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One speaker said that the solution of the question was to befound not so much in the treatment of the vagrant as in thediscovery how to educate the public not to encourage theselazy wanderers. So long as the public would give food andmoney so long would the tramp flourish. An illustration ofthe manner in which disease may be spread was given fromStow-on-the-Wold where a tramp was discovered to have

small-pox. There was no isolation hospital in the union andtemporary accommodation had to be provided, the cost ofwhich with medical attendance and nursing amounted to220. As a commentary upon this costly experience therecent action of the Monmouth board of guardians may becited. For several months past the public vaccinator (Mr.T. G. Prosser) has by instruction of the board vaccinated orrevaccinated tramps who have passed through the Monmouthworkhouse but as the fees during the last six monthsamounted to £20 the guardians have decided to discontinuethe practice.

Asylum Maintenance Charges.The weekly charge per head made to the various Poor-law

unions for the maintenance of patients in the Hereford Cityand County Asylum is now 9s. 71/2. and in the SomersetshireAsylum the charge is 9s. 4d. per head.

Plymouth Public Dispensary.The annual meeting of the subscribers to this institution

was held on Oct. 21st under the presidency of Mr. H. Lopes.The medical report stated that 3881 patients were treatedduring 1902, as compared with 3922 in the previous year ;765 of these were attended at their homes. The financialstatement showed that the receipts amounted to £1024 andthe expenditure to £1023. During the year Sir MasseyLopes had given £500 towards the endowment fund. The

gross receipts of the provident department during the yearamounted to £104, as against £114 in the previous year. Itwas decided on the recommendation of the committee toappoint an honorary gynæcologist to the dispensary.

Oct. 27th. _______________

SCOTLAND.(FROM OUR OWN CORRESPONDENTS.)

The Edinburgh New Fever Hospital.LAST week it was noted that the new fever hospital at

Colinton Mains had been open for public inspection. It hasnow begun to be occupied. Fresh cases of scarlet feverhave been admitted into it and also pasents convalescentfrom scarlet fever from the old hospital in Infirmary-street.No new cases of scarlet fever are to be received into the oldbuilding but cases of diphtheria and typhoid fever are stillto be received there. It is, however, anticipated that inthe course of six weeks or so the transference to the newhospital will be complete. There are at present 366patients suffering from infectious disease in the hands ofthe public health authorities.

Epidemic of Scarlet Fever in Edinburgh.Scarlet fever has assumed moderate epidemic dimensions

in Edinburgh, this being a period of the year when it is likelyto do so. In July there were 96 notifications of its presence ;in August these had risen to 123 and in September to 143During the month of September there were, in addition toscarlet fever, 60 notifications of diphtheria and 26 of

erysipelas. During the same month 128 of the cases ofscarlet fever were admitted into hospital and 46 of the casesof diphtheria.

Infant Milk Ilepots.The subcommittee (of the health committee) on infantile

mortality and the milk-supply of the city of Glasgow, aftervisiting the municipal depots in Battersea, Liverpool, StHelen’s, and Bradford, has submitted a report containingcertain definite conclusions which are as follows. Infantilemortality has a definite relationship to (1) the feeding ofinfants ; (2) personal care of infants by parents ; and (3)housing accommodation. Other elements enter into the

problem but so far as municipal action is concerned theseare the three main elements. It is clear that housingschemes, unless associated with efforts calculated to meetdifficulties arising out of the first two conditions, willbe disappointing in reducing infantile mortality. Further,it is believed that if the local authorities can succeedin raising the quality, as regards purity, of the milk on

which infants are fed they will at the same time educateand improve the sense of duty towards their infants on thepart of parents. The mischief lies in polluted milk. Thesources of the pollution are not only in unsatisfactorymethods of milking and in storing and conveying themilk supplied but also very largely in dirty domesticconditions and particularly in carelessness in the use

of feeding bottles. To attack successfully by municipaladministration all the sources of pollution is at presentimpossible but the ideal of health administration is a

pure milk-supply which needs no sterilisation and towardsthat end all efforts should be directed. Meanwhile the betthat can be done under existing conditions involves sterilisa.tion of the milk. The subcommittee therefore recommendsthat the corporation should agree to the principle of supply-ing milk for infant feeding in poor localities. This involves(1) the setting up of an establishment for the preparation ofthe milk supplied, modified and sterilised according to re-quirements, and (2) depots for the sale of the milk unlesssupplied through milk-dealers to whom an allowance forretailers’ profit would require to be made. It is suggestedthat the experiment should be made in three or four of the

districts where the infantile mortality is high. The price atwhich the milk could be sold consistent with reaching thepoorest would be no more than is at present paid for ordinarymilk, and in any case, even were it necessary, a small chargeupon the health-rate would be justified by the result. Thehealth committee has accepted the report and has recom-mended that it should be adopted by the corporation andthat the health committee should be empowered to carry thebusiness through.

