1382 PARIS.—ROME.

Whitaker, was accorded to the President for his address.’The annual dinner is to be held on the evening of Thursday,Nov. 21st. Four new members were elected at the meeting.

The Belfast Medical School.The total number of students attending the Royal

Victoria Hospital this session (1901-1902) is 143, being 12less than last year. The number of medical students at

Queen’s College, Belfast, is also slightly less than last year,but in the Arts Faculty there is a much greater drop in the,number of entries.

.Nov. 12th. __________________

PARIS.

(FROM OUR OWN CORRESPONDENT.)

Z%6 Provincial Hospital Surgeons’ Union,I HAVE already mentioned 1 that Dr. Bousquet of Clermont

took steps to convoke a meeting of provincial hospitalsurgeons just before the sitting of the Congress of Surgeryfor the discussion of the system whereby workmen injured inthe course of their employment are admitted into the hos-pitals and treated at rates only drawn up for indigentpatients. The meeting was held on Oct. 22nd, and Dr.Bousquet, after thanking his colleagues for their generousresponse to his appeal, proceeded to explain the object of themeeting-namely, the violation of the law concerningaccidents to workmen, which operated so disastrously for thewhole of the medical profession. The facts were these. Whena workman was injured to any serious extent he was sent to ahospital where he was treated at a rate imposed solely forindigent patients. When this rate had been paid the

employer, who alone was responsible by the new law for theexpenses of the treatment of his men, considered that he wasquite absolved from the payment of any more fees. Themedical man who would have treated the patient had he notbeen taken to hospital was thus deprived of his fee and thehospital surgeon who did the work got no advantage out ofit either. Thus if the loss was reckoned throughout the entiremedical profession the figure mounted up to many millions offrancs ; for instance, in the department of the Seine alone theloss counted up to 15 million francs. Dr. Bousquet asked hiscolleagues to unite in putting an end to an abuse so harmfulto the interests of the medical profession. Dr. Lande saidthat the members of hospital staffs were wrong not to

lay more stress upon the regulation for hospital administra-tion which provided that a hospital should be kept for thepoor and that patients who were not poor should be madeto pay for professional treatment and medicine in addition tothe cost of food and lodging. The speaker pointed out that to treat patients who could pay at the rate of poorpersons-a rate which varied from two to five francsper diem-was prejudicial to the interests of the AssistancePublique. For instance, a patient in a hospital on whomlaparotomy had been performed cost the hospital, only forthe expenses of the operation, the dressings, and the drugs,at least 150 francs, while if he stayed in the hospital for onemonth at three francs per diem he paid 90 francs. Thereforethe deficit had to be made up out of the funds for gratuitousmedical assistance-that was to say, practically by the poorthemselves. After some further discussion the meetingunanimously passed the following resolution in conformitywith the decisions arrived at by the Congress of Deonto-

logy :-That this meeting of provincial hospital surgeons unanimously

pledges its members to demand from their various Members of Parlia-ment a new reading of article 4 of the law of 1898.

A committee of four members was appointed to form a

deputation to the Minister of the Interior to lay beforethe Director of the Assistance Publique the grievancesof the medical profession and to try their utmostto get him to apply, by means of administrative com-mittees under himself, the strict regulations of theAssistance Publique. Resolutions were also adopted tothe effect that the permanent Committee for Profes-sional Medicine should by circular call the attention of

hospital administrations to the abuse of hospitals causedby the treatment of injured workmen and asking them tomake such persons pay a higher rate than that appointed forpoor patients ; and that the fees of the medical men and

1 THE LANCET, Oct. 26th, p. 1163.

apothecaries should be paid in separately to the hospitaladministrations who could then divide them among those towhom they were owed, unless the hospital authorities pre-ferred that the medical men and apothecaries should be paiddirectly. If these reforms were not carried out it wasdecided that every hospital surgeon before undertaking thetreatment of a patient should inform the hospital authoritiesthat his fees were not included in the sum paid for theresidence of the patient in hospital, and that he shouldreserve the right to sue for such fees unless they were paid tohim through the intermediation of the hospital authorities.The proposed alteration of Article 4 of the law of 1898 willmake it run as follows :-

