INTERCOLONIAL MEDICAL CONGRESS, and yet how hard to secure in private practice. One

of the requirements of a sanatorium was a good cook. SIXTH SESSION, HOBART, 1902.

No special diet was required, but it must be liberal and nutritious, and include plenty of meat, milk and

butter. FURTHER PROCEEDINGS OF SECTIONS.

Rest was so important that they were apt to

forget the value of exercise, but it was the due pro. SECTION I.

portioning of these that was one of the main features

of the Nordrach treatment. Rest was necessary for MEDICINE.

active disease, high temperature and losing weight, SANATORIUM TREATMENT or CONSUMPTION. but to restore health, strengthen the circulation, deDr. A. H. GAULT (Adelaide), read a paper, entitled velop the healthy part of the lungs, exercise was re“A plea for the sanatorium treatment of consumption."

quired. He thought he had said enough to prove the He said there were at least 10,000 persons at the present open-air treatment of consumption, but it must be ad

vast superiority of the sanatorium over the private time in Australia suffering from pulmonary tuberculosis in an active form, and we had sanatorium accommoda

mitted a great deal depended on the medical superin. tion for only 150 of the poorer classes. The only salary, who only intended to hold the position for a

tendent. A young, inexperienced man, with a small provision throughout the whole continent for paying short time, was not likely to make it a success. A man patients was one small home with seven beds. It was possible that the value of the open-air method had

must have a special training, and be willing to devote been over-estimated, but there could be no question of

his whole time and energy to the work, its great superiority over any previously tried. Most The PRESIDENT said there was one sanatorium near of their patients previously died, after many ups and

Melbourne, but it had not grown to a large size, and downs, in the course of a few years—the death-rate was simply a charity. must have been 90 per cent. Of the cases brought Dr. Camac WILKINSON (Sydney) said he would under sanatorium treatment, with only one lobe of one like to have facts and results in support of the sana. luog affected, he thought that they might safely say torium treatment. He agreed with most of what Dr. one-half were cured, but even this would mean the Gault had said, but the physician who trusted in sana. saving of over 1,000 lives annually in Australia alone. torium treatment in a bard and fast way was lost. It On the part of the public, there was a rooted objection was absolutely impracticable as a means of dealing to all kinds of institutions, which nothing would with tuberculosis in the poor classes, among whom the overcome but the firm attitude of the profession, disease was chiefly found. One could not expect the backed up by actual results. The disadvantages of poor to go to a sanatorium when they were able to leaving home would be more than counter-balanced by work. Sanatorium treatment was valuable if money a speedy restoration to health. There was no doubt and time were of no account. But was it not better to that this form of treatment would embrace other kinds cure a patient in the climate in which he had to spend of disease. A san'ı torium afforded a choice of climate his life? Climate, per se, was not the important factor and situation ; a building thoroughly adapted for the that it was at one time considered. purpose ; strict medical supervision, careful nursing, Dr. VERCO said that the open-air method of treatregularity, and discipline. The things desired were ment was recognised as an advance in the treatment of climate and situation, plenty of sunshine, pure air, | tuberculosis. Personally he felt certain that the absence of strong winds. He was told that the site method was the best they had ever had, and the further selected at Wentworth Falls, New South Wales, for they extended it the better for the phthisical patient. the proposed sanatorium in New South Wales was sub- If they could impress its value upon the charitably dis. ject to such strong winds that trees would not grow posed they might do much. In South Australia they without proper protection. Other cooditions required had a sanatorium, which was a partial charity. But were avoidance of extremes of temperature, a bracing the sanatorium treatment was simply an accessory to atmosphere, a dry, well-drained sub-soil. Excessive rain. other treatment. fall, or the prevalence of fogs, was a decided drawback, Dr. Hovey said he went to South Africa some years and must be avoided. It had been tried in Victoria to ago with lung trouble, and settled in the climate of a have one sanatorium suitable for summer and another highland plateau. Subsequently, when he got to Sydfor winter, but this was quite unnecessary, and a great ney and was examined for life assurance they could not waste of money. A properly constructed building find in which lung there had been a cavity. would cost at least £200 per bed. A sanatorium Dr. JARVIE HOOD suggested that the North Shore erected with due regard to proper conditions would railway line was the best place for a sanatorium in possess advantages most difficult to find in a private New South Wales. home. In a private house it was almost impossible to The PRESIDENT did not like to say anything about find a room suitable for a consumptive. Fresh air the management of the congress by the executive, but could be best secured by erecting a substantial stone thought that the subject of sanatoria might have been building on the Nordrach plan—a single row of rooms given prominence to instead of cancer. with a passage behind. The front of the building Dr. G. H. Hogg (Launceston) read a paper on "The should face the north, be sheltered by a verandah, not Medicines of the Aboriginals of Tasmania." He said: too wide, having glass over the windows of the rooms Back house mentions an old man or doctor who had for to admit sunlight in winter. All windows must be of his instrument supply a stock of broken glass, which he the casement pattern, much larger than ordinary ones, used as lancets for superficial and deep scarification. and having a large fanlight over them, as well as over This old gentleman suffered from some form of " fits," each door. At Nordrach the windows and doors took which were attributed to a devil, and made use of to up about one-quarter of the wall space. It was only in impose upon his fellows—the first recorded example, the sanatorium that one could get strict medical super- doubtless, of a Tasmanian "quack.” As to nursing, vision, careful nursing and feeding, combined with the that was left to the women of the tribe ; confinement regularity and discipline of an institution. The three cases were left in charge of one or more women; and cardinal principles of the open-air treatment were the sick also were, if attended to at all, nursed by fresh air, good food and rest. How simple it seemed, them, although frequently the sick person was left

