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1000 was 18-1, which is 0-9 higher than in 1911, but 1. 5lower than the average rate for 1902-11. Of the total deaths

(7111) there were 1408 in children under 1 year of age fromall causes. Respiratory diseases, including pneumonia andpulmonary tuberculosis, caused 2592 deaths-i.e., 802from pulmonary tuberculosis, 799 from pneumonia, and991 from other diseases of the respiratory system. 338deaths were from forms of tuberculosis other than pulmonary,317 from cancer, 217 from whooping-cough, 171 frommeasles, 159 from diarrhoeal diseases, 48 from scarlet fever,37 from diphtheria, and 17 from typhoid fever. If, as Dr.Arthur Newsholme teaches, I I infant mortality is the mostsensitive index we possess of social welfare and of sanitaryadministration, especially under urban conditions," then therate in Belfast-129 per 1000 births in 1912-demands someconsideration. Mr. H. W. Bailie, the medical superintendentofficer of health, seems to hit the great cause when, on p. 54of his report, he says: ’’ There can be no doubt that theremoval of all insanitary conditions improves public healthgenerally, but more particularly that among infants, by theprevention of accumulation of refuse, the breeding places forflies. " In Belfast house refuse is removed only once a fort-night. Mr. Bailie suggests in his report" that more frequentremovals of house refuse be undertaken, particularlyduring the summer and autumn months," and he drawsspecial attention to "the existence of hundreds of back

passages which require to be paved, drained, and completed,as in their present condition they are a menace to publichealth." If the plan in use in so many Scotch and Englishcities were adopted in Belfast-that is, the compulsory useof house-bins and their frequent emptying-the infantilemortality would in all likelihood decrease. It takes thosecarriers of disease-the flies-a week to come to maturity intheir growth, and this pest would be combated by the promptremoval of house refuse. As in many other cities, the death-rate from pneumonia in Belfast keeps very high ; in 1912there were 799 deaths from this disease, being 331 in excessof the number in 1911. Is it not time that a campaign wasstarted against this modern urban cause of mortality One ofthe special facts brought out in the report is the continuedprevalence of scarlet fever, which commenced in an epi-demic form in Belfast in the middle of October, 1909.In 1910 there were notified 734 cases of scarlet fever, in 1911the number was 766, while in 1912 it has risen to 916 (anattack rate of 2.3 per 1000). That is, in three years (1910-11-12) in Belfast 2416 cases have been notified. In 1912 thedisease was prevalent during the entire year, but most so inthe last four months. There were 48 deaths, which gives amortality-rate of 5-2 per cent. of those attacked-a factindicating that in a number of cases the type of the feverwas virulent. It is regrettable to find that the epidemic hasremained during 1913.1 In the epidemicity of scarlet feverBelfast is having the same experience as many English cities,and the problem of such a long-continued epidemic has notyet been solved. This medical report of Mr. Bailie is amost welcome one, indicating, as it has done, that the

public health department of the City of Belfast has inrecent years been greatly improved ; and any friendlycriticisms made are simply in the direction of trying toimprove the public health of the great industrial and com-mercial city of Ireland, of which its inhabitants are justlyso proud.

Medioal Advisers to Insurance Committees.The secretary of the Irish Medical Committee has sent a

circular to the members of the medical profession in Irelanddrawing their particular attention to the following resolutionwhich was passed at the last meeting of the Irish MedicalCommittee :-That every consultant should ask the medical man who calls him in

tf he be a " medical adviser," and in case of doubt should confer withthe local secretary of the district, so that the consultant may exercisehis option of refusing to meet such a man in consultation.There is no doubt whatever that in some quarters the feelingagainst the institution of these appointments is very strong.

King Edward VII Memorial, Belfast.At a meeting of the executive committee of the King

Edward VII. memorial, which is to take the form of a newblock at the Royal Victoria Hospital for X ray and vaccinetherapy, held in the City Hall, Belfast, on Sept. 23rd, thecontract for the building was given to the same firm which

1 THE LANCET, Sept. 27th, 1913, p. 959.

built the new hospital. The contract will amount to about£14,000, and there is an additional £4000 in reserve for

furnishing.Sept. 30th.

PARIS.

(FROM OUR OWN CORRESPONDENT.)

,.’ A S’u.ggested Cause of Appendicitis.3t A THEORY has recently been advanced which attributesy to drinking water a causative role in certain obscure cases ofIe appendicitis. It is a remarkable fact that in a family ofe 16, six who drank only water had to be operated on while theLt rest escaped. Appendicitis has certainly notably increased,4 especially in the well-to-do classes, since water-drinkinge became fashionable-i.e., within the past 25 years. Ish this to be ascribed solely to an increased precision ofe diagnosis? Does water contain a hitherto unrecognised

microbe of appendicitis? Since many of the patients;- drank only mineral water or germ-free fluids, it must bet a question not of what water supplies, but rather of what ity does not remove or destroy. The researches of Professors Sabrazes and others have shown that unsophisticated winemay be regarded as a good antiseptic-as also may cider,, beer, and soured milk-in the absence of which the intestinal

microbes germinate freely. Appendicitis might be the occa-isional result of this free germination. Professor Jalaguier,3 whose statistics are numerous, maintains an open mind, for

his operation cases are divided equally between the twoclasses. But it must not be overlooked that there are many

i kinds of appendicitis, even tuberculous and cancerous, andt that these arise from a variety of causes. In any case the. hypothesis in question, based as it is on a wide collection of: facts, appears not without point and calculated to assist in; the rehabilitation of wine to its proper place.: Tuberaulosis of the Aged.’

