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- societies (societes libres) included the payment of 1,600,000francs for medical fees by 1505 societies and 792,457 francsfor pharmaceutical charges by 1466 societies, the number ofpatients being 99,550. Another group of societies (sociétésapprouvées) had in the same year 446,392 patients on- account of whom 4,064,151 francs were paid to the medicalpractitioners and 4,765,166 francs to the pharmacists. Inthe sociétés approuvées each patient therefore cost 9 francsfor medical advice and 10 francs 70 centimes for medicine,whilst in the societes libres the analogous charges were aboutfrancs for medical advice and 8 francs for medicine. In

the societes approuvées the 446,392 patients were ill for an

aggregate of 7,187,441 days, and in the sociétés libres the’99,550 patients were ill for an aggregate of 1,456,935 days,or a general average of 14 days’ illness per patient. Forhis attendance during these 14 days the medical practitionerreceived 6 francs from the sociétés libres and 9 francs fromthe societes approuvées.

Treatment of Cancer.At a meeting of the Academy of Medicine held on

May 25th M. Tuffier gave an account of his treatment ofcancer by various physical methods recommended of late

years, including x rays, high-frequency currents, radium,and superheated air. In his opinion, none of these methodsof treatment were ever followed by genuine recoveries, butthe observation of the manner in which they individuallyacted was an interesting study. The x rays had a specificinfluence on the cancer cells, but not on the other anatomicalelements; this influence on the cancer cells was, however,limited to a depth of less than two millimetres from thesurface. Radium also had a selective power of attackingcancer cells, and in course of time this effect might extend toa depth of two centimetres from the surface. High-fre-quency currents had no selective action on the cancer cells ;whatever slight effect they produced was distributed overthe tissues generally. A jet of air heated to 3000 or 4000 C.acted not unlike a high-frequency current, only rather morecapriciously. -

Medical Attendance on Pauper Patients.The medical practitioners of the town of Chalon-sur-Saone,

being dissatisfied with the system under which medicaladvice is given free of charge both in that town and in the- entire department, have sent an ultimatum to the munici-pality and have resolved to cease giving attendance underthe present system if the modification proposed by them isnot adopted by June 30th. They request that all themedical men practising (patentés) in Chalon and willing to

-accept the position shall be placed on the list of medicalattendants of poor persons. Patients will be seen at therelief office (bureau de bienfaisance) on Mondays and

Wednesdays at 10 A.M. by the medical men on the list,each of them serving in his turn for a month at a time with,a remuneration of 5 francs for each attendance. Patientsrequiring to be visited at home may select their medical.attendants, who will receive 1 franc for each visit.June 12th.

_________________

SWITZERLAND.(FROM OUR OWN CORRESPONDENT.)

Food and Clothesfor Indigent School Children.Dr. F. Elsrismann, town councillor and head of the sani-

tary department of the town of Zurich, has just publisheda lengthy report on the gratuitous supply of food and clothesto school children in Zurich. For many years poor schoolchildren in Switzerland have received food (either breakfastor lunch) supplied partly from private sources and partlyfrom local district authorities at the public expense. Oflate years the expenditure to be met by the ratepayers hasbeen rapidly increasing. Already, in 1894, Dr. A. Huberreported that out of a total of 475,000 school children attending,the primary schools and aged from 6 to 11 years, 25,000 weresupplied with food and 30,000 with clothes. Nearly one-third(28 per cent.) of all the public schools in Switzerland hadintroduced this system. The children in question eitherlived more than half an hour’s journey from the school-houseor were underfed at home. In Ziirich the system is asfollows. A minority of the children, some 700, receive milkdiet, the majority are served with a simple soup meal, some-times with the addition of meat, for such reasons as the

poverty of the parents, the poor state of nutrition of thechildren, absence of the parents from home -at midday, thelarge number of the family, and the unemployment or illnessof the parents. The number of children thus provided for inZurich, which has a population of 180,000, has risen from256 in 1894 to 2251 in 1902-03, and to 3334 in 1907-08. Theannual outlay has increased from 7200 francs (£88) in 1900to 48,367 francs (nearly .62000) in 1907-08. During the lastyear over E2400 were spent for this purpose. The expense ofeach meal varies from 1½d. to 22d. An increasing numberof children were furnished with necessary articles of clothing(785 in 1907-08), and the expenses reached a sum of 5407francs, or about £216. The great amount that is done forthe physical welfare of school-children in Zurich is evidencedby the further facts that in 1908-09 a sum of E2160 was spentfor afternoon and evening classes of supervision and recreation,also during holidays, and a further sum of 91600 to provide1000 children with a three weeks’ stay in the Alps.

