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THE CAUSES OF INTRA-UTERINE DEATH.
302
CONVALESCENCE.-THE CAUSES OF ITRA-UTERINE DEATH.
him to do
so
many
foot-pounds
of work
underground ? viewpoint
Many political economists fail to appreciate,
or
argue
of medicine and in
cases, and that it has
dealing with acute neglected the care of the con-
if there were such failure, that calculations must valescent. Patients are left " half cured." Convalesgive way before the laws of life, whereas they should cence is as much a mental as a physical condition, be founded upon those laws. Dublin, the American and occupational therapy combined with prescribed medical statistician, has suggested forcibly that the graduated exercise is of as much importance as good real value of human life at any time amounts to five food and country air. Arguments on the economic times that of property, while healthy life is of more side are no less convincing. Convalescent homes are value than unhealthy life. Public health has so greatly far less costly than hospitals to construct, and the improved as to be deserving of an improved governance cost of maintaining a patient in them is estimated to match. Whether adoption of the comprehensive at one-third of the cost of a hospital case. Again, as
programme advocated in this report-and the programme has the merit of boldness in some fields,
even though so neglectful of certain fundamentalswould meet the need, we do not presume to discuss. One advantage it possesses in strongly advocating development of the homeland, the place where the people live, by extended road construction, by more
garden cities, by slum clearance on a large scale, by developing docks, harbours, canals, and electrical supply. Health, like wages, must be earned by work, and, in so far as this development would find work where to-day there exists unemployment, it would further improve the nation’s health. The means to this end are set out well in this report which is long, but well written; it deals in sequence with the condition of industry, and the organisation of business, with industrial relations, national development, and finance ; finally come 36 closely printed pages of summary of conclusions. For us the interest lies in the contribution made to furthering the economics of health. Health is largely a product of environment and food, and by health is meant both physical and mental vigour. Both environment and food-supply in the homeland can be improved. By the time England has been made a land fit for heroes to live in, a heroic race will be found inhabiting it, and indeed to have made the land fit for their habitation. Meanwhile it isThat unto him who works, and feels he works, This
same
grand year is
ever
at the doors.
CONVALESCENCE. EVERYONE with experience of hospital practice will agree that, owing to the pressure of a long waitinglist, many patients must be discharged in an only partially cured condition. In England a fortunate minority do indeed obtain a few weeks at one of the convalescent homes attached to the larger hospitals, but of necessity the majority must return to their own homes, which, as a rule, cannot provide a suitable Some of these environment for convalescence. patients continue to attend as out-patients for tonics or dressings, but many take their final leave of the hospital still feeling far from strong and receive little or no further guidance and encouragement to help to restore sufficient vigour and self-confidence Confor a return to full work. In a new book on valescence, Historical and Practical,"1 Dr. John Bryant records the efforts that have been made in the past by different countries to remedy this defect and to prevent this class of patient drifting to chronic invalidism, a prey to charlatans, and a burden to the rates. London took the lead with the Metropolitan Convalescent Institution established in 1844, and was followed by Paris in 1857, when Napoleon III. decreed the foundation of special convalescent hospitals at Vincennes and Vesinet. America was slow to follow this example, and it was not till 1915 that the Burke Relief Foundation was established for New York and equipped with every facility for occupational therapy. Armed with a keen interest and wide experience of military and civilian practice in this type of work, Dr. Bryant writes with authority and a wealth of detail. Struck by the scantiness of the literature on the subject, he insists that the profession is absorbed in the laboratory "
1 Convalescence, Historical and Practical. M.D. 1927.
By John Bryant, New York : The Sturgis Fund of the Burke Foundation.
Pp. 269.
