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as there is a very wide difference of opinion between theestimate of some of the Committee and the ideas of themedical profession.The Advisory Committee, Insurance Committees, and Local

Medical Committees.The Insurance Commissioners have notified the restoration

to the Advisory Committee of the following medical practi-tioners who had resigned their seats at the request of theConjoint Committee : Dr. P. T. O’Sullivan, Cork; Dr. T.

Donnelly, Dublin ; Dr. T. B. Costello, Tuam ; and Dr. J. S.Darling, Lurgan. A number of medical vacancies on

Insurance Committees has also been filled on the nominationof the Conjoint Committee. The Commissioners have at lengthnotified their recognition of Local Medical Committees inthose areas in which they have been formed-six countyboroughs and 20 counties, and they invite the formation ofmedical committees in the remaining areas. InsuranceCommittees are directed to confer with Local Medical Com-mittees in carrying out the scheme of medical certification.

The Insurance Commissioners and Medical Certification.On March 18th a conference of representatives of the

Insurance Committees of Ireland was held in Dublin at theinvitation of the Insurance Commissioners to discuss thescheme of medical certification put forward by the Com-missioners. 1 On March 22nd a communication was issued toall registered medical men in Ireland informing them thatit is proposed, out of the Exchequer grant-in-aid of £50,000recently voted by Parliament, to provide the cost of allmedical certificates required by Approved Societies andInsurance Committees in Ireland. The Commission has

agreed to set up for the purpose the panel system,and invites medical men now to join it in the particularboroughs or counties in which they reside. The arrange-ments for the distribution of the grant will beginon April 13th, 1913, and will continue till Jan. 14th,1914, inclusive, or such longer time as may be agreed uponbetween each medical practitioner and the Insurance Com-mittee, subject to the approval of the Commission. Practi-tioners wishing to join the panel are imtructed to notifytheir willingness to do so to the clerk of the InsuranceCommittee on or before April lst next, and forms of

agreements are also sent, which have to be executedand forwarded to the Committee. The Commissioners

lay down the conditions which are to be observed incase of any dispute arising under the scheme. TheInsurance Committee have no power to remove a

practitioner from the panel. Any question in disputebetween two practitioners on the panel arising out of theirposition in that capacity, will be referred to the LocalMedical Committee. Questions arising between doctor andpatient may be referred to a Committee of Complaints, con-sisting of two doctors chosen by the Local Medical Com-mittee and two representatives of insured persons, and thechairman, chosen from and by the Insurance Committee.The investigation will be in private session. If theInsurance Committee find the insured person at fault theymay transfer him to another practitioner ; if the practitioneris found to be at fault they may transfer the insured personto another practitioner, but they cannot remove the

practitioner from the panel, nor inflict any penalty upon himbeyond the transfer of the insured person. In com-

municating the scheme to the press the Commissionersmake a general statement, which requires considerable

qualification to be strictly accurate. It is that the ConjointCommittee has approved of the scheme. The approval of theConjoint Committee was limited to the principle of thescheme, while at the same time the Committee pointed outthat the remuneration offered was quite inadequate. More-over, the Committee declared that it had no power to pledgethe profession to the acceptance of any scheme, and couldgive no guarantee that the scheme would be accepted by theprofession. As a matter of fact, the proposals have calledforth much protest from the profession both in town andcountry areas, and it is very doubtful whether the panelswill be filled. Again, in their letter to medical practitionersthe Commissioners make an equally questionable statement-viz., that the Insurance Committees have agreed toadminister the scheme. The conference summoned by theCommissioners had no power to bind the Committees

1 THE LANCET, March 8th, p. 722, Scheme No. 2.

to any line of action, and at the time the Com-missioners issued their letter few, if any, InsuranceCommittees had had an opportunity of examining the pro-posals. Even apart from the question of remuneration, thescheme as proposed is still incomplete. It must be recog-nised that a number of practitioners will decline to puttheir names on a panel, and yet they will occasionallybe called on to attend insured persons. No provision hasbeen made for payment in such cases, although the Com-missioners lay it down that " where there is a ductor inattendance on the patient only that doctor shall give acertificate." Again, no provision has yet been offered forpayment for certificates given by members of hospital staffs.March 2jth.

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PARIS.

(FROM OUR OWN CORRESPONDENT.)