The contractor is the person who shall be always and directlyresponsible for both preliminary medical expenses such as certificatesand attendance, whether given at the injured party’s home or at thehospital, for expenses of drugs, for hospital expenses, and any specialapparatus furnished by the hospital or any other institution, and finallyfor burial expenses. These last shall not exceed 100 francs at the most.The injured party, whether directly after his accident or at any timeduring his course of treatment, shall be at liberty to choose, either byhimself or his representative, his medical man or his apothecary fromthose who live in his own neighbourhood. In case of dispute theamount of the bill for medical and pharmaceutical expenses shall hefixed by the magistrate of the parish, according to the workman’s tariffin use in that parish. The contractor on his side can submit to themagistrate the name of a medical man who will have the right to makeperiodical inspections of the patient so long as such inspection does notinterfere with his treatment.

The Hygiene of Railway Tunnels,The Paris Prefect of Police, M. Lepine, recently requested

M. Grehant, Professor of Physiology at the Museum, to

analyse the air in the tunnels and carriages of the Metro-politan Railway. M. Grehant’s report has just been issued.He states that, beginning from Oct. 18th, he made 100analyses of the air in the carriages and obtained some im-portant results. Even in the second-class carriages, whichare generally packed, the carbonic acid never reached 1 percent. and the oxygen was diminished in equivalent proportion.The air samples taken outside the carriages and in the in-tervals between the tunnels contained no excess of carbonicacid and very nearly the normal proportion of oxygen.M. Grehant concludes from this that the sole cause of theFouling of the air is the respiration of the passengers, for theLrains, which are very frequent and are always travellingquickly in opposite directions, act as powerful ventilatorsand effect a change of air through the entrance and exitloors of the stations.Nov. l2th.

_______________

ROME.

(FROM OUR OWN CORRESPONDENT.)

The Health oj Rome in 1900.THE annual abstract of the Statistical Bulletins for the

commune of Rome lately issued reveals a considerableincrease in the death-rate of the city for 1900 over that ofthe previous year. In 1899 the exceptionally low rateof 17’2 per 1000 inhabitants was recorded, whereas in thesucceeding year it rose to 20’2 per 1000. The report doesnot make it clear how the latter result was arrived at, butit is certain that the former is understated owing to someunfortunate blunder in estimating the population which hasnever been satisfactorily explained. By the census takenon Feb 10th, 1901, it was definitely ascertained that thetotal number of inhabitants was then 467,992, whereas theofficial estimate of the population on Dec. 31st, 1900, wasno less than 521,159. On the 512,423 at which it hadbeen estimated for the corresponding date of 1899 a veryconsiderable reduction would require to be made in orderto arrive at the true figures, and an equivalent increasemust therefore result in the estimated death-rate. Fromthe following table it will be seen how the death-rate ofRome compares with that of some other large cities ofEurope during 1900 :-

Rate of mor- Rate of mor-tality per 1000 tality per 1000inhabitants. inhabitants.

Brussels ......... 16-4 Vienna ......... 20’6

London ......... 18’7 Glasgow ......... 21’9

Edinburgh ...... 19’3 Liverpool ......... 25’6

Berlin............ 19’3 St. Petersburg ... 27’0

Rome ............ 20’2 Dublin ", ".." 27.9

Paris ........... 20’5 Moscow ......... 30’0

1383ROME.-OBITUARY.

