- Email: [email protected]
DEFATTED BACTERIAL VACCINES.
586 A MEDICAL AND NURSING SERVICE IN
RURAL MANITOBA. To the Editor of THE LANCET. think SIR,—I your readers will be interested in a brief account of a combined medical and nursing service organised for rural areas by the Manitoba Division of the Canadian Red Cross Society, especially as it has been of tremendous assistance to many British-born settlers whose wives in many cases have come directly from the Old Land to live in what are known as the unorganised areas of Manitoba. It , illustrates also the value of the whole-hearted cooperation of the medical profession with the Red Cross ’, peace-time service. In 1919 the Red Cross Society, finding a great and ’, urgent demand for some sort of skilled assistance in dealing with the health of certain districts which ’, had no other civilised social service, established at Reynolds, where Poles and Ruthenian settlers abound, z, 63 miles east of Winnipeg, Fisher Branch, 72 miles N.W. and Grahamdale, 134 miles N.W. (both points z’ lying between Lakes Winnipeg and Manitoba), and also at Kinosota, 140 miles N.W., on the west side of Lake Manitoba, nursing stations, which were at first disciplined and managed by the Provincial Board of Health but now are under the exclusive management of the Red Cross Society with its Medical Advisory Board. These nursing stations proved of great value, but it soon became apparent that medical supervision was needed and that too great a responsibility was being placed on nurses whose calling does not include the ability to diagnose and to decide the final destination of any given case. It must be remembered that these districts, except Reynolds, were 40 miles at least from the nearest doctor and that very few of the people could afford to pay any fees. The problem was how to cover the ground effectively. For most of the year the roads are only passable by foot or horsedrawn vehicles, and not always thus. Bush country in unorganised Manitoba is always very boggy in spring and often in summer ; in winter snow may block the trails. At the request of the Red Cross Society the Winnipeg Medical Society appointed an advisory committee of five doctors who had had a wide experience of rural conditions in Manitoba, under the chairmanship of one of the leading surgeons. After examining such propositions as the organisation of a travelling hospital the medical committee declared itself in favour of appointing a medical officer to the Unorganised Areas Service, who should be paid an ample salary with free transport, give full-time service without other remuneration, and make Winnipeg his headquarters, whence he should visit in turn or as occasion demands these or other nursing stations established by the Red Cross Service. This recommendation was adopted and financed entirely by the Red Cross Society, with the exception that the Winnipeg Medical Society presented the service with the necessary outfit of instruments for midwifery as well as for medical and surgical purposes. Since the fall of 1920 a succession of well-trained young medical men have manned this service to the great comfort and support of the nurses and to the relief of hundreds of settlers and their families. Here I would like to emphasise the splendid services of our nurses, many of whom have been trained in the Old Country and have proved the value of their training for the C.M.B. diploma when handling the inevitable midwifery perforce single-handed and under difficult conditions. - As an eloquent sample of the appreciation of this service to unorganised areas the following is a quotation from a recent letter to the
I
present writer :" The Red Cross people have done a great work here. It is so comforting to us to have the nurse near us and the doctor’s monthly visits. This spring the trails have been awful ;the land is too wet to seed and now the meadows Our post office is 3t miles away are too wet to cut the hay. but we have to go about seven miles to get there ! Nurse has done fine work since she came here ; has visited hundreds in all kinds of weather by land and lake ; has been caught
in storms and tumbled into snow-drifts, stuck in sloughs, and got lost on several occasions in happy ignorance of the danger !Few nurses would have gone through it, cold and hungry many a time, and no complaints, night and day. " In fact she has had as many escapades as St. Paul"
This is not exaggerated, and refers, of course, only to the unorganised parts of Manitoba. My committee consists of Dr. Jasper Halpenny (chairman), Drs. N. W. Warner, G. S. Fahrni, T. C. Brereton, and mvself.-I am. Sir. vours faithfullv. H. M. SPEECHLY, M.R.C.S. Eng., Hon. Secretary, Medical Advisory Committee. -_
Winnipeg,
__
-
-
_
__
August 22nd, 1923.
