharged 1000 kronen for each visit from a doctorwould still only pay a fraction of the fees to whichhe is accustomed at home--1000 kronen being atpresent worth about two-thirds of a Dutch florin,1¼ Swiss francs, or about ls. 3d. But medical fees areconsiderably higher in their own countries, and suchpatients are expected to pay accordingly. For thecountry practitioners in Austria conditions are quitedifferent; their payments are mostly made in

" kind."For a consultation at the doctor’s office the charge is5 kilos of grain, or a kilo of meat, or half a kilo ofbutter or lard, or the equivalent in money. Thisarrangement satisfies both parties, as the conditionsof peasant life are not much altered, but it is, ofcourse, inapplicable to the towns. Panel doctors, andthose holding appointments under private corpora-tions, have also demanded an adjustment of salariesto meet the new monetary conditions. The result ofall such increases is, however, only transitory ; aman now earning 100,000 kronen a month is fairlywell paid, but that is really equivalent to no morethan a monthly salary of six or seven pounds sterling.

Statistical Data of Vienna Medical Students.During the last university term 3228 ordinary

students (including 450 women) and 127 extraordinarystudents appeared on the register of the medicalfaculty, being 35 per cent. of the total number of

students at the university. For the present semesterthe number of first-year students to be admitted isfixed at 400. Jjast term very many nationalitieswere represented; the youngest students registeredwere 17½ years of age, and the number of ordinarystudents above :30 was 17. Students usually obtaintheir diploma of M.D. at, the age of 25 or 26: over600 qualified during the past semester. Foreignstudents can obtain diplomas only if thev bind them-selves not to practise in this country, but otherwisethey are eligible to all house appointments or vacanciesas internes and second assistants. About 28 percent. of students were regular users of the cheap mealkitchen, chiefly supported by grants from the Anglo-American Relief Mission and the Red Cross Society.Synchronous Combined Treatment of Metrorrhagia by

Radium and Y Rays.At a recent meeting of the Vienna Gynaecological

Society, Prof. Weibel reported the results of treatmentof haemorrhagic conditions of the uterus, includingmyomatous haemorrhage, by a single (castrating)X ray dose, combined with radium application.The patient’s abdomen is exposed for three to fourhours to X rays. with a 3 mm. platinum or aluminiumfilter ; meanwhile a quantity of 40-50 mg. radium isinserted into the posterior fornix vaginae and lefttherein-well filtered-for 36 to 40 hours. Of the160 cases so treated, amenorrhoea was at once inducedin 33, 35 had only one more haemorrhage, 47 ceasedto menstruate after two months, and 8 after threeor four months ; the remainder had oligomenorrhoea,and 6 were altogether refractory. In youngerpatients oligomenorrhoea is produced by a dose whichin older women is followed by amenorrhcea. As thelatter often has disagreeable sequelæ (e.g., castration)it is advisable to aim at reducing the bleeding ratherthan causing it to disappear. A radium injury wasonly once noted-an extensive necrosis in the pos-terior fornix in a case of a patient with perniciousanaemia. In a series of 1510 women exposed for thesame purpose to X rays during the years 1911-19,only 17 again became pregnant, with 24 fcetuses.Thirteen full-term children were born, and in ninecases abortion took place ; the living children seemedto suffer no ill-effects from X ray treatment of themother.

Nov. 3rd. _______________

KING EDWARD’S HOSPITAL FUND FORLONDON.

A SPECIAL meeting of the President and GeneralCouncil of King Edward’s Hospital Fund for Londonwas held at St. James’s Palace on Nov. 9th, when theEARL OF DONOUGHMORE, member of the President’sPower Committee, presided. He read a letter fromthe Prince of Wales, in which his Royal Highnesspointed out that under the Hospitals Commissionthe King’s Fund had been constituted the centralauthority for London, and that this would involvecertain duties which could only be properly carriedout by reconstructing the committees of the Fund.