The Clyde Port Sanitary Authority.The special subcommittee of the Glasgow corporation, the

members of which visited several seaport towns in Englandand ascertained the procedure followed out in these places,has issued its report in which it recommends-1. The medical officer of health to be the chief medical officer of the

port and responsible to the port authority in every matter and way inwhich he is now responsible under the Acts and regulations made bythe corporation of the city for the proper discharge of his duties asmedical officer of health for the city.

2. The chief sanitary inspector to be the chief sanitary inspector ofthe port and responsible to the port authority in every matter and wayin which he is now responsible under the Acts and regulations made bythe corporation of the city for the proper discharge of his duties assanitary inspector for the city.

3. The clerk of police to be clerk to, and law adviser of, the port localauthority, to issue statutory notices when required, carry on anynegotiations or correspondence arising out of questions of detention ofvessels, damage to, or destruction of, cargo, or any other claim or

matter arising out of the operations on board infected vessels, and toact as agent for the port authority in any court proceedings which maybe found necessary.

Small-pox in Glasgow.There has been an outbreak of small-pox again in Glasgow.

On Oct. 16th there were six cases and on Oct. 23rd 21cases. The outbreak originated from a labourer who onSept. 12th travelled by train to Glasgow, staying that andthe following night at one of the model lodging houses.Thereafter he went to another model lodging.houbewhere he sickened and where subsequently six cases

occurred among persons sleeping in the same dormitory.No fresh cases supervened until Oct. 20th when a seriesbegan to appear in the model lodging-house in which theman slept first. All the cases which have occurred up to thepresent have been traced to the same source. Summarymeasures have been taken throughout ; these have con-

sisted in the immediate removal of all cases to the hospital,thorough disinfection, and revaccination. No new inmateshave been admitted into either of the lodging houses wherethe cases occurred unless ’they had been recently revac-einated or submitted themselves to revaccination.

Aberdeen University Medical Society.The opening lecture on Medical Ethics was delivered on

Oct. 23rd by Dr. Angus Fraser to a very large audience.Professor J. T. Cash presided and in introc:ucing the lecturerreferred to the eminent position held by him in the medicalprofession and to his special fitness for delivering such anaddress. Dr. Fraser referred to the necessity of youngpractitioners at the beginning of their professional careerhaving some definite knowledge of the relations whichshould guide their intercourse with other medical men andwith their patients. Medical men ought to "do to others asthey would that others should do to them "-e.g., a medicalman was not entitled to take over a patient to whom hehad been introduced while acting as a substitute or as a

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consultant, not even for a different or a subsequent illnessunless in special circumstances. In a small town it wasmore difficult to stick to that rule, but the practitioner oughtto inform the recent medical attendant of his being called inand, as a general rule, also to tell the patient to pay any feedue to the former physician. This engendered friendlyfeeling which was usually reciprocated. On no account oughtone medical man to call in question the treatment adoptedby another to any patient-if he thought previous treat-ment should be changed then let him do so without drawingany special attention. With regard to patients he advisedthe medical man to " possess himself of an irresistible,indestructible optimism." If there were any serious case

he might tell a relative in the event of death and futurerecriminations. He strongly advocated the great benefit tobe derived by a newly fledged medical man in taking ahouse surgeonship in any general hospital for a short periodor, failing tbat, he recommended an assistantship under anexperienced practitioner. He then gave several useful hintsas to the best way to begin practice for oneself, particularlyreferring to the bogus concerns where a medical man workedup a practice, more or less non-paying, in a few years andthen offered it for sale preparatory to shifting to pasturesnew and repeating the dodge. At the close of the addressa vote of thanks to the lecturer was proposed by Mr. JamesClark and a similar compliment to the chairman was movedby Dr. Fraser, both of which were heartily accorded.

Oct. 27th.

IRELAND.

(FROM OUR OWN CORRESPONDENTS.)

Irish Poor-law Medical Service.

AT the meeting of the Cookstown board of guardians onOct. 24th it was decided after a long discussion to increaseDr. C. H. P. D. Graves’s salary from E50 to £90. Dr Gravesis medical officer of the union infirmary and fever hospitaland this increase simply brings his pay up to that of his

predecessor and it is only after 15 years’ service that thesalary has been brought up to what it formerly was. I am

glad to report that this has been done but sorry to note thatone of the guardians who supported the increase said he didso all the more heartily as Dr. Graves had not joined theIrish Medical Association which is battling so hard to

improve the wretched position of the Poor-law medicalofficers. At the (’aille meeting Mr. H. Harris’s applicationas medical officer of Stewart&town for more than 20 years foran increase of salary was not only refused but his letter wastreated with great contempt, being marked "read." Hiswork has greatly increased as medical officer to the ruraldistrict council and, as he stated in his letter of application,"his salary would not pay cab hire." The ways of theguardians are at present peculiar.Annual Dinner of the Cork Medical and S2crg’eal Society.The annual dinner of the Cork Medical and Surgical