PATHOLOGICAL DEPARTMENTS. To the Editor of THE LANCET. SIR,-On this subject communications appeared last week in THE LANCET Which call for comment.
The utilisation of university pathological departments for money-making may bring them into competition with the pathological departments of county hospitals in an unfair manner. This hospital, for instance, has a fully equipped pathological and bacteriological department with a specialist in charge, who is only allowed to practise as such and whose livelihood depends on this practice. There is a V.D. clinic in the hospital, a few yards from the laboratories, but bloods for Wassermanns must be sent to a distant university. The Ministry of Health refuses to allow the county council to pay the hospital department for Wassermann tests in spite of the representations of the county M.O.H., the County Public Health Committee, the clinic medical officers, and the medical and surgical staff of the hospital. The result is that the clinic bloods are " split " and with the hospital bloods (not " split ") are done weekly as a matter of routine by the pathologist, who though unpaid, is not without honour in his own laboratory when reports differ. " Seeing the wheels go round " is preferred to a five-shillings-in-the-slot postal machine delivering a piece of pasteboard ! The position is the same in an adjoining county, and will no doubt be the same in a third county which is considering the appointment of a county
pathologist.-I
am,
Salisbury, Sept. 10th,
Sir,
yours
1923.
faithfully,
H. ST. ARNAUD AGATE.
DEFATTED BACTERIAL VACCINES. To the Editor of THE LANCET. SIR,-In a lecture delivered on June 14th at St. Mary’s Hospital, Prof. G. Dreyer claimed to have made an important discovery by using defatted tubercle bacilli as antigen for diagnostic and therapeutic purposes in tuberculosis. This work has been enthusiastically received by the whole press, and may arouse hopes that will not be satisfied. The Institute of Microbiology in Saarbrilcken has been working on very similar lines for years and the use of defatted tubercle bacilli has proved a delicate matter. I should therefore be very much obliged if you will allow me to indicate two things that will lead to a sober valuation of Prof. Dreyer’s investigations. In 1921and 19222I published experiments that demonstrated the necessity of defatting tubercle bacilli before using them as specific antigen. I described then a special method of defatting tubercle bacilli by means of the vapours of ether or other fatdissolving liquid, and was able to show that in this process the biologic albumin of the bacilli remains intact and unaltered. The defatted tubercle bacilli form a stable emulsion that is specifically precipitated the serum of tuberculous persons and this so-called by " " is already in constant tuberculo-diagnosticum use at many sanatoria and by medical officers to schools. The same emulsion gave complement deviation when brought in contact with serum from 1 Annales de l’Institut Pasteur, xxxv., 797. 2 Deutsche Archiv für klinische Medizin, cxxxviii., 229.
587 tuberculous persons and showed remarkable effect when used as anti-tuberculous vaccine in men.3 These facts have been fully confirmed by Wassermann4 who used another process of defatting the tubercle bacilli. Of the earlier publications recommending defatted tubercle bacillus as specific antigen, Prof. Dreyer’s observations appear to be a confirmation. The second and more remarkable point in Prof. Dreyer’s lecture is the fact that his tuberculous antigen’withstands exposure for four hours and more to 100°C., at which temperature tubercle bacilli must, according to him, be boiled with formalin and acetone if they are to lose their acid resistance.5 Up till now bacteriologists have always carefully tried to avoid as much as possible any alteration of the antigen contained in the living microbe, the immunising power of which is demonstrated to us daily by practical experience. That Prof. Dreyer’s boiled tuberculous antigen still possesses the same immunising power is a real discovery of highest theoretical importance, unless further investigation should prove that his good results are due rather to the effect ofa protein than of a real immune-therapy. I am, Sir, yours faithfully, W. FORNET. Saarbriiekeia, Sept. 4th, 1923.
