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to hospital with a comminuted fracture of the malar boneand a very peculiar fracture of the superior maxilla con-sisting in a complete separation of the whole of the alveolarprocess. For the repair of the damage M. Delair, who is incharge of all matters involving the manufacture of protheticappliances for M. Sebileau’s patients, contrived a splintconsisting of an aluminium plate which fitted inside themouth. The plate was held in position outwardly by a three-branched arrangement taking its bearing from the foreheadand the occiput. The result was altogether excellent. Theprocess united firmly and the restoration of the palatine archwas so perfect that no one examining the patient wouldform any idea of the extent of the injury which he hadsustained.

Syphilis and General Paralysis.At two successive meetings of the Academy of Medicine,

on Feb. 22nd and 28th, Professor Fournier read an importantpaper upon the relations between syphilis and generalparalysis and treatment with a view to prevent the onsetof the latter. According to Professor Fournier the greatmajority of cases of general paralysis occur in old cases ofsyphilis. Other observers, however, consider that syphilis isnot the only cause of general paralysis and in view of thefact that cases of syphilis are extremely common they con-sider that general paralysis is not so common as it would bewere it always due to syphilis. Anyway it-is an indisputablefact that in nearly every patient affected with generalparalysis there is a history of syphilis and, moreover, of

syphilis which has been treated improperly. ProfessorFournier gave some striking statistics. General paralysisis unknown in the first two or three years of syphilis, it iscommon between the sixth and the twelfth year, and mostcommon of all about the tenth year. The predisposingcause is syphilis which has not been treated at all or morecommonly that which has only been treated for two or threemonths-i.e., until the disappearance of the secondarysymptoms. General paralysis most frequently occurs in

patients who have had a slight attack of syphilis and whotherefore have only been treated for a short time. ProfessorFournier considered that the treatment of syphilis was farfrom being what it should be. The disease should be treated

according to a definite system. For the first two years thetreatment should be intensive, then the patient should havea year’s rest, then there should be another year’s treatment,then two years’ rest, and finally another year’s treatment. Ifany one organ appears particularly liable to the effects ofthe poison of syphilis special attention should be paid to it.No treatment is of any avail for general paralysis when onceit is declared and the only thing to do is to prevent thesyphilitic poison from bringing about that terrible affection.On March 7th the Academy resumed the discussion andM. Raymond who spoke first said that for his part he agreedwith Professor Fournier as to the enormous frequency ofsyphilis in cases of general paralysis. Heredity, however,played a large part by giving rise to degenerationswhich prepared the soil, so to speak, for syphilis to

bring about general paralysis. This latter complaint wascommon in emotional persons in whom reflex congestiveconditions were rapidly and easily produced. Generalparalysis had been observed even in children. M.Joffroy, on the other hand, disagreed with ProfessorFournier. In his opinion there was no such thingas syphilitic general paralysis. In many countries, forinstance, in Bosnia, Tunisia, Ethiopia, India, and Japan,the reports of medical men showed that syphilis attacked anenormous proportion of the population, as much as 80 percent. in Abyssinia, but general paralysis was unknown.General paralysis, said M. Joffroy, can appear in patientswho have undergone a carefully carried out mercurial courseand, moreover, he had seen cases in which the mercurialtreatment only accelerated the onward march of the

paralysis.paralysis. A New Sanitary 6N:.?M.

The Minister of the Interior has just nominated a newcommittee called, " Comite Consultatif d’Hygiene Penitenti-aire," to which will be referred all questions of prisonhygiene, more particularly those concerning "light labour

"

(travauae a1bae infirmeries), and prophylactic or hygienicmeasures to be taken. The committee, which consists of 17members, includes one inspector-general of the SanitaryService, four medical men who have already served on com-mittees nominated by the Minister of the Interior, and twomedical men in the prison service.

ERRATUM.—In the fifth paragraph of the letter from our

Paris correspondent which appeared in THE LANCET ofMarch llth occurs the phrase, "a solution of the venomis freed from all germs, being both microbicidal and anti-venomous." After the word "germs," the words "theaction of radium " should be inserted.March 14th.

