1151

stillbirths, the early age of the mother at marriage, theurban conditions of life, domestic insanitation, housing con-ditions, and the ignorance and carelessness of mothers. In

many north country towns, among the insanitary con-

ditions which are said to increase the number of deaths

among young children there is usually included the

presence of privy middens or of the accumulationon household premises of house refuse. It is interestingto learn from Dr. Jenkins that water-carriage is practi-cally universal in the Rhondda urban district, for nearly27,000 houses are provided with water-closets, and at only146 houses are there privy middens or pail closets. Fixed

ashpits are also non-existent, for there is a daily removal ofall household refuse, the collection being completed before1 P.M. each day. The ultimate destination of this refuse is,however, not at all satisfactory. For about ten years anduntil two years ago a small destructor was in use, but itdealt with quite an inappreciable quantity of the refusecollected, and the greater part was deposited on hugetips in various parts of the district. With the largeamount of building that has been going on there hasbeen an increasing difficulty in obtaining sites for this

deposit, and dwellings have crept nearer and nearer

to the existing tips. There is now to be erected atPorth a modern destructor capable of dealing withabout 82 tons of refuse daily, or about one-third of thetotal amount produced in the whole district. The heatderived from the use of the destructor is to be used by theElectric Power Distribution Company, and if Dr. Jenkins’sadvice is carried out it will also be available for a steamdisinfector to supplement that at the isolation hospital somefive miles distant. Among other recommendations made byDr. Jenkins are the erection of municipal slaughter-houses ;the application of provisions contained in the special Actsof Parliament of the district for the control of the milk-

supply, with special reference to the spread of infectiousdisease; and the acquisition of plots of land situated inlocalities at present unprovided for and suitable for purposesof recreation.Oct. 14th.

_________________

SCOTLAND.(FROM OUR OWN CORRESPONDENTS.)

Edinburgh University : the New Cltair of Bacteriology.Professor James Ritchie delivered his inaugural lecture in

the McEwan Hall on Oct. 7th, in the presence of a largegathering of students and of the public. Principal SirWilliam Turner presided, and was accompanied on theplatform by a number of professors and lecturers. ProfessorRitchie took as his subject the Place of Bacteriology amongthe Sciences.

Olinical Instr2cetion in Edinburgh Royal Infrmzary.Sir Thomas Fraser, in his opening address to the combined

classes of clinical medicine at the Royal Infirmary, which isreported in another column, outlined the new scheme whichis now adopted, and which has already been described inTHE LANCET. A successor to Professor Greenfield has notyet been appointed, but the joint committee of the Uni-

versity Court and the infirmary managers met on Oct. llthto recommend a leet of two to the University Court, in orderthat one of them may be appointed to the Moncrief[ Arnottchair of Clinical Medicine. It is understood that the com-mittee selected from the list of applicants for the new chairDr. William Russell and Dr. Graham Brown. These nameswill be submitted to the University Court, which will makethe appointment.

Scarlet Fever Outbreak in Edinburgh.There has recently been a considerable outbreak of scarlet

fever in the city, with the result that between 20 and 30cases are under treatment at the city fever hospital. The

public health office, acting with commendable celerity, atonce traced the milk-supply of the sufferers to its source,with the result that the origin of the disease was discovered,and risk of an epidemic almost certainly averted.

Queen Mary’s Nursing Home for Patients of Limited Means,Edinburgh.

The new nursing home, Chalmers-street, Edinburgh,recently opened by Lord Balfour of Burleigh, is in-tended to bridge the gap between the supply of

nursing accommodation and treatment provided for the

poorer class in the hospitals and that for the well-to-do

given in expensive private homes. It is an extensionof a pioneer institution in Rutland-square. At a publicmeeting in Edinburgh in 1911, under the chairmanship ofSir Robert Usher, Bart., a committee was formed, with LordDunedin as chairman, Professor Lodge, chairman of executive,and Dr. D. Chalmers Watson, the initiator, as honorary secre-tary, to appeal for the sum of 13,500 to defray the cost ofbuilding and furnishing, when the home, at the moderatefees it was intended to charge patients, could be made self-supporting. Of that sum over f.13,000 have been raised.Three continuous villa residences were purchased in Chalmers-street, and under the supervision of Mr. T. Duncan Rhind,A. R. 1. B. A., the intericu:s were reconstructed to fit them fortheir new purpose. All coriaices and skirting have beeneliminated to reduce the lodgment of dust to a’minimum.The home, available for both sexes and either medical or

surgical treatment, contains about 50 beds ; two wards eachof 8 beds; five of 3 beds; one of 2 beds ; twelve privaterooms with 1 bed ; and a children’s nursery, 4 beds. The

charges range from <E1 Is. to f.3 3s. per week for main-tenance and nursing, the patients also being responsible for thedoctor’s fee. Her Majesty the Queen, in becoming a Patron,has given permission for the Home to be called by her name.The doors of all rooms have been made wide enough toallow a bed to be easily passed in and out. There are twofirst-class operating theatres, lighted from the east side andfrom the roof. The floor and the walls (to the height of4 feet) are in green and white Terrazzo marble ; the upperwalls in cement, plaster enamelled. Between the twotheatres is a sterilising room. Opening off the hall thatconducts to the operating theatres is an anuesihetio-roomwith side folding doors ; there is a store for sterilisedinstruments. In the basement is a room fitted up withX rays, with a dark room, and a doctor’s room adjoining.The nursing staff consists of 16, and the domestic staff of7, with a porter. The matron and chief officials have beentransferred from the Rutland Nursing Home, now incor-porated in the new Home.