Fox's paper.

behind by the tribe to take his chance, a stock of food

SECTION II. and a supply of the leaves of the mesembryanthemum,

SURGERY a native purgative, being given to him before his deser- A special meeting of this section was held on Thurstion. With regard to the surgery of the Tasmanian day evening, February 20th, to discuss X-Ray work. aboriginals, it was, as might be expected, of a most In the absence of the President (Hon. Dr. Butler, primitive character. Bleeding was stopped by the M.L.C.), Dr. Drake called on Dr. Crowther to read Dr. application of clay and leaves. Incisions and scarifications were held in much favour in the treatment of Dr. E. L. CROWTHER, M. D., M.H.A. (Hobart), said various diseases ; thus Truganini treated the swollen he was pleased to read the paper, and, in doing so, dethigh of her husband by six incisions, which produced sired to express the thanks of the Hobart Hospital sloughing, and cured him in nine days; and Robinson Committee to Drs. Fox and Clendinnen, of Melbourne, relates how a woman, suffering from sick head, breast for the assistance given by those gentlemen to the and belly was incised in each of these parts, the idea in committee in the selection of an X-Rays apparatus, the this and similar cases being that the pain was a dis. result of which was that the hospital would, in a very tinct entity and must be put out. Billandiere, the short time, be equipped with one of the best X-Ray naturalist of the D'Entrecasteaux expedition, was of apparatus in the Southern Hemisphere. He then prothe opinion that they used the actual cautery in some ceeded to read the paper, -" On Recent Developments diseases ; snake bites certainly were treated by a kind in X-Rays Apparatus, and in the Use of Rays," preof cauterisation, a hole being bored in the flesh near pared by Dr. W. R. Fox, L.R.C.P., L.R.C.S. (Melthe wound and stuffed with fur, which was then singed. bourne). The writer stated that the tremendous im. Massage seems to have been occasionally employed, petus given to this branch of physical research by and applications of cold by means of compresses were Röntgen's discovery continued to make itself felt. used for the relief of headache and other pains. As to One of the results had been a very great improvement the diseases which prevailed amongst the aboriginals in induction apparatus generally. The different sys. our knowledge is of the slightest, the early medical men tems of interruption were dealt with, and the compara. having interested themselves very little in the matter. tive advantages of electrolytic interruptors and Before European colonisation they seemed to have been photography were discussed. It would be reallily seen a healthy race. The scientists of D'Entrecasteaux's ex- that there were many cases in which the interruptor pedition found but little trace of disease, although there method possessed advantages over photography. For existed among the aboriginals themselves a tradition instance, where much time and trouble had been ex. that their race-at one time much more numerous-was pended over setting a limb, and where it was impera. decimated by an epidemic which swept through the tive that the splints should not be removed, unless island prior

