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the number of specialists really is, for of 27,374 medical menin Germany no less than 3431 described themselves aa such.There was one medical man to every 2014 of the populationof the empire and one specialist to every 16,066 of the popula-tion. In Saxony there were no less than 370 specialists among2048 medical men, the proportion thus being 1:5’5. The

majority of the specialists, of course, resided in the largetowns with more than 100,000 inhabitants, the number being2068, or 60’3 per cent. of all the specialists ; in the townsof medium size, with from 45,000 to 100,000 inhabitants,there were 512, or 14 per cent. of the whole, and in smalltowns with less than 45,000 inhabitants there were 851, or34 per cent. of the whole. It might appear strange that somany specialists resided in small towns-but these latterincluded several university towns, with many professors andf1rivat-docenten. Moreover, a great number of sanatoria,asylums, &0., were situated in small towns or in the country. I

Of the large towns, Stuttgart had relatively the greatestnumber of specialists, the number being 73, and their pro-portion to the general practitioners being 1: 2-6 ; inHamburg, where there were 107 specialists, the proportionwas 1: 5’2 ; in Berlin it was 1: 6’4. Altona had relativelythe smallest number of specialists, the total number beingseven and the proportion to the general practitionersbeing 1 : 13’1. With regard to the classification ofthe several specialties it was found that 609 were ophthal-mologists, 534 practised surgery, 533 were obstetricians.and gynecologists, 516 were specialists for diseases of thear, the nose, and tne larynx, 485 for mental and nervousdiseases, electrotherapy, &c., 269 for internal diseases,224 for diseases of the skin, 134 for diseases of children,and 127 for genito-urinary diseases. In Berlin, where therewere 493 specialists, 47 devoted themselves to internaldiseases, 58 to mental and nervous diseases, 75 to diseasesof the ear, &o., 58 to diseases of the eye, 66 practisedsurgery, 10 were orthopasdic surgeons, 46 were specialistsfor genito-nrinary diseases, 36 for syphilis and diseases ofthe skin, 77 for obstetrics and gynseoology, and 20 fordiseases of children.

Operationsfor Gastric Lleer.Professor Korte lately read a paper before the Verein fiir

Innere Medicin on the Surgical Treatment of Gastric Ulcer.He said that the principal indication for operation wasstenosis of the pylorus with dilatation of the stomachas a sequel of cicatrised ulcers ; operation was alsosometimes indicated in open ulcers of the pyloric or

prsepyloric region, when the pain was very severe and could<not be relieved by internal treatment. Other indicationswere small but repeated haemorrhages, profuse haemorrhages,perigastric adhesions, and perforation of the stomach. Inperforation, owing to the imminent danger of peri-tonitis, an operation must be performed as soon as possibleand not later than 12 hours after the perforation had takenplace. In the other cases-viz., in stenosis with dilatation,hemorrhages, &c.-the indication was not so absolute as itwas in perforation. The dangers to be anticipated dependedon the nature of the case, on the general state of the patient,on the size and position of the ulcer, on its adhesions, &c.Some of the immediate dangers of the operation, such asinfection of the peritoneum and giving way of the sutures,might be diminished by the adoption of improved methods,but there still remained a liability to complications overwhich the surgeon had no control, am8ng which might be men-tioned pneumonia, embolism, and haemorrhage from openulcers. Notwithstanding these dangers an operation mustnot be postponed too long, as in an exhausted patient theTisk became, of course, mnch greater. Professor Korte hasperformed operations on 38 patients with gastric ulcers; in17 cases there were open ulcers and in the remainder therewere cicatrices. All the patients had been ill for a greatwhile, some of them for as long as 20 or 30 years, and allof them had undergone protracted internal treatment.Their general condition was bad and they complained ofgastric pains and vomiting. In 18 cases there was

haematemesis; in 32 cases there was stenosis with dilata-tion, the seat of the stenosis being as a rule the pylorus ;in one case, however, it was in the duodenum, in five- cases in the praspylorio region, and twice in the middleof the stomach. Apart from stenosis operations wereperformed once for profuse hemorrhage, 10 times for per-foration into the peritoneum. and six times for perforationinto the subphrenic tisaue. With regard to the methods ofoperation, resection ought to be performed only when there

l were no adhesions and when the case was suspected to, be one of cancer. In five circular resections one deathl occurred. Gastro-enterostomy was performed 29 times. with a mortality of 20’6 per cent. In one case