with adequate convalescent accommodation to fall back on, the average stay in hospital can be shortened and expensive hospital extensions may be avoided by a more rapid turnover of patients. Finally, the rates are relieved of the burden of a large number of chronic invalids. The book consists of a series of articles by Dr. Bryant, revised and incorporated in a single volume. This construction leads to lack of continuity of argument and some repetition, but the work is of real value in pointing the remedy of a serious defect in our present hospital and public health systems. The chapters describing the Burke Relief Foundation and the occupational therapy employed in the U.S. military convalescent camps during the war are of particular interest. They show what can be done given sufficient resources and enthusiasm, and should be read by all who are interested in the future of our hospital and public health services. ____
THE CAUSES OF INTRA-UTERINE DEATH. THE Medical Research Council published in 1926 a clinical and pathological study, by Dr. Eardley Holland and Dr. Janet Lane-Claypon,l of 1673 dead births and neonatal deaths. This summarised the combined investigations of many workers at different centres throughout the country. In a further report just issued Mr. A. C. Palmer publishes a detailed account of one of these investigations, dealing with 144 cases of foetal death observed at the London Hospital; 141 of the patients were Whitechapel women delivered in their own homes by students or nurses from the hospital; three were private patients of members of the staff. A complete necropsy, including weights and measurements, was performed on all the infants, and the placenta, when obtained, was weighed, measured, and examined macroscopically and microscopically. Most of the sections were prepared according to Levaditi’s method and investigated for syphilis ; other specimens were stained with Ehrlich’s haematoxylin and eosin, with Weigert’s iron heematoxylin and van Gieson’s mixture or with Weigert’s fuchselin and lithium carmine. Others were examined fresh on dark-ground illumination. Eardley Holland’s first investigation, published in 1922, showed that about 20 per cent. of stillborn foetuses are macerated. Of this series 39, or 27 per cent., were macerated and 35-9 per cent. of these were proved to be syphilitic by the identification of the Spironema pallidum in their tissues. Toxaemia of pregnancy, indicated by albuminuria in the mother, probably accounted for the death of 11, 7-6 per cent. of the total or 28-2 per cent. of the macerated. The cause of death in 12 more was obscure, but maternal albuminuria could only be certainly excluded in one of these. Maternal morbus cordis and foetal malformation each accounted for one death. Asphyxia accounted for the death of 91 out of the 99 nonmacerated foetuses, in 12 of whom intracranial haemorrhage from excessive moulding appeared to be the fatal factor. Of the eight cases showing no asphyxia three had foetal anasarca and the others all died from conditions, such as hydrocephalus and eclampsia, which would have caused asphyxia had the child lived long enough. Of the six infants who breathed for a short time after delivery, four had asphyxia and one had intracranial haemorrhages. 1 Special Report Series No. 109. Office.
1926.
3s. 6d.
2 Ibid., No. 118.
London: H.M. Stationery 1928.
3s.
303
MOTOR-CAR ACCIDENTS AND HOSPITALS.
Of all the 105 non-macerated foetuses, 27 died as a result of maternal disease and 5 of fcetal disease or malformation. Labour accounted for the death of 73, or just under 70 per cent. ; syphilis for less than 1 per cent. The placenta revealed no signs of maternal or fostal disease in any of the 99 cases in which it was examined. This report emphasises once more the findings of the larger series. With a few exceptions a dead baby is the result of one of three things : difficulty in labour (50 per cent. of this series), maternal disease (18-7 per cent.), or syphilis (11-3 per cent.). All these are preventable conditions, and adequate antenatal care would have removed or foreseen the threat to the child’s life. It also appears that syphilis is unlikely to have caused the death of a non-macerated foetus. MOTOR-CAR ACCIDENTS AND
HOSPITALS.
FOR some years past the pressure upon hospital beds and hospital finances caused by the rapid increase in the number of motor-car accidents has been growing in severity. The enormous annual output of motor vehicles of all kinds from the formidable trolley and hardly less formidable charabancs to the deadly motor-cycle, which must move the jealousy of Jehu in the shades, forbids the hope that the pressure has reached its peak, and we may therefore confidently expect that the difficulty will become still more acute. All over the country hospitals, large and small, are embarrassed by the necessity of admitting casualties to already overcrowded wards and by the cost of treating patients who are often so seriously injured that their tenure of beds, sorely needed for local purposes, is prolonged. Thus the annual report of the great Manchester Royal Infirmary, which has just been issued, records the admission of a daily average of 80 casualties-one every 18 minutes throughout the 24 hours. Most general hospitals can tell much the same story in proportion to their size and geographical situation. In the hope of obtaining precise information on the subject Mr. H. W. Burleigh, the chairman of the Hospitals Motor Accident Policy Association, last autumn addressed a letter to us asking for details of motor accidents treated at hospitals throughout the country. His invitation has been responded to by 183 hospitals, representing 14,169 beds-about one-third of the total of available beds-and the information he has obtained satisfies him that, irrespective of fees to medical men, the cost of motor accidents to the hospitals in the mass must be about half a million a year. That is an alarming figure, but, as we have said, the trouble does not end there. Lack of pecuniary elasticity is accompanied by inelasticity of beds, and Mr. Burleigh is informed that in many small hospitals. at the approach of the week-end, when the maiming is at its height, medical officers have to hasten the discharge of the local patients for whom the institution primarily exists, to be ready for injured motorists, mainly from a distance. To say that this is a grotesque state of things is to put the situation mildly. This part of the difficulty will not be removed by any