The chief cause of mortality was pneumonia, whichaccounted for no less than 1216 out of the total of 9937deaths, or 12’24 per cent. of the whole. Next in importanceas causes were pulmonary tuberculosis (830 deaths), bronchitis(523), apoplexy (499), measles (253), and enteric fever (248).Influenza was responsible for 154 deaths, syphilis for 128, andmalaria for 123. It will doubtless be noticed by manywith surprise how comparatively trifling is the mortalityfrom malaria in this city, where "Roman fever" even yet isa name of terror to the majority of newcomers. For everyvictim claimed by that disease twice as many succumbed totyphoid fever and nearly ten times as many to pneumonia.Beyond all question the winter visitor, not only to the EternalCity but to Italy generally, has much more to dread fromthe deadly pneumococcus than from the malarial microbe,or even from the ubiquitous bacillus of typhoid fever.

Against the latter two he can at least take precautions byavoiding the now well-known causes of infection, and evenif attacked can hope for much help from skilful treat-

ment, however severe the seizure may be. But who cantell him where the mysterious diplococcus springs fromwhich breeds an attack of pneumonia ? And what chancesof recovery can we hold out when the malady assumesthat virulent form so frequent in Italy which no remedyappears to control and which often carries off the youngand robust with the same startling rapidity as it doesthe old and feeble ? The outbreak of typhoid fever, or

rather the extension of the endemic already existing,raised the death-rate from that cause to quite an abnormalextent. Usually the rate of mortality from enteric feverin Rome oscillates between 3 and 5 per 10,000 inhabitants,but in November and December of 1900 it rose to 11’5and 14’7 respectively. The mean for the year was 4’9,which is higher than anything recorded since 1888, whenthe relative mortality rose in the month of October to

104, and the mean for the year was also 4-9. Gualdihas ascribed the increase in the years preceding 1888 tothe influx of workmen consequent on the activity in build-ing which took place at that time, and he considers that asimilar cause operated in the years 1898, 1899, and 1900,since the great majority of cases notified in these yearsoccurred amongst the masons and labourers engaged inthat class of work. The case-mortality of typhoid fever was14’5 per cent. out of a total of 1704 cases notified

during 1900. The statistics of suicides, of which therewere 88, showed a preponderance of male over femaledeaths in the proportion of nearly 3 to 1 (64 malesand 24 females). Of the suicides by males 18 personsthrew themselves from heights, while 20 killed them-selves with firearms, 13 by drowning, and six by poison.Among the females the favourite way in Rome of putting aviolent end to life would appear to be by the first (11 deaths)and the last (nine deaths) of these methods. It appears fromone of the tables given in the abstract that the deaths

amongst the non-resident population last year were unusuallynumerous-namely, 1948. In this fact lies the explanation,at least in part, of the augmented mortality. During this"Anno Santo "-or ‘° Anno Sporco" (dirty year) as itwas popularly called-Rome was filled with pilgrims fromall parts of Christendom who not only added to the death-rate by force of numbers (of which no official record waskept) but doubtless imported the germs of various in-fectious diseases amongst the permanent residents. The

dirty, unkempt appearance and unwholesome odour of manyof these visitors suggested such a result, and, indeed, con-sidering their numbers and the length of time over whichthe presence of these pilgrims extended, one is surprised thatthe public health did not suffer a great deal more from theirinvasion. Nov. llth.

SANATORIUM AT DELAMERE -Manchester hasnot been long in following Liverpool to Delamere. The firstsod of the new branch sanatorium at Delamere, which willbe connected with the Manchester and Salford Hospital forConsumption and Diseases of the Chest, was cut on Nov.2nd by Mrs. Crossley, whose husband, Mr. W. I. Crossley,has been a most munificent supporter of the institution.Indeed, it is owing to his generosity that the sanatorium atDelamere has been made possible. There will be 75 bedsin the main building, while the nurses’ and servants’ homewill form a separate block. 65 acres of land with a southaspect have been secured. They are in the parish of Kingsleywithin the precincts of the forest.

Obituary.HENRY SPENCER SMITH, F.R.C.S. ENG.,

CONSULTING SURGEON TO ST. MARY’S HOSPITAL.

