1083 made acquainted with a case of diphtheritic sore-throat, or .even with one which he suspects to be diphtheritic, he should at once give an injection of from 10 to 20 cubic centimetres of anti-diphtheritic serum. This should be done before any attempt is made to verify the diagnosis by taking swabs from the throat and sending them for culture experiments. "Even children who have only come into contact with a case of diphtheria should be injected. Broncho-pneumonia, one of the chief causes of death in diphtheria, can be made much milder by strict attention being paid to antiseptic precau- tions with a view to prevent secondary infections. Oct. 13th. _________________ SWITZERLAND. (FROM OUR OWN CORRESPONDENT.) Tubercuclosis in Switzerland. THE Swiss Society for Statistics held a meeting at Lucerne on Sept. 29th and 30th, which was well attended by members of the society and deputies of various official departments. A number of medical men were attracted by the fact that tuberculosis formed the special subject of dis- cussion. Professor Wyss (Zurich) recommended a thorough investigation in country districts, as tuberculosis was on the increase, or at least stationary, in the country, whilst it had happily diminished in the larger towns. The average number of deaths from this disease for 20 years amounted to 7352, or about 12 per cent. of all deaths. England, Scotland, Norway, Belgium, Italy, and Holland showed better results, whereas Germany, Sweden, Austria-Hungary, and especially Russia had much higher rates of mortality. Dr. Käppeli said that the present methods of combating this dire disease had proved inadequate and only reached a small percentage of the population. He strenuously argued that the etiology of the disease must be the basis of a more efficacious treatment. This inferred combined efforts for better statistical reports. Dr. Hiirlimann pleaded that medical men should unite to promote exact statistics, although Switzerland was so far much ahead of other countries as regarded proper medical reports with regard to the cause of mortality. A form of notification which invited the practitioner to answer some 250 questions (sic) with regard to each patient should be sent to each medical man to fill in. It was, however, considered desirable that these questions should be simplified and that the State should provide funds to remunerate the medical men who undertook all the extra work. The Etiology of Peritonitis. Dr. de Quervain of Chaux-de-Fonds reviews 62 cases of peritonitis due to pneumococci and reports at length on two cases under his own care. In one of his cases the appendix was to be blamed as on removing it five months after laparo- tomy had been performed to evacuate a large collection of pus in the abdomen the appendix, though apparently sound, contained pneumococci. Such cases of peritonitis are often proved to be secondary, the primary seat of infection being the fauces, the lungs, the pleura, the female genital organs, and very often the appendix. It is extremely doubtful whether a primary infection of the peritoneum exists at all, though French surgeons support this theory and indeed classify it under a distinct clinical form. Dr. de Quervain pleads for the removal of the appendix in all cases of perito- nitis where the abscess is situated in the proximity of this organ. Operation.for Cirrhosis of the Liver. Professor Lanz of Bern, who has been appointed as Pro- fessor at the University of Amsterdam, reports on the ’results of operation in cases of cirrhosis of the liver. Drummond in England and Talma in Utrecht almost simultaneously originated this operation for the relief of patients suffering from impeded circulation in the liver. The operation, which has been performed about 60 times with 40 per cent. of good results, consists in performing laparotomy and suturing the omentum to the abdo- minal wall either extra.-peritoneally or intra-peritoneally. Professor Lanz adduces two cases recently operated on. The first refers to a woman, aged 54 years, who had been tapped three times. Each time from two and a half to five gallons of fluid had been evacuated, but in a week the abdomen was generally as distended as ever. The patient seemed in a very precarious state and anaesthetisation had to be conducted with every possible precaution. The operation was performed on March 20th with the best results, so that the patient was discharged after three weeks. There was no return of ascites and in June the medical attendant reported that she felt quite well and considered herself cured. In a second case the patient was greatly relieved though fluid had again collected in the abdomen. It thus seems that the practitioner can with advantage recommend palliative operation. Ziirich, Oct. 6th. ROME. (FROM OUR OWN CORRESPONDENT.) 