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NOTES FROM INDIA.(FROM OUR SPECIAL CORRESPONDENT.)

The Lioenoe Fees of Medical Practitioners in Caloqttta.MEDICAL practitioners in Calcutta are the victims of a

peculiar form of local taxation. By the Municipal Actthey are divided into two classes : (1) practising surgeon,physician, and dentist, who pay 50 rupees as a licence feeannually; and (2) practising licentiate of medicine] andpractising apothecary who pay 25 rupees only. It has hither-to been the practice for M.B.’s of the University of Calcuttato pay at the lower rate but the question of their liabilityhaving been raised it has been decided that they belong tothe first class and that the lower rate is for persons who holda licence from any body or university to entitle him topractise medicine. As there is no registration and anybodycan hold a presumed licence to practise from any self-constituted or other worthless college the legal decisioncan only be considered of value for the purposes of taxation.That the licentiates of the University should be classed withpractitioners who only hold bogus or other unrecogniseddegrees is a distinct reflection upon their training ; on theother hand the difference between M.B. and L.M.S. of theUniversity is hardly sufficient to warrant the former beingovertaxed for the whole of his practising life.

Accelepated Promotion in the -Indian Medioal Service.It is notified that the promotion of an officer of the Indian

Medical Service to the rank of major may be accelerated ifhe produces while in the rank of captain satisfactoryevidence of progress in any branch of knowledge which is

likely to increase his efficiency, such as obtaining a higherdegree, or a special qualification of repute, or by furnishingproof of having pursued with diligence and advantageserious study of an approved subject. The period ofacceleration that may be granted is fixed at six months

provisionally.The New Water Supply for Rangoon.

Rangoon may congratulate itself on having obtained apure and abundant supply of water. The new Hlawgawaterworks consists of a reservoir about seven miles longand from one and a quarter to two miles wide. It isestimated to provide for a population of 650,000, at an

average consumption of 25 gallons per head daily. At the

present time the consumption is about 40 gallons per headand at this rate the supply is sufficient for 400,000 persons.The new reservoir can be even extended much further at a

comparatively trifling cost so that there is no likelihood ofcontinuance of the scares of scarcity of water to whichRangoon has been periodically subjected in the past.The Plague Epidemic: its 31ortality and Continued Extension.The magnitude of the plague mortality which has been

recorded for some weeks past has so come to be an annualoccurrence that it seems almost as if familiarity with theterrible death roll had bred contempt for it. For the weekending Feb. llth there were recorded throughout India33,660 deaths, as against 36,117 for the week preceding. Itis curious that a small decline has been noticed in Bengal,

; United Provinces, the Punjab, and some other places, but bycomparing the course of the disease with that followed last

, year it is too much to hope that it is more than a temporaryset back. The outbreak in Bombay city is growing rapidly,511 deaths being recorded, as against 395 for the preceding

, seven days. In Calcutta also the recrudescence is un-

mistakeable. Other figures of importance are as follows :.

United Provinces 14,438, as against 15,367 ; the Punjab 8419, as against 9472; Bengal 4926, as against 5150;Bombay districts 2755, as against 3161 ; Rajputana 799,as against 603 ; Hyderabad State 550, as against 526;Central Provinces 438, as against 467 ; Mysore State 301,as against 346 ; Burmah 9, as against 1 ; and Calcutta 106,

’

as against 84. The outbreak at Rangoon is unfortunately) increasing. It has been decided to do away with the plague

segregation camp and to let the cases be treated either at the: contagious diseases hospital or in private houses. This plan