Free Blood Examinations in Glasgow.Provision has been made in the Public Health Laboratory

of Glasgow for carrying out free of charge to medical menthe Wassermann reaction and other tests mentioned in theresolution of the corporation of April 17th. The requisiteequipment for collecting the sample to be examined will besupplied on application by medical men, and this should bereturned to the medical officer of health with the information

requested in the schedule accompanying the equipment.The name of the patient need not be given, but the age,sex, and occupation, together with the leading symptomspresent, and the name of the ward of the city in whichthe patient resides, must be stated. The test should behad recourse to only where external manifestations of specificdisease are absent and the symptoms otherwise obscure. Afee of 2s. 6d. will be paid for each sample of blood forwardedfor examination.

Diphtheria in Aberdeen.The number of cases of diphtheria notified last week in

Aberdeen was 92 up to Friday morning. For the same periodin the previous week only 60 cases were notified. The casescontinue for the most part to be mild, there having been veryfew deaths so far. Not only is there no sign of abatement ofthe epidemic, but the number of children affected increasesdaily. The school water is still cut off, and on the advice ofthe medical officer of health the children are urged to

gargle with a disinfectant three times a day. The teachersare also endeavouring to keep articles such as pen, pencils,&c., from circulating in the classes.

Typltoid Fever in Aberdeen.The report of Dr. Matthew Hay, medical officer of health,

on the typhoid outbreak which occurred in Aberdeen last yearhas now been laid before the public health committee of theAberdeen town council. The report is divided into four

parts, the first part dealing with the previous history oftyphoid fever in Aberdeen, the second part dealing with lastyear’s outbreak, the third with paratyphoid cases, and thefourth giving additional information regarding the personsattacked in the outbreak of typhoid and paratyphoid. With

regard to the outbreak in 1912, the report states that

1152

suddenly in the course of October, 1912-after the notifica-tion of only 15 cases (including four cases from a foreignship) in the whole of the preceding nine months, most, ifnot, all of which had been traced to their sources-54 casesof typhoid (including paratyphoid) were notified or dis-covered, followed by 43 in November and by eightin December. Only once in the preceding 25 years hadthe number of cases in any one month exceeded thenumbers in October and November, 1912. This was in

December, 1898, when there were 61 cases. In the pre-ceding months of that year, September, October, andNovember, the numbers were 30, 20, and 30 respectively, andin the immediately succeeding month of January, 1899,there were 32 cases, making in all 173 cases in five months.In the two months preceding the outbreak of 1898 thenumbers were 5 and 6 respectively, and in the whole first

eight months of the year only 38 cases were notified. Thetwo outbreaks, therefore, bear some resemblance to eachother. The earlier outbreak Dr. Matthew Hay believes tohave originated in milk infection. The report goes on todescribe how the search for possible sources of infection ofthe 1912 outbreak led to a creamery, and on from there toa farm-the only one-which sent part of its milk to thecreamery and part into Aberdeen.Oct 14th.

________________

IRELAND.(FROM OUR OWN CORRESPONDENTS.)

The Laboicr Trouble in Dublin.THE labour dispute in Dublin carmot fail to have

important effects upon the state of the public health shouldits settlement be long postponed. Up to the present, thoughall social workers admit that distress is keen and widespread,there has not been any marked increase of disease, at anyrate among adults. There is not any unusual pressure on

hospital accommodation, at any rate since the attacks onthe police and the consequent retaliations in the early daysof the dispute. Among infants there has been an exces-sively high mortality during the past few weeks, which,though due primarily to the prolonged dry summer; musthave been accentuated by the present distress. Many reliefagencies are doing useful work among those out of employ-ment. On each of the last three Saturdays a relief shiploaded with supplies of household provisions has arrived inthe river from Manchester. In addition, provisions are

dispensed at Liberty Hall, as the headquarters of the IrishTransport Workers’ Union are called. It is natural that the

system of distribution has not been perfect, and abuses havearisen. Some of the supplies of food have been sold by therecipients, and the money spent in the purchase of drink.On the whole, however, there is little doubt that the supplieshave reached those for whom they were intended. A relieffund for women and children only has been organised bythe Lady Mayoress and a committee of ladies, andhas reached some .S500 or .E600, in spite of a somewhatchilling reception by the daily press, which, havingtaken a definite stand against the workers, appears to

