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several cases were cited in which various manifestations, isuch as glycosuria, severe headache, with high-tension pulse, 1and even convulsions, were present, in addition to the usual 1

symptoms, and where it was likely that these manifestations (

were due rather to the product of disturbed metabolism than tto any initial toxin. The treatment in this acute mucosa-

hepatic class was mercury in a purgative dose, a saline, a t

farinaceous mild diet, and salicylate of sodium and potassium; <

empirically, this last drug (salicylic acid) when combined 1with potash was found to be of immense service; whether 1the scientific fact that it caused an increased output of auric acid was explanatory or not it was hard to say. Gout 1was probably a disease of the chronic mucosa-hepatic type occurring in a person with a special diathesis, mostly 1

inherited, and defective eliminatory powers. Of the largeclass of disease, such as "flatulence," "acidity," I I bilious-ness," and migraine," they were not gout, but allied to gout; for these he ventured to coin the name" para-podagrous."Of the primary disorders of metabolism might be cited the" composite type of diabetes mellitus, where the dextrosemolecule seemed to escape from the huge proteid moleculeof the tissues ; also obesity and that curious class in whichnervous influence and strong emotion more particularly werepresent with more or less gastro-intestinal trouble, phosphat-uria, azoturia, baruria, oxaluria, and, as has been latelypointed out, chiefly by French clinicians, the cases of renalinadequacy for chloride of sodium and its connexion withdropsy and the excessive amount of the salt passed incirrhotic kidney. Finally, the speaker made an appeal forscientific work to become more clinical and clinical workmore scientific. On the motion of Dr. J. Walton Browne,seconded by Professor J. A. Lindsay, a hearty vote of thankswas accorded to the President

The Royal University of Ireland.At a meeting of the council of the Royal University

Graduates’ Association held in Belfast on Nov. 7th motionsbearing upon the recent Crown appointments to the senatewere unanimously adopted, condemning in language ofmarked disapproval the action of the Government in thematter.

l’he Belfast Wor7tho?ise Sanatorium.In reference to the sanatorium for consumptives at the

Abbey, Belfast, the board of guardians have decided toadopt a plan the principle of which combines both sleepingand sitting accommodation, the approximate cost beingf.1250 each hut.Nov. 15th.

_________________

PARIS.

(FROM OUR OWN CORRESPONDENT.)

Dr. Variot’s " Goutte de Lait " at Belleville.

IN connexion with’the debated subject of the employmentof different kinds of milk for the artificial feeding of infantsspecial interest attaches to the dispensary bearing the

picturesque name of " Goutte de Lait," which has beencarried on at Belleville by Dr. Variot for the last nine years.It may be here remarked that in France institutions for thebenefit of suckling infants are of three kinds. First, thereare the creches (day nurseries), to which mothers who areat work all day long bring their infants in the morning,taking’ them away at night, and where the infants through- !out the day obtain nourishment either from wet nurses orfrom feeding bottles. Infants may also be brought foradvice as out-patients to the obstetric departments ofmost of the Paris hospitals, and the women who have beendelivered there come once a week, bringing their infants tobe examined by a medical man. The infants, each ofwhom has a special card (fic7te), are weighed and in accord-ance with their weight and general health the mothersare advised as to the proper method of feeding them, bygiving them less milk if too much is taken, and by increasingthe supply if the mother’s milk is insufficient. In the lattercase the mother comes every morning to the hospital forbottles of sterilised milk the number of which is decided bythe medical man and entered on a card. These bottles arefilled by hospital officials in a laboratory where the milk issterilised in a Sohxlet apparatus in graduated bottles

stoppered by means of an indiarubber disc. In the eventof the medical man being satisfied that a woman is quite’unable to suckle her infant even partially artificial feeding

is resorted to and the woman receives every day at the

hospital the necessary number of bottles of milk as orderedby the medical man. The bottles each contain the amountof milk to be given at one time and the woman carriesthem home in a basket. A sum set apart for this

purpose by the Assistance Publique enables the milkto be distributed free of charge and the mothers

every morning bring back the empty bottles which hadbeen given to them full of milk the day before. Onlybroken bottles have to be paid for. The gouttes de lait

"

are institutions of a different nature. The infants broughtthere by their mothers are all bottle-fed and there is no agelimit. The medical man of the establishment examinesthem each week in order to observe their state of healthand to give directions as to feeding them. The requisiteamount of sterilised milk is distributed not free of chargebut at half the ordinary retail value. The dispensaryat Belleville in which Dr. Variot has established his