omnibuses and taxi-cabs should do likewise, but it is obviously desirable that there should be as much insurance as possible. There is grim irony in the provision that half benefits only can be paid in respect of motor-cycles and sidecars, though the driver of these dangerous machines may equalise matters by taking two policies for each seat. Simultaneously with the creation of this interesting policy we learn that the Middlesbrough Motor Club has instituted an insurance scheme which, for a premium of half a crown a year secures payments to hospitals in any part of the country ranging from half a guinea for a dressing to £ l5 for a detention of five or six weeks. If the motor insurance companies would now recognise the indebtedness of their insurers to the hospitals the pecuniary side of the difficulty might be fairly met on large lines. That would surmount what is supposed to be the legal obstacle to voluntary hospitals levying a charge for the treatment of road casualties, and if it be the fact, as has been urged on behalf of these companies, that their premiums are too low to admit of payments to hospitals, it would merely seem that an essential element of protection is lacking. The low terms of the new policies to which we have referred suggest that a very small addition to their premiums would meet the difficulty. To safeguard a man against the injury or destruction of his car while he sponges upon hospitals and doctors for the cost of mending his body suggests a lack of appreciation of rather elementary ethics. Meanwhile it is announced that the King’s Fund intends shortly to call a conference of representatives of the hospitals, the insurance companies, and the leading motorists’ organisations to consider the whole subject.
Sir James Berry, consulting surgeon to the Royal Free Hospital, has retired from practice, but will remain
the Council of the Royal College of England and complete his term of office President of the Royal Society of Medicine. on
Surgeons as
of
A SPECIAL meeting of the Charity Organisation Society will be held at 296, Vauxhall Bridge-road, S.W., on Feb. 13th, at 3.30 P.M., under the chairmanship of Lord Dawson of Penn, when Sir William Hamer, Dr. Graham Little, and Dr. Humphrey Nockolds will speak on the Voluntary Hospitals and the Public Authorities. TO "THE LANCET," VOL. II., 1927. THE Index and Title-page to Vol. II., 1927, which was completed with the issue of Dec. 31st, is now ready. A copy will be sent gratis to subscribers on receipt of a post-card addressed to the Manager of THE LANCET, 1, Bedford-street, Strand, W.C. 2. Subscribers who have not already indicated their desire to receive Indexes regularly as published should do
INDEX
so now.
CONGRESSES
CAIRO.-The
celebration
centenary arrangement for payment by, or on behalf of, these of the Cairo Faculty of Medicine, combined with an intercasualty patients, but it would at least ease the national congress of Tropical Medicine and Hygiene, will pecuniary perplexities of the hospital and help, in be held from Dec. 15th-22nd. The centenary celebration some measure, towards the provision of more extended will include sectional meetings in the different departments accommodation. It is, therefore, hopeful news that of the faculty, including operations and demonstrations, the Eagle Star and British Dominions Insurance and the programme for the congress will include two general on ankylostomiasis and bilharziasis. It is also Company have devised a policy which, for a premium meetings and proposed to arrange a medical exhibition of of 5s.
IN
drugs
year, hospital which guarantee appliances. Further particulars may be had from the patient, injured by a moving road vehicle, a payment Secretary-General, Congress Bureau, Faculty of Medicine, of half a guinea a day up to 30 days. together with Cairo. three guineas for medical fees, or five guineas should The Journees Medicales d’Egypte will take place from the patient be detained for more than a week. For Dec. 12th-23rd under the presidency of Prof. J. L. Faure. The subjects under discussion will include the diseases of casualty patients treated, but not admitted, half a both temperate and hot climates. There will also be an guinea would be paid to the hospital and a similar international exhibition of arts and science as applied to a
will
to the
treats
a
fee to the medical officer. The thoughtful and considerate motorist may reasonably be expected to avail himself of these facilities, especially as he may take out a policy for each seat in his car-the careful driver is often the victim of the reckless one. It is suggested with less reason that the pedestrian and the rider in
medicine, surgery, pharmacy, and sanitary hygiene. Further particulars may be had from the general secretary, 32, rue Gay-Lussac, Paris Ve. At both the congresses the official languages will be French, English, Arabic, German, and Italian, and members will be granted reduced fares and facilities for travel.