Infantile Mortality in Switzerland.The Federal Statistical Office at Berne has published the

following details on the mortality of children under the ageof one year. Since 1876 the statistics show that for everyfive years the mortality per 1000 births has undergone a con-tinual decrease from 188 to 134, the last-mentioned figuresbeing for the period 1901-05. This decrease has continuedin 1906 and 1907, when the deaths were respectively 126 and121 per 1000 births. The different cantons vary consider-

ably in this respect, some having a very low infantile mor-talit,y, such as Unterwalden with 79 deaths per 1000 births.In other cantons the corresponding figures are exceptionallyhigh-namely, 157 in Valais, 187 in Fribourg, and 188 inTessin ; whereas Vaud and Neuchatel with 144, Zurich with124, and Berne with 121 deaths per 1000 births keep aboutthe average.

Ziirich, June 12th. _________________

ITALY.

(FROM OUR OWN CORRESPONDENT.)

The Darwin Centenary.THE catholicity of science will have fresh illustration

next week in honouring the hundredth anniversary of thebirthday of Charles Darwin. Every civilised nation will join inthefesta-none more cordially than the Italian. For months

past her press, medical and lay, scientific and political,metropolitan and provincial, has either devoted specialarticles to the theme or given extended reports of élogesof the master from academic chairs. Among these latter,one of the best inspired was that of the professor ofthe history of the natural sciences in the Roman Uni-

versity, Dr. Mario Cermenati, summarised about a yearago in THE LANCET ; while among the independenttributes ofeered by individual students to "the immortalmemory " none will be read with warmer appreciationthan the " Profilo," as he modestly calls it, of Dr.Alberto Alberti. A brighter biography of the author of the" Origin of Species " it would be difficult to find in the samecompass, and the estimate of the man and his work will beseen to have the impartiality due to a detachment which,according to Madame de Stael, makes the "judgment offoreigners that of a contemporaneous posterity." One meritit will be found to possess-a merit, I regret to say, not inall cases characteristic of Italian treatment of the sametheme-abstention from anti-religious or anti-Christianpolemics. As already pointed out in these columns, manytributes to Darwin, particularly in Italy, have been marredby an aggressive attitude towards the "creeds," nationalor nonconformist, an attitude with which Darwin himselfwas not in sympathy and would certainly have been the lastto countenance or to encourage.

At the Vatican.The edile, under the inspiration of Pius X., has been ousy

in the apostolic palace recasting the accommodation of thepersonnel, high and low, to the great improvement of its con-ditions, sanitary and other. Hitherto the said personnelhas been scattered up and down and right and left inthe vast tenement, or congeries of tenements, but now

1 Carlo Darwin: uno Studio di Alberto Alberti. Modena: A.Formiggini. 1909. Pp. 78. Prezzo 1 fr.

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they will find shelter in the" grandioso edifizio" whichis just completed and only waiting to be occupied. Anyimpatience on the part of the prospective lodgers to ’’ enterinto residence" has, however, been met by a wise vetoemanating from His Holiness, to wit, that they must findtemporary accommodation elsewhere until the close of thesummer months, by which time the brand-new " edifizio

"

will be thoroughly dried. So all the personnel willhave to clear out with the exception of the CardinalVicar (Merry del Val), Cardinal Gasparri, the MonsignoriBisleti, Misciatelli, and Pifferi, and the secretaries and

private chaplains. Another wholesome provision will bethe transference of the Vatican Pharmacy from the Cortileof San Damaso to the new edifice. The Vatican will thus be

spared the unsightly spectacle, not to say the positive in-convenience, of men, women, and children armed withmedicine bottles or baskets coming in from the Borgo oradjacent quarters and meeting the cardinals, archbishops,and other dignitaries face to face on their way to or fromthe presence of the Holy Father. The Pharmacy, I may add,sharing the privileges accorded to the Holy See underthe "law of the guarantees"-a law framed by theItalian Government and partially acquiesced in bythe Vatican - can provide medicines, surgical appli-ances, and such like articles at a cheaper rate than therival establishments outside, as it pays no octroi duty, nor"business tax," nor house-rent, and gets its lighting andheating gratis. It is much resorted to accordingly by morethan the "faithful," and has been found a convenient andfreely utilised mode of admitting to this or that official theimportunate client, or the needy petitioner, or even the

decently attired mendicant. So that the imminent changesin the accommodation of the Apostolic community will notonly make for improved sanitation, for economy of time, andfor acceleration of business, but will also conduce to theamenities of a quarter which has long been, and is destinedlong to continue, the most largely and multifariouslyfrequented in Rome.June 13th.

________________

VIENNA.

(FROM OUR OWN CORRESPONDENT.)

The Hot Weather and the Schools.