The New Hôpital de la Pitié.THE President of the Republic has inaugurated the new

Hopital de la Pitie, which is erected on a site between theBoulevard de 1’Hopital, the Rue Jenner, and the Rue Bruant.A central avenue, a third of a mile in length, starting at theprincipal gate in the Boulevard de 1’Hopital, traverses thesite from end to end. To the left of this avenue liethe out-patient buildings, which are very spacious. More-over, at the gate there are isolation rooms for the recep-tion of such cases as the gate officials may suspectto be contagious. On the left also of the principal avenueare the administration buildings, the quarters for themedical internes, and the dispensary and linen store.Further on, the avenue passes between the medicalservices on the left and the surgical on the right. The

buildings are of three storeys. While reserving largeopen spaces on the 61,000 metres of site available,the new Piti6 is yet one of the three great hospitalsof Paris. It contains 988 beds, without counting cots, andthus comes next after the Lariboisiere, which has 1200, andthe Tenon with 1020. The two buildings devoted to medi-cine contain each three services, one on each floor. Theyboth have the form of a letter H, of which the transverselimb is occupied by the general services-office, linen,and laboratory of the chief of the service. One of thevertical branches is reserved for men, and comprises on eachfloor 40 beds and three isolation rooms ; the other, for women,contains 32 beds and eight isolation rooms. The surgicalbuildings are less extensive, and comprise only threeservices. Each of these services is subdivided into two

secticns, one reserved for patients suffering from septicwounds or abscesses, the other for those with tumours or

simple fractures who are entirely free from contagion. Eachof the sections contains independent operating and dressingrooms provided with all modern improvements. Beyondthese buildings is the maternity ward, which has a specialentrance in the Rue Jenner and constitutes a service entirelyindependent of the hospital. It comprises 85 beds. Furtheron is the accommodation for the male staff, and still furtherthe mortuary. The kitchens, offices, and accommoda-tion for the female staff are situated behind the surgicalservice. For the nurses is provided a sitting-room witha piano, and there is hardly anything left for themto desire. In the kitchens are 16 steaming pots. There aresix steam generators from which hot water is pumped intothe services. A formol disinfecting chamber for the clothingof the patients, subterranean passages connecting thedifferent services, and numerous ingenious appliancescomplete this new hospital.

Human Ovarian Grafting.At the Academy of Medicine on March 4th M. Tuffier read

a communication in which he showed that in certain cases inwhich extirpation of the uterus and its appendages appearednecessary the uterus might nevertheless be left and theovaries grafted to the abdominal wall. The problem ofsuppressing infectious lesions and re-establishing menstrua-tion-that is to say, of restoring the physiological equilibriumof the woman-is thus solved. Out of 19 patients on whomM. Tuffier had operated in this way, in 16 the menses

reappeared in from three to seven months, and have per-sisted respectively for periods varying from 5 years to 11months. In all these women the troubles consequent on

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castration have disappeared and have not returned. It is notovulation apparently, but menstruation, which is necessaryfor the elimination of the toxins whose retention is said to

provoke all the accidents associated with a premature meno-pause. Human ovarian grafts may suffice to re-establishmenstruation in a woman who has preserved her uterus, andmay save her from the accidents due to the prematuresuppression of menstruation.

A l’llerited Reward.The silver medal of the Carnegie foundation, with an

honorarium of 2000 francs, has been awarded to Dr.

Carpentier, an interne of the hospitals of Rouen, who,while hardly recovered from an attack of scarlet fever, wason April lst last stricken with a most severe diphtheriticangina, contracted during repeated efforts at intubation on achild affected with diphtheria. After a painful convalescence,Dr. Carpentier remains permanently affected with lamenessand atrophy of the right arm and leg.

Wo?tndsfro2i?, Modern Weapons.Various communications by surgeons who have taken part

in the Balkan war led M. Ferraton to show, at the Societe deChirurgie or. March 12th, some examples of wounds pro-duced by modern weapons and to set forth his views on thetreatment of the wounded in war. M. Ferraton showed the

bayonets in use in the different European armies, the variousrifle bullets, fragments and bullets from shrapnel, andfragments of a melinite shell. He then briefly described theprincipal forms of wound produced by these weapons andprojectiles, respectively in the soft parts, the bones, and thejoints. Referring to the statistics contained in the medicalreports on the great wars, M. Ferraton showed that they wereerroneous, though inevitably so, for they revealed only thewounds observed in the hospital services and did not take intoaccount those found upon the battlefield. They thus failed toappreciate fully the gravity of certain traumatisms. Howeverthis may be, if one takes into consideration what has beenobserved in the later wars, the general rule in militarysurgery, at least in the stations near the field of battle,should be an attitude of expectancy towards wounds of thelimbs (except in cases of shattering, of gangrene, or of

septicæmic invasion) and in wounds of the chest, as well asin wounds of the abdomen, save where there is internalhaemorrhage or extensive visceral perforations. In woundsof the cranium, on the other hand, surgical interventionseems called for, if the surgeon has a sufficient equipment.This intervention should at first be limited to the toilet ofthe bone-the raising of depressed fragments and theremoval of accessible splinters, but without any deepinvestigation of the wound.Statistics of the Medical and Allied Professions in France.The Direction of Assistance and Hygiene to the Ministry

of the Interior has published the personal medical andpharmaceutical statistics of France for 1911. The depart-ments that occupy the chief places are : La Seine, 4393medical men, 1125 dentists, 1329 midwives, and 1789 phar-macists ; Le Nord, 811 medical men, 97 dentists, 422 mid-wives, and 523 pharmacists ; La Gironde, 614 medical men,123 dentists, 389 midwives, and 400 pharmacists ; Le Rhone,585 medical men, 117 dentists, 304 midwives, and 322pharmacists ; Les Bouches du Rhone, 575 medical men, 72dentists, 345 midwives, and 250 pharmacists. The depart-ments lowest on the list are : Les Hautes-Alpes, 29 medicalmen, 2 dentists, 33 midwives, and 14 pharmacists ; Le Haut-Rhin, 32 medical men, 7 dentists, 46 midwives, and 23pharmacists: La Lozere, 39 medical men, 2 dentists, 30midwives, and 19 pharmacists. Finally, for the whole ofFrance the figures are : 20,809 medical men, 2848 dentists,13,066 midwives, and 11,585 pharmacists.llarch 24th.

