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518 733 in Munster, 726 in Greifswald, 681 in Jena, and 512 in Rostock. As regards attendance in the various faculties there are 2327 students of Protestant theology, 1584 of Roman Catholic theology, 10,511 of law and national economy, 7113 of medicine, 5200 of philosophy and history, 4722 of mathematics and natural science, 1157 of pharmacy, 1512 of agriculture, and 448 of dental surgery. Moreover, at the University of Giessen there are 126 students of veterinary medicine, but in other parts of Germany veterinary medicine is taught at special colleges not belong- ing to the universities. These figures, compared with those of the previous year, show that the students of Protestant theology have decreased by 86 and the students of medicine by 430. The students of other branches have increased con- siderably, especially the students of law, where the increase has been 47 per cent. during the past 10 years. At the University of Berlin there are 366 students registered in the faculty of theology, 2359 in the faculty of jurisprudence, 1312 in the faculty of medicine, and 2636 in the faculty of philosophy. With respect to nationality, 4679 students come from Prussia. 994 from the other States of the empire, and 714 from foreign countries. Of foreigners of European origin the majority (318) come from Russia, 112 from Austria, 88 from Switzerland, 62 from Hungary, 32 from Great Britain and Ireland, 22 from Italy, 20 from France, 20 from Roumania, 17 from Turkey, 17 from Servia, 16 from Bulgaria, 15 from Sweden, 15 from Greece, 12 from the Netherlands, 11 from Luxemburg, five from Belgium, four from Spain, three from Denmark, and one from Portugal. Of foreign students from distant parts of the world 114 come from America, 62 from Asia, three from Africa, and one from Australia. Berlin University is therefore in reality cosmopolitan. In addition to the duly registered students there are 5466 persons who are entitled to attend the lectures there ; for instance, the students of the technical and other academies and others to whom this right has been granted by a special decree of the Senate of the University. The number of female students is 439. Feb. llth. ROME. (FROM OUR OWN CORRESPONDENT.) 1’Eortality and Serum Treatment {if diphtheria W Rome. A PAPER by Dr. Spolverini in a recent number of the Policlinico 1 on the mortality from diphtheria in Rome shows that a remarkable increase occurred last year both in the number of cases and in the death-rate of that disease in this city. The period studied (from July 1st, 1895, to I May 31st, 1900) covers the time following the introduction of the serum treatment. During each of the first four years of that period the average mortality was only 16 per cent., whereas previously it had ranged between 60 and 70 per cent. From July 1st, 1899, to May 31st, 1900, however, the cases were much more numerous than in the four preceding years, whilst the death-rate was almost doubled, reaching no less than 28 per cent. To explain such a sudden and exceptional rise various factors must be considered, chief amongst which is the occurrence of previous febrile diseases, more especially of measles. This complaint was indeed very prevalent in Rome from November, 1899, till the end of the following May, and an analysis of the cases treated in hospital during that time shows that out of a total of 56 cases 20 had a history of an attack of measles pre- ceding the diphtheria. Amongst these same cases there were 16 deaths, of which 12 occurred in children who had suffered from measles not long before. The localisation of the false membrane is always a powerful factor in deter- mining a high rate of mortality in diphtheria. This is well seen from the following analysis of the 985 cases notified to the authorities during the years under consideration :- 1 Policlinico, Sezione Pratica, anno vii., fasc. 5. This cause operated still more fatally in children the resistance of whose tissues had been weakened by preceding attacks of measles, for of the 133 laryngeal cases which occurred between July lst, 1899, and May 31st, 1900, no less than 44 (33’83 per cent.) were fatal. Over the same period intercurrent acute affections (which invariably swell the rate of mortality in diphtheria) were exactly double the average of the first four years and the death-rate was increased to a corresponding degree. The paper concludes with remarks on the serum treatment, which Spolverini regards as unfailing if employed on the first day of an attack of diphtheria, but as next to useless if delayed until the third or fourth day, as happens only too often in a hospital, to which the most desperate cases are usually sent, very frequently late in the course of the disease. A quantity of serum varying from 3000 to 4000 units was used, and the first signs of improvement were generally noticed after 24 hours from the time of injection. No bad results are attributed to the administration of the serum and in those cases treated early all the patients recovered completely without ever presenting any complication. Proposed Law for the Prevention of Malaria. The text of this Bill as drawn up by Celli and others has been published. It consists of five articles, the first of which provides for the official declaration of affected zones, and the second for the gratuitous distribution of quinine to the poor by municipal authorities and the taxa- tion of the property for the purpose of raising the necessary funds. Article 3 makes it incumbent upon the Governmental department or Government contractor responsible for the execution of any public works which give rise to the occur- rence of malarial fevers to supply quinine gratuitously, and requires that if any person dies or becomes permanently disabled from malaria whilst employed on such works the same indemnity must be paid as that established for persons under the Employers’ Liability Act of 1893. Article 4 enjoins the protection against the entrance of insects to all houses within the malarial zone inhabited by persons employed in the public service and on public works from the beginning of June till the end of December, and offers rewards not ex- ceeding 1000 lire (.S40) to proprietors and manufacturers who do the like for the houses of their employes and of the peasants. Article 5 empowers the Government to take whatever further measures may seem necessary for the carrying out of the provisions of the law after such measures have been approved by the Superior Council of Sanitation and by the Council of State. The Foreign Practitioner Question. On coming up for discussion in the Chamber of Deputies the Bill proposing amendments in the law regulating foreign practice in Italy, the text of which I gave in my last letter, à was, at the request of its sponsor, Dr. Santini, referred back to the Parliamentary Committee which drew it up. On account of the change of Government now taking place a considerable time must elapse before the measure can be re- introduced, and hopes are entertained that it will be abandoned altogether. Feb. 9th. __________________ NEW YORK. (FROM OUR OWN CORRESPONDENT.) Elmira Reformatory, New York State. IN this large reformatory there has been within the past year and a half a complete change in management with a corresponding somewhat radical alteration in the methods pursued. Mr. Brockway, the late superintendent, had been at the head of the institution for a number of years, and although the means followed by him to preserve discipline among and to educate the inmates had for a considerable time been harshly criticised in the lay papers as unneces- sarily severe, it must in his favour be said that his results were on the whole satisfactory and met with the general approval of the majority of the medical journals of America. The twenty-fifth annual report of the board of managers has recently been presented to the New York State Legislature, and referring to methods of administration the report says : .. The radical difference of views which had existed between the remaining members of the old board THE LANCET, Jan. 26th, 1901, p. 290.
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Page 1: NEW YORK

