801

(Continued from previous page.)Dr. G. Blacker. XVII. Measles, by Dr. Foord Caiger. XVIII.and XIX. Heart Failure, Preventive Treatment, Therapeutics,by Dr. J. Parkinson. XX. Gonococcal Epididymitis and itsBearing on Sterility, by Mr. Kenneth M. Walker. XXI.Ante-partum Haemorrhage, by Dr. T. Watts Eden. XXII.Ringworm, by Dr. A Whitfield. XXIII. Cystitis, by Mr.J. B. Macalpine. XXIV. Hsemorrhoids, b Mr. R. M. Rowe.XXV. Puerperal Sepsis, by Lady Barrett. XXVI. CyclicVomiting, by Dr. G. F. Still. XXVII. Asthma, by Dr. E. P.Poulton. XXVIII. Traumatic Rupture of the Urethra, byMr. G. Grey Turner. XXIX. Habitual Constipation, byDr. Arthur F. Hurst. XXX. Hypertrophied Prostate, byProf. Charles A. Pannett. XXXI. Infantile Eczema, byDr. H. MacCormac. XXXII. Exophthalmic Goitre andOther Forms of Hyperthyroidism, by Prof. G. R. Murray.XXXIII. Syphilis in the Woman of Child-Bearing Age, byDr. Margaret Rorke. XXXIV. Anaesthetic Sickness, by Dr.J. Blomfield. XXXV. Enureais, by Dr. H. Thursfield.XXXVI. Menorrhagia in Young Women without GrossLesion, by Dr. J. S. Fairbairn. XXXVII. Chronic Arthritis,by Dr. W. H. Wynn. XXXVIII. Glycosuria in Pregnancy,by Dr. G. Graham.

Special Articles.IRELAND.

(FROM OUR OWN CORRESPONDENT.)

A Ministry of Health.THE question of the establishment of a Ministry of

Health in the Free State has lately attracted somepublic attention. On Sept. 19th the Council of the IrishNurses’ and Midwives’ Union at its annual congressunanimously passed a resolution authorising itsexecutive to take whatever steps lay in its power toorganise a united demand by nursing organisations,and other bodies interested in health, that a Ministryof Health should be established. The following day inDail Earann, Sir James Craig, in a debate dealing withthe appointment of ministers, regretted that nothinghad been said about the establishment of a Ministry forPublic Health. He was not one to urge the multipli-cation of ministries, but surely the health of the peoplewas of more importance than fisheries. The healthof the country was in a very serious position. If aspecial ministry could not be set up he suggested thesetting up within the Local Government Departmentof a department of public health, with a secretary orsome other person responsible in the Dail. He regrettedthat Mr. Ernest Blythe was giving up the Ministry ofLocal Government. Mr. Blythe, in reply, said thatthere could be no question of having a department forlocal government and a separate department forpublic health at the same time. The Local GovernmentDepartment was almost entirely concerned withmatters of public health. It was really a matter ofchoosing a name, for it was intended to give theLocal Government Department the real substance of aMinistry of Public Health, with one or two functionsadded to it for the sake of convenience. The positionis by no means satisfactory. If the Department ofLocal Government is to be in truth a Ministry ofHealth, it should be so called, that both the Ministerand his permanent staff might know where their real Iduties lie. At the present time the Ministry deals withmany matters not remotely connected with health,such as the maintenance of roads and the control offairs and markets. On the other hand, some importantmatters of health, such as the inspection of factoriesand the department of vital statistics, are not underits control.

__ __ __ _ _

PARIS.

(FROM OUR OWN CORRESPONDENTS.)

Cancer Congress at Strasbourg.THE summer vacation, now ending, was at least

partially filled for those engaged in scientific medicineby a series of important Congresses, of which theCancer Congress held at Strasbourg at the end of July

was among the more important. The Congress waspresided over by Prof. Pierre Delbet, was opened byMr. Paul Strauss, Minister of Hygiene, and includedamong its members many distinguished foreigners.Of the three main subjects dealt with at the Congress,the first was the experimental production of cancer.Prof. J. Fibiger (Copenhagen) discussed the Spiroptera-cancer discovered by him in 1907. This growthis produced by a parasite living in the upper part ofthe digestive tract of rats and mice, with the cockroachas intermediate host, the insect being infected byingestion of the faeces of these animals. Fibigerbelieves that the cancrogenous action is due to thesecretion of the parasites themselves in a soil predis-posed to cancer. The nature of the predispositiondepends on factors affecting the entire organismtogether with the cells at whose expense the cancergrows. Prof. K. Itchikawa (Sapporo, Japan) gave afully documented resume of his researches into theexperimental production of cancer with tar. Thesimple chemical and physical irritation of tar appliedrepeatedly and continuously to the internal aspect ofa rabbit’s ear produces cancer of the epithelial cellsin the same way as the action of the parasites describedby Fibiger. Dr. J. A. Murray (London) read a