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BUDAPEST.(FROM OUR OWN CORRESPONDENT.)

Penetrating Wounds of the Abdornen.Dr. Widder, who has been sent to the Balkan war by the

Hungarian Red Cross Society, reports two interesting casesof penetrating wounds of the abdomen. One of the patientswas a man 22 years of age, in whom there was a pro-trusion of the intestines through the gunshot wound, and inthe protruded intestine there was a wound 4 centimetreslong. The organs were replaced and the abdominal wall

was closed with sutures ; the subsequent process of the casewas uneventful, the patient leaving the hospital recoveredtwo weeks after the injury. In the other case there was a

protrusion of the pancreas. This was first resected, thenrendered thoroughly aseptic, and replaced. As in the firstcase, the subsequent course was uneventful. In treatingother penetrating wounds in the Servian military hospitalsDr. Widder, as a rule, found it advisable not to close thewounds tightly, but to leave a corner for the introduction ofiodoform or sterilised gauze. The prognosis of such wounds-was more favourable at the present time than it used to be,,and the earlier the cases were taken in hand the better.

" Certified Milk. "

The continually increasing scarcity of milk makes it moreand more difficult to procure thoroughly pure milk forinfants and sick people. In Hungarv there are no lawsregulating the production of milk, and for this reason the"Budapest Medical Circle " has undertaken the makingof contracts with dairy farmers, binding them to supplywholesome milk under strictly prescribed conditions, andto bring it to market in sealed bottles bearing the seal ofthe Medical Circle. This milk will be sold under the nameof I certified milk." The production of this milk is super-vised by experts employed by the Medical Circle. Thecows and the milk will be subject to examination by theauthorities of the Milk Laboratory of the Veterinary HighSchool, and chemical and bacteriological examinations willalso be made daily in the Bacteriological Institute of thecity of Budapest. Milk must be taken only from cows notreacting to tuberculin, and it must not be more than 1&hours old when supplied to the consumer. The certifiedmilk is sold for 46 hellers per litre-that is, about 22d. perpint.

The Number of Medical Men in Europe.Statistics which have been published in the Orvosi Hetilap

assert that the number of medical men in the whole of

Europe amounts to about 100,000. With respect to theirdistribution as between various nations, England is said tohave both the largest absolute number and also the largestproportion relatively to the population-namely, 28,900’altogether and 7’8 per 10,000 inhabitants. Bulgaria hasthe smallest number of pra,ctitioners-only 0’47 per 10,000’inhabitants. In Germany the total number of practitionersis 22,500, or 5.6 per 10,000 inhabitants ; in France thetotal number is 19,800, giving 5.1 per 10, 000 inhabitants; pand in Italy the total number is 18,270, giving 5.6 per10,000 inhabitants. Among the capital cities of Europethe proportion of medical practitioners to inhabitants is

greatest in Brussels-namely, 27-1 per 10,000; while inAmsterdam it is 7. 1 per 10,000.

General Meeting of State Circle Medical Officers.In Hungary the counties are divided into circles, each

circle including on an average 12 villages, and having anarea corresponding to a radius of 10 or 15 miles. The

larger villages within the circle are provided with their ownvillage practitioners. In each circle one circle medicalofficer (Kreis-Arzt) is employed and paid by the State forattending -residents in the circle who are certified to be

indigent, and for acting as medical officer of health ona small scale. The salary of a circle medical officer isbetween .E.65 and <&75 a year, and has not been raised for thelast 30 years, although the cost of living has increased byabout 80 per cent. even in agricultural districts. In 1908the salaries were nominally raised by E10 or E15 a year,but as a set off against this concession these medical officershave been entrusted with attendance on workmen under theWorkmen’s Compensation Act. At the same time the intro-duction of a Pension Bill was promised them, but five yearshave now elapsed without either any rise of salary beinggranted or the Pension Bill introduced. Their patiencebeing exhausted by this long-continued policy of inactionon the part of the Ministry of Public Health, the circlemedical officers held a general meeting in Budapest in theend of February. At this meeting they resolved that theywould first send a memorandum to the Hungarian MedicalAssociation, and then, with the support of the Association,they would send a deputation to the Minister of PublicHealth in order to ask for definite information as to whenthe raising of salaries will take place and when the PensionBill will be introduced.

Post-gradate Courses in Hungary.Up to last year post-graduate courses of a fortnight’s