ROYAL DENTAL HOSPITAL
LONDON.-The
prize of the London School of Dental Surgery will s , distribution take at the hospital when Oct. lst at 5
I
Medical News. FELLOWSHIP QF MEDICINE
AND
OF
on place P.M., Christopher Addison will distribute the prizes. SMALL-POX IN ENGLAND AND WALES.-In the ended Sept. 1st 21 cases of small-pox were reported week in England and Wales, ten of these being from Gloucester. Three cases were reported in London on Sept. 7th, one each from Paddington, Finsbury, and Camberwell respectively, and in the five days following five further cases and two suspects came to light. The Camberwell patient was employed at a London hotel, and two cases in Westminster
Dr.
and Lewisham have been attributed to the same source. Infection in the others has been traced to a visitor recently arrived from Spain, whose indisposition was not recognised until the maid who attended her was found to be suffering from small-pox.
THE LATE DR. CLARENCE ROBINSON.-Dr.
Robinson,
who died suddenly at the early age of 42 on August 29th while on holiday in the Isle of Man, was a popular practitioner in Warrington. A native of Cork, he qualified L.R.C.P. & S. Irel. from Queen’s College in 1903 and was appointed house surgeon at the General Hospital, Ramsgate, afterwards becoming visiting surgeon to the Ramsgate and St. Lawrence Dispensary. He went into partnership in general practice at Camberwell Green, and about 15 years ago migrated to Latchford, Warrington, where he became surgeon to the Warrington Infirmary, a member of the panel committee, and surgeon to the pensions board. In the early days of the war he worked at the Lord Derby War Hospital at Winwick, and afterwards served for five years at Thelwall Heys. He leaves a wife and two sons.
POST-GRADUATE
MEDICAL ASSOCIATION.—A fortnight’s " Refresher " Course in general medicine and surgery will be given at the London Temperance Hospital in conjunction with Bethlem Royal Hospital, North-Western Fever Hospital, and the Royal Westminster Ophthalmic Hospital from Oct. 8th to 20th. The course will include daily lectures and clinical demonstrations in the wards and out-patient department. A course on genito-urinary diseases will be given at St. Peter’s Hospital from Oct. lst to 27th. In addition to demonstrations in the out-patient department a series of lectures will be given on various aspects by the members of the staff. A course of eight lectures on tropical diseases will be given by Dr. G. Low and Dr. P. Manson-Bahr at the School of Tropical Medicine, beginning on Tuesday, Oct. 2nd. The subjects considered will be the more important diseases of tropical countries. A course in laryngology, rhinology, and otology, consisting of clinical demonstrations, lectures, &c., each day from 9.30 A.M. to 5 P.M., will be given at the Central London Throat, Nose, and Ear Hospital from Oct. 8th to 26th. A further course on children’s diseases will be given at the Victoria Hospital for Children from Oct. 8th to 20th, and in ophthalmology at the Royal London Ophthalmic Hospital from Oct. 8th to Nov. 3rd. The National Hospital for Diseases of the Heart and St. Mark’s Hospital for Diseases of the Rectum will each give a fortnight’s course on cardiology and proctology respectively, from Oct. 15th to 27th. Copies of the syllabus and further particulars regarding any of the above coupses will be forwarded on application to the secretary to the Fellowship of Medicine at 1, Wimpole-street, London, W. 1.