CONVALESCENCE.-THE CAUSES OF ITRA-UTERINE DEATH.
him to do
so
many
foot-pounds
of work
underground ? viewpoint
Many political economists fail to appreciate,
or
argue
of medicine and in
cases, and that it has
dealing with acute neglected the care of the con-
if there were such failure, that calculations must valescent. Patients are left " half cured." Convalesgive way before the laws of life, whereas they should cence is as much a mental as a physical condition, be founded upon those laws. Dublin, the American and occupational therapy combined with prescribed medical statistician, has suggested forcibly that the graduated exercise is of as much importance as good real value of human life at any time amounts to five food and country air. Arguments on the economic times that of property, while healthy life is of more side are no less convincing. Convalescent homes are value than unhealthy life. Public health has so greatly far less costly than hospitals to construct, and the improved as to be deserving of an improved governance cost of maintaining a patient in them is estimated to match. Whether adoption of the comprehensive at one-third of the cost of a hospital case. Again, as
programme advocated in this report-and the programme has the merit of boldness in some fields,
even though so neglectful of certain fundamentalswould meet the need, we do not presume to discuss. One advantage it possesses in strongly advocating development of the homeland, the place where the people live, by extended road construction, by more
garden cities, by slum clearance on a large scale, by developing docks, harbours, canals, and electrical supply. Health, like wages, must be earned by work, and, in so far as this development would find work where to-day there exists unemployment, it would further improve the nation’s health. The means to this end are set out well in this report which is long, but well written; it deals in sequence with the condition of industry, and the organisation of business, with industrial relations, national development, and finance ; finally come 36 closely printed pages of summary of conclusions. For us the interest lies in the contribution made to furthering the economics of health. Health is largely a product of environment and food, and by health is meant both physical and mental vigour. Both environment and food-supply in the homeland can be improved. By the time England has been made a land fit for heroes to live in, a heroic race will be found inhabiting it, and indeed to have made the land fit for their habitation. Meanwhile it isThat unto him who works, and feels he works, This
same
grand year is
ever
at the doors.
CONVALESCENCE. EVERYONE with experience of hospital practice will agree that, owing to the pressure of a long waitinglist, many patients must be discharged in an only partially cured condition. In England a fortunate minority do indeed obtain a few weeks at one of the convalescent homes attached to the larger hospitals, but of necessity the majority must return to their own homes, which, as a rule, cannot provide a suitable Some of these environment for convalescence. patients continue to attend as out-patients for tonics or dressings, but many take their final leave of the hospital still feeling far from strong and receive little or no further guidance and encouragement to help to restore sufficient vigour and self-confidence Confor a return to full work. In a new book on valescence, Historical and Practical,"1 Dr. John Bryant records the efforts that have been made in the past by different countries to remedy this defect and to prevent this class of patient drifting to chronic invalidism, a prey to charlatans, and a burden to the rates. London took the lead with the Metropolitan Convalescent Institution established in 1844, and was followed by Paris in 1857, when Napoleon III. decreed the foundation of special convalescent hospitals at Vincennes and Vesinet. America was slow to follow this example, and it was not till 1915 that the Burke Relief Foundation was established for New York and equipped with every facility for occupational therapy. Armed with a keen interest and wide experience of military and civilian practice in this type of work, Dr. Bryant writes with authority and a wealth of detail. Struck by the scantiness of the literature on the subject, he insists that the profession is absorbed in the laboratory "
1 Convalescence, Historical and Practical. M.D. 1927.
By John Bryant, New York : The Sturgis Fund of the Burke Foundation.
Pp. 269.