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has been adopted to prevent a scare. This is following theexperience obtained elsewhere-viz., that it is the regulationswhich the ignorant people become alarmed at and not reallythe disease. In fact, the apathy shown when the people arebeing decimated by cholera, plague, or small-pox is extra-ordinary, while the mildest regulation which causes anyrestriction is met by active as well as by passive resistance.It is perhaps too early to describe the outbreak in Madras asrecent because the city is by no means safe from a furtherdevelopment. The prompt measures taken are deserving ofthe highest praise because they were not only energetic andstringent but liberal. There have been from time to timesome 60 imported cases of plague in Madras but they havebeen ferreted out and appropriately dealt with and thedisease has not spread. In this instance, however, a smalloutbreak had actually become established before it wasdiscovered. The patients were immediately removed andthe whole village, consisting of 118 huts, was burnt down.The Mauritius emigration depot close by was probably thesource of the mischief, as dead rats showing plague bacilliwere discovered close to it. This depot receives coolies fromall parts of the province. Every rat burrow was dug up andevery rat found was killed, while a reward of 6 pies (=-2Ld.)per head for every rodent brought in daily bags. The

displaced villagers were liberally provided for and the oldsite has been abandoned. The success of Madras is probablydue to the fact that in the neighbourhood of this emigrationdepot the population was not thick and there were not manyrats, but the thoroughness of the operations was equallynecessary to stamp out the disease completely. Had theoutbreak occurred in the city there is every likelihood that itwould have spread.Feb. 24th.

AUSTRALIA.

(FROM OUR OWN CORRESPONDENT.)

The Bubonic Plague.BUBONIC plague continues in New South Wales and

Queensland. At Ulmarra, near Grafton, six cases have

proved fatal. Exception has been taken by the Sydneypress to the action of the Board of Health in removingplague patients from Ulmarra to the Grafton Hospital.Grafton is a sea port and the usual shipping restrictions arebeing enforced, ships not being allowed to come to thewharves and no produce is allowed to go from infecteddistricts. Several cases have occurred in Brisbane and it isbelieved that the infection of the Ulmarra cases can be tracedto Brisbane. In Victoria the Board of Health has revisedthe regulations for the berthing of ships and urged theimportance of continued vigorous destruction of rats.

Infectious Disease in Vicotoria.The returns presented to the Board of Health of Victoria

for the fortnight ending Jan. 14th showed that the numberof typhoid fever cases reported was 98, four of which hadresulted fatally. In the corresponding period of 1904 therehad been eight deaths out of 133 cases. For the metro-

politan area there had been 28 cases, resulting in two deaths,as against 43 cases and three deaths in the same fortnight oflast year. Diphtheria cases had been recorded as follows forthe fortnight ending Jan. 12th :-For the whole State : 1904,45 cases, 4 deaths; 1905, 52 cases, 1 death; for themetropolitan area : 1904, 15 cases, 2 deaths ; 1905, 22 cases,1 death. For the fortnight ending Jan. 14th the comparisonin regard to scarlet fever cases reported in 1904 and 1905respectively was :-For the whole State : 1904, 36 cases,1 death ; 1905, 18 cases, 1 death ; for the metropolitan area :1904, 29 cases, 1 death ; 1905, 7 cases, no deaths.

Vital Statistics of New South Wales.The Government statistician of New South Wales has

published the vital statistics of that State for the year 1904.He says :There has been a substantial increase in the number of marriages and

births and a substantial decrease in the number of deaths. During theyear the births numbered 38,697, which is the largest record since 1895,the excess over the previous year being 2731. The increase in thenumber of births is very perceptible in the last three-quarters of the

year, as will he seen from the following statement of the two years1903 and 1904 : -

Births.Quarter ending- 1903. 1904.

March 31st ..................... 8827 ...... 8,876June 30th ........, ", ,........ 9009 ...... 9,635Sept. 30th... ... ... ... ... ... 9001 ...... 10,209Dec.31st ..................... 9129 ...... 9,977

The birth-rate represents an average of 26’77 per 1000 of populationcompared with 25’28 for the year 1903. Although the increase comparedwith the previous year has been considerable t,he rate is still very farbelow that of ten ypars ago-namely, 31’75 in 1894 and 3844 in 1884.