remarkable paper on Primary and Secondary Resist-ance to the Production of Cancer.l Dr. A. Leitch(London) contributed a communication on the speci-ficity of various cancer-producing agents, interpretingcellular cancerisation as a continuous and prolongedmanifestation of the normal action of tissue repair.The second subject of discussion, the general reactionof the organism in connexion with cancer, was dealtwith by Dr. Rubens-Duval (Paris) and Dr. W. H.Woglom (New York). The third subject, the treat-ment by radium and X rays of spino-cellular epithe-liomas of the skin and mouth, was discussed by Profs.A. Bayet (Brussels) and Cl. Regaud (Paris).

Other Vacation Congresses.The conference of French alienists and neurologists

held at Besancon in August was remarkable for an attackby Dr. Hesnard on Freud’s theory. Hesnard main-tained that the cause of nervous and mental diseaseswas only related to sex in exceptional instances, beingfar more commonly connected with poverty, businessfailure, thwarted ambition, or physical infirmity. Healso criticised psycho-analysis as a means of diagnosis,holding that the method is uncertain, and may inducehysterical symptoms or further derange patients.already unbalanced. From a therapeutic standpoint,he considered that the numerous cases whose aetiologyincluded an organic factor were incurable by thismethod, and that when psycho-analysis gave resultsthese were no better than those obtained by any otherpsycho-therapeutic method. Dr. Courban attributedthe success of psycho-analysis in Anglo-Saxon countriesto the mystery with which sexual matters are sur-rounded by Protestant morality.The Fourth International Congress of Neurology,

held at the Salpetriere, Paris, in the summer vacation,was attended by many foreign delegates, among themSir James Purves-Stewart and Dr. G. Riddoch.The following Congresses will shortly be held in

Paris at the Faculty of Medicine : Twenty-thirdCongress of Urology, beginning on Oct. 10th,President, Prof. Andre; Thirty-second Congress ofSurgery, Oct. 8th to 13th ; Congress of Orthopaedics,Oct. 12th ; Annual Congress of Hygiene, Oct. 22ndto 26th.

A Home for Doctors in France.A party of members of the French medical profession

recently assembled at Valenton (Seine-et-Oise) in theChateau de Charmilles, which has been establishedas a home or retreat for aged and infirm medical men,and it has been christened " La Maison du Medicin."The home owes its origin to an association which wasfounded in 1908 with headquarters in No. 9, RueAstorg, Paris, whose object was to establish and controlone or more homes where aged, infirm, sick, or needy

1 Published in THE LANCET, July 28th, p. 159.

802

medical men might be cared for. The Associationdoes not aim at making financial profit ; the home ismaintained by donations and by subscriptions frommembers of the Doctors Home Association. Residentsin the home contribute towards the expenses of theirkeep, but before the war the income from this sourcewas never more than Fr.12,000 (2480) per annum.From the start all the best known medical men ofFrance have given their support to the work of theAssociation. The principles of making a charge,however small, for board and lodging helps to preservea sense of independence, yet while the principle is oneof " paying guests," no really destitute case is everturned away. In recent years the grounds of the homehave been extended and they now cover over 15 acres.Many of the boarders spend their time working inthe gardens or the orchards, and during the wintertheatrical performances and concerts are held. Englishmedical men are invited to visit the home at Valenton.

VIENNA.

(FROM OUR OWN CORRESPONDENT.)

Vienna Medical Faculty : Weekly Discussions.ACTING on a suggestion thrown out by a few members

of the Vienna University, the medical faculty organisedlast year a series of discussions with a view to attractingthe attention of the profession to the latest achieve-ments in the art of medicine. By providing post-graduate opportunities for the interchange of ideas andopinions this scheme has, within one year, become animportant asset to the entire medical profession ofVienna. The discussions are held on Monday evenings.Admission is free, no membership is required, andany medical man is welcome. Any practitioner maysuggest in writing to the secretary of the faculty asubject on which he desires- information. Thequestions submitted are handed over to leadingspecialists, each of whom volunteers to deliver alecture on a particular subject. Generally a week isallowed for preparation. At the meetings anyonemay put questions to the lecturers. The discussionslast two hours and are well attended, the averagenumber present being about 50. An interesting featureis the eagerness with which the older members of theprofession take an active part in the proceedings ofthe " Seminar-abend," as these evening meetings arecalled. It speaks well for the institution that it hasalready served as a model for similar developments invarious university towns of Germany. That the earnestspirit underlying such work is already bearing fruitis shown in the rising scientific standard and publicreputation of the profession.