"goutte de lait" is one of the oldest institutions of itskind and is at the present time very prosperous. The milkwhich he distributes has been heated to 108&deg; C.-i.e., abovethe boiling point of water-is supplied by purveyors inNeuchatel and Normandy, and is sold to the mothers at therate of 30 centimes per litre instead of 60 centimes. Theinstitution is situated at No. 126, Boulevard de Belleville, inone of the most populous working-class quarters of Paris.The premises consist of a wooden house, extremely clean,containing a large, well-ventilated, and well-lightedconsultation room, a laboratory, and a pharmacy; on

the first floor there are some small rooms’ for cases

requiring surgical attention. Dr. Variot, surrounded by hisassistants, gives advice every Friday morning. The systemwhich he follows is scientific and exact. Commerciallysterilised milk for 750 bottle-fed infants is distributed everyday, the quantity amounting to about 150 litres per day,from 4000 to 5000 litres per month, and from 50,000 to 60,000litres per annum. The total quantity of milk distributed atthe Belleville Dispensary now exceeds 400,000 litres in tenyears. The distribution of this milk at half price to theinfants of the poorer classes in Belleville was commenced atthe end of 1892 ; after an interruption of a year the supplyhas continued regularly since 1895. More than 3000 infantsduring the first year of life have been reared on these400,000 litres of milk. The milk is cow’s milk, the nutritivevalue of which has been ascertained, sterilised soon after

milking in rooms kept for the purpose. It is run into half-litre bottles corked before sterilisation ; the corks are kept inposition by iron hooks during the superheating to 108&deg; C. andare paraffined after the sterilisation. The milk is in this wayperfectly sterilised, it is very easily carried to Paris in boxes,and is very convenient for distribution on the large scale tothe working classes. It can be easily kept for eight or tendays without any deterioration even during the heat ofsummer ; only one-half litre bottle in 1000 is spoiled duringthe summer and only one or two in 3000 during thewinter. For the feeding of an infant the contents of eachhalf-litre bottle are subdivided by the use of a graduatedfeeding-bottle and the mothers are strictly charged tomeasure the milk each time that the child takes it. Thebottle is re-corked when milk is withdrawn and the sterilisa-tion is practically maintained until the milk is finished-a period of 12 hours at the most. The effect produced bythe milk is noted regularly once a week at least ; the infantsare weighed without clothing and their weights are entered onseparate cards. If the infant becomes ill he or she is takento the dispensary for advice. Infants of all ages up to one yearare admitted to the dispensary whether fed with the bottlealone or with the bottle and the breast together, or withthe breast alone. A good many of them are in a state ofwasting, their growth being retarded through gastro-enteritiscaused by unwholesome milk and the inexperience of themothers. By the weekly inspections of from 150 to 200infants much precise information may be obtained withrespect to the rearing both of normal children and of thosesuffering from disease, such as tubercle and congenitalsyphilis. After a patiently continued experience of ten

years in this special field of observation Dr. Variot adhere!entirely to his first conclusions which he submitted to theinternational congress of pediatry held in 1900. Hefinds that the nutritive value of milk that has beenheated to 108&deg; C. is as satisfactory as that of milksterilised in a Sohxlet apparatus, or boiled milk, or pas-teurised milk. The infants reared on this milk are notonly those whose condition is normal but those who show

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symptoms of wasting. lb may often be given even tothose in a state of advanced atrophy and suffering fromParrot’s athrepsia. The proportion of infants incapableof assimilating this milk is less than 3 or 4 per cent.of the total number. Infantile scurvy has not beenobserved in any case during ten years and among more than3000 children. Infants who are taken proper care of do notsuffer from rickets ; symptoms of rickets appear if they areoverfed and if they are given preserved food too soon. Itdoes not appear that the slight reduction of the proportionof phosphates and citric acid or the destruction of the

enzymes or living ferments in the highly heated milk is ofsufficient importance to interfere with its value as a

food. All theoretical criticisms directed against sterilisationof milk, and especially against raising it to a hightemperature, are contradicted by the extremely numerousobservations made at the " goutte de lait " in Belleville.

Presumably it is from want of experience that men of thescientific standing of Professor von Behring have questionedthe nutritive value of milk sterilised by heat and havesuggested a method so dangerous as the use of formalin.The objections to the highly heated milk appear to be asfollows. The heating makes it slightly yellow and thebutter tends to collect on the surface after a journey.It often causes prolonged constipation which requires theadministration of laxatives, but this slight interference withthe gastro-intestinal functions is compensated by the effectof the highly-heated milk in preventing summer diarrhoea.Anaemia is also more common among infants taking thismilk than among those taking breast milk. Such is acomprehensive view of the very interesting work carriedon by Dr. Variot. There is no denying that it as

well as "gouttes de lait" in general are discountenancedby the organisations for the benefit of infants on the groundthat they favour bottle-feeding, whereas the proper course is above all things to urge mothers to suckle and the I gouttes de lait " make neglect of this duty too easy. But to thiscriticism Dr. Variot replies that the children brought to himare already weaned and it is then too late to influence themothers. In the maternity hospitals, on the other hand,mothers are fully informed as to the advantages of sucklingtheir infants.Nov. 15th.

_______________

SWITZERLAND.

(FROM OUR OWN CORRESPONDENT.)

Vital Statistics.

THE census results for 1903 have just been published bythe Federal Statistical Office at Berne. The population ofSwitzerland has increased from 3,268,494 in 1899 to 3,391,645in 1903. The number of marriages has been fairly stationary,varying only from 25,128 in 1902 to 25,537 in 1900, and

numbering 25,283 in 1903. The number of births in 1903was 93,824 and that of deaths was 59,626, the correspondingdeath-rate being 17-6 6 per 1000. The death-rates from 1899to 1902 were 17 - 6, 19 - 3, 18 - 0, and 17 - 2 per 1000. About one-fifth of all the deaths were of infants under one year of age(12.506 in 1903).

