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Medical Society,l he remarked that the time was passed whenmedical men ought to use expressions like "genius epidemi cus" and attribute to it the degree of mortality. He stated that vaccination had succeeded in compelling the genius to withdraw, and that the genius epidemicus of small-

pox epidemicus of malaria must in a large proportion 1of cases leave the victim when qninine is used. To

prove that antitoxin had the same effect on the diphth-eria genius was the purpose of his speech. In theabove-mentioned debate one of the principal argumentsof Professor Behring’s adversaries had been the allegedfact that, whilst formerly grave cases of diphtheriaonly were treated in hospitals, since the antitoxin perioda greater number of mild cases were received. This

argument could easily be rebutted by statistics, these

showing that in 1893-94 55-9 per cent. and in 1894- t

95 52’9 per cent. only of all diphtheria cases were treated (

in hospitals. The total hospital mortality was 21’1

per cent. and that of home patients 26’8 per cent. In thefour years preceding the antitoxin period there were inBerlin 15,958 cases with a mortality of 5617, or 35’2 per ’’

cent. The year 1894-95 showed a widely spread epidemicin Berlin, not less than 5578 cases having been i

registered by the health officer, a fact not very favonr- table to the statement of a mild genius epidemicus. If

tthe mortality had been the same as in the other years 1963patients would have died, whereas last year’s mortality was ‘

only 1056 patients ; in the antitoxin era, therefore, 907 lives (were saved. A most striking result, too, was afforded by the ]

comparison of two hospitals, one having used and the other (having abstained from employing antitoxin. In the Charit6 cHospital in the first class there were 299 patients with 53deaths, or 16’7 per cent. ; in the Bethania Hospital, where cantitoxin was excluded, there were 249 patients with 112 (

deaths, or 43 per cent. This exclusion of antitoxin Professor cBehring sarcastically declared to be of great value to the (

statistics, but not so in the interests of the patients of the iBethania Hospital. A collective investigation of home-treatedcases showed a mortality of 7 to 8 per cent. only-i.e., halfthe number of hospital cases. There were also numerous

1other interesting statistical tables reported by ProfessorBehring, which I must abstain from mentioning. If in the afuture the quantity of the remedy injected was sufficiently ]

great, and mild and grave cases were both treated by anti- itoxin, the statistics surely would be still better. An earlyapplication, too, must be regarded as a matter of extreme aimportance, and, as it was proved by Escherich’s and Bose’s icommunications, that in that case tracheotomy might be iavoided. The mortality of this terrible illness, Professor ‘

Behring was sure, could be made to fall to 5 per cent.,but if only 75 per cent. of deaths were avoided 45,000 lives cwould be yearly saved in Germany. Even now, when the 1application of antitoxin is still in its infancy, the mortality Ehad fallen to 75 per cent. of the former amount, so that 15,000 people had escaped from death. The immunising ]effect was not yet so obvious as the curative one, because the 1number of cases reported was still too small ; but up to thepresent no case had occurred where real harm had been doneby the prophylactic injection. After having shortly spokenof the anti-tetanic and the anti-choleraic serum, Professor Behring closed by saying that everything which he and 1others had done in this direction was based upon theimmortal researches of Professor Koch.

The Second General Meeting, on Sept. 18th.Professor Riedel (Jena) first read a paper on Surgical

Operations on the Skull. As, of course, the audiencewas not composed of medical men only, he dealt withthe subject in a somewhat popular manner ; therefore,a short account will be sufficient. He mentioned that

trephining was long ago performed by the Incas,the ancient inhabitants of Mexico, and also by the Romans, as the discoveries of Pompeii and Herculaneumproved. To-day we trephine for fractures, for hsemor- ’rhage from the meningeal arteries, and for cysts,suppuration, and tumours. In the last case the principalobstacle is the difficulty of diagnosis and localisation.Of 100 tumours six only are found and operated on; inthree of those death occurs from the operation, so that 3per cent. only have a favourable issue. Another drawbackis that often a great deal of the brain must be removed owingto the operation. The results of trephining for injury are ’better. Suppuration often arises from apparently insignificant

1 THE LANCET, Jan. 19th, 1895.

causes, and Professor Hiedel mentioned a case where a.

cerebral abseess followed n, slight wound received in astudent’s duel where the necessary antiseptic precautionshad been neglected.

After Professor Riedel, Professor Victor Meyer (Heidel-berg) read a paper on the Problems of Atomicity.

(To be continued.)..

THE IRISH WORKHOUSE INFIRMARIES.(BY our, DUBLIN CORRESPONDENT.)