to Europern discovery. After the good reason were shown-examination by the interEnglish colonisation, however, various diseases spread ruptor method would permit of the bones being seen amongst them, syphilis, phthisis, and pneumonia from every point of view ; also, in examination of the becoming frequent and faiai. Various skin diseases heart and lungs. Originally introduced into surgery became very prevalent, and were particularly noticed with the object of locating foreign bodies and the by the early colonists. Thus there are described by position of fractured bones, X-Rays had extended various writers :-1. “Scabby sores, affecting the their usefulness in a very wide manner. At the recent whole body.” 2. “ Loathsome ulcerated sores, attended British Congress on Tuberculosis, it was shown that sometimes by fatal results." 3. "Leprosy," so offensive the rays would give evidence of the existence of tuber. as to cause isolation of the sufferer. 4. “Scurvy." cular disease as soon as, or perhaps before, it mani. 5. " Eruptive disorders, attended by fever.” Doubtless, fested itself in other Ways. The results of the some of these skin diseases were syphilitic, some experiments of Wolfenden and Forbes-Ross on the parasitic. The usual treatment for all skin diseases effects by the rays on micro-organisms were explained, was the application of ashes, the patient wallowing in it being proved that the cultures of some microthem if necessary. Rheumatism was common, and organisms exposed to the rays grew luxuriantly. Other was treated by scarification and incision, sometimes by tests proved that milk X-Rayed for an hour showed mutton bird oil. Headaches were treated sometimes a greater degree of acidation than milk not so treated ; by cold compresses, sometimes by scarification, some. cress seed X-Rayed for an hour, and then sown, started times by charms made of human bones. Thus germination, and grew much more vigorously than Backhouse relates how one man had a charm of seed not so treated. The experiments on the tubercle three bones fixed as a triangle on his head as a cure for bacillus, howerer, were not satisfactory, the scientists headache. The use of such charms, made of the bones stating their belief that it was in possible to kill of the dead, often of a dead relative or friend, was growths of bacilli in the lungs, or cocci, by X-Rays. common, not only as a cure, but also as a preventive | The effects of the rays on ihe skin were theu discussed, against sickness or death. Lung diseases became very the writer expressing the opinion that the destruction common among the Tasmanian natives, and were the of tissues, etc., was due, not strictly to the X-Rays, but cbief cause of the final extinction of the race. In- to the radiation of some other nature, proceeding from flammation of the lungs was often very rapid and an excited Crookes' tube, Experiments to test the fatal ; and phthisis was prevalent, partly because of curative value of the rays were detailed. It was hoped the alteration of the habits of the rece, partly, no that it would exercise some beneficial influence over doubt, because of the introduction of that disease by cancer, but the only effect so far produced was to ease Europeans. Some luog troubles were apparently the pain--which it certainly did. The only case of treated by incisions in the chest walls. With regard cancer improved by the rays so far was one of to nervous diseases, madness and convulsions were carcinoma of the breast, reported by Dr. Andrew Clark known by the aborigines, and were believed by them in the British Medical Journal, Vol. I., 1901, p. to be due to an evil spirit ; while that peculiar form of 1,368. In this the improvement was must remarkable, melanchol known as nostalgia became a marked

the beneficial effect continued, it certainly feature amongst the survivors of the race interned in looked as if it should have ended in a cure. In the Flinders Island, many of whom became the sad victims treatment of rodent ulcer, the rays had proved singu. of that strange disease.