Inanaeeliecte Operation in Appendicitis.At a meeting of the Medical Society of Ziirich, held on

Oct. 22nd, Dr. Haeberlin gave an account of 14 cases ofacute and four cases of chronic appendicitis which he hadoperated on at his private clinique during the last two years.According to the classification of Dr. 0. von Brigners he hadfour cases of simple epityphlitis, three cases of purulentepityphlitis, and seven cases of diffuse peritonitis. Ofthe latter category he lost three cases-one a baby, aged18 months, and two women, aged 60 and 76 years respec-tiveJy. He made especial reference to the case of a child,aged -en years, where the clinical symptoms and the pyrexiawere inconsiderable, the temperature varying from 99&deg; to100-3&deg; F., and only the pulse-rate, varying from 108 to 120,gave rise to suspicion. Operation on the fourth day revealedgangrene of the appendix. The patient was discharged onthe thirteenth day. The chronic cases, which were mis-leading with regard to diagnosis as they manifested gastricsymptoms, were also instructive. Dr. Haeberlin recom-mended operation as soon as the diagnosis was established,and the experience of other surgeons, such as Riedel and

Sprengel, went to prove that cases of perforation were then

rarely met with. In uncomplicated cases the patient mightalmost be promised a rapid recovery. Patients were moreready to consent to the surgeon’s proposal of an operationduring an attack than after it.

Sanatorium Treatment of Tuberculosis.Dr. Staub, the medical superintendent of the Ziirich

Sanatorium at Wald for tuberculous patients of the poorerclass, has just published his fifth annual report dealing withthe events of the year 1903. 284 patients were admittedand 266 were discharged, of whom 240 were suffering frompulmonary tuberculosis. He gives a resunee of 219 patientswho stayed more than one month at the sanatorium. The

average duration of their stay was 125 days, a slight increaseas compared with the previous year. 41 per cent. were inthe first stage, 23 per cent. were in the second stage,and 36 per cent. were in the third stage. 81 per cent. ofall the patients were discharged in an improved condition.Dr. Staub makes an interesting statement as to definite

results obtained. They compare very favourably with thoseof German sanatoriums situated in the lowlands and supply anadditional proof that the factor of elevation above sea levelmust not be underrated in the treatment of pulmonary tuber-culosis. Investigations two and three years after dischargeproved that 92’ 6 per cent. of the patients in the first stage,75’ 3 per cent. of those in the second stage, and 42’ 4 percent. of those in the third stage were still in full work,having been able to resume their previous occupations.These data speak for themselves and Dr. Staub is so far

encouraged that he does not wish to shut the doors of thesanatorium to suitable cases even in the third stage. Evenof the patients discharged in 1899 the reports in 1903 werefavourable. According to the more or less advanced stageof the disease on admission 90 per cent., 45 per cent., and7’ 3 per cent. respectively were fit for work. At a sanatoriumthe majority of patients increase in weight. An investigationproved that from 70 to 80 per cent. of the patients treated atWald still kept up their extra weight for from two to fiveyears after discharge. The financial state of the sanatoriumwas satisfactory, the voluntary contributions of the cantonalauthorities amounting to e672 and those of the public toalmost &pound;800.

Z&uuml;rich, Nov. 14th. __________________

AUSTRALIA.(FROM OUR OWN CORRESPONDENT.)

The Plague.Two fatal cases of bubonic plague have occurred at East-

wood, New South Wales. Both patients were employed, oneas groom, the other as housekeeper, at the same place andthe groom had been handling produce from Sussex-street,Sydney. Rats had been also dying about the house and theassumption is that infected rats were conveyed in fodder fromSussex-street. The authorities have recognised that nearlyevery outbreak of the disease starts from the neighbourhoodof this street, in which are many old dilapidated buildingsused as produce stores. Orders have been issued for thedemolition of these buildings, many of which belong to theHarbour Trust.

Infectious D-iseases in Victoria.The returns presented to the Board of Health, Victoria,

for the last fortnight showed that there were only two casesof typhoid fever, neither of which proved fatal. Last year,however, there were ten cases of typhoid fever and two ofthem ended fatally. The number of cases of diphtheria wasin excess of last year, though there were fewer deaths. Last

year there were 66 cases and four deaths, while this year,though there were 79 cases, there were but three deaths.There were the same number of cases of scarlet fever

reported this year as last-39-but whereas one case provedfatal last year there were no deaths to report this year.

Sanitary Condition of Mines.The municipal sanitary inspector at Broken-hill recently

made an application to the local police magistrate for anorder to inspect the sanitary condition of the Broken-hillproprietary mine and its underground workings. The

application was refused. The chief inspector of minesstated that all mining inspectors were specially instructedto see that sanitary arrangements are properly carriedout. New regulations have been drafted, to come into

operation next month, with special reference to preventingankylostomiasis.