Dr. Baudet seeks to show that tuberculosis of the aged is,

much more frequent than is commonly supposed, a fact ofimportance from both a family and a social point of view.In the Department of the Seine in ten years 12,293 agedpersons died from tuberculosis, so that 5’53 per cent. of oldpeople in Paris who died must have been tuberculous.The danger to society from this frequency is greaterbecause the aged subject of tuberculosis usually presentsthe open form with cavities, and because in such sub-

jects the tuberculosis is very often unrecognised. Dr. Baudetadduces examples of these sluggish pulmonary infec-tions, progressing silently without either the patientor the medical man suspecting it. This frequency of un-recognised tuberculosis affords an explanation of cases

frequently observed by medical men in which families seemparticularly predisposed to phthisis. Dwelling with an agedrelative in apparent good health, children of all ages oneafter another fall victims of the infection, or if they do notdie are attacked with Pott’s disease, a white tumour, or abacillary orchi-epididymitis. This aged relative, sharing theovercrowded miserable lodging, goes out but little, fearing tocatch cold, but spares neither kisses nor caresses to the littleones, and often sleeps in the same room with them. It isnot to be wondered at that she coughs somewhat, easily getsout of breath, and "catches cold" from time to time,without the least suspicion arising as to her con-

nexion with the recurring deaths. These facts showthat the measures of disinfection ordained after a deathshould not be restricted, as is the case under the presentlaw, to the cases of those who died between 2 and 60 yearsof age. Aged or not, known or unknown, such tuberculoussubjects disseminate contagion much more than those

actually sick, and those about them do not take precautionsagainst a condition which does not appear serious or thenature of which is unrecognised. Finally, it must beremembered that even though the child is not born tuber-culous he is born particularly "tuberculisable," and it is

contrary to the interests of society not to remove the newlyborn from such a serious menace to disease and death.

The Treatment of Burns by Heliotherapy.Dr. Aimes has had remarkable success in the treatment of

burns, recent or otherwise, by the action of the sun. Thesun acts on burns bactericidally, destroying the germs by

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causing active vase-dilatation which creates a focus of

vitality highly favourable to tissue repair and obnoxious tomicro-organisms, by its analgetic action, by the formationof a protective pellicle, and by promoting cicatrisation. Thetechnique is easy. Heliotherapy may be purely local or

regional, it may be direct without the interposition of glass,of gauze, or of fatty bodies. Insolation should beadministered in progressive doses, the head being alwaysprotected from the rays.

TAe Treatment of Hydrocele by Formol.M. Morestin has again directed the attention oi the

Societe de Chirurgie to a mode of treatment alreadyadvocated by him, and one which seems likely to replace theuse of iodine injection. Take the case, for instance, of aone-sided ordinary hydrocele of medium size, with walls

supple and uniformly thinned, and containing a completelytranslucent fluid. The subject lies on his back and thescrotum is lightly painted with tincture of iodinewhere the puncture is to be made. Anæthesia, eitherlocal or general, is unnecessary, and, moreover, there is nooccasion to remove the hair. Taking up the tumour in onehand, M. Morestin inserts in its upper part the needle of aPravaz syringe. When the needle is fully inserted, its

mobility in the cavity is made sure of. A little lower downa trocar is quickly inserted, and nearly the whole of thefluid is evacuated. When the cavity is almost entirelyemptied the trocar is withdrawn, and through the Pravazneedle M. Morestin injects 2, 3, or even 4 c.c. of a mixtureof equal parts of formol, glycerine, and alcohol. The needleis then withdrawn, and the fluid is caused by light massageof the scrotum to penetrate the recesses of the cavity. No

dressing is necessary. The patient remains in bed or not as hepleases. The injection is hardly painful, and the consequentreaction causes very little pain, often none at all, although it isconsiderable; for the scrotum swells and becomes osdematous,without, however, showing any of the inflammatory redden-ing usually seen after the injection of iodine. After two orthree days the swelling reaches its height. The greater partof the time the patient can get up without experiencinganything worse than weariness. The general health doesnot suffer, and the patient is deprived of neither appetite norsleep. In three or four days retrogression begins andtakes place rapidly, being finished in from three to fiveweeks. Long before this time the patient can resume hisordinary life.

Sept. 29th. _________________

VIENNA.

(FROM OUR OWN CORRESPONDENT.)