LEBANON HOSPITAL.-Great Britain, America, Holland, and Switzerland all share in the work of the Lebanon Hospital for Mental Diseases, Asfuriyeh, Beyrout, Syria, and the report for the twelvemonth ended March 31st, 1923, shows that the institution has accomplished much good work. During the year under notice there were 279 patients under treatment including 181 n8W patients, of whom 132 were men and 49 women. Dr. H. Watson Smith, the medical
Medical Diary. LECTURES, ADDRESSES, DEMONSTRATIONS, &C. FELLOWSHIP OF MEDICINE, SPECIAL COURSE IN INFANTS’ DISEASES, at the Infants Hospital, Vincentsquare, Westminster, S.W. MONDAY, Sept. 17th.-2-3.30 P.M., Dr. William Robinson : Congenital Heart. 4.30-6 P.M., Dr. Eric Pritchard : Premature Infants, Management and Feeding. TUESDAY.-2-3.30 P.M., Dr. Eric Pritchard : Syphilis in Infants. 4.30-6 P.M., Mr. Philip Franklin : Tonsils and Adenoids. Demonstration and Operation WEDNESDAY.-2.30-3.30 P.M., Dr. Helen Mackay : Special Cases in Wards and Out-patient Department (Diabetes and Insulin Treatment, Mongolism, Malaria, Enlarged 4-6.30 P.M., Dr. Donald Paterson : Thymu, &c.). Lecture : Encephalitis and Poliomyelitis. THURSDAY.-2-3.30 P.M., Dr. Donald Paterson : Special Cases (Wind Swallowing). 4.30-6 P.M., Mr. M. S. Mayou : Lecture and Demonstration : Some Common Eye Conditions from the Practitioner’s Point of View. FRIDAY.-2-3.30 P.M., Dr. Eric Pritchard : Round Table Consultation. Special Cases for Diagnosis. 4.30-6 P.M., Dr. Donald Paterson : Summer Diarrhcea. LONDON POST-GRADUATE COLLEGE, West WEST London Hospital, Hammersmith-road, W. 17th.-10 Mr. Maingot : Surgical MONDAY, Sept. A.M., Pathology. 12 noon, Mr. Simmonds: Applied Anatomy. 2.30 P.M., Dr. Saunders : Medical Wards. 2 P.M., TUESDAY.-12 noon, Dr. Burrell: Chest Cases. Mr. Banks-Davis : Throat, Nose, and Ear Department. 2.30 P.M., Dr. Pritchard : Medical Wards. WEDNESDAY.-10 A.M., Dr. Saunders : Medical Diseases of 2 P.M., Dr. Burnford: Medical Wards. Children. 3 P.M., Dr. Pernet : Skin Department. THURSDAY.-10 A.M., Dr. Grainger Stewart: Neurological Department. 12 noon, Mr. Simmonds : Demonstration of Fractures. 2 P.M., Mr. Bishop Harman : Eye
Department.
FRIDAY.-10 A.M., Mr. Dudley Buxton : Dental Department. 2 P.M., Dr. Burrell: Medical Out-patients. 2 P.M., Mr. Sinclair : Surgical Out-patients. SATURDAY.-9.30 A.M., Dr. Burnford : Bacterial Therapy. 10 A.M., Dr. Saunders : Medical Diseases of Children.
director, states that the increase in the number of patients necessitated the squeezing in of additional 10 A.M., Mr. Banks-Davis : Operations on Throat, beds in the American and Philadelphia pavilions to accomNose, and Ear. modate them, and so resulted in an unavoidable congested Daily, 10 A.M. to 6 P.M., Saturdays 10 A.bi. to 1 P.M., Incondition of these houses. The opening of the Strawbridge patients, Out-patients, Operations, Special Departments. Memorial House for women patients fortunately relieved this state of affairs. The general statistics show that 38 men and 18 women recovered, and that 49 men and 5 women benefited by their stay in the hospital, while 26 men and 7 women left the hospital for various reasons. The needs of the institution include a permanent and adequate waterL. C., M.D., B.Ch. Oxf., M.R.C.P. Lond., F.R.C.S. supply at an estimated cost of 21000, an X ray plant at PANTING, Eng., has been appointed Honorary Consulting Surgeon to 2500, a laundry at 21000, and a septic tank at 2100. The the Helston and District Cottage Hospital. address of the general secretary is at the Lebanon Hospital ROBERTS, C., M.B., B.S. Lond., F.R.C.S. Eng., one of the Office, 35, Queen Victoria-street, London, E.C.4. Medical Referees under the Workmen’s Compensation Act women
_____
______
Appointments.
3 Münchener Medizin. Wochenschr., May 11th, 1923. 4 Deutsche Medizin. Wochenschr., March 9th, 1923. 5 Brit. Jour. of Exp. Pathology, June, 1923, iv., 146.
for County Court Circuits No. 5 and 8. Certifying Surgeons under the Factory and Workshop Acts: MACKAY, W. M., lBI.B., Ch.B. Edin. (Crook, Co. Durham) ; FOXTON, H., M.B., Ch.B. Leeds (Uttoxeter).
