854 WALES. -SCOTLAND.

cicatrix begins to shrink, by treatment with diathermy andhigh-frequency currents and with massage, hot baths, andfibrolysin.

Dr. HIRSCH (Berlin) read a paper onWoman’s TVork and lYo-natcn’s Diseases.

He said that economic development in Germany and othercivilised countries obliges an ever-increasing proportion ofthe female population to do industrial work. Thislabour is very injurious to the health of women, first onaccount of the conditions of life which are generally veryunfavourable, but more in consequence of the specificdiseases associated with industrial activities. The genitalorgans of working women are implicated indirectly by organicand constitutional injuries and directly by industrial diseases.The consequences of feminine work are manifested both in

gynaecological diseases and in an increase of miscarriages andpremature births and of troubles in pregnancy, birth, andpuerperium. An ample legislation for protecting workwomenmust be demanded in which the first place must be given tofactory-hygienic protective measures and to the protection ofmaternity. The preliminary condition is the study of thepathology of feminine industrial diseases, and in this thegynaecologist must take an active part.

OtAer Papers.Dr. STROGANOFF (St. Petersburg) read a paper on the

Theoretical Foundation of the Prophylactic Method of theTreatment of Eclampsia, in which he advocated his well-known conservative treatment of this disease.On the Roentgen rays in obstetrics and gynaecology Dr.

HEYNEMANN, Dr. IMMELMANN, Dr. MANFRED FRAENKEL, Dr.KROENIG, and others spoke. Some of these highly advocatedthe use of the X rays for treatment of myomata.At the close the PRESIDENT addressed the meeting

and thanked the members for coming to Berlin and

contributing to the success of the Congress. ProfessorPESTALOZZA expressed the appreciation of the Italian

members, and Dr. MACNAUGHTON-JONES proposed the voteof thanks to Privat-docent E. Martin, the secretary-general.As the meeting place of the next congress in 1915 America ’,

was chosen.

WALES.

(FROM OUR OWN CORRESPONDENT.)

Seheme for Dealing with the Feeble-minded.MANY of the boards of guardians in South Wales have e

shown commendable zeal in providing for those under theircare accommodation and treatment in accordance with

present-day views. In the Pontypridd union, for example,which contains a population of nearly 300,000 persons andwhich includes the two Rhondda valleys, there have in recentyears been established homes for children, an institution forold people, and a separate sick infirmary. The question ofdealing with the feeble-minded has lately been under theconsideration of a joint committee representing the unions ofBridgend, Gower, Neath, Pontardawe, Pontypridd, MerthyrTydvil, and Swansea, which are concerned with an aggregatepopulation of 866,000 persons and in which the assessablevalue is over £3,500,000. The result of the committee’sdeliberations has crystallised into a proposal to estab-lish institutions to accommodate 85 children, 145 maleadults, and 212 female adults. To that for the children asmall school would be attached where the younger childrencould be taught according to their capacity, and usefulknowledge imparted to the elder children. The main institu-tion would be built on the pavilion system, and give accom-modation to about 200 adult persons, and there would be inaddition five separate homes each to accommodate 40 to 50persons, who would be received in them for the purpose ofclassification. It is proposed that about 100 acres of goodfarm land should provide the site of these buildings, so thatwork might be found for those who are capable of doing any.The cost of the whole scheme is estimated at about L60,000,which it is intended should be borne, together with theadministrative expenses, by each union in proportion to therespective assessable values.

School Clinics for Monmouthshire.One of the earliest school clinics to be established in this

country was that in the urban district of Abertillery, Mon-mouthshire, which is under the care of the school medicalofficer, Dr. A. E. Remmett Weaver. The local educationauthority of Monmouthshire has now agreed to the principleof establishing other clinics at an estimated capital cost of.Ell,000 and an annual expenditure of E2000. The countyschool medical officer, Dr. A. Rocyn Jones, recommends thatthe headquarters should be at Newport, with subsidiaryclinics at Abergavenny, Blaina, Blaenavon, Chepstow, CrossKeys, Maesycymmer, Monmouth, Newbridge, Pontllanfraith,Pontypool, Rhymney, Usk, and Tredegar. In the firstinstance it is proposed to appoint two whole-time dentists,a whole-time ophthalmic surgeon, and four nurses, and itis hoped that arrangements may be made with the WelshNational Memorial to share the waiting-rooms and consulting-rooms in connexion with the tuberculosis scheme.

