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immediate relief. There was defective accommodation inthe day-rooms, and it was pointed out that the responsibilityfor the providing of suitable accommodation rested with thecommittee and that it was necessary for them to satisfy theLord Lieutenant that the requisite accommodation and build-ings had been provided before the rate-in-aid could be paid.The temporary buildings, which were to have been completedin the spring of 1899, had not yet been occupied, nor had thefurniture been obtained for them. The overcrowding of theasylum was not only disastrous to the treatment of patientsbut menaced their safety should any epidemic occur.

Winter Session of the Belfast Medieal School.The winter session (1900 -1901) of the Medical School in

Belfast began on Oct. 16th. In the morning Dr. H. L.McKisack gave the introductory address in the theatre of theRoyal Victoria Hospital when there was a large audienceof students and members of the medical and surgicalstaff. After welcoming the students on behalf of the staffDr. McKisack referred to the recent losses which they hadsuffered by the death of Dr. Strafford Smith and by theretirement of Dr. Henry O’Neill. The new Royal VictoriaHospital, of which the foundation-stone is to be laidearly in 1901 by H.R.H. the Prince of Wales, was de-scribed, and while the advantages to be expected from athoroughly well-equipped modern hospital were fully acknow-ledged it was impressed upon the audience that earnest-ness on the part of teachers and students was the

essential, and it was pointed out that much of the real

progress had been effected with very simple and often

imperfect apparatus. The importance of educating thesenses thoroughly was therefore emphasised, whilst the mentaleducation and the use of scientific diagnostic instrumentswere not to be neglected. The students were advised tostrive to grasp the case in all its bearings and not to becontent with discovering the pathology of an affected organ.After commenting on the difficulty of erecting a typical caseas a standard for comparison and on the constant occurrencecf variations, the lecturer summarised the advisory part ofhis remarks to the students as follows :-" (a) Follow thecourse mapped out for you during the session, without stray-ing aimlessly from ward to ward. (b) Learn thoroughly howto examine a case and to take notes of it in a methodicaland orthodox manner. (c) Follow up your cases perseveringly,examining them frequently and keeping notes of their pro-gress. (l) Be as regular and punctual in your attendance atthe hospital as at your meals, or, if anything, be rather moreso. Come early and do not be in a hurry to get away. Youcannot be better employed anywhere else. (e) Do not miss anyopportunity of coming into the hospital as resident." Collegelectures began also on Oct. 16th.

Royal Victoria Hospital, Belfast.Owing to the sad death of Dr. R. S. Smith and the

regretted resignation of Dr. H. O’Neill, two importantvacancies have occurred, one on the medical side, the otheron the surgical side, of the Royal Victoria Hospital staff atBelfast. Dr. H. L. McKisack will succeed to Dr. Smith’splace and become full physician, and up to the presentDr. W. B. McQuitty is the only candidate for the position ofassistant physician vacant by Dr. McKisack’s promotion.On the surgical side, Dr. A. D. Mitchell will become full

surgeon. Dr. T. S. Kirk will become senior assistant surgeon,and Mr. Robert Campbell is the only candidate for thejunior assistant surgeoncy. For the position of surgicalregistrar, vacated by Mr. R. Campbell, there will be a sharpcontest, as already several candidates are in the field.

Oct. 16th. ______________

PARIS.(FROM OUR OWN CORRESPONDENT.)

The Giving of Medical C’ertificates by Hospital haternes.THE Association of Medical Practitioners in the Depart-

ment of the Seine has for some time past over and overagain had to consider some of the many difficulties whicharise concerning the application of the new law dealing withaccidents to workmen, especially where the wounded manis taken to a hospital. The insurance companies naturallyenough demand a medical certificate as to the extent of theinjuries given as soon after the accident as it is possible toform an opinion, so that they shall know whether to imputeJ.iability for the accident to the originator of it or to the

employer. The administrative body of the hospitals, how.ever, place great difficulties in the way of the medicalofficers of the insurance companies with regard to theirentry into the hospitals for the purpose of satisfy-ing themselves as to the condition of the woundedman. In a recent case a medical student who was

employed as interne of the ward refused to give entryto the insurance company’s medical officer, saying that arecent circular of the director of the Assistance Publiquegave internes the sole right of giving certificates with

regard to hospital cases and that, therefore, he had noinformation to give. The medical officer of the insurancecompany remarked that he only wanted a certificate for thecompany so that it might be able to ascertain when thewounded man would be able to resume work and in

particular how much compensation it ought to pay to thefamily of the workman. The interne, however, stuck tohis guns and refused any information. The administrativecouncil of the Medical Association of the Seine took up thematter and protested strongly against the attitude of youngpractitioners who begin their medical career with such anunbrotherly mode of action. It also went into the pointwhether a certificate granted by a student although aninterne should be considered really valuable from a