MANY allusions have been made in THE LANCET duringthe last four months to the unsatisfactory condition of someof the workhouse hospitals of Ireland. It will be remem-bered that early in June a circular was addressed by theIrish Medical Association to the medical officers of all thePoor-law infirmaries, the replies to which disclosed theabsolute necessity for a widespread reform in the manage-ment and nursing’ arrangements of many of these institu-tions. On June 25th an influential deputation, organised bythe Irish Medical Association, and consisting of its chairmanand secretary, the President and Vice-President of the RoyalColleges of Physicians and Surgeons, the President of theRoyal Academy of Medicine, &c., waited upon the Local

Government Board and made some suggestions the outcomeof which was a circular letter from the Board directing theattention of the Poor-law guardians to ’’ the alleged insuffi-ciency of the nursing and requesting that the medical officerof each workhouse might be called upon to furnish a reporton this most important matter." Many irregularities anddefects in the nursing and administration of the Poor-lawinfirmaries have since been brought to light.The South Dublin Union Infirmary has been looked upon

as a model institution, but Mr. Lenehan, one of the

guardians, recently made the suggestion that trained nursesshould be employed to see after the patients there. Hisstatement, and the comments of the Irish Figaro on thematter, had the effect of calling forth a letter addressed twothat journal by Sir Robert Sexton, the Protestant and Con-servative chairman of the board of guardians, in whichstrong testimony was made to the improvement in moraltone, in regularity, cleanliness, &c., which had followed theintroduction of the members of a community of nuns-thesisters of mercy-as nurses to the institution.In the meantime an investigation was held at Athlone by

one of the Local Government Board medical inspectors as tothe condition of the union infirmary there, in reference moreespecially to the nursing arrangements, and a correspondencetook place between the Local Government Board and theboard of guardians, in which the former threatened to dismissthe board of guardians unless their requirements as to thenursing were carried out. The guardians wished to appoint.as nurse in the infirmary a nun belonging to a religious com-munity of ladies, while the Board refused to sanctionthe appointment on the ground that the lady was not atrained hospital nurse. The guardians then suggested thatshe should be duly trained in a Dublin hospital, to whichthe Board assented. According to the local papers the RomanCatholic Bishop of the diocese now intervened and refused topermit this arrangement, giving as a reason that it was

against the rules of the religious order to which the ladybelonged for her "to undergo training in the manner

required." The guardians then declared that they wouldadhere to their appointment of the lady mentioned, notwith-standing the threat of the superior court to dissolve them.That threat has been promptly transmuted into action. The

guardians have been dismissed by a sealed order, datedSept. 21st, and two paid guardians, at an annual salary of.6250 each, appointed in their place. The above is a plainstatement of the condition of affairs at the Athlone Union, thesituation not being caused by any difficulty from want offuncls. Mr. Gerald Balfour, the Chief Secretary for Ireland, notlong since stated in the House of Commons, and doubtlesswith perfect accuracy, that the shortcomings in some ofthe union workhouses in the West of Ireland were reallycaused by the poverty of the districts. This excuse doesnot apply to the board of guardians at Athlone, forit has transpired that the union there is in an excellent.financial position, and, according to the statement of the

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late chairman of the dissolved board, has at presenta balance of over Z2000 to its credit.A leading article of a somewhat unwise and intemperate

character appeared in the Freeman’s Journal of Saturday lastheaded " Intolerant Bureaucrats," in which the action of theLocal Government Board in this matter is attributed toreligious bigotry. According to the report in that journalthe Roman Catholic Bishop stated that "the nurse (whohad been at the Athlone Infirmary for five years) hadactually been trained for five years. They, the nurses " (heis said to have stated) " have undergone training at least asgood as they could undergo in any Dublin hospital." Nowit seems unnecessary to say that nurses in Dublin, as inLondon and elsewhere, are now obliged to undergo a course’of study and training of at least two years’ duration in a dulyrecognised clinical or teaching hospital in which classesof students of medicine are also trained or taught.The probationer nurses are taught not only the mere tech-nique of nursing the sick, but also the principles whichunderlie it. They are obliged to learn the elements of

anatomy, physiology, medicine, and surgery in order thatthey may be qualified, not alone to strictly carry out, but alsoto fully understand and appreciate the directions of a medicalman in charge of a patient. Their experience and training in.a teaching hospital places them accordingly in a distinctly.different position from that of the ordinary lay nurse, forthey are taught what they should do in cases of difficulty- and emergency in the absence of any medical man and- during the time that must often intervene before his arrival.The very fact that the most intelligent probationernurse cannot be made proficient in her course in a less timethan two years or more shows that her task is not an easy one.No certificate of training and no authentic diploma or

,-authoritative statement of the person being a trainednurse " is given in Dublin or in London, or elsewhere in.England, under less stringent conditions.The whole matter is a most important one and has begun

to excite great interest in Ireland, not alone among the.members of the medical profession, but also among the.educated general public. When it is remembered that in nofewer than sixty-seven of the union infirmaries through-out this country the nursing is controlled or carried out by.nuns, who, while their unselfish devotion to works of charityis universally recognised, have not received what is under-stood as hospital training, the importance and possiblyfar reaching effect of the recent action of the Local Govern-ment Board in dissolving the Athlone guardians will be

recognised.

BIRMINGHAM.

(FROM OUR OWN CORRESPONDENT.)