IN Austria, where compulsory education is responsible forthe appearance of nearly all children between six and 14years of age in the schools twice daily, the intense heat inthe months of May to July has often caused much discom-fort to delicate children, who had to be in school from2 to 4 P.M. Several times the school boards have attemptedto introduce a system of continuous attendance for five hoursfrom 8 A.M. to 1 P.M., thereby saving the children and theteachers the necessity of coming twice a day to school. TheMinistry of Education has, however, this year tried tomake the children come twice a day to school, in spiteof the" Hitzeferien " (hot-weather holidays), as these idleafternoons are appropriately termed. Parents naturally madeobjections to this regulation and conflicts resulted. Finallythe old system of reducing the school attendance to fourhours before noon and leaving out the afternoon lessons wasagreed to if the temperature at 10 A.M. reaches 20° C.(770 F.). At the same time it has been decided to bring thenext school term to an end on July 1st and to have theholidays in July and August, which are the hottest monthswith us, and not as at present from the middle of July to themiddle of September. The changes are due to the reportsof several school medical officers, who as yet are too few innumber to compel attention, but whose reports are alreadymuch appreciated.

The Jubilee Fund " for the Children."At the recent jubilee of the Emperor a fund was collected

bearing the title " Für das Kind (for the children), as theEmperor wished that the money intended to be laid out onthe jubilee celebrations should be devoted to charitablepurposes, notably for the benefit of children. The fund hasnow been handed over to the organisation committee, whichconsists of 56 members, mostly presidents of variouscharitable institutions, medical men, and five ladies. The

objects of the fund are: (1) to found model institutions for theprotection of children ; (2) to make grants in aid of alreadyexisting institutions of this kind; i and (3) to arouse among

the general population an interest in measures intended forthe protection of children. All endeavours to promote themental and bodily development of the juvenile portion of thepopulation come within the scope of the fund, which it isintended to augment by constant donations and collections,so that it will be possible to grant large sums out of this fundfor the above-mentioned purposes. The idea is to make the ad-ministration something like that of the King Edward HospitalFund in England, although, of course, the sums collected heredo not approach those which are subscribed in England.

Professional Secrecy and Sou.rces of Public -Da?2,qer.In a case heard recently in a court of law the familiar

question of professional secrecy and the duty of the medicalpractitioner towards the public and the patient were wellillustrated, and much comment in medical circles has beencaused by the legal decision. A medical man who wastreating a female patient for syphilis acquired extra-ge-nitallywarned her that she might be a source of danger to the publicowing to her position as post-mistress in a rural place. She-

neglected his cautions and when he saw another case of

extra-genital syphilis, which could be traced to her, heinformed the postmaster-general, without being asked

by anybody to do so. The patient having conse-

quently lost her appointment and suffered some other

inconveniences, claimed damages from the medicalman who had, without her consent, disclosed the natureof her disease to a third party. The judge decidedthat the medical man ’’ had been acting in the publicinterest, and therefore in defence of the public, conductwhich could not be considered a breach of professionalsecrecy." The defendant was acquitted by the jury. Nowthere are under consideration certain new medical regulationswhich stipulate that a medical practitioner must disclosethe nature of a patient’s illness to a legal authority if he isasked. In a similar case a well-known dermatologist recentlyfound that by wilful neglect of his advice a syphilitic fatherinfected his two children, eight and ten years of age respec--tively, and allowed them to continue to attend a publicschool where they might be a source of infection to others.The medical man accordingly made them wear large patchesof grey plaster on the face, and when the school board askedfor an explanation he only answered that the children,were suffering from an infectious disease. The conse-

quence was that they were excluded from school until he-had given them a certificate of freedom from infection.Of course, there is often a conflict between the duty of-the medical man towards the patient and his duties as a,

citizen. Hitherto it has been an invariable rule with the-

profession here to consider only the duty of the medicalman towards the patient and the law itself was very stricton this point. The development of social life tends, how-ever, to lessen the sense of personal attachment of the

physician to his patients in preference to his public duty,though the majority of the profession here show on this point.a decidedly conservative tendency.

The Scandal at a Lunatic Asylum.In a previous letter I mentioned the sad occurrence in one-

of our lunatic asylums where a patient who had become-unmanageable was actually killed by an attendant in thecourse of "quieting" him. The jury returned a verdict ofmanslaughter and the attendant, by a series of fortunate cir-cumstances, was sent to prison for only six months. But in the-course of the action it became manifest that the real culpritwas to be sought for elsewhere. The system was responsible,-and public indignation has been only partly allayed by theannouncement that the old regulations have been replaced’by new ones more in accordance with modern ideas. The-false economy of placing only 19 medical men in charge of-3000 insane persons being thus exposed, it is only naturalthat the number of psychiatric experts in the asylums will beamply increased, and sufficient funds must be found to obtaina better class of attendant than the boards of managementhas hitherto been satisfied with.June 14th.

THE CONJOINT DIPLOMA IN PUBLIC HEALTH.-We are requested to state that on and after Jan. 1st next anew syllabus will be adopted for Parts I. and II. of theexamination for the Diploma in Public Health of the RoyalColleges of Physicians and Surgeons, and that such syllabuscan be obtained on application to the Secretary at theExamination Hall, Victoria Embankment.