MR. HENRY SPENCER SMITH, who died on Oct. 29th athis residence in Oxford-terrace, Paddington, played an

important part in the early history of St. Mary’s Hospital.The greater part of his professional education was received.at St. Bartholomew’s Hospital, where he entered as a studentin 1832, and was a pupil of Mr. (afterwards Sir William)Lawrence. To widen his experience he spent several monthsin Paris, and in 1837 he was admitted a Member of the Royal.College of Surgeons of England, after which he held theoffice of house surgeon at St. Bartholomew’s Hospital andsurgeon to the Royal General Dispensary, Aldersgate-street.When St. Mary’s Hospital was instituted in 1851 Mr. Smith,was appointed one of the three assistant surgeons, the othertwo being, as mentioned in THE LANCET of Sept. 27th, 1851,p. 301, Mr. Haynes Walton and Mr. James Lane. The sur--

geons of the original staff were Mr. Coulson, Mr. Lane, andMr. Ure. In 1854 a movement took shape for the purpose offorming a medical school at St. Mary’s Hospital, a

meeting being held with that object on April 24th, andrecognition by the Royal College of Surgeons of England fol-lowed in the same year. Mr. Smith was appointed to the im-portant office of dean of the school and for six years he labouredunremittingly at the work in all its details. He had herein,an opportunity of showing considerable administrative talent,and the appreciation which his success evoked was shown,by the fact that when he resigned the post in the middle of1860 and was succeeded by Mr. G. G. Gascoyen he waspresented by the students with a piece of plate weighing101 ounces and by the lecturers with a silver-gilt inkstand.For many years he was one of the lecturers on surgery in,the school. He was a member and the secretary of thefirst Government commission of inquiry into the question ofvenereal disease as occurring in the navy and the army andwas also a secretary and a vice-president of the Royal Medicaland Chirurgical Society. Mr. Smith was one of the 150Fellows of the Royal College of Surgeons of England chosenwhen that order was created in 1843, and the death of Mr.Carsten Holthouse last July left him as the sole survivor ofthose original holders of the Fellowship. From 1867 to 1875,he was a member of the Council and in 1872 he was electeda member of the court of examiners. Mr. Smith translated,from the German" Schwann’s Microscopic Researches intothe Accordance in the Structure and Growth of Animals andPlants," which was published by the Sydenham Society andfor which the translator in 1845 was awarded the Copleymedal of the Royal Society. Mr. Smith also translated Pro-fessor Bischoff’s memoir On the Periodical Maturation andExtrusion of Ova, independently of Coitus, in Mammaliaand Man." Mr. Spencer Smith, who was in his eighty-ninthyear at the time of his death, has left a widow and a sonand a daughter by a previous marriage.

SIR JAMES WILSON AGNEW, M.D. GLASG.,M.R.C.S. ENG.

BY the death of Sir James Wilson Agnew, which occurredon Nov. 8th, we are once more reminded of the valuable workdone by medical men in a political direction. James Wilson

Agnew was born in 1815 and became a Member of the-

Royal College of Surgeons of England in 1838, graduatingas M.D. of the University of Glasgow in 1839. About a

year later he went out to Tasmania and practised as a

physician in Hobart for some years. From 1877 to 1881he was a member of the Legislative Council of Tasmania,while from 1886 to 1887 he was Premier and Chief

Secretary. He was also for many years a member of theTasmanian Council of Education. The medical man, evenif he follows no other calling but a purely professionalone, is a most useful member of the body politic, butwhen he takes up politics in addition he is oiten even moreuseful. We have only to mention the names of Fayrer,Rutherford Alcock, John Kirk, James Mackie, and Jameson-despite the error into which the last-named fell with regardto the Transvaal-to tell how the work of empire has beenaided by the toils of medical men. The foundation of ourIndian Empire practically sprang from certain concessionsgranted by the Emperor of Delhi to. Gabmiel Broughton, a