regard assistance given in any form to those in distressarising out of the dispute as a subsidy to one of the parties.The Lady Mayoress’s committee spends mest of its funds in

supplying free meals in the schools, and has enlisted thecordial help of the teachers, many of whom are members ofreligious communities. The sisters who visit the poor intheir homes also undertake to distribute assistance in needycases, and the cooperation of the Jubilee nurses has beenfreely given. In the early days of the dispute some anxietywas felt by hospitals and other institutions, as well as byprivate consumers, as to their coal supplies. At present,however, the coal merchants are meeting all orders. Morerecently some inconvenience has been experienced withregard to the delivery of other goods. In particular, therehas been a scarcity of nitrous oxide gas on a few occasions,and the dealers can never be confident of having a supplyin hand.

Excessire Claims for Sickness Benefit.The Irish Insurance Commission has recently appointed a

committee of inquiry for the following purposes : (a) "Toinvestigate the question of excessive claims for sicknessbenefit and of the safeguards to be taken to prevent insured

persons from receiving sickness benefit unless they are

properly entitled thereto : and (b) to formulate and submitto the Commission a scheme for the distribution of theincreased Exchequer grant-in-aid of .c91,00O which it is pro-posed to ask Parliament to grant next year towards the costof medical certificates and other expenses of administrationowing to the absence in Ireland of medical benefit underthe National Insurance Act, 1911." " The committee is totake evidence on the various points of the terms of refer-ence, and will hold sittings in certain convenient centres.Help is asked from the Approved Societies, the InsuranceCommittees, and the Local Medical Committees. It would

appear that complaints have been made by the officials of

Approved Societies that excessive claims were being madefor sickness benefit. This is no doubt true, but it is equallytrue that many persons entitled to sickness benefit havebeen denied it, particularly in the case of one society.Frauds on both sides are bound to be frequent as long as noarrangement exists for obtaining the evidence of the medicalpractitioner in attendance on the claimant. Up to the

present societies have refused to exercise their powerswith regard to paying for such evidence, leaving theonus of obtaining it on the insured person. They have insome instances refused to recognise any medical certificateother than those of their own medical advisers. TheInsurance Commissioners have rendered confusion worse

by appointing a number of official medical adviserswhose only duty in regard to sickness benefit is to detectmalingering. Their competence for this task has not madeitself apparent, while except in Dublin and one or two

populous areas, geographical considerations render theminaccessible. Their appointment has met with oppositionfrom the medical profession, the members of which refuse tocooperate with them in any professional way.

Assistant Tuberculosis Officer in County Galivay.At a meeting of the County Galway Medical Committee

on Oct. 10th the following resolution was unanimouslyadopted :-That the County Galway Medical Committee has objected to the

appointment of assistant tuberculosis officers in the county for theseamong other reasons: the Prevention of Tuberculosis (Ireland) Act andthe sanatorium benefit clauses of the Insurance Act have now been inoperation for two and a half years in this county. The majority of thepeople in the rural districts who suffer from tuberculosis are not insuredpersons. Up to this we have seen no steps taken to give efficient treat-ments to these poor people, for we cannot regard the appointment ofmedical advisers or assistant tuberculosis officers as being of adequateassistance to meet the exigences of the case.

1lfalingeriag under the National Insurance Act.At a meeting of the Irish Medical Committee held in

Dublin on Oct. 7th it was decided to advise all LocalMedical Committees to act in reference to the inquiry pro-posed to be held by the Irish Insurance Commissionersthrough the central body-the Irish Medical Committee.The matter came before the Belfast Medical Committee onOct. 10th, when it was decided to reply to the Com-missioners’ letter asking members of the Belfast MedicalCommittee to give evidence before an inquiry to be held intothe question of undue sickness under the Insurance Act, andalso as to the best way to allocate money that it is supposedwill be voted next session, that the time was far too shortto prepare a report on a matter requiring such careful con-sideration. The feeling was that the Commissioners shouldapproach first the Irish Medical Committee on such matters.It was also arranged to appoint a subcommittee to prepareevidence for subsequent use if required.

Oct. 14th. ________________

PARIS.

(FROM OUR OWN CORRESPONDENT.)

A -zVe7v Vaccine for GonorrAva.AT the Acad&eacute;mie des Sciences, on Oct. 6th, M. Laveran

presented the discovery of a vaccine for gonorrhceal infectionby Dr. Charles Nicolle, director of the Institut Pasteur atTunis. Dr. Nicolle, to whom already we owe many valuableresearches on cholera, trachoma, whooping-cough, andtyphus, has been working for more than a year at the vaccinetreatment of gonorrhcea. He has prepared a vaccine frommicrococci killed by a special procedure, of which he hasnot yet published the technique. He prefers, he says, to