larly successful. In all probability the local character

was

RONTGEN RAYS.

of this disease, as distinguished from other forms of only of his own individual health, to recognise in his cancer, contributed to this result. In lupus, certain neighbour a possible source of danger to himself, and forms of eczema, sycosis, and in one case leprosy of the and he, therefore, looked to a paternal Government for skin, the treatment of the rays has been successful. In that protection, which he imagined legislation was able the large suppuratiug surfaces, left after extensive to afford. There was no sanitary reformer like an burns and scalds, the rays would promote rapid heal. epidemic of some dread disease, such as plague or small. ing, and resulted in much less cicatricial deformity. It pox. The recent visitation of plague to the Australian was possible that they were not aware of the nature of States brought about a great sanitary awakening, both all the radiation emanating from an excited Crookes' of the authorities and of the more intelligent citizens. tube, but they knew it included :-(1) Anode Rays. Legislation on matters pertaining to the public health which include X-Rays, properly so-called ; (2) Cathode must necessarily be progressive, and, therefore, of a Rays, about which not much seemed to be known ; (3) piecemeal character. 'In enacting our statutes sight Heat Rays, which were more manifest in small tubes must never be lost of the fact that the conditions of than in those of six or seven inches in diameter ; (4) life, and the environment of the people in Australia Light Rays ; (5) Electric Rays, or waves, which mani. were somewhat different to wbat existed in the old fested their presence in a similar manner to the waves country. However good and wise legislation might be, given out by other apparatus generating electricity of it was of little service unless it would be backed by extremely high tension. When one, said the writer, equally effective administration. In fact, it considered the above constituents of X-Ray radiation, administration rather than legislation which was at it ceased to be surprising that its effects were so many default. Since the establishment of the Commonwealth and so varied. With regard to rodent ulcer and lupus, there was a tendency on the part of the State Govern. he was strongly inclined to think it would be found ments to reserve to themselves many departments later that the curative agent in this form of radiation, which were formerly under the control of the local and in that from the Finsen light, were one and the authorities. To some extent municipal authorities had same thing. Photographs taken by the X-Rays were only themselves to blame if Parliament was unwilling show of an injured elbow joint ; a diseased neck to delegate its powers to them. Until there was a (atlanto-axoid) of a fætus born dead ; of the bullet in keener interest in municipal affairs no solid advance in Dr. Wraser's head ; a compound comminuted fracture sanitation was possible. The Health Act of 1900, of of both bones of the fore arm.

Queensland, cast upon each local authority the responsibility of protecting the public health of its

own district. It further provided for hospital accom. Dr. L. II. HARRIS (Sydney Hospital) read a paper

modation and isolation of infectious diseases, and on the “ Rontgen Rays, with Special Reference to Repal indicated to local authorities, more especially to those Radiography." (l'o appear in a future issue.)

of districts of small or moderate size, the means by

which they might advantageously make such provision. EXHIBITION OF X-RAY WORK,

Some 20 local authorities within a radius of 12 miles of Dr. F. J. CLENDINNEN (Melbourne Hospital) gave Brisbane had combined to form what was known as an interesting exhibition of Rontgen Ray work. The the Metropolitan Joint Board for the Prevention of views exhibited showed the effects of broken and de. Infectious Diseases. The board was subsidised by the formed bones, the presence of foreign substances in State to the extent of £1 for £1 on the amount raised different parts of the body, and the result of several by precepts levied on the local authorities represented bullet wounds received by soldiers during the war, con- on the board. It was the duty of the board to cluding with slides showing adulterations of various deal with all diseases of an infectious and epidemic articles of food, such as four with chalk, sugar with character. Sanitary administration by local selfsanri, tea with various substances, etc.

governing bodies, as well as administration by a

central authority, was nowhere in the Commonwealth SECTION 5.

better illustrated than in the State of Queensland. In POBLIC HEALTH.