.
RURAL MANITOBA. To the Editor of THE LANCET. think SIR,—I your readers will be interested in a brief account of a combined medical and nursing service organised for rural areas by the Manitoba Division of the Canadian Red Cross Society, especially as it has been of tremendous assistance to many British-born settlers whose wives in many cases have come directly from the Old Land to live in what are known as the unorganised areas of Manitoba. It , illustrates also the value of the whole-hearted cooperation of the medical profession with the Red Cross ’, peace-time service. In 1919 the Red Cross Society, finding a great and ’, urgent demand for some sort of skilled assistance in dealing with the health of certain districts which ’, had no other civilised social service, established at Reynolds, where Poles and Ruthenian settlers abound, z, 63 miles east of Winnipeg, Fisher Branch, 72 miles N.W. and Grahamdale, 134 miles N.W. (both points z’ lying between Lakes Winnipeg and Manitoba), and also at Kinosota, 140 miles N.W., on the west side of Lake Manitoba, nursing stations, which were at first disciplined and managed by the Provincial Board of Health but now are under the exclusive management of the Red Cross Society with its Medical Advisory Board. These nursing stations proved of great value, but it soon became apparent that medical supervision was needed and that too great a responsibility was being placed on nurses whose calling does not include the ability to diagnose and to decide the final destination of any given case. It must be remembered that these districts, except Reynolds, were 40 miles at least from the nearest doctor and that very few of the people could afford to pay any fees. The problem was how to cover the ground effectively. For most of the year the roads are only passable by foot or horsedrawn vehicles, and not always thus. Bush country in unorganised Manitoba is always very boggy in spring and often in summer ; in winter snow may block the trails. At the request of the Red Cross Society the Winnipeg Medical Society appointed an advisory committee of five doctors who had had a wide experience of rural conditions in Manitoba, under the chairmanship of one of the leading surgeons. After examining such propositions as the organisation of a travelling hospital the medical committee declared itself in favour of appointing a medical officer to the Unorganised Areas Service, who should be paid an ample salary with free transport, give full-time service without other remuneration, and make Winnipeg his headquarters, whence he should visit in turn or as occasion demands these or other nursing stations established by the Red Cross Service. This recommendation was adopted and financed entirely by the Red Cross Society, with the exception that the Winnipeg Medical Society presented the service with the necessary outfit of instruments for midwifery as well as for medical and surgical purposes. Since the fall of 1920 a succession of well-trained young medical men have manned this service to the great comfort and support of the nurses and to the relief of hundreds of settlers and their families. Here I would like to emphasise the splendid services of our nurses, many of whom have been trained in the Old Country and have proved the value of their training for the C.M.B. diploma when handling the inevitable midwifery perforce single-handed and under difficult conditions. - As an eloquent sample of the appreciation of this service to unorganised areas the following is a quotation from a recent letter to the
I
present writer :" The Red Cross people have done a great work here. It is so comforting to us to have the nurse near us and the doctor’s monthly visits. This spring the trails have been awful ;the land is too wet to seed and now the meadows Our post office is 3t miles away are too wet to cut the hay. but we have to go about seven miles to get there ! Nurse has done fine work since she came here ; has visited hundreds in all kinds of weather by land and lake ; has been caught
in storms and tumbled into snow-drifts, stuck in sloughs, and got lost on several occasions in happy ignorance of the danger !Few nurses would have gone through it, cold and hungry many a time, and no complaints, night and day. " In fact she has had as many escapades as St. Paul"
This is not exaggerated, and refers, of course, only to the unorganised parts of Manitoba. My committee consists of Dr. Jasper Halpenny (chairman), Drs. N. W. Warner, G. S. Fahrni, T. C. Brereton, and mvself.-I am. Sir. vours faithfullv. H. M. SPEECHLY, M.R.C.S. Eng., Hon. Secretary, Medical Advisory Committee. -_
Winnipeg,
__
-
-
_
__
August 22nd, 1923.