A School of Nursing for Medical Men.The Vienna University Clinic for Children inaugurated

a few months ago a totally new departure in the medicalcurriculum-a school of nursing for doctors. It is awell-known fact that very often the practitioner has toorder this or that measure in the course of the manage-ment of a serious case of illness in a child, but themother or even the nurse does not always know howto carry out his instructions in the most effective andsatisfactory way. Often, too, doctor and mother areat cross purposes, through sheer ignorance on thedoctor’s part of domestic exigencies. To such con-siderations we owe the opening of the above-mentionedschool in the Pirquet Clinic. The plan of work is asfollows : Four physicians of the clinic-housephysicians of the hospital-are entrusted with theentire care of the ward. They have to do all the workusually resting on the shoulders of the nurses or" sisters," in managing a sick child. This task is bestillustrated by the following programme of the duties.At 5.45 A.M. the doctors take over the charge of theward. From that time till 7.15 A.M. they must wash,bathe, and tidy the children (or babies, as the casemay be). The next 30 minutes the breakfast is servedby them to the patients. Up till 9 A.M. the preparation

of the patients for the morning round of the professor,marking the temperature charts, giving medicine orother treatment prescribed, superintending feedingthe sucklings. 9-10 A.M., morning round. 10 A.M. to12 noon, examination of newcomers, dismissal of oldpatients, temperature taking, feeding of babies.12 noon to 1 P.M., serving out of dinner (or lunch),feeding of the older children. 1-3 P.M., nursing workon the new patients, feeding of babies. 3-4 P.M.,preparation for the evening round, tea for the olderchildren. 4-5 P.M., evening round. 5-6.30 P.M.,temperature taking, feeding of the babies, supper forthe older patients. 6.30-7.30 P.M., filling in of thecharts and records of each patient. At 7.30 P.M., theday service terminates. The night duties are at presentdischarged by a nurse, but will in future also fall tothe lot of the physicians. Physicians attached to thisward must serve a term of two months. It is hopedthat in the future all house physicians of the

Pirquet Clinic will be obliged to undergo training inthe school. Not a few of the duties hitherto regardedas purely " feminine," such as shaking the bed-quilts,spreading the table-cloths, or the administration of anenema, are rather embarrassing at first, but the youngdoctor soon gets used to it. In order to ensure varietyof experience in nursing duties, the children are leftin this school " for doctors only " for a few days. All

,

new patients must pass through this ward before theyare distributed in the other wards of the clinic, so thatin these few days the doctor has the opportunity ofstudying a larger number of differing types of patientthan was formerly possible. Many useful " tips " infeeding, holding, and calming children are learned andinsight into the little patients’ minds is gained-apoint of paramount importance for the future task ofthe practitioner. The ward personnel includes twowomen, a maid for purely household work, and a nursewhose duty it is to initiate the " essentially masculine

"

students into what has too long been consideredwoman’s province. The idea of this " school ofnursing " has been received with great approval bythe profession generally, and it is contemplated thatthe new curriculum for the medical student which isnow under consideration and which will necessitatea year of practical work before giving the right topractise, might also include a course in this school.

BUDAPEST.

(FROM OUR OWN CORRESPONDENT.)

Numbers of the 111 medical Profession in Hungary.ACCORDING to a report issued by the Hungarian

Medical Association there are at present 4489 physi-cians practising in Hungary. Of these, 2012 practisein Budapest. As the population of the country issomething over 8,000,000, the ratio of physicians topopulation is too high. The number of physicians isdecreasing on an average by 225 a year ; the numberof medical students in the country in 1922-23 was6751. The Medical Association is now advisingparents not to encourage their children to enter thisovercrowded profession. The distribution of doctorsis very uneven ; in towns the ratio of doctors topopulation is 1 in 350-500, but numerous small pro-vincial towns have no resident medical men at all.

The Scientific and Commonwealth Universities.At the opening of the present session of the Scientific

University of Budapest the number of registeredstudents was greatly reduced as compared with thatof previous years, particularly in the Faculties ofMedicine and Philosophy. Many students are pre-vented from taking up the study of medicine by theexpense involved. The Minister of Public Instructionpermitted the registration of no more than 500students in the Faculty of Law, but the

" Common-wealth " University admitted 1400 students withoutobjection from the Minister. The Scientific Univer-sity does not even now recognise the Faculties of the