The International Congress on First Aid and Ambulance Work.THE month of September, 1913, will be long remembered

in Vienna as the month of scientific congresses, the twomost important, from a medical point of view, being theCongress of German Naturalists and Medical Men and theInternational Congress on First Aid and Ambulance Work.With the first-mentioned one, which was also the largerof the two, were combined the annual meetings of theGerman Dermatological, Pædiatric, Psychiatric, and Laryngo-Otological Societies. The International Congress on FirstAid and Ambulance Work was held here from Sept. 9th to13th. The number of enrolled members was over 1200, andno speaker was allowed more than 15 minutes, in order toenable the business to be completed within the stipulatedfour days. The Congress was an interesting manifestationof the achievements of the modern spirit of pity for thosewho may be in danger or distress, and Austrians mightjustly feel patriotic satisfaction on finding that their countrywas foremost in many respects as regards this subject.Apart from the social entertainments, which the representa-tives of the inviting city and country seem to regard asindispensable, the actual work done in the sections wasextensive enough. The papers read before the Congress hadto be presented under one of the following ten heads : first-aid in accidents, instruction of non-medical persons in first-aid, first-aid in towns and in country places, first-aid in

travelling (with subsections devoted to automobiles, rail-

ways, and aeronautics), first-aid on the seashore and on thehigh seas, first-aid in mining industries, first-aid in con-

flagrations, in mountaineering, and in sport, and finally theprevention of accidents generally.

Practical Demonstrations in First-aid.An interesting practical demonstration on first-aid on a large

scale was presented to the Congress and the populationgenerally by the Vienna Rettungsgesellschaft (AmbulanceCorps). A test alarm was given to the effect that an accidenthad happened at the racecourse, that some 40 or 50 persons.required immediate help because a wooden platform hadgiven way under a mass of spectators, and that many victims.had also been trampled on by horses and a panic-strickencrowd. A few minutes after the message arrived an ambu-’lance detachment, consisting of 20 cars, with one medicalman and one male nurse on each of them, made its appear-ance at the scene of the supposed disaster. Boy scoutsacted the part of the injured. The methods of first-aid, thebandages ready for use for such cases, as well as themethod of distributing the patients to the nearest hospitals,were demonstrated. To each supposed injured person asmall board was attached giving information to the hospitalstaff of the nature of the injury and the treatment adopted,thus enabling the case to be promptly dealt with at thesurgical station. A very similar demonstration of life-savingin the water was given a little later, when the methods ofbringing out of the water a person unable to swim and ofresuscitation of the apparently drowned were practised.The British Royal Humane Society served here as a modelfor the establishment of a society for first-aid in ship-wreck, floods, attempted suicide by drowning, &c. As amatter of fact, it happened by a curious coincidence that,just at the time of the demonstration a candidate for self-destruction wanted to drown himself at the scene of the

proceedings. Needless to say, his attempt was promptlyfrustrated.

Exotio Diseases. -Life-saving at Sea.The Transactions of the Congress contain many interest-

ing papers. The danger of diseases epidemic in Asiabeing imported into Europe by the continuous stream ofMahomedan pilgrims returning from the hotbeds of

plague, cholera, and small-pox in Arabia, was discussed byDr. Kobler, the head of the Board of Health of Bosnia andHerzegovina. Since the completion of the railway betweenthe Mahomedan holy places and Damascus the quarantineformerly provided by the caravan journey of a week’sduration has been lost. 1 The journey now lasts only a fewdays, and European countries with Mahomedan popula-tions must be on the alert and must provide special pilgrimstations on the frontier for all suspicious cases.-The pre-vention of loss of life in sea voyages was discussed in a

paper by Professor Flamm, who said that watertight com-partments should be constructed in the long axis as well asin the cross section of a modern ship, the stability of thevessel being of paramount importance. The number andcapacity of the life-boats should be in direct relation to thenumber of persons on board the ship, and not to the tonnageof the vessel. A modern passenger steamer must have

apparatus for wireless telegraphy, must be carefullyballasted by proper storing of the cargo and trimming ofthe fuel, and must have the fuel stored in fireproof com-partments. Medical aid must be provided for each 300 or500 souls, one medical man and a ship’s hospital or ward,with at least six beds, being available. Cork belts must bewithin easy reach in the berths and on deck.

First-aid in Mountaineering and Aeronautics.The organisation for first-aid in mountaineering is interest-

ing, and for it thanks are due to the German and’ Austrian

Alpine Society. The paper by the representative of this societygave particulars of the network of ambulance stations spreadover the mountains of these countries (mostly the Alps).There are over 200 first-aid outfits distributed amongstthem for emergency cases, and the services of a largenumber of voluntary helpers, as well as of paid officials,have been secured. They chiefly form rescue or searchparties, and are supplied with ropes, ladders, and hammocks.Each station contains a first-aid chest, with splints, medi-cines, stretchers, bandages, and several small first-aid outfitsfor the authorised mountain guides. These latter have to,attend Samaritan classes, where medical knowledge neces-sary for them is obtained. The Alpine danger signal is nowadopted as an international signal, and the recognisedguides are trained to deal with the ordinary accidents met.with in the mountains, such as snow-blindness, frost-bites,

1 THE LANCET, 1908, vol. i., p. 1799; vol. ii., pp. 971, 1104, 1248. 1405