with adequate convalescent accommodation to fall back on, the average stay in hospital can be shortened and expensive hospital extensions may be avoided by a more rapid turnover of patients. Finally, the rates are relieved of the burden of a large number of chronic invalids. The book consists of a series of articles by Dr. Bryant, revised and incorporated in a single volume. This construction leads to lack of continuity of argument and some repetition, but the work is of real value in pointing the remedy of a serious defect in our present hospital and public health systems. The chapters describing the Burke Relief Foundation and the occupational therapy employed in the U.S. military convalescent camps during the war are of particular interest. They show what can be done given sufficient resources and enthusiasm, and should be read by all who are interested in the future of our hospital and public health services. ____
THE CAUSES OF INTRA-UTERINE DEATH. THE Medical Research Council published in 1926 a clinical and pathological study, by Dr. Eardley Holland and Dr. Janet Lane-Claypon,l of 1673 dead births and neonatal deaths. This summarised the combined investigations of many workers at different centres throughout the country. In a further report just issued Mr. A. C. Palmer publishes a detailed account of one of these investigations, dealing with 144 cases of foetal death observed at the London Hospital; 141 of the patients were Whitechapel women delivered in their own homes by students or nurses from the hospital; three were private patients of members of the staff. A complete necropsy, including weights and measurements, was performed on all the infants, and the placenta, when obtained, was weighed, measured, and examined macroscopically and microscopically. Most of the sections were prepared according to Levaditi’s method and investigated for syphilis ; other specimens were stained with Ehrlich’s haematoxylin and eosin, with Weigert’s iron heematoxylin and van Gieson’s mixture or with Weigert’s fuchselin and lithium carmine. Others were examined fresh on dark-ground illumination. Eardley Holland’s first investigation, published in 1922, showed that about 20 per cent. of stillborn foetuses are macerated. Of this series 39, or 27 per cent., were macerated and 35-9 per cent. of these were proved to be syphilitic by the identification of the Spironema pallidum in their tissues. Toxaemia of pregnancy, indicated by albuminuria in the mother, probably accounted for the death of 11, 7-6 per cent. of the total or 28-2 per cent. of the macerated. The cause of death in 12 more was obscure, but maternal albuminuria could only be certainly excluded in one of these. Maternal morbus cordis and foetal malformation each accounted for one death. Asphyxia accounted for the death of 91 out of the 99 nonmacerated foetuses, in 12 of whom intracranial haemorrhage from excessive moulding appeared to be the fatal factor. Of the eight cases showing no asphyxia three had foetal anasarca and the others all died from conditions, such as hydrocephalus and eclampsia, which would have caused asphyxia had the child lived long enough. Of the six infants who breathed for a short time after delivery, four had asphyxia and one had intracranial haemorrhages. 1 Special Report Series No. 109. Office.
1926.
3s. 6d.
2 Ibid., No. 118.
London: H.M. Stationery 1928.
3s.
303
MOTOR-CAR ACCIDENTS AND HOSPITALS.
Of all the 105 non-macerated foetuses, 27 died as a result of maternal disease and 5 of fcetal disease or malformation. Labour accounted for the death of 73, or just under 70 per cent. ; syphilis for less than 1 per cent. The placenta revealed no signs of maternal or fostal disease in any of the 99 cases in which it was examined. This report emphasises once more the findings of the larger series. With a few exceptions a dead baby is the result of one of three things : difficulty in labour (50 per cent. of this series), maternal disease (18-7 per cent.), or syphilis (11-3 per cent.). All these are preventable conditions, and adequate antenatal care would have removed or foreseen the threat to the child’s life. It also appears that syphilis is unlikely to have caused the death of a non-macerated foetus. MOTOR-CAR ACCIDENTS AND
HOSPITALS.
FOR some years past the pressure upon hospital beds and hospital finances caused by the rapid increase in the number of motor-car accidents has been growing in severity. The enormous annual output of motor vehicles of all kinds from the formidable trolley and hardly less formidable charabancs to the deadly motor-cycle, which must move the jealousy of Jehu in the shades, forbids the hope that the pressure has reached its peak, and we may therefore confidently expect that the difficulty will become still more acute. All over the country hospitals, large and small, are embarrassed by the necessity of admitting casualties to already overcrowded wards and by the cost of treating patients who are often so seriously injured that their tenure of beds, sorely needed for local purposes, is prolonged. Thus the annual report of the great Manchester Royal Infirmary, which has just been issued, records the admission of a daily average of 80 casualties-one every 18 minutes throughout the 24 hours. Most general hospitals can tell much the same story in proportion to their size and geographical situation. In the hope of obtaining precise information on the subject Mr. H. W. Burleigh, the chairman of the Hospitals Motor Accident Policy Association, last autumn addressed a letter to us asking for details of motor accidents treated at hospitals throughout the country. His invitation has been responded to by 183 hospitals, representing 14,169 beds-about one-third of the total of available beds-and the information he has obtained satisfies him that, irrespective of fees to medical men, the cost of motor accidents to the hospitals in the mass must be about half a million a year. That is an alarming figure, but, as we have said, the trouble does not end there. Lack of pecuniary elasticity is accompanied by inelasticity of beds, and Mr. Burleigh is informed that in many small hospitals. at the approach of the week-end, when the maiming is at its height, medical officers have to hasten the discharge of the local patients for whom the institution primarily exists, to be ready for injured motorists, mainly from a distance. To say that this is a grotesque state of things is to put the situation mildly. This part of the difficulty will not be removed by any