PATHOLOGICAL DEPARTMENTS. To the Editor of THE LANCET. SIR,-On this subject communications appeared last week in THE LANCET Which call for comment.
The utilisation of university pathological departments for money-making may bring them into competition with the pathological departments of county hospitals in an unfair manner. This hospital, for instance, has a fully equipped pathological and bacteriological department with a specialist in charge, who is only allowed to practise as such and whose livelihood depends on this practice. There is a V.D. clinic in the hospital, a few yards from the laboratories, but bloods for Wassermanns must be sent to a distant university. The Ministry of Health refuses to allow the county council to pay the hospital department for Wassermann tests in spite of the representations of the county M.O.H., the County Public Health Committee, the clinic medical officers, and the medical and surgical staff of the hospital. The result is that the clinic bloods are " split " and with the hospital bloods (not " split ") are done weekly as a matter of routine by the pathologist, who though unpaid, is not without honour in his own laboratory when reports differ. " Seeing the wheels go round " is preferred to a five-shillings-in-the-slot postal machine delivering a piece of pasteboard ! The position is the same in an adjoining county, and will no doubt be the same in a third county which is considering the appointment of a county
pathologist.-I
am,
Salisbury, Sept. 10th,
Sir,
yours
1923.
faithfully,
H. ST. ARNAUD AGATE.
DEFATTED BACTERIAL VACCINES. To the Editor of THE LANCET. SIR,-In a lecture delivered on June 14th at St. Mary’s Hospital, Prof. G. Dreyer claimed to have made an important discovery by using defatted tubercle bacilli as antigen for diagnostic and therapeutic purposes in tuberculosis. This work has been enthusiastically received by the whole press, and may arouse hopes that will not be satisfied. The Institute of Microbiology in Saarbrilcken has been working on very similar lines for years and the use of defatted tubercle bacilli has proved a delicate matter. I should therefore be very much obliged if you will allow me to indicate two things that will lead to a sober valuation of Prof. Dreyer’s investigations. In 1921and 19222I published experiments that demonstrated the necessity of defatting tubercle bacilli before using them as specific antigen. I described then a special method of defatting tubercle bacilli by means of the vapours of ether or other fatdissolving liquid, and was able to show that in this process the biologic albumin of the bacilli remains intact and unaltered. The defatted tubercle bacilli form a stable emulsion that is specifically precipitated the serum of tuberculous persons and this so-called by " " is already in constant tuberculo-diagnosticum use at many sanatoria and by medical officers to schools. The same emulsion gave complement deviation when brought in contact with serum from 1 Annales de l’Institut Pasteur, xxxv., 797. 2 Deutsche Archiv für klinische Medizin, cxxxviii., 229.
587 tuberculous persons and showed remarkable effect when used as anti-tuberculous vaccine in men.3 These facts have been fully confirmed by Wassermann4 who used another process of defatting the tubercle bacilli. Of the earlier publications recommending defatted tubercle bacillus as specific antigen, Prof. Dreyer’s observations appear to be a confirmation. The second and more remarkable point in Prof. Dreyer’s lecture is the fact that his tuberculous antigen’withstands exposure for four hours and more to 100°C., at which temperature tubercle bacilli must, according to him, be boiled with formalin and acetone if they are to lose their acid resistance.5 Up till now bacteriologists have always carefully tried to avoid as much as possible any alteration of the antigen contained in the living microbe, the immunising power of which is demonstrated to us daily by practical experience. That Prof. Dreyer’s boiled tuberculous antigen still possesses the same immunising power is a real discovery of highest theoretical importance, unless further investigation should prove that his good results are due rather to the effect ofa protein than of a real immune-therapy. I am, Sir, yours faithfully, W. FORNET. Saarbriiekeia, Sept. 4th, 1923.