’rhe number of deaths in New South Wales during the past year was15,410, compared with 16,497 in the previous year. As stated, per 1000of the population, the deaths in 1904 were 10’66, which is considerablybelow 11’87, the average for the last ten years. Every quarter of theyear, with the exception of the September quarter, is more favourablefor 1904 than for the previous year, as will be seen from the following ’

statement:-Deaths.

Quarter ending- 1903. 1904.March 31st ... ... ... ... .... ... 4539 ...... 3884June 30th ..................... 4040 ...... 3917Sept.30th ..................... 3821 ...... 3935Dec. 31st........................ 4097 ...... 3674

The number of marriages celebrated in the State during the year1904 was 10.429, which is 670 in excess of the previous year and a largernumber than was registered in any previous period, the years 1901 and1902 alone excepted. The number for 1904 give a ratio of 7’21 marriagesor 14’42 persons married per 1000 of the population, which comparesfavourably with the 6’95 and 13’9U which are the averages of thepreceding ten years.

Preservatives in Milk.Prosecutions of milk-vendors for selling milk containing

preservatives continue in all the States. At the Glebe courton Jan. 18th a milk distributer doing a very large businesswas heavily fined for selling milk which contained threegrains of formalin to the gallon and added water to 8-2L percent. In two other cases of a similar character fines wereinflicted. At the Newtown court several almost identicalcases were dealt with.

Hospital A lratrs.An interesting account of the work of all the Sydney

hospitals for the year 1904 has just been published. At thefive metropolitan hospitals 72,160 patients received treatmentdistributed as follows :-

Sydney, 32,188; Royal Prince Alfred Hospital, 15,846; St. Vincent’sHospital, 12,835; Children’s Hospital, 7561; Coast Hospital, 3730. Theywere attended to by a staff of 117 doctors, 291 nurses, and 188 otherattendants and servants, irrespective of the clerical staffs. The totalcost of maintenance of the five hospitals for the year was £56,411. Ofthis amount the Government contributed about two-thirds, theremainder being secured from public subscriptions, fees from patients,and interest on bequests. Of the total number of persons dealt with,14,455 were admitted to the wards as indoor patients. The remaindersimply called at the institutions on an average of about four times tohave their ailments attended to or wounds dressed.The average stay of each indoor patient was 26 days and they were

divided over the institutions as follows: Sydney Hospital, 4549 ; CoastHospital, 3730 ; Prince Alfred Hospital, 3516; St. Vincent’s Hospital,1870; and Children’s Hospital, 790. Out of the 14,455 cases treated,9196 were permanently cured ; 2700 were relieved of their suffering; in559 cases the doctors could afford no relief; while 1005 of the patientsdied. About a third of the total number of deaths occurred within24 hours of the admission to the wards. At the close of the year therewere 984 persons still in the institutions. With the aid of an anaes-thetic 6891 indoor patients underwent one or more operations as

follows: in Sydney Hospital, 2744; in Royal Prince Alfred Hospital,2220; St. Vincent’s Hospital, 1181; Coast Hospital, 445; Children’sHospital, 301.-The annual meeting of the Sydney Hospital was held onFeb. lst, the State Governor presiding. The report washighly satisfactory and the finances appear to be sound, theincome sufficing to meet the expenditure. It was statedthat-

Perhaps the highest tribute that could be paid to the members ofthe honorary medical staff is to record the fact that the total numberof official visits paid in the 12 months under review is 5797.The year’s operations total 2856, which is an increase of 228 on those

performed in 1903. The results all through show that the higheststandard of asepsis is maintained and will bear comparison with resultsobtained in the hospitals anywhere.-The Government of Victoria still declines to allow theKronheimer wing at the Austin Hospital to be opened for thereception of advanced cases of consumption. Instead itproposes to erect a sanatorium at Broadmeadows on an areaof 300 acres of Crown land, 500 feet above sea-level andthree and a half miles from the Somerton railway station.The objections to this proposal are the want of a properwater-supply and the distance of the site (about 13 miles)from the metropolis. The Premier also proposes to establishan epileptic colony on the same site.-Trouble has occurredat the Ararat Hospital (Victoria) owing to a proposal of the