New South Wales there was, practically, no local selfHYGIENE IN AUSTRALIA,

He suggested that the proposed Australian Institute This was as important as the proposal to establish a should, if possible, be affiliated or federated with the federal institute of hygiene. British Institute. If this could be brought about it

Dr. KENDALL said the sanitary conditions of many would add weight and dignity to the institution.

public schools are the wurst eye-sores we possess. With regard to the outbreak of plague in Australia, the medical men of Brisbane were unanimous in their

Dr. LOVEGROVE (Perth) sympathised with what Dr. opinion that true bubonic plague existed in Brisbane.

Thomson had said. Central Boards of Health overThe epizootic among the rats had been somewhat shadowed local boards of health ; while they continued extensive in Brisbane, and large sums of money had

to do so the latter showed a tendency to remain been spent in killing off the rodents. “No rats, no quiescent. Another reason why local boards of health plague," was a truism which supplied a remedy as well were wanting in energy and pushfullness, was because as a warning, and while all authorities agreed that the they were in the nature of excrescences on municipal relationship between rat plagne and human plague was

councils, instead of being altogether separate and free now a well established fact, there were many factors bodies. in the rat question which were as yet very imperfectly Dr. Ham, in replying, urged that with an improved understood. The practice of classifying plague under public opinion on the subject of public health, reforms many types of the disease was misleading. Plague was would be brought about. He moved—“That, in the plague, whether of the deadly or benign variety. The opinion of this section, the time will shortly arrive term “Pestis minor” was misapplied, and should be when, in the interests both of the sanitary medical dropped altogether, except as applying strictly to true service of the various States, and the public of the plague cases. By far the most promising gain of a Commonwealth, the Federal Government, with the of a substantial kind to practical medicine was the assent of the States, should appoint a Minister of improved method of acquaintance with the eausation of Public Health." disease. A fully equipped laboratory, a hospital for clinical cases, and instruction by competent teachers

In reply to Dr. Thomson, Dr. HAM said that the who had made a special study of tropical diseases,

federal authority could under its constitution take this would be one of the best efforts in the direction of

course, with the consent of the States. medical and scientific progress yet attempted in Dr. MACANSH (Victoria) said the feeling was growing Australia, In conclusion, Dr. Ham referred to the that there was altogether too much federation. (Hear, question of food adulteration and food preservatives. hear.) Instead of interference with the medical officer All medical and health authorities seemed agreed that of health's duties, his experience was that such officers the indiscriminate use of preservatives in food was a rather got assistance. They were as a rule, carrying practice to be greatly condemned. The noblest out their duties very well, and with much self-sacrifice. aims of sanitary science, it had been well said,

Dr. Thomson was a strong opponent to federal action, was the maintenance of the people in the highest state

As the Commonwealth Government was going on, it of efficiency to fit them for the labours of peace and the

seemed as though it was going to ruin us. struggles of war, and the success of the federation of

Dr. LOVEGROVE felt it would not be wise to turn all Australia would, in the long run, depend on the

such matters over to the Federal Government. quality of its citizens, and good citizens could not be reared under unhealthy conditions.

The motion was negatived on the voices. Dr. KENDALL (Sydney) said Dr. Ham's paper was

Dr. MACANSA moved :—“Tbat, in the opinion of the an important one. He complained of the verbose, long.