Epidemic of Scarlet Fever.THE increase in the number of scarlet fever cases in the

city is a source of much anxiety to the Health Committee..At present there are 457 cases under treatment at the

Borough Hospital. It is alleged that some of the cases aresent out too soon, and thus become centres for the further

spread of the disease. The difficulties of the committee are

being met by utilising the new small-pox hospital at Yardley,where it is proposed to send a number of the scarlet fever.patients forthwith. Fortunately, there is not a single case,of small-pox in the hospital for the reception of such cases.The medical officer of health, Dr. Hill, believes that theii.nerease is periodic, being due to the accumulation of suscep-tible material. This is hardly a satisfactory explanation ofthe present rapid increase. It fails to bring consolation tothe sufferers or to the authorities in dealing with so severe an- outbreak as the present one.

Periodical Collections for Local Cliarities.The committee recently met to make the necessary arrange-

ments for the collections to be made on Hospital Sunday,Oct. 27th. The chairman, Alderman Johnson, stated thatthis was the thirty-seventh occasion on which tne appealwould be made. At the first collection, in 1859, it was

pointed out that the sum raised was .65200; this has beenthe average sum, with little alteration, ever since. With- regard to Hospital Saturday, the first collection, in 1873,realised .64705; this has gone on steadily increasing,until last year it reached the large .sum of .613,000.

rhree reasons were adduced to show why the HospitalSunday collections had not increased in the same proportion:’1) those who furnished the largest contributions on

Hospital Sunday were the people who were the regular sub-scribers to the charities throughout the year; (2) since thenovement was founded the number of medical charities hadbeen doubled, and they required support from the very class)f people from whom they expected large contributions onHospital Sunday; and (3) that the resources of the great alms-giving classes were not now what they were in 1859. I’rofits’rom trade had decreased, interest from investments was less,and it required an effort on the part of the classes who sup-ported Hospital Sunday to keep up the level of their contribu-tions.

The Lunacy Act.At the Police-court, on Sept. 30th, Mr. F. R. A. Evans, a

!urgeon, was summoned for a number of offences under thisct in the alleged wrong treatment of a patient under his?are. After evidence had been given the defendant wascommitted for trial at the Quarter Sessions, bail beingallowed, the defendant in E50 and a security of E25.

Medical Men, (oroners, and Death Certificates.The death of the Rev. Prebendary Finch Smith at Lichfield

was the subject of an inquest, at wllich the deputy coroner,Mr. H. H. Jordan, made some strong remarks. It seems that

Prebendary Finch Smith, who was eighty years of age, felliownstairs a few days previously, sustaining an injury

his side, from which he never rallied. A certificate ofleath was given by his medical attendant. A verdict of"Accidental death " was recorded. The deputy coroner

observed "that he felt bound to express his regret that theloctor was not better up in the law than to have given acertificate of death in case of an accident, and that the

Deputy Registrar of Births and Deaths had not been betteroached in his work than to have accepted such certificateand registered it. Luckily the inspector of police heard of:.he accident and duly reported it, otherwise there might havebeen great trouble and annoyance caused to the family."fhe medical attendant justified his action by the authorityof the British Medical Association, to which the deputycoroner took exception as not being a legal authority. Itseems that some friction of the same kind had previouslyxisted, hence the disposition to lay down the strict interpre-tation of the law in its present form in terms which, howevermuch to be criticised, are still the legal ones.

Ambulance hastructiort in the Police Force.The chairman of the Watch Committee recently distributed

a number of certificates in these classes and made a pre-sentation to Dr. Holdsworth and Mr. Morrison, divisional

surgeons, for the assistance they had rendered in the

principles and practice of the work. The assembly was wellattended.

The late Dr. 11-esley Hayes Thompson of Cradley.The death of Dr. Thompson at the comparatively early age

of forty-five cast a gloom over the district, in which he heldan extensive practice. Essentially a self-educated man, hebecame an apprentice of Dr. Morrow of Cradley Heath,and afterwards went to Anderson’s College, Glasgow. In1871 he took the L.R.C.P. and L.R.C.S. of Edinburgh, andin 1889 the M.D. of Durham. An active and intelligentworker, he soon rose into a prominent position and laboured un-ceasingly in a large club and colliery practice. His uprightconduct and his unassuming manners gained him respect andconfidence. He was an earnest advocate of temperance and adevoted member of the Wesleyan body. Some two years agohis health began to fail, and malignant abdominal disease wassuspected. Gradually his strength failed, and he passedaway on Sept. 26th, leaving a name widely honoured anddeservedly esteemed. Mrs. Thompson and seven childrenmourn their loss, receiving wide and universal sympathy inthe district in which Dr. Thompson was born and in which hedid so much good and faithful work.

Oct. 2nd.

BRISTOL ]ROYAL INFIRMARY.-At the half-yearlymeeting of the Bristol Royal Infirmary held last week thechairman stated that increased subscriptions were urgentlyneeded as the annual income still fell far short of what wasrequired. A timely and anonymous gift of B1000 had beenrecently received, but what was wanted was an increase inthe regular annual contributions.