medical and legal point of view. Such students are onlyauthorised to perform medical acts inside the hospital by atolerance established by force of circumstances, but theyhave no legal right, without paying the proper tax (patente),to take responsibility for a written document which will goout of the hospital and eventually come on for discussionin a court of law. Such an act would come under the headof illegal practice of medicine, especially, as must be remem-bered, when the certificate has to be paid for. A letter wastherefore sent to the Minister of Commerce dealing withthe subject, and the Minister, who obviously found himselfin a tight corner, replied that such a certificate as would begiven by an interne was not a real certificate, that it wasnot designed to establish the right as between two adver-saries at law, but simply to give an exact account from thebeginning of the condition of the wounded man and by givingsome indication of the probable results of the accident toenable the alderman of the ward (maire) to decide as towhether an inquiry should take place before a magistrate orno. The Medical Association protested against the hair-

splitting of this distinction, for it argued that the certificate7ras a certificate and one moreover which was very important,dealing as it did with the conditions existing immediatelyafter the accident-a state of things which certainly couldnot recur later, and so would be the most important piece ofevidence at the trial. Besides, supposing that further

explanations were necessary and that the interne were

called upon to give evidence before the magistrate, wouldhe have to be paid the regular fee due to a medicalwitness-namely, five francs ? ? If so-and this was a

course of events which was quite likely to happen-the reception of this sum, together with that already paidfor the certificate, would be a second act of illegal prac-tice. Unfortunately it is much to be feared that theGovernment, to get out of finding a solution of so difficulta problem, will accept the dangerous ruling of the Minister.On the other hand, it must be remembered that the law ofNov. 30th, 1892, granted certain concessions to internesand certain other students which were full of peril to

medical practitioners. This law laid it down that suchstudents should be allowed to practise medicine in time ofepidemics or while acting as the temporary locum-tenent of amedical officer. Practice in the first case can be easilyexplained ; the second concession was demanded by medicalmen themselves who feared that if ill or very tired theywould not be able to get a substitute if they had to employa qualified man. This, however, is only a temporary con-cession which has to be obtained previously from the prefectand which lasts for only three months, although renew-able at the end of that time. It is this first clauseof the law which is the cause of abuses. As a matterof fact, a prefectural order authorises every threemonths a certain number of students to perform acts ofmedical practice even when there is no epidemic and noquestion of filling the place of an absent medical officer.The object is to assure immediate attendance for urgentcases, so that they should not have to wait unattended forthe visit of the surgeou of the day or until the followingmorning when the chief medical officer of the ward pays hisvisit. This, however, is no ground for arguing that such

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students have the right to give certificates in case ofaccident for use outside the hospital. An injured workmanor his employer has 48 hours’ grace before he must handover certificates at the Mairie. Such a certificate couldeasily be given on the following morning by the principalmedical officer of the ward, at least in all cases where animmoveable dressing did not prevent a clear statementas to the injuries being drawn up. The presidentof the Medical Association is of opinion that the

hospital medical officer cannot be considered to be

replaced by his interne while he continues to practisein the same town. The replacing can only be considered asgenuine if the medical officer is really absent or has left offwork for the time being. Unless such is the case it wouldbe inconceivable that a practitioner with one diploma andwho had paid only his own tax should be able to practise bymeans of an intermediary. In these circumstances theMedical Association has appointed a committee which afterdue inquiry will decide as to whether the order of thePrefect of the Seine giving to internes the right to practisein hospitals should not be annulled by the Conseil d’Etat.

The Prophylaxis of Plague.A. recent order of the Minister of the Interior decrees that

ships coming from localities definitely recognised as infectedwith plague or carrying cargo which has come indirectlyfrom such localities cannot enter or discharge cargo atany port of France or Algeria, except Dunkirk, Havre,St. Nazaire, Pauillac, Marseilles, or Algiers. The Ministerof the Interior will from time to time give notice of otherports which may under exceptional circumstances be thrownopen to the above-mentioned description of vessels, due

regard being had to the ship’s bill of health and the billof lading.

AUSTRALIA.(FROM OUR OWN CORRESPONDENT.)

Health of New Soutla Wales.THE report of the Board of Health of New South Wales for

1893 has jast been presented to Parliament. The population"is increasing at a at,e such as to have led to its havingbecome more than trebled during the 30 years covered bythe censuses ; the increase is partly due to natural incrementand partly to immigration. The mean annual birth-rate for10 years was 33.61 per 1000 of the population," but theBoard noted with regret a continued fall in the mean annualbirth-rate. The general death-rate had, however, alsodiminished, but the Boardregrets that while the death-rate of children under one year isdiminished in the metropolitan district there is no such diminution inthe country districts, where the rate is even higher for 1897 than for1838. This is the more to be regretted in that it is generally admittedthat many of the disorders carrying off young infants are to a greatextent preventable, being largely caused by ignorance and carelessnessin the management, especially of the food, of infants. The conditionof the dairies continues to give the Board much solicitude, and thatmainly because of the inefficiency of the supervision by municipallocal authorities. The mortality rate from typhoid fever for the wholecolony shows a tendency to progressive diminution ; as does also, andmore markedly, the rate for the metropolitan district. But in the countrythis decline is much less distinct. During the year 3302 persons in thecolony were attacked by the disease ; and the deaths numbered245. The notification returns show that during 1898 scarlet fevprattacked 6342 persons in this colony, an incidence at the rate of 4’75per 1000 of the estimated mean population. As usual with scarlet feverthe main incidence was upon persons under 15 years of age, with specialpredilection for age-group 5-10 years. The notified deaths from scarletfever in the whole colony during 1898 numbered 51. a mortality at therate of 0’04 per 1000. During 1838 diphtheria attacked 1493 persons inthis colony, an incidence at the rate of 1-12 per 1000. There were 126deaths from diphtheria notified during the year, a mortality at the rateof 0’09 per 1000. During the year nine cases of illness were reported tothe Board under the Leprosy Act. It was found that aix were casesof leprosy. One of these was a Chinese woman, three were whites ofnative birth who had never left New South Wales, and two wereChinese males.