Lord STUART OF WORTLEY, the Chairman of theKing’s Fund Policy Committee, in presenting a reportof that committee on the question of the reorganisationof the King’s Fund, said that the proposals wouldinvolve no change in the Act of Incorporation. Aresolution approving of the need for certain changeshaving been adopted, he presented a report of theExecutive Committee on the conditions attached toGovernment grants to voluntary hospitals. Thisincluded the following resolutions :-

(1) That the President and General Council of King Edward’sHospital Fund for London have considered the conditionsattached by the Treasury to the temporary assistance voted byParliament to voluntary hospitals requiring that fresh moneyshall be raised pound for pound with the Government grantsand are of opinion that the application of this condition, whichwas not recommended in the report of Lord Cave’s Committee,nor separately considered (much less expressly enjoined) byParliament, will lead to great difficulties and probably to great

1075PUBLIC HEALTH SERVICES.-THE SERVICES.

injustices as between different hospitals in the distribution of Ithe grants; and they trust, therefore, that the condition willnot be pressed.

(2) That copies of this resolution should be forwarded to thePrime Minister, the Chancellor of the Exchequer, and thelIinister of Health, and the Voluntary Hospitals Commission.

These resolutions having been seconded by SirARTHUR STANLEY and supported by Mr. HOPKINSON,were, after discussion, put and carried.The meeting closed with the usual votes of thanks.

Public Health Services.REPORTS OF MEDICAL OFFICERS OF HEALTH.

CITY OF LEEDS.Dr. J. J. Jervis tells us that the year has been

one of progress in every direction, as the vital statisticsand other records embodied in the report show.The population was estimated by the Registrar-General at 448,913 for death-rate and 449,410 forbirth-rate. The most important figures were as

follows: Birth-rate, 25-01 ; death-rate, 14-68 ; infantmortality rate, 110 ; death-rate from pulmonarytuberculosis, 1-23 ; and from other forms of tuber-culosis, 0-33. The death-rate from diarrhoea andenteritis under two years per 1000 births was 12-47.The figure of 8-3 represents the death-rate for Englandand Wales, and the table given on p. 16 shows thatLeeds does not come out well in comparison with the10 large English cities. Dr. Jervis has much to sayon the smoke problem, pointing out that respiratorydiseases as a group (including phthisis and influenza)were responsible for 31 -3 per cent. of the total deaths.He believes that " prevention can only be achieved bytackling the smoke nuisance resolutely and compellingmanufacturers to adopt cleaner and more rationalmethods of extracting heat from coal fuel and at thesame time by extending the system of central heatingfor domestic purposes." Dr. Jervis shows that infantmortality from respiratory diseases was highest inthose wards in which the atmospheric pollution ismost marked, and suggests that where plant lifefails to exist, it is impossible for the delicate humanorganism to escape some damage. From the para-graphs on smoke inspection we gather that the limitadopted is three minutes of dense smoke in the hour,and that although in 544 cases this limit was exceededthere were no prosecutions. We trust that publicopinion will support the health committee of Leedsif it acts on Dr. Jervis’s advice and institutes a reallyvigorous campaign.Dr. Jervis wants more hospital accommodation for

pneumonia, and suggests that some of the beds inthe Poor-law infirmaries should be used to supplementthe deficiency of the general hospitals in this respect.The pooling of the hospital accommodation of thePoor-law and sanitary authorities for the generalinterests of the community would appear to be apossible solution of many problems now confrontingmedical officers of health. Dr. Jervis does not believein the grading of milk; he contends that those whosuffer most from the drinking of impure milk are theworking classes, many of whom are finding it hardenough even now to purchase sufficient milk and couldnot afford the higher price demanded for graded ’’,milk. Dr. Jervis reports that the quality of cattlearriving in Leeds for slaughter has shown a markedimprovement since control was removed. He wouldlike to see the closing of the private slaughter-housesand the provision of adequate accommodation at thepublic abattoir.Seven beds are reserved at the Maternity Hospital

for mothers and babies in case of ophthalmia neona-torum. Of 141 cases of this disease notified, fivemade an imperfect recovery, eight died, two werestill under treatment, and six were lost sight of owingto removal. The work done by the V.D. clinics hasincreased ; 2697 new cases of syphilis and gonorrhoeaattended, 829 patients discontinued treatment before

being pronounced cured, of which a very large pro-portion were still capable of transmitting the diseaseto others. There e is urgent need," continuesDr. Jervis, " for Parliamentary powers to compelinfected individuals to continue treatment until cureis effected." The death-rate from pulmonary tuber-culosis in Leeds showed an increase during the waryears and has now again reached pre-war levels.The Ministry of Health have withheld approval of ascheme for the dental treatment of the tuberculouson the score of expense, and the provision of a newsanatorium at Moortown with beds for 320 cases hasbeen postponed for the same reason. The corporationhave taken over the two tuberculosis hospitals(Armley House and Gateforth) belonging to theVoluntary Tuberculosis Association. There is a

comprehensive scheme for maternity and childwelfare. The ante-natal work is growing, but, as

elsewhere, the reduction in infant mortality does notextend to the neo-natal mortality. The deaths frompuerperal fever have risen from six in 1919 to 29 in1920. Dr. Jervis emphasises the need for the estab-lishment of small maternity homes in the congestedworking-class areas.

Dr. Jervis is strongly in favour of public healthpropaganda by sanitary authorities and says thatin Leeds this policy has been adopted with the bestresults. The housing problem is rendered speciallydifficult in Leeds by the large number of back-to-backhouses. Of the total 113,310 houses in the city,34,904 are " through " houses and 78,406 are back-to-back. Dr. Jervis divides the back-to-back housesinto three groups. The first or oldest group, num-bering 35,100, built in long unbroken rows, " isfrankly bad and unhealthy, and must be got rid ofas soon as practicable." The second group, numbering29,082, and built in blocks of eight, " is better, butrequires drastic improvement to bring it up tostandard." The third group, the erection of whichwas approved up to 1909, numbers 14,224, and" consists of a good type of house which, while notquite up to the standard of the modern through house,does not fall very far short of it." Apart from thequestion of the back-to-back houses, there is an

estimated shortage of 5800 houses owing to house-building being in abeyance during the war. Theprogress of the housing schemes has been very slow-only 309 have been completed ; but there are nowsome signs of speeding up and it is hoped about1000 will be completed before the end of the currentyear. A strenuous effort is being made to overtakethe arrears of sanitary work and repairs left by thewar.

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The Services.ROYAL ARMY MEDICAL CORPS.

Lt. (temp. Capt.) E. H. W. Elkington to be Capt.TERRITORIAL ARMY.

Lt.-Col. F. W. Gibbon, having attained the age limit, isretired and retains the rank of Lt.-Col., with permission towear the prescribed uniform.

Maj. J. 0. Summerhayes resigns his commn. and isgranted the rank of Lt.-Col., with permission to wear theprescribed uniform.

Capt. J. J. E. Biggs to be Maj.Capt. W. A. Jackman (late R.A.M.C., Spec. Res.) to be

Capt.1st N. Gen. Hosp.-Maj. D. W. Patterson, having attained

the age limit, is retired, and is granted the rank of Lt.-Col.TERRITORIAL ARMY RESERVE.

Lt.-Col. J. B. Jamieson, from General List, to be Lt.-Col.Maj. M. A. Archdale, having attained the age limit, is

retired and retains the rank of Maj.

WESTMINSTER HOSPITAL.-A dance in aid of thishospital and medical school will be held at King EdwardVII. Rooms, Hotel Victoria, Northumberland-avenue,London, W.C., on Friday, Dec. 2nd. Tickets (In Is.) maybe obtained from the hon. secs., Mr. A. D. Hepburn andMr. J. Wilson, at the hospital.