2’tee Fourth International Congress of Obstetrics and Gynœcology. UNDER the patronage of the King of Italy, who, however, was unable to attend in person, and under the presidency of the Minister of Public Instruction, Signor Nasi, the Fourth International Congress of Obstetrics and Gynaecology was inaugurated at Rome on Sept. 15th in the large hall of the Palace of the Curators on the Capitoline Hill. Signor Nasi’s presidential address, with which the meeting opened and which began with a kindly message of welcome from the King, was partly devoted to a eulogy of the late Professor Porro and the late Professor Virchow and concluded with an appeal for the establishment of maternity hospitals throughout Italy, which at present is behind most other countries in providing such institutions and where so much might thus be done to alleviate the sufferings of motherhood amongst the poorer classes of the people. Signor Palomba, acting syndic of Rome, welcomed the members in the name of the municipality, while Com- mendatore Pasquali, professor of obstetrics in the Uni- versity of Rome, bade them welcome on behalf of the organising committee. A long series of speeches from the representatives of the various nationalities taking part in the congress followed, the speahers succeeding one another in the alphabetical order of heir respective countries. Austria was represented by Chrobak, Belgium by Hennotay, Bulgaria by Slartcheff, France by Pinard, Germany by Hofmeyer, Greece by Balanos, England by Simpson, Holland by Veit, Roumania by Jonnesco, Russia by Rein. Spain by De Castillos de Pineyro, and the United States of America by Engelmann. Each spoke in his own tongue except the Roumanian and Spanish representatives who made fluent use of Italian. The honorary presidents of the sections were then chosen, those selected for England being Simpson, Macnaughton Jones, Horrocks, Purefoy, and Sinclair, while Mann, Engelmann, Kelly, Jewitt, Hirst, Cullen, and Wakefield were nominated for the United States. The attendance of members, over 300, considerably exceeded that of the three previous congresses ; several lady doctors were among them and many of the members were accom- panied by their wives and daughters. The important work of the Congress terminated on Sept. 18th, the three remaining days being devoted chiefly to excursions. Four principal themes had been selected for debate, the leaders being as far as possible recognised authorities upon the subjects treated and of different nationalities. Thus, on the 16th Hirst of Philadelphia, Hofmeyer of Wurzburg, Pinard of Paris, Rein of St. Petersburg, Schauta of Vienna, and Simpson of Edinburgh had undertaken to bring forward the question of the Medical Indications for the Inter- ruption of Pregnancy. On the same day Hyster- ectomy in the Treatment of Puerperal Infection formed the subject of debate, the leaders being Fehling of Strasburg, Leopold of Dresden, Treub of Amsterdam, and Tuffier of Paris. On the 17th Aman of Monaco, Faure of Paris, Martin of Greifswald, and Veit of Leyden discussed Tuberculosis of the Genital Organs. Finally, on the 18th, the Surgical Treatment of Cancer of the Uterus was the theme introduced by Cullen of Baltimore, Freund of Berlin, Jonnesco of Bucharest, Pozzi of Paris, and Wertheim of Vienna for consideration by the congress. The mere enumeration of these distinguished names will serve to indi- cate the truly international character of this meeting and to stamp the high standard of the scientific work which it has accomplished. It will be noted that there were no Italians amongst those charged with the task of opening the debates on the four principal themes, the organising committee having courteously assigned the leading roles exclusively to foreigners, but many distinguished Italian gynæcologists
Transcript
1083
made acquainted with a case of diphtheritic sore-throat, or.even with one which he suspects to be diphtheritic, he shouldat once give an injection of from 10 to 20 cubic centimetresof anti-diphtheritic serum. This should be done before anyattempt is made to verify the diagnosis by taking swabsfrom the throat and sending them for culture experiments."Even children who have only come into contact with a caseof diphtheria should be injected. Broncho-pneumonia, oneof the chief causes of death in diphtheria, can be made muchmilder by strict attention being paid to antiseptic precau-tions with a view to prevent secondary infections.
Oct. 13th. _________________
SWITZERLAND.
(FROM OUR OWN CORRESPONDENT.)
Tubercuclosis in Switzerland.THE Swiss Society for Statistics held a meeting at
Lucerne on Sept. 29th and 30th, which was well attendedby members of the society and deputies of various officialdepartments. A number of medical men were attracted bythe fact that tuberculosis formed the special subject of dis-cussion. Professor Wyss (Zurich) recommended a thoroughinvestigation in country districts, as tuberculosis was on
the increase, or at least stationary, in the country, whilst ithad happily diminished in the larger towns. The averagenumber of deaths from this disease for 20 years amountedto 7352, or about 12 per cent. of all deaths. England,Scotland, Norway, Belgium, Italy, and Holland showedbetter results, whereas Germany, Sweden, Austria-Hungary,and especially Russia had much higher rates of mortality.Dr. Käppeli said that the present methods of combating thisdire disease had proved inadequate and only reached a smallpercentage of the population. He strenuously argued thatthe etiology of the disease must be the basis of a moreefficacious treatment. This inferred combined efforts forbetter statistical reports. Dr. Hiirlimann pleaded thatmedical men should unite to promote exact statistics,although Switzerland was so far much ahead of othercountries as regarded proper medical reports with regardto the cause of mortality. A form of notification whichinvited the practitioner to answer some 250 questions (sic)with regard to each patient should be sent to eachmedical man to fill in. It was, however, considereddesirable that these questions should be simplified andthat the State should provide funds to remunerate themedical men who undertook all the extra work.