Swansea Hospital Staff and the National Insurance Act.The board of management of the Swansea Hospital, of

which Dr. E. Le Cronier Lancaster is the chairman, has con-sidered at a meeting specially called for the purpose a com-munication from the honorary medical staff stating that allthe members of the staff with one exception had subscribedtheir names to the pledge of the British Medical Association,and that after that portion of the National Insurance Actreferring to medical benefits comes into operation and untilthe terms and conditions of administering those benefitshave been approved by the profession they would not,except in cases of urgent necessity, render professionalservice to an insured person through the service of

any voluntary medical charity or cooperate with anymember of the profession who is under contract to renderservice to insured persons upon terms which are not

approved by the profession. Dr. Lancaster was careful tomake it clear that there was no quarrel between the staff andthe board of management-indeed, he rightly said that therelations between the medical staff and the controllingauthority had always been of the most cordial character.He added, however, that it was deemed desirable that the

position of the staff should be made clear at the earliestmoment. In the course of discussion the action of the staffwas criticised by some of the lay members of the board,though in no unfriendly spirit, and the phrase "urgentnecessity" was defined as cases of serious accident and ofillness seriously endangering life. In the end it was decidedto adjourn the consideration of the whole question untilNov. 27th next.

Sept. l6th. ________________

SCOTLAND.(FROM OUR OWN CORRESPONDENTS.)

Tuberculosis in Aberdeen: The Recommendations of theMedical Officer of Health.

Dr. Matthew Hay, medical officer of health for the city,has issued to the public health committee of the Aberdeentown council an exhaustive report in accordance withinstructions in view of the Parliamentary grant for sana-torium purposes under the National Insurance Act. Dr. Haysays that as public health authority of the city the towncouncil’s scheme must embrace practically all tuberculouspatients, except those whose means render them inde-

pendent of any assistance from a public authority; it cannotbe confined to persons insured under the Insurance Act.The ultimate object of the present movement being theextinction, not the mere treatment and cure, of tuberculosis,its object cannot be attained unless all the cases requiringaid and control are brought within the scheme. ’’ The ulti-mate aim of administrative work in regard to the preventionand treatment of tuberculosis should be, Every home andevery workshop a sanatorium."’ It is very desirable thatcontrol of the whole campaign against tuberculosis shouldrest, as far as possible, with the public health authority,which alone is vested with necessary powers under thePublic Health Acts, and whose officers alone possess thepower of entry into insanitary dwellings and workshops.Taking the number of insurable persons as 30 per cent. ofthe population, the number of the insured tuberculous willprobably amount to about 49,000. At ls. 3d. per insured

person this gives an annual sum of £3062 for sanatorium

855SCOTLAND.-IRELAND.

benefit ; this is assuming that the whole of the ordinarysanatorium benefit is available. It is, therefore, importantthat any steps taken may proceed along the right lines,or at least not difficult to retrace if necessary.The gist of Dr. Hay’s recommendations is that the

treatment of tuberculous cases be continued at the CityHospital until sanatorium accommodation is provided.When that is established the City Hospital tuberculosiswards should be used for advanced and observation casesand for educative purposes, the shelters being used at nightby such as can work in the day. The council should pro-vide a dispensary for examination and treatment, attachedfor convenience and economy to the City Hospital. Asenior tuberculosis medical officer should be chosen from

among the medical consultants of the city at an honorariumof 8200 and a junior at a salary of 9300 to £400-or £50less if with residence at the hospital-both to act as medicalofficers of the dispensary and hospital tuberculosis wards.That the health visitor should also attend the dispensary twoor three times a week, an additional visitor being appointedif necessary. Medicines and a dispenser should be pro-vided at the dispensary. The Departmental Committee’ssuggestion that married women living at home should beplaced under the care of a general practitioner to be paid outof the sanatorium funds he thinks would involve a cost of81000 per annum, or of £2000 if

" dependents " are included.Such payments should be uniform for different districts.Food might be provided out of sanatorium benefit for

patients cared for at home. The greatest opportunity forthe public health authority will lie in the dispensary part ofthe benefit, for exercising control and prevention ; thereforethe medical officers should be in touch with the PublicHealth Department, and the junior tuberculosis officer shouldhave the status of an assistant medical officer of health.The Insurance Act grant available for Aberdeen for a

dispensary would be about 8220.The council should undertake the provision of a country

sanatorium containing 40 or 50 beds, with facilities forincrease, erected on a sheltered site of 50 to 100 acres,above the sea level, near rail and tram, not too far from Aber-deen, and with suitable gravitation for water and drainage.Dr. Hay suggests the desirability of combination between thelocal authorities of Aberdeenshire, Kincardinshire, and Banff.A portion of the ground might be farmed to reduce rental.The Departmental Committee state that the cost of a sana-torium should not exceed £150 per bed, inclusive of cost ofsite and equipment. If, as is expected, the amount of theTreasury grant will be partly based on population, since thetotal sum for Great Britain and Ireland is 81,500,000, theshare available for the city of Aberdeen would be about85000. A 50-bed sanatorium at £150 a bed would cost87500, or more if the area of ground were large. Thisdoes not include wards for children, for which an

additional 81200 might be allowed, the same admin-istrative buildings sufficing for all. The cost of main-