The medical officer of health of the Hunter River combinedsanitary districts, Dr. Robert Dick, has also sent in his

report for the year 1899. He stated that the local authoritiesin the district had shown more activity in sanitary matters,though deficient in regard to thorough disinfection after casesof infectious disease and in systems of refuse removal, &c.Fewer deaths occurred from typhoid fever, influenza, measles,diarrhoea., and respiratory diseases other than phthisis. In

many towns in the district cesspits still existed and the

greater incidence of typhoid fever in houses with cesspitswas very marked. In the town of Wickham the ratio was1 case of typhoid fever to every 100 houses where pail-closetswere used and 1 to every 48 houses where cesspits existed.An inspection of the whole of the dairies in the districtshowed a steady improvement in their sanitary conditions.

Isolation Treatment of Consumption.A deputation recently waited on the Government of

Queensland with a request that measures should be taken toprovide for the isolation and separate treatment of personssuffering from consumption. The deputation pointed outthat all that could be done at present was the establish-ment of hospitals for the reception of a percentage of thoseafflicted with the disease.

Regulations for Patent Med’icines.The same deputation also urged the Government to take

some steps to regulate the sale of patent medicines and toinsure the public against fraud. It was suggested that theGovernment should see that all proprietary medicineswere analysed and their exact composition made known,and that the sale of such as were dangerous should besuppressed.

The North Sydney Hospital.Some years ago a small cottage hospital was established in

North Sydney. Since then the population of this divisionof the metropolis has increased to between 50,000 and60,000 inhabitants, but nothing has been done to increase thehospital accommodation, which is utterly inadequate, andpatients have to cross the harbour to the other hospitalswhich are also overcrowded. A deputation recently waitedon the Government to ask for a grant of .620,000 for theerection of new buildings. The Colonial Secretary gave afavourable reply and promised to put this amount on theestimates. In his reply the Colonial Secretary observedthat notwithstanding the liberal expenditure on hospitalsrecently the demand continued to outstrip the supply, andhe " was afraid the hospitals were being made too attractiveand were abused, patients preferring the treatment availableto that which they could get at their own homes."

Obituary.Deep regret was felt in Australia at the announcement of

the death in England of Dr. Alfred Shewen who left Sydneyabout six months ago for a holiday trip to England in thehope that it would restore his failing health. Dr. Shewencame to New South Wales soon after taking his M.D. degreein 1873 and began practice as a physician in partnership withthe late Dr. Fortescue. He soon reached a very high posi-tion and gained a large practice. He was one of the firsthonorary physicians at the Prince Alfred Hospital, Sydney,and was joint lecturer on clinical medicine at the universityand a frequent contributor to the local medical societies andjournals. He was extremely popular with both the publicand the profession and was only 56 years of age at the timeof his death.-Mr. Edward Hyacinth O’Doherty diedsuddenly at Brisbane on July 5th and his funeral wasattended by nearly every medical man in Brisbane. He waseducated at the Brisbane Grammar School and studiedmedicine in Dublin, returning to Brisbane in 1882 andjoining his father, Dr. K. 1. O’Doherty, in practice.For 17 years he was medical officer to out-patients atthe Brisbane Hospital and latterly he was honorary phy-sician. For many years he was a member of councilof the Queensland Branch of the British Medical Asso-ciation and in 1897 he was President. He was exceptionallypopular with all classes ; full of genial good humour, uni-formly courteous and sympathetic, and often brilliantlvwitty, his charm was felt by everyone. He was remarkablefor his loyalty to the profession, and all these qualities.combined with professional skill of no mean order, securedhim success. His sudden death came as a great shock to thecommunity.-The late Miss Dagmar Berne was one of thebest known and most successful of the women practitioners inSydney. She matriculated at Sydney University in 1888 andwas a student at the Sydney Medical School for a time.She then went to London and Edinburgh, and was at theRotunda Hospital, Dublin, for a year and returning to Londonwas appointed house surgeon at the Women’s Hospital. Shecommenced practice in Sydney in 1895 and continued in fullwork until recently, when she was attacked with phthisisand died suddenly from haemorrhage on August 21st.

Sept. 8th.