ROYAL DENTAL HOSPITAL
LONDON.-The
prize of the London School of Dental Surgery will s , distribution take at the hospital when Oct. lst at 5
I
Medical News. FELLOWSHIP QF MEDICINE
AND
OF
on place P.M., Christopher Addison will distribute the prizes. SMALL-POX IN ENGLAND AND WALES.-In the ended Sept. 1st 21 cases of small-pox were reported week in England and Wales, ten of these being from Gloucester. Three cases were reported in London on Sept. 7th, one each from Paddington, Finsbury, and Camberwell respectively, and in the five days following five further cases and two suspects came to light. The Camberwell patient was employed at a London hotel, and two cases in Westminster
Dr.
and Lewisham have been attributed to the same source. Infection in the others has been traced to a visitor recently arrived from Spain, whose indisposition was not recognised until the maid who attended her was found to be suffering from small-pox.
THE LATE DR. CLARENCE ROBINSON.-Dr.
Robinson,
who died suddenly at the early age of 42 on August 29th while on holiday in the Isle of Man, was a popular practitioner in Warrington. A native of Cork, he qualified L.R.C.P. & S. Irel. from Queen’s College in 1903 and was appointed house surgeon at the General Hospital, Ramsgate, afterwards becoming visiting surgeon to the Ramsgate and St. Lawrence Dispensary. He went into partnership in general practice at Camberwell Green, and about 15 years ago migrated to Latchford, Warrington, where he became surgeon to the Warrington Infirmary, a member of the panel committee, and surgeon to the pensions board. In the early days of the war he worked at the Lord Derby War Hospital at Winwick, and afterwards served for five years at Thelwall Heys. He leaves a wife and two sons.
POST-GRADUATE
MEDICAL ASSOCIATION.—A fortnight’s " Refresher " Course in general medicine and surgery will be given at the London Temperance Hospital in conjunction with Bethlem Royal Hospital, North-Western Fever Hospital, and the Royal Westminster Ophthalmic Hospital from Oct. 8th to 20th. The course will include daily lectures and clinical demonstrations in the wards and out-patient department. A course on genito-urinary diseases will be given at St. Peter’s Hospital from Oct. lst to 27th. In addition to demonstrations in the out-patient department a series of lectures will be given on various aspects by the members of the staff. A course of eight lectures on tropical diseases will be given by Dr. G. Low and Dr. P. Manson-Bahr at the School of Tropical Medicine, beginning on Tuesday, Oct. 2nd. The subjects considered will be the more important diseases of tropical countries. A course in laryngology, rhinology, and otology, consisting of clinical demonstrations, lectures, &c., each day from 9.30 A.M. to 5 P.M., will be given at the Central London Throat, Nose, and Ear Hospital from Oct. 8th to 26th. A further course on children’s diseases will be given at the Victoria Hospital for Children from Oct. 8th to 20th, and in ophthalmology at the Royal London Ophthalmic Hospital from Oct. 8th to Nov. 3rd. The National Hospital for Diseases of the Heart and St. Mark’s Hospital for Diseases of the Rectum will each give a fortnight’s course on cardiology and proctology respectively, from Oct. 15th to 27th. Copies of the syllabus and further particulars regarding any of the above coupses will be forwarded on application to the secretary to the Fellowship of Medicine at 1, Wimpole-street, London, W. 1.