taining a sanatorium is usually reckoned at not lessthan 25s. a week for each patient, or f.65 a year foreach bed occupied. The Departmental Committee have putit at 25s. to 30s. a week. The experience of the tuberculouswards at the City Hospital shows that the cost per patient isabout 14s. to 15s. a week for food, drugs (including tuber-culin), cleansing materials, clothing and bedding repairs,laundry, wages and food and uniform of nursing staff andward maids. This does not include any allowance for

cooking, heating and lighting, water-supply, rates and

insurance, rent and repair of buildings, upkeep of grounds,matron or medical attendance. For a sanatorium of 50 bedsat 870 a bed, the annual maintenance would cost £3500, orwith beds for children, say, 84400. Besides the properlyqualified medical superintendent at a salary recommended bythe committee of not less than £500 a year, with house, aninstitution of 50 or 60 beds up to 100 beds would require anassistant medical officer, whose salary may be put at not lessthan 8150 per year with board.

In estimating the cost to the community of a completescheme allowance ought to be made for the payments thatmay be required by various institutions--e.g., cases requiringsurgical treatment will probably continue to be treated inthe Royal Infirmary. If ’’ dependents " likewise are to share,payments may also be due to the Sick Children’s Hospital.A comprehensive scheme for tuberculosis, such as is con-templated by the Departmental Committee and the Local

Government Board, implies provision for the treatment andcare of nearly all the tuberculosis cases in four-fifths of theentire population. An after-care committee ought to becreated for the purpose of helping the tuberculous patientafter he leaves the sanatorium. The following is a summaryof the cost of the more pressing of these proposals, on theassumptions that dependents are included, that a sanatoriumis erected, and that the cases of tuberculosis at present atNewhills and Oldmill have begun to come into the CityHospital and the sanatorium, and also that the Children’sHospital and the infirmary are being relieved of a proportionof their cases :-A. Capital Account. -Expenditure : Dis-

pensary, Z275 ; Sanatorium (for adults and children), £8700.Total, £8975. Grants in Aid : Finance Act, 1911 (probably3/5ths of expenditure but not exceeding f.5500), .65355.Deficit, f.3520. B. Income and Expenditwre Account.-Expenditure : Dispensary, £3100; Sanatorium, f.4900 gHospital treatment, f.5010, Total expenditure, £13,000.Income : Sanatorium benefit, f.3062, Deficit, f.9938.

Sept. 17th. _________________

IRELAND.

(FROM OUR OWN CORRESPONDENTS.)

Local Medical Committees and Secrecy.AT present Local Medical Committees all over Ireland are

busy organising the forces of the profession and discussingplans for their future action, both as regards the administra-tion of the sanatorium benefit and in reference to friendlysociety practice. Attempts are being made to persuade allpractitioners to sign a pledge promising, inter alia, to makeno bargain with a friendly society except through the LocalMedical Committees. It is generally understood that dis"cussions arising out of such matters should be regarded ashighly confidential, and that nothing should be com-municated to the press except through official channels.Unfortunately, some members of the medical committees-seem to have been rather careless of their obliga-tions in this respect, with the result that the workof the committees has been greatly hampered. InDublin the Local Medical Committee has been particu-larly unfortunate, There has been a constant leakageof information toward certain newspapers, and both the

public and members of the profession outside the committeehave been misled as to the policy and conduct of the com-mittee. For instance, last week a paragraph appeared inone of the leading daily papers purporting to be a report ofa meeting of the Local Medical Committee held a day or twopreviously. An official contradiction the next day explainedthat what was merely a desultory conversation was reportedas if it were a decision of the committee on an importantpoint of policy. The paragraph gave the impression ofbeing inspired by a desire to support medical men acceptingoffices in breach of their undertakings.

The Congratulatory Addresses to Dublin University.An interesting exhibit is at present on view in the School

of Anatomy, Trinity College. It consists of the several con...

gratulatory addresses presented to Dublin University last

July on the occasion of the celebration of the Bicentenarof the School of Physic. Very many of these addressesafforded excellent examples of the suitability of Latin asthe medium of dignified communications from one learnedbody to another. The "neatness" with which topicalallusions were interwoven by the authors was only equalled bythat of the Public Orator of Dublin (Dr. L. C. Purser) in pre-senting the candidates for honorary degrees at the celebrations.Though the majority of the addresses are in Latin, not a fewlearned bodies have used the vernacular without loss of

dignity. It is interesting to note the names of those famousin the history of the Dublin School who are chosen for

special mention by the various authors. The most fre.

quently met are Stearne, Dun, Robinson, Cleghorn,Fielding, Ould, Macartney, Stokes (father and son), Graves,Corrigan, Bennett, Cunningham, Haughton, and FitzGerald.The decorative features of most of the addresses are verycharming. Tokyo and Kyoto send from far Japan repre-sentative specimens of the wonderful art that Japan alonecan produce. Cairo sends a beautiful example of Egyptianwork. The Trinity College authorities have done wisely in