omnibuses and taxi-cabs should do likewise, but it is obviously desirable that there should be as much insurance as possible. There is grim irony in the provision that half benefits only can be paid in respect of motor-cycles and sidecars, though the driver of these dangerous machines may equalise matters by taking two policies for each seat. Simultaneously with the creation of this interesting policy we learn that the Middlesbrough Motor Club has instituted an insurance scheme which, for a premium of half a crown a year secures payments to hospitals in any part of the country ranging from half a guinea for a dressing to £ l5 for a detention of five or six weeks. If the motor insurance companies would now recognise the indebtedness of their insurers to the hospitals the pecuniary side of the difficulty might be fairly met on large lines. That would surmount what is supposed to be the legal obstacle to voluntary hospitals levying a charge for the treatment of road casualties, and if it be the fact, as has been urged on behalf of these companies, that their premiums are too low to admit of payments to hospitals, it would merely seem that an essential element of protection is lacking. The low terms of the new policies to which we have referred suggest that a very small addition to their premiums would meet the difficulty. To safeguard a man against the injury or destruction of his car while he sponges upon hospitals and doctors for the cost of mending his body suggests a lack of appreciation of rather elementary ethics. Meanwhile it is announced that the King’s Fund intends shortly to call a conference of representatives of the hospitals, the insurance companies, and the leading motorists’ organisations to consider the whole subject.
Sir James Berry, consulting surgeon to the Royal Free Hospital, has retired from practice, but will remain
the Council of the Royal College of England and complete his term of office President of the Royal Society of Medicine. on
Surgeons as
of
A SPECIAL meeting of the Charity Organisation Society will be held at 296, Vauxhall Bridge-road, S.W., on Feb. 13th, at 3.30 P.M., under the chairmanship of Lord Dawson of Penn, when Sir William Hamer, Dr. Graham Little, and Dr. Humphrey Nockolds will speak on the Voluntary Hospitals and the Public Authorities. TO "THE LANCET," VOL. II., 1927. THE Index and Title-page to Vol. II., 1927, which was completed with the issue of Dec. 31st, is now ready. A copy will be sent gratis to subscribers on receipt of a post-card addressed to the Manager of THE LANCET, 1, Bedford-street, Strand, W.C. 2. Subscribers who have not already indicated their desire to receive Indexes regularly as published should do
INDEX
so now.
CONGRESSES
CAIRO.-The
celebration
centenary arrangement for payment by, or on behalf of, these of the Cairo Faculty of Medicine, combined with an intercasualty patients, but it would at least ease the national congress of Tropical Medicine and Hygiene, will pecuniary perplexities of the hospital and help, in be held from Dec. 15th-22nd. The centenary celebration some measure, towards the provision of more extended will include sectional meetings in the different departments accommodation. It is, therefore, hopeful news that of the faculty, including operations and demonstrations, the Eagle Star and British Dominions Insurance and the programme for the congress will include two general on ankylostomiasis and bilharziasis. It is also Company have devised a policy which, for a premium meetings and proposed to arrange a medical exhibition of of 5s.
IN
drugs
year, hospital which guarantee appliances. Further particulars may be had from the patient, injured by a moving road vehicle, a payment Secretary-General, Congress Bureau, Faculty of Medicine, of half a guinea a day up to 30 days. together with Cairo. three guineas for medical fees, or five guineas should The Journees Medicales d’Egypte will take place from the patient be detained for more than a week. For Dec. 12th-23rd under the presidency of Prof. J. L. Faure. The subjects under discussion will include the diseases of casualty patients treated, but not admitted, half a both temperate and hot climates. There will also be an guinea would be paid to the hospital and a similar international exhibition of arts and science as applied to a
will
to the
treats
a
fee to the medical officer. The thoughtful and considerate motorist may reasonably be expected to avail himself of these facilities, especially as he may take out a policy for each seat in his car-the careful driver is often the victim of the reckless one. It is suggested with less reason that the pedestrian and the rider in
medicine, surgery, pharmacy, and sanitary hygiene. Further particulars may be had from the general secretary, 32, rue Gay-Lussac, Paris Ve. At both the congresses the official languages will be French, English, Arabic, German, and Italian, and members will be granted reduced fares and facilities for travel.