: complicated with stenosis of the oesophagus gastro-! enterostomy was combined with gastrostomy. Hacker’sI method was exclusively used without a Murphy’s button,: and only one pyloroplasty was performed. One patientI bad to be operated on for profuse hasmatemeais, a hgature

was put on the bleeding artery and it seemed as if he mightrecover, but after a week he died from renewal of the heamor-rhage. Nearly all the patients operated on for perforatedulcer showed the symptoms of peritonitis. The operationswere performed, as a rule, from 20 to 24 hours after theperforation had taken place, the result being that out of 10patients only one recovered. In the discussion the views ofProfessor K&ouml;rte were received with approval by ProfessorEwald, Professor Rosenheim, Professor Fraenkel, and otherspeakers.June 10th.

ROME.

(FROM OUR OWN CORRESPONDENT.)

The Society for the Study of Malaria.THE Minister of the Interior has placed the sum of 5000

lire at the disposal of the Society for the Study of Malaria as acontribution towards the expense of the prophylacticmeasures which they intend to adopt during the approachingmalarial season; and the King himself has set a goodexample to all large land-owners in malarious districts byproviding a sum of 10,000 lire to be employed for a similarpurpose on his estate of Castel- Porzano, where it will beremembered Dr. Sambon and Dr. Low carried out their suc-cessful experiment last year. The society have providedstations for study in the provinces of Udine, Verona, Vicenza,Padua, Ravenna, Pisa, Basilicata, and Siracusa, in additionto those already established in the provinces of Rome, Milan,Cremona, Mantua, Ferrara, Foggia, and Lecce. A specialeffort is to be made for the protection of the agriculturalpopulation against malaria. A prophylactic experiment ona large scale will be made along the Emilian coast ; and,indeed, in all the malarial districts the authorities are exert-ing themselves in preparing for a vigorous anti-malaria cam-paign during the coming season. In the city, and especiallyin the Campagna of Grosseto, a careful series of prophy-lactic experiments from which valuable results are expectedhas been in progress for some time. The measure of successwhich has already attended the efforts of the society hasled some foreign Governments, including those of Spain andPortugal, to apply to it for information as to the bestmethods of carrying- out an efficient prophylaxis againstmalaria.

Sinatoriuvt for Tuberculous Ohildren.The birth of the new Italian Princess has been made the

occasion for a handsome donation by the King of 200, 000 lire(8000) to the Commune of Rome towards the erection ofa sanatorium for tuberculous children.

Malaria and Typlwid Fever.The record of cases in which malaria and typhoid fever

have co-existed in the same individual is not yet an exten-sive one ; or, rather, the cases in which a thoroughly reliablediagnosis has been made are not numerous. At a recent

meeting of the Lancisian Society of Rome, Fiocca, who isknown for his accurate investigations in connexion withWidal’s reaction, reported an indubitable instance of thiscombination. The patient, who had never previouslysuffered from illness, paid a visit on Oct. 4th to

Leprighano ; on the 15th he was attacked with malarialfever and was admitted to the Hospital of St Giacomo,where he remained until apparently cured till the 30th ofthe same month. He then returned to Leprignano, butwas again taken ill and had to be re-admitted to the hospitalon Nov. 25th suffering from a fever which continued tillDec. 28th with symptoms of typhoid fever, the blood givinga positive Widal reaction but showing no malarial parasites.After the latter date followed six days of complete apyrexia,and then, on ttan. 4th, another attack of malaria, withthe presence of sestivo-autumnal parasites in the blood,which soon yielded to quinine. On the 10th the temperature

1719

again rose, ushering in a relapse of typhoid fever which con-tinued until Jan. 22nd, when another period of apyrexiafollowed lasting nine days. On Jan. 31st came another

relapse, this time of malaria. Again quinine was employedwith good effect, since which time the patient has kept quitewell. Here, then, were present simultaneously the infectionsboth of malaria and of