Congress, steps should be taken by the states of the winded, inefficient character of the Health Acts,

Commonwealth and New Zealand to unify the Public. especially ihose of Victoria and Tasmania. They

Health Acts throughout Australasia. contained involved and confusing sentences in numerous Dr. THOMSON seconded, and the motion was carriel sections. Much of this was, no doubt, due to too close Dr. Ham moved :—“That, for the purpose of colattention having been paid in drafting the bills to the lecting and imparting information upon all matters Health Acts of England, without sufficient regard being connected with the subject of public health, a national paid to the different interest and requirements of these society be formed, to be styled · The Sanitary Institute States. He commended the South Australian Act as a of Australasia.'' great improvement, though he did not say it was Dr. KENDALL secunded, and the motion was agreed to. perfect. The latest Public Health Act the A further discussion ensued as to insanitary closets, Queensland one. It was so drastically drawn up that etc., at State schools, and that the elements of hygiene when it was put into practice it fizzled out. He felt should be part of the State school curriculum. with Dr. Ham the necessity for showing the people Dr. MASON said that in New Zealand State school that scientitic hygiene was not a fad, but the outcome children were taught the principles of hygiene, and a of the experience and thought of many men, who had text book had been specially prepared for Maori chilstudied the sufferings of mankind throughout the ages. dren in their native language.

Dr. McDouaLL (Sydney) pointed out the reforms On the motion of Dr. Thomson, seconded by Dr. that would come with medical officers of health being McDOUALL, it was resolved :-" That steps should be appointed and paid by a central or State authority, so taken by the Departments of Public Education and that he would be independent, both pecuniarily, and other public departments throughout Australasia to with respect to the permanency of his appointment. make and keep the water supplies, water closets, urinals Such an appointed officer would be able to devote the and other sanitary conveniences of all public buildings, whole of his time to his duties.

including floor space and ventilation, in such a condiDr. THOMSON (Brisbane) felt that hygienic education tion as to be an object lesson to the public. That the required to be started in the State schools. elements of hygiene, somewhat after the lines adopted resolution from Congress might advantageously go in New Zealand, should form part of the State school forth on this point. Every public building should be curriculum.” itself an educative centre as to sanitary arrangements. Dr. Ham moved :-" That the term “pestis minor' At present many of the schools and other public should not apply to plague cases." Plague was plague, buildings were lamentably deficient in this respeot. and the term was not desirable.

was

А

CORRESPONDENCE.

of whom three died, a percentage of 1:87 ; 12 doubtful cases, of whom 78 died, a percentage of 58:33, and 151

un vaccinated cases, of whom 79 died, a percentage of London.

49:07. There seems to be a diminution in the protec

tive power afforded by primary vaccination after the (FROM OUR OWN CORRESPONDENT).

age of 20 years, the death rate rising from 9.85 in Prognosis of Phthisis - Death of Professor Von Ziemssen vaccinated cases between 20 and 25 years of age to - Vaccination Statistics— Professional Census

28.95 in cases between 35 and 40. Notification of Chicken Pox - Practice in South

Of 2,198 persons employed at the small-pox hospitals Africa — Accident to Professor Virchow, Lady between 1884 and 1900 inclusive, in which period 17,900 Doctors.

small-pox cases were received into the hospitals, only INVESTIGATIONS have been undertaken at different 17 persons contracted small-pox, of whom 13 were not times, by various observers, into the occurrence and revaccinated until after they had joined the ship, and value of the Diazo re-action in the urine of patients | 4 were workmen who had escaped medical observation, suffering from tuberculosis. A communication made During the year there was a large increase of the to the November issue of the Zeitschrift für Tuberkulose staff on the ships and at the Gore farm hospital, among by Blad and Videbeck confirms the results previously whom not one case of small-pox occurred. No member recorded by others, and goes to prove that, in a very of the staff of the hospital ships has died, or even large proportion of cases, the reaction is negative or suffered, from the disease for the past eight years. inconstant in favourable cases, but positive and well These facts confirm the conclusions arrived at by the marked in cases which are, from the clinical point of special committee appointed by the managers to collate view, bad. Should this observation be established by statistics after the small-pox epidemic of 1870-1.2. further experience, the test may prove useful, not only as That committee, in their report, dated 11th July, 1872, an aid to prognosis, but also as a means of guidance for said :the selection of cases best suited to the open air method of treatment in Sanatoria.