Society wac held on Oct. 24th. There were about 40 personspresent, including several guests. The chair was occupied bythe President, Dr J. Cotter. The toasts were "The King," "The Cork Medical School," "Our Guests," and "TheOfficers of the Society." Professor J. J. Charles and Pro-fessor W. E A. Cummins replied to the toa,t of the CorkMedical School. Professor Charles referred to the numerousimportant posts occupied by past students of the Queen’sCollege and the desirability of maintaining the medicalschool at its present high standard. "Our Guests" was re

sponded to by Sir Abraham Sutton, high sheriff, and Mr. 0. CCowan, chief engineering inspector to the Local GovernmentBoard. The high sheriff referred to the rumoured proposedsettlement of the University question and commented on theloss it would be to the people of Cork if the medical schoolwere swept away as the result of any political manoeuvring.Mr. Cowan expressed his admiration for the medical pro-fession and his sympathy with the grievances of the Poor-lawmedical officers but pointed out that unjust odium hadattached to the Local Government Board, as its action is

necessarily limited by the amount of the funds received fromthe Treasury. A nun ber of songs contributed to the pleasureof the evening and the proceedings did not terminate till alate hour.

Oct. 27th.

PARIS.(FROM OUR OWN CORRESPONDENT.)

The Remuneration of Assistants at Surgical Operations.IN general the remuneration of medical men who act as.

assistants at surgical operations is very small in comparisonwith that of the operator himself, but this seldom leads todisputes because in most cases the surgeon brings men who-have studied under him. Exceptions, however, sometimes.occur and an important judgment has just been deliveredon this subject deciding that the surgeon is not to have the-only voice in the matter. This judgment is founded on thefollowing considerations. When the medi. al man who-acted as assistant has only been engaged on work of anordinary character such as does not require the possessionof a dioloma, and might in fact have been done by almostanybody, then it is reasonable that the surgeon should decidehow much shall be paid and that his decision shall befinal, but the case is different when the assistanceswas indispensable to the success of the operation andwas such as only a medical man could give. In thesecircumstances the courts may intervene if the surgeon andthe assistant required by him cannot come to an under-

standing. In the case which led up to the decision justmentioned the surgeon had charged the patient an inclusivesum to cover both his own fees and those of his assistant.The surgeon’s own feea were calcu’ated on the basis of the.-

patients’ presumed standing, the difficulty of the operations,and the standing of the operator ; the fees of the assistantwere calculated in the same way, regard being had to the-relative positions of the surgeon who operated and of theassistant who adminitered chloroform. The court orderedthe surgeon to pay his assistant the sum of 70 francs(£10 16s.), considering that the latter w8s a practitioner ofrepute and that he had evidently been selected on the groundof his admitted experience.

The Causes and Treatment of Rhewnbatism.At a recent meeting of the Academy of Science M. Pénière-

discussed chis question. He reminded the meeting that the-researches of Bouchard had shown that ordinary healthyurine contains toxins and still more tha<i which is in a.

pathological condition. These poisons are eliminated with-out danger to the health of the body through the action ofthe epithelium which lines the urinary passages. This layerof epithelium forms a fragile barrier but one which isquite sufficient against the absorption of these products.If, however, this protective layer is injured in any wayabsorption of the poison takes place into the generalcirculation. It is this which produces rheumatism. The

product which is reabsorbed is a ferment analogous to, ifnot identical with, the fibrin ferment studied by Schmidtand A. Gautier. The epithelium lining the ureter is thatwhich is particularly concerned in the absorption ; viscera]congestion provoked by cold or damp, erosion brought aboutby ca’culi or the passage through the ureter Of toxic sub-stances, wounds of the surrounding tissue, straining, andpressure brought about by the intestines or by the psoasmuscle may all cause a desquamative ureteritis which is aforerunner of rheumatism. This desquamation manifestsitself at the beginning of an attack of rheumatism by a,

high-coloured urine. As regards therapeutics in rheumatismit is necessary in accordance with this pathogenic view torestore the epithelium of the ureter and to destroy or elseto neutra’ise the ferments. Some antiseptic must thereforebe S 1ught for by which the ureter can be freely irrigatedwithout inconveniencing the stomach, the kidneys, or the

general health. M. Peniere generally uses a combination ofvarious resins, among which is that obtained from cubebs.

Sleeping S2ekness.On Oct 20th M. Blanchard showed to the Academy of

Medicine three negroes suffering from this strange diseasewhich on the African continent is the cause of a highermortality than either plague or cholera. These three negroeshad been brought from the Congo by M. Brumpt who is theassistant of M. Blanchard. At Brazzaville M. Brumpt hadseen 38 cases of this disease. The unfortunate sufferersfrom it fall little by little into a state of sleep and atthe end of a longer or shorter period die. The three

patients exhibited to the Academy of Medicine showedoscillations of the head and erratic movements of the eyesand had a very peculiar air of stupidity and heaviness.