The Etiology of Peritonitis.Dr. de Quervain of Chaux-de-Fonds reviews 62 cases of
peritonitis due to pneumococci and reports at length on twocases under his own care. In one of his cases the appendixwas to be blamed as on removing it five months after laparo-tomy had been performed to evacuate a large collection ofpus in the abdomen the appendix, though apparently sound,contained pneumococci. Such cases of peritonitis are oftenproved to be secondary, the primary seat of infection beingthe fauces, the lungs, the pleura, the female genital organs,and very often the appendix. It is extremely doubtfulwhether a primary infection of the peritoneum exists at
all, though French surgeons support this theory and indeedclassify it under a distinct clinical form. Dr. de Quervainpleads for the removal of the appendix in all cases of perito-nitis where the abscess is situated in the proximity of thisorgan.
Operation.for Cirrhosis of the Liver.Professor Lanz of Bern, who has been appointed as Pro-
fessor at the University of Amsterdam, reports on the’results of operation in cases of cirrhosis of the liver.Drummond in England and Talma in Utrecht almostsimultaneously originated this operation for the relief ofpatients suffering from impeded circulation in the liver.The operation, which has been performed about 60 timeswith 40 per cent. of good results, consists in performinglaparotomy and suturing the omentum to the abdo-minal wall either extra.-peritoneally or intra-peritoneally.Professor Lanz adduces two cases recently operated on.
The first refers to a woman, aged 54 years, who had beentapped three times. Each time from two and a half to fivegallons of fluid had been evacuated, but in a week theabdomen was generally as distended as ever. The patientseemed in a very precarious state and anaesthetisation had tobe conducted with every possible precaution. The operation
was performed on March 20th with the best results, so
that the patient was discharged after three weeks. Therewas no return of ascites and in June the medical attendantreported that she felt quite well and considered herselfcured. In a second case the patient was greatly relievedthough fluid had again collected in the abdomen. It thusseems that the practitioner can with advantage recommendpalliative operation.
Ziirich, Oct. 6th.
ROME.
(FROM OUR OWN CORRESPONDENT.)
2’tee Fourth International Congress of Obstetrics andGynœcology.
UNDER the patronage of the King of Italy, who, however,was unable to attend in person, and under the presidency ofthe Minister of Public Instruction, Signor Nasi, the FourthInternational Congress of Obstetrics and Gynaecology wasinaugurated at Rome on Sept. 15th in the large hall of thePalace of the Curators on the Capitoline Hill. Signor Nasi’spresidential address, with which the meeting opened andwhich began with a kindly message of welcome from theKing, was partly devoted to a eulogy of the late ProfessorPorro and the late Professor Virchow and concluded withan appeal for the establishment of maternity hospitalsthroughout Italy, which at present is behind most othercountries in providing such institutions and where so
much might thus be done to alleviate the sufferings ofmotherhood amongst the poorer classes of the people.Signor Palomba, acting syndic of Rome, welcomed themembers in the name of the municipality, while Com-mendatore Pasquali, professor of obstetrics in the Uni-
versity of Rome, bade them welcome on behalf of theorganising committee. A long series of speeches from therepresentatives of the various nationalities taking part inthe congress followed, the speahers succeeding one anotherin the alphabetical order of heir respective countries.Austria was represented by Chrobak, Belgium by Hennotay,Bulgaria by Slartcheff, France by Pinard, Germany byHofmeyer, Greece by Balanos, England by Simpson, Hollandby Veit, Roumania by Jonnesco, Russia by Rein. Spain byDe Castillos de Pineyro, and the United States of Americaby Engelmann. Each spoke in his own tongue exceptthe Roumanian and Spanish representatives who madefluent use of Italian. The honorary presidents ofthe sections were then chosen, those selected for Englandbeing Simpson, Macnaughton Jones, Horrocks, Purefoy, andSinclair, while Mann, Engelmann, Kelly, Jewitt, Hirst,Cullen, and Wakefield were nominated for the United States.The attendance of members, over 300, considerably exceededthat of the three previous congresses ; several lady doctorswere among them and many of the members were accom-panied by their wives and daughters. The important workof the Congress terminated on Sept. 18th, the three remainingdays being devoted chiefly to excursions. Four principalthemes had been selected for debate, the leaders being asfar as possible recognised authorities upon the subjectstreated and of different nationalities. Thus, on the 16thHirst of Philadelphia, Hofmeyer of Wurzburg, Pinard ofParis, Rein of St. Petersburg, Schauta of Vienna, and
Simpson of Edinburgh had undertaken to bring forwardthe question of the Medical Indications for the Inter-
ruption of Pregnancy. On the same day Hyster-ectomy in the Treatment of Puerperal Infection formedthe subject of debate, the leaders being Fehling of
Strasburg, Leopold of Dresden, Treub of Amsterdam, andTuffier of Paris. On the 17th Aman of Monaco, Faure ofParis, Martin of Greifswald, and Veit of Leyden discussedTuberculosis of the Genital Organs. Finally, on the18th, the Surgical Treatment of Cancer of the Uterus wasthe theme introduced by Cullen of Baltimore, Freund ofBerlin, Jonnesco of Bucharest, Pozzi of Paris, and Wertheimof Vienna for consideration by the congress. The mereenumeration of these distinguished names will serve to indi-cate the truly international character of this meeting and tostamp the high standard of the scientific work which it hasaccomplished. It will be noted that there were no Italians
amongst those charged with the task of opening the debateson the four principal themes, the organising committee
having courteously assigned the leading roles exclusively toforeigners, but many distinguished Italian gynæcologists
1084
were present and took part in the discussions, including sucheminent men as Pasquali of Rome, Morisani of Naples,Calderini of Bologna, Tibone of Turin, Pestalozzi of Florence,and Mangiagalli of Milan. Whilst on their way to the
congress a large number of the members had, on the 12thand 13th of the month, visited Salsomaggiore in order toparticipate with over 200 other medical men from all partsof Italy in commemorating Professor Porro, to whoseenthusiastic support that rising watering-place largely owesits great reputation for the treatment of gynaecologicalailments. During its progress the more serious business ofthe Congress was lightened by visits to the Roman Forum,the Palatine Hill, and other places of interest in and aroundRome, as well as by social gatherings in the evenings in the liCapitoline Museum, on the Pincian Hill, &c. The arrange-ments for the public entertainment of the members were inevery way excellent and reflected much credit upon theorganising committee which spared no effort to render thesojourn of the visitors in the Eternal City both interestingand agreeable. The seat of the next International Congressof Obstetrics and Gynaecology will be St. Petersburg.The Ne7v Regulations for the Medical Curriculum in Italian
UniversitiesThe frequently recurring disorderly scenes which ordinary
disciplinary measures were powerless to prevent, togetherwith the repeated protests and representations of studentsand teachers alike as to the inefficiency of the former
regulations, have long since convinced the Superior Councilof Education that extensive changes were called for in thegeneral scheme of medical education in the Italian univer-sities. To frame a new law replacing the old Casatieducation code would have involved too much delay ; theMinister of Public Instruction, has therefore been obligedto content himself with altering and improving existingarrangements in as far as the elastic provisions of the oldlaw would permit. Since the latter was the outcome ofconditions other than those now existing and as various
changes, tending in different directions and not alwaysstrictly legal, had from time to time been made as
the need for them arose, the necessity of a complete revisionand unification of the old regulations had become too
pressing to be longer postponed. Judging by the commentsof the medical press the efforts of the present Minister, ofwhich these new regulations are the outcome, ought to bringsome order out of the old state of chaos and to remove theworst, at any rate, of the defects of the former system.Perhaps the most important of the changes now introducedis the division of the six years’ curriculum into three biennialperiods which will be kept distinct from one another in thesense that no student will be permitted to pass from onebiennium to the next until he has obtained his" grade certi-ficate " testifying to his knowledge of the subjects belongingto the period he has just completed. Formerly the examina-tions were so ill-timed that students were required, for ex-ample, to answer questions upon the pathology of an organbefore they had studied its anatomy or physiology The new
plan, although open to objection as being too artificial, putsan end to much of this confusion and will also tend toeliminate from the classes in the medical faculty theincorrigibly idle and the incompetent students who havehitherto been too numerous. Its gravest defect appears tobe that too many subjects (no less than eight) are crowdedinto the examination for the grade certificate of the lastbiennium. In the first period the student is required toattend courses of (1) organic and inorganic chemistry ;(2) physics ; (3) botany ; (4) zoology and comparativeanatomy of vertebrates and invertebrates ; and (5) humananatomy. Students may enter the second biennium without