“ The necessity of re-vaccination, when the protective

power of the primary vaccination has to a great extent By the death of Professor Von Ziemssen, which took passed away, cannot be too strongly urged. No greater place on the 20th January, the University of Munich

argument to prove the efficacy of this precaution can be has lost one of its most distinguished teachers, and the adduced than the fact that out of upwards of 14,800 profession of medicine one of its most popular and

cases received at the hospitals only four well authentibrilliant members. He was born at Greifswald in

cated cases were treated in which re-vaccination had 1829, and graduated there in 1854. In 1863 he was

been properly performed, and these were light attacks. appointed Professor of Clinical Medicine at the Univer

Further conclusive evidence is afforded by the fact that sity of Erlangen, and in 1874 was transferred to the

all the nurses and servants of the hospitals, to the University of Munich, where all the rest of his career

number at one time of upwards of 300. who are hourly was spent. There were few subjects connected with brought into the most intimate contact with the disease, clinical medicine on which, throughout his long and who constantly breathe its atmosphere, and than whom busy life, he did not write; but he is probably most none can be more exposed to its contagion, have, with widely known, and will be lougest remembered, as tbe

but few exceptions, enjoyed complete immunity from editor of two great medical encyclopædias which have

its attacks. These exceptions were cases of nurses or been extensively read, not in Germany only, but over

servants whose re-vaccination, in the pressure of the the whole medical world.

epidemic, was overlooked, and who speedily took the At a meeting of the Metropolitan Asylums Board, disease, and one case was that of a nurse who, having held on the 11th January, some important information had small-pox previously, was not re-vaccinated, and was given in reference to the small-pox epidemic. A

took the disease a second time." special interim report concerning the outbreak in the From the last edition of Churchill's Medical Directory, metropolis during the year 1901 was presented by the which was published at the beginning of January, it Statistical Committee. In this report it was pointed appears that there is a net increase in the members of out that small-pox had been practically absent from the profession for the last year of 434. This is a smaller London during the first five months of the year. The addition than that recorded for the previous year, when first patient was admitted from Islington on the 29th it amounted to 1.98 per cent. on all the names recorded May, and thereafter single cases occurred from time to in the Directory, as compared with 1.19 per cent. for time in various parts of London up to the 21st August. 1901. In these days, when the spirit of trades-unionism in From this date and onwards the disease obtained a hold the shape of medical aid associations, friendly societies, in the parishes of St. Marylebone and St. Pancras. Sub- and other similar organisations, for co-operative pro• sequently cases occurred in every one of the thirty-one vision among the working classes to deal with the poor law parishes and unions comprising the Metropoli- exigencies of sickness and death, is becoming such a tan Asylums District. The gross mortality for the year prominent feature in professional life, and when the was given at 24.28 per cent. ; but this death rate is struggle for an adequate livelihood is greater, perhaps, higher than will appear in the final statistics, because than it has ever been before, it is remarkable that there many cases are included in this figure which were of should be this progressive increase in numbers to record. recent admission, whereas contemporary cases, which It may not be more than what is commensurate with will nearly all ultimately recover, cannot be included the growing population of the country ; but there is until completed by discharge. The percentage of some risk that the labourer, though worthy of his hire, death in vaccinated cases was 14:21; in doubtful cases, may, in medicine, come to be so poorly rewarded for 65.08; in unvaccinated cases, 50:52. Looked at in the his toil that the profession comes to lose in some light of age periods, the statistics bring out the follow- measure its attraction for that large class of desirable ing figures : Under 10, there were 12 vaccinated cases young men who, however enthusiastic over the scienand no deaths ; 6 doubtful cases, all of whom died ; and tific and philanthropic interest which attaches to the 95 unvaccinated cases, of whom 52 died, a percentage work of a doctor, must needs live by the “gweat of of 54.74. Under 20, there were 161 vaccinated cases, their brow."