LEBANON HOSPITAL.-Great Britain, America, Holland, and Switzerland all share in the work of the Lebanon Hospital for Mental Diseases, Asfuriyeh, Beyrout, Syria, and the report for the twelvemonth ended March 31st, 1923, shows that the institution has accomplished much good work. During the year under notice there were 279 patients under treatment including 181 n8W patients, of whom 132 were men and 49 women. Dr. H. Watson Smith, the medical
Medical Diary. LECTURES, ADDRESSES, DEMONSTRATIONS, &C. FELLOWSHIP OF MEDICINE, SPECIAL COURSE IN INFANTS’ DISEASES, at the Infants Hospital, Vincentsquare, Westminster, S.W. MONDAY, Sept. 17th.-2-3.30 P.M., Dr. William Robinson : Congenital Heart. 4.30-6 P.M., Dr. Eric Pritchard : Premature Infants, Management and Feeding. TUESDAY.-2-3.30 P.M., Dr. Eric Pritchard : Syphilis in Infants. 4.30-6 P.M., Mr. Philip Franklin : Tonsils and Adenoids. Demonstration and Operation WEDNESDAY.-2.30-3.30 P.M., Dr. Helen Mackay : Special Cases in Wards and Out-patient Department (Diabetes and Insulin Treatment, Mongolism, Malaria, Enlarged 4-6.30 P.M., Dr. Donald Paterson : Thymu, &c.). Lecture : Encephalitis and Poliomyelitis. THURSDAY.-2-3.30 P.M., Dr. Donald Paterson : Special Cases (Wind Swallowing). 4.30-6 P.M., Mr. M. S. Mayou : Lecture and Demonstration : Some Common Eye Conditions from the Practitioner’s Point of View. FRIDAY.-2-3.30 P.M., Dr. Eric Pritchard : Round Table Consultation. Special Cases for Diagnosis. 4.30-6 P.M., Dr. Donald Paterson : Summer Diarrhcea. LONDON POST-GRADUATE COLLEGE, West WEST London Hospital, Hammersmith-road, W. 17th.-10 Mr. Maingot : Surgical MONDAY, Sept. A.M., Pathology. 12 noon, Mr. Simmonds: Applied Anatomy. 2.30 P.M., Dr. Saunders : Medical Wards. 2 P.M., TUESDAY.-12 noon, Dr. Burrell: Chest Cases. Mr. Banks-Davis : Throat, Nose, and Ear Department. 2.30 P.M., Dr. Pritchard : Medical Wards. WEDNESDAY.-10 A.M., Dr. Saunders : Medical Diseases of 2 P.M., Dr. Burnford: Medical Wards. Children. 3 P.M., Dr. Pernet : Skin Department. THURSDAY.-10 A.M., Dr. Grainger Stewart: Neurological Department. 12 noon, Mr. Simmonds : Demonstration of Fractures. 2 P.M., Mr. Bishop Harman : Eye
Department.
FRIDAY.-10 A.M., Mr. Dudley Buxton : Dental Department. 2 P.M., Dr. Burrell: Medical Out-patients. 2 P.M., Mr. Sinclair : Surgical Out-patients. SATURDAY.-9.30 A.M., Dr. Burnford : Bacterial Therapy. 10 A.M., Dr. Saunders : Medical Diseases of Children.
director, states that the increase in the number of patients necessitated the squeezing in of additional 10 A.M., Mr. Banks-Davis : Operations on Throat, beds in the American and Philadelphia pavilions to accomNose, and Ear. modate them, and so resulted in an unavoidable congested Daily, 10 A.M. to 6 P.M., Saturdays 10 A.bi. to 1 P.M., Incondition of these houses. The opening of the Strawbridge patients, Out-patients, Operations, Special Departments. Memorial House for women patients fortunately relieved this state of affairs. The general statistics show that 38 men and 18 women recovered, and that 49 men and 5 women benefited by their stay in the hospital, while 26 men and 7 women left the hospital for various reasons. The needs of the institution include a permanent and adequate waterL. C., M.D., B.Ch. Oxf., M.R.C.P. Lond., F.R.C.S. supply at an estimated cost of 21000, an X ray plant at PANTING, Eng., has been appointed Honorary Consulting Surgeon to 2500, a laundry at 21000, and a septic tank at 2100. The the Helston and District Cottage Hospital. address of the general secretary is at the Lebanon Hospital ROBERTS, C., M.B., B.S. Lond., F.R.C.S. Eng., one of the Office, 35, Queen Victoria-street, London, E.C.4. Medical Referees under the Workmen’s Compensation Act women
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Appointments.
3 Münchener Medizin. Wochenschr., May 11th, 1923. 4 Deutsche Medizin. Wochenschr., March 9th, 1923. 5 Brit. Jour. of Exp. Pathology, June, 1923, iv., 146.
for County Court Circuits No. 5 and 8. Certifying Surgeons under the Factory and Workshop Acts: MACKAY, W. M., lBI.B., Ch.B. Edin. (Crook, Co. Durham) ; FOXTON, H., M.B., Ch.B. Leeds (Uttoxeter).
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