passing in anatomy, but this subject must be passed beforethe third year is over. To obtain the grade certificate of thesecond period it is necessary to attend courses of, andto pass examinations in, (1) physiology ; (2) pathologicalanatomy ; (3) general pathology ; (4) special medical
pathology ; (5) special surgical pathology ; and (6) materiamedica (pharmacology and toxicology). For the third periodthe subjects are as follow : (1) medicine ; (2) surgery ; (3)nervous and mental diseases ; (4) ophthalmology ; (5)hygiene and medical police ; (6) legal medicine ; (7)dermatology and syphilopathy ; and (8) obstetrics and
gynæcology. No changes have been made in the actualsubjects of the curriculum except in dissociating hygienefrom legal medicine and pathology from internal medicine,and by the addition of a course in nervous and mental
diseases. Two courses of physics, normal anatomy, physio-logy, and pathological anatomy are obligatory, whilstthree are demanded in medicine and in surgery. A singlecourse only is required in the other subjects. In thosecourses which are continued over one year the professorexamines the student orally on the work done in the
year that ;s passed, signifying his approval or disapproval,but if the result is unfavourable the year still counts tothe student. The biennial examinations are conducted by acommission consisting of not less than three professors ofthe subjects included in the examination (or of allied
subjects) and of two liberi docente engaged in teachingsuch subjects and must be of 20 minutes’ duration for eachsubject. Before he can be admitted to the final examinationor esame di laurca the candidate for a degree must havepassed in at least 21 subjects, two of which he is free tochoose from almost any of those taught either in the medicalor any other faculty, or even in another school. The methodof conducting the esame di laurea has already been
fully described in a former letter, and for Italian studentsthe regulations which obtained when that was writtenstill hold good subject to certain modifications. Butfor foreign graduates who desire to be admitted to thatexamination a complete change has been effected, as I thenventured to predict would be the case. Such candidates, ifthey have obtained their degree in a foreign university ofgreat repute, may be admitted to the Zaurea examinationin accordance with the provisions of Article 128 of the Ordi-nance of Nov. 15th, 1859, which, though nominally in forcefor all candidates, had reallv become a dead letter and isnow resuscitated only to render thorny the path of foreignaspirants after an Italian degree. As a result of this and ofthe new regulations the foreign candidate, in order to gainadmission to the esame di laurea, must not only pay the fees ofthe six years’ curriculum but he must pass in all the subjectsincluded in it in which he had not been specially examinedwhen taking his foreign degree and in addition he mustbe prepared to submit to a written examination lastingnot less than eight hours upon any one of the longlist of subjects belonging to the second biennium. As thechoice of the particular subject must be made by lot thefield over which the examination may range is a wide one,including as it does physiology, pathological anatomy,medical and surgical pathology, and materia medica. How-ever disappointing this change may be to those foreignerswho desire to obtain the laurea of an Italian university,it cannot be said to be unreasonable or unfair, consideringhow stringent are the regulations of nearly all other uni-versities in this matter of granting degrees to foreigngraduates. Nor is it just to speak of the change thusintroduced as restricting the privileges accorded in Italyto foreign practitioners and as a breach of the reciprocityarrangement with regard to medical practice which nowexists between Great Britain and Italy. No change whateverhas been made in the law regulating foreign practice in Italy,nor is it likely that the Italian Government will consent toany such change, since there is no general desire for it andanything in the nature of further restriction would certainlybe resented by the British Government and probably leadto the withdrawal of the Order in Council under whichItalian medical graduates are now enabled to enter theirnames upon the British Medical Register.
Oct. llth. ___
EGYPT.(FROM OUR OWN CORRESPONDENT.)
Tornaer Epidemics of Cholera.THE preceding epidemics of cholera in Egypt hav&
behaved so uniformly as regards their seasons of outbreakand disappearance that a short account of them will showwhy one is justified in prophesying the end of the presentinvasion. In 1831, when cholera first broke out in Egypt,it was brought by bands of pilgrims returning fromArabia to Suez. It reached Cairo in July, spread up theNile as far as Luxor, and lasted till the end of October,the official deaths from cholera alone in Cairo beingreckoned at 36,000, while Dr. R. Graves in his clinicallectures says that Egypt as a whole lost 150,000victims. In 1848 cholera existed in Egypt from June tillthe end of October, killing about 20,000’people. In 1850