518

733 in Munster, 726 in Greifswald, 681 in Jena, and 512 inRostock. As regards attendance in the various facultiesthere are 2327 students of Protestant theology, 1584 ofRoman Catholic theology, 10,511 of law and national

economy, 7113 of medicine, 5200 of philosophy and history,4722 of mathematics and natural science, 1157 of

pharmacy, 1512 of agriculture, and 448 of dental surgery.Moreover, at the University of Giessen there are 126 studentsof veterinary medicine, but in other parts of Germanyveterinary medicine is taught at special colleges not belong-ing to the universities. These figures, compared with thoseof the previous year, show that the students of Protestanttheology have decreased by 86 and the students of medicineby 430. The students of other branches have increased con-siderably, especially the students of law, where the increasehas been 47 per cent. during the past 10 years. At the

University of Berlin there are 366 students registered in thefaculty of theology, 2359 in the faculty of jurisprudence,1312 in the faculty of medicine, and 2636 in the faculty ofphilosophy. With respect to nationality, 4679 studentscome from Prussia. 994 from the other States of the empire,and 714 from foreign countries. Of foreigners of Europeanorigin the majority (318) come from Russia, 112 fromAustria, 88 from Switzerland, 62 from Hungary, 32from Great Britain and Ireland, 22 from Italy, 20 fromFrance, 20 from Roumania, 17 from Turkey, 17 from Servia,16 from Bulgaria, 15 from Sweden, 15 from Greece, 12 fromthe Netherlands, 11 from Luxemburg, five from Belgium, fourfrom Spain, three from Denmark, and one from Portugal.Of foreign students from distant parts of the world 114 comefrom America, 62 from Asia, three from Africa, and onefrom Australia. Berlin University is therefore in realitycosmopolitan. In addition to the duly registered studentsthere are 5466 persons who are entitled to attend thelectures there ; for instance, the students of the technicaland other academies and others to whom this right has beengranted by a special decree of the Senate of the University.The number of female students is 439.Feb. llth.

ROME.

(FROM OUR OWN CORRESPONDENT.)

1’Eortality and Serum Treatment {if diphtheria W Rome.A PAPER by Dr. Spolverini in a recent number of the

Policlinico 1 on the mortality from diphtheria in Rome showsthat a remarkable increase occurred last year both in thenumber of cases and in the death-rate of that disease inthis city. The period studied (from July 1st, 1895, to IMay 31st, 1900) covers the time following the introductionof the serum treatment. During each of the first four yearsof that period the average mortality was only 16 per cent.,whereas previously it had ranged between 60 and 70 percent. From July 1st, 1899, to May 31st, 1900, however,the cases were much more numerous than in the four

preceding years, whilst the death-rate was almost doubled,reaching no less than 28 per cent. To explain such a suddenand exceptional rise various factors must be considered,chief amongst which is the occurrence of previous febrilediseases, more especially of measles. This complaint wasindeed very prevalent in Rome from November, 1899, till theend of the following May, and an analysis of the casestreated in hospital during that time shows that out of a totalof 56 cases 20 had a history of an attack of measles pre-ceding the diphtheria. Amongst these same cases therewere 16 deaths, of which 12 occurred in children who hadsuffered from measles not long before. The localisation ofthe false membrane is always a powerful factor in deter-mining a high rate of mortality in diphtheria. This is wellseen from the following analysis of the 985 cases notifiedto the authorities during the years under consideration :-

1 Policlinico, Sezione Pratica, anno vii., fasc. 5.

This cause operated still more fatally in children theresistance of whose tissues had been weakened by precedingattacks of measles, for of the 133 laryngeal cases whichoccurred between July lst, 1899, and May 31st, 1900, noless than 44 (33’83 per cent.) were fatal. Over thesame period intercurrent acute affections (which invariablyswell the rate of mortality in diphtheria) were exactly doublethe average of the first four years and the death-rate wasincreased to a corresponding degree. The paper concludeswith remarks on the serum treatment, which Spolveriniregards as unfailing if employed on the first day of anattack of diphtheria, but as next to useless if delayed untilthe third or fourth day, as happens only too often in a

hospital, to which the most desperate cases are usually sent,very frequently late in the course of the disease. A quantityof serum varying from 3000 to 4000 units was used, and thefirst signs of improvement were generally noticed after 24hours from the time of injection. No bad results areattributed to the administration of the serum and in thosecases treated early all the patients recovered completelywithout ever presenting any complication.

Proposed Law for the Prevention of Malaria.The text of this Bill as drawn up by Celli and others

has been published. It consists of five articles, the firstof which provides for the official declaration of affectedzones, and the second for the gratuitous distribution of

quinine to the poor by municipal authorities and the taxa-tion of the property for the purpose of raising the necessaryfunds. Article 3 makes it incumbent upon the Governmentaldepartment or Government contractor responsible for theexecution of any public works which give rise to the occur-rence of malarial fevers to supply quinine gratuitously, andrequires that if any person dies or becomes permanentlydisabled from malaria whilst employed on such works the sameindemnity must be paid as that established for personsunder the Employers’ Liability Act of 1893. Article 4 enjoinsthe protection against the entrance of insects to all houseswithin the malarial zone inhabited by persons employed inthe public service and on public works from the beginningof June till the end of December, and offers rewards not ex-ceeding 1000 lire (.S40) to proprietors and manufacturers whodo the like for the houses of their employes and of the peasants.Article 5 empowers the Government to take whatever furthermeasures may seem necessary for the carrying out of theprovisions of the law after such measures have been

approved by the Superior Council of Sanitation and by theCouncil of State.

The Foreign Practitioner Question.On coming up for discussion in the Chamber of Deputies

the Bill proposing amendments in the law regulating foreignpractice in Italy, the text of which I gave in my last letter, à

was, at the request of its sponsor, Dr. Santini, referred backto the Parliamentary Committee which drew it up. Onaccount of the change of Government now taking place aconsiderable time must elapse before the measure can be re-introduced, and hopes are entertained that it will beabandoned altogether.Feb. 9th.

__________________

NEW YORK.(FROM OUR OWN CORRESPONDENT.)

Elmira Reformatory, New York State.IN this large reformatory there has been within the past

year and a half a complete change in management with acorresponding somewhat radical alteration in the methodspursued. Mr. Brockway, the late superintendent, had beenat the head of the institution for a number of years, andalthough the means followed by him to preserve disciplineamong and to educate the inmates had for a considerabletime been harshly criticised in the lay papers as unneces-sarily severe, it must in his favour be said that his resultswere on the whole satisfactory and met with the generalapproval of the majority of the medical journals ofAmerica. The twenty-fifth annual report of the board ofmanagers has recently been presented to the New York StateLegislature, and referring to methods of administrationthe report says : .. The radical difference of views which hadexisted between the remaining members of the old board

THE LANCET, Jan. 26th, 1901, p. 290.

Page 2: NEW YORK

519

and those more recently appointed by Governor Roosevelthad made harmony of action impossible and it was not untilthe beginning of the year 1900 that the latter were able toundertake and enforce the measures for improvement. Fora number of years tuberculosis has been an increasing anddangerous feature among our prisoners. Many have it uponarrival in a more or less advanced stage ; others develop itunder the trying conditions of prison life and associationwith those already affected. The management furtherbecame convinced, by careful scrutiny extending over manymonths, that prisoners healthy on arrival became affected.There was marked absence in the medical department of ourpredecessors of full and detailed records both as to cases ofordinary disease and of insanity." Under the head" dis-cipline" the report says : " Since the statement in the lastannual report that flogging had been abandoned at Elmirasome sincere friends of the reformatory have expressed thefear that its discipline would deteriorate. The board has notshared that fear." The maintenance of the educationalsystem by the present board has been seriously questioned bythose who profess to see in the withdrawal of Mr. Brockwaythe first step towards the destruction of the fabric which hehas laboriously created. The board finds in this system muchto admire and uphold, something to criticise and modify, andsomething to condemn. The gross number of inmates whohave been on the books during the past 12 months is 2050, ofwhom 666 were received during that period and 774 weredismissed, producing a daily average of 1365. The efficientcontrol of so large a reformatory is an undertaking whichwill tax the brains and energies of the most active andintelligent superintendent and staff. Iti remains to be seen

. how the new methods will work. The result will be amatter of much interest to philanthropists everywhere.

Dental Surgeons in the United States Army.The new Army Bill before Congress has the following pro-

vision : The Surgeon-General of the Army, with the approvalof the Secretary of War is authorised to employ dentalsurgeons, to serve the officers and enlisted men of the

regular and volunteer army, in the proportion of not

exceeding one for every 1000 of said army and not exceeding30 in all. The said dental surgeons shall be employed as con-tract dental surgeons under the terms and conditions appli-cable to army contract surgeons, and shall be graduates ofstandard medical or dental colleges, trained in the variousbranches of dentistry, and of good moral and professionalcharacter, and shall pass a satisfactory professional examina-tion. It is also provided that three of the number of dentalsurgeons to be employed shall be first appointed by the

surgeon-general, with the approval of the Secretary of War,with reference to their fitness for assignment under thedirection of the-surgeon-general, to the special service ofconducting the examinations and supervising the operationsof the others. and for such special service an extra com-pensation of$60 per month will be allowed; also, further,that dental college graduates now employed in the hospitalcorps, who have been detailed for a period of not less than12 months to render dental service to the army and whoare shown by the reports of their superior officers to haverendered such service satisfactorily, m-ty be appointed con-tract dental surgeons without examination.

Vaccination in Alaska.The Yukon Council, the legislative body of the region,

has passed an ordinance requiring all persons in Yukon

Territory, extending from White Horse to Forty Mile, tobe vaccinated as soon as the vaccine arrives. This orderaffects from 10,000 to 15,000 persons. The Council hasappointed the six Dawson physicians to make a house-to-house visitation throughout Dawson and along all the ’,Klondyke creeks and to vaccinate all persons who bave notbeen vaccinated within the last seven years. The Govern-ment bears all cost of vaccination under this compulsoryorder and the operators are paid$30 a day for their services.A mounted policeman will accompany each physician to seethat his mission is not abused. Anyone refusing to submitto vaccination will be liable to a fine of $250 or three monthsin jail, and anyone not reporting a case of rash or anythinglooking like small-pox will be subject to a much heavierpenalty.Notification of Tuberculosis.

Dr. H. M. Biggs, of the Board of Health of New YorkCity, in a recent address referred to certain English writerswho had argued against the notification of tuberculosis, amongwhom was the late Sir Richard Thorne. To Dr. Biggs it

seemed incomprehensible that a tuberculous person shouldbe permitted to live in a crowded workroom where he wouldbe a menace to all about him. Tuberculosis, while it is ahighly infectious disease, in his opinion should be put in aclass by itself. As to the means of limiting its spread, thebest plan is compulsory notification and registration. TheNew York Board of Health has not classed it as a " con-

tagious disease" but as a "communicable" disease. When areport comes into that department notices are at once sentout to the physician and to the patient giving proper instruc-tions as to preventive measures. Another important thingis that it is not necessary for the general public to be awarethat a case of tuberculosis has been reported to the Board ofHealth; the records are simply for the use of the depart-ment. It was from fear of publicity that a strong protestwas made against compulsory registration in New York. Atthis time in New York, where there is compulsory registra-tion, about 10 000 cases are reported annually, excludingduplicates. It has been found that a man suffering fromthe disease goes from institution to institution, thus beingreported as many as 15 or 20 times. City hospitals foradvanced cases and country hospitals for incipient cases

seem to Dr. Biggs to be the ideal plan.Jan. 18 the.

________________

AUSTRALIA.(FROM OUR OWN CORRESPONDENT.)

The New Medical Act, New South Wales.THE first prosecution under the new Medical Practitioners

Amendment Act took place at the Central. Court. Sydney, onDec. 28th, 1900, when Charles Saunders was charged that,"not being a legally qualified medical practitioner withinthe meaning of the Medical Practitioners Act, 1898, -orentitled to be registered as a legally qualified medical prac-titioner within the meaning of the Medical PractitionersAmendment Act, 1900, he did on Dec. 12th use the title’ Doctor,’ implying that he was a legally qualified medicalpractitioner." The proceedings were taken by the police andconducted by the Crown law officers. Evidence was given thatsuspended from the balcony of defendant’s residence in Pitt-street, Sydney, was a lamp with " Dr. Saunders" printed enit, and on the window was printed, " Advice and medicinefree." The defendant was not registered and he admitted thathe intended the letters " Dr." to mean " doctor," though hewas merely a chemist. He was fined E50 and costs with thealternative of a month’s imprisonment.-The Council of theNew South Wales Branch of the British Medical Associationhas passed the following resolution with reference to Mr.

Meagher, M.P., who took charge of the Medical Act in the

Legislative Assembly :-The council desires to convey to you its high appreciation of yourendeavour to improve the legislation governing the relations betweenthe medical profession and the public.

Election of Dr. James Graham aslvayor of Sydney.On Dec. 13th, 1900, was held the first meeting of the new

council of the city of Sydney and one of its first acts wasto elect Dr. James Graham as mayor. The Sydney CityCouncil has of late come in for very searching criticism forits lax conduct, especially of the financial and sanitaryaffairs of the city. A party of reform was instituted whichtook active measures when the plague broke out, a vigilancecommittee being appointed to inquire into sanitary defects.

Dr. Graham took a very leading part in this reform move-ment and was chairman of the vigilance committee. Inthis capacity he gave a great deal of time and labour to thework and roused the civic authorities out of their lethargy.The value of ’his services to the community in this respectcan hardly be over-estimated and it is gratitying to find thatthey have been rewarded. The new mayor prcmises to do hisutmost for the reorganisation of the health departmentof the city. The medical officer of health of Sydney will infuture be required to give his whole time to the duties of hisoffice with a reorganised and enlarged staff of competentinspectors. The new mayor will also endeavour to conductthe business of the council on more orderly lines and to havethe exact financial position of the city made clear. The pastcareer of Dr. Graham both in the profession and in publiclife is a warrant that he will be successful in carrying out theproposed and necessary reforms. He is a native of Edinburghand is 44 years of age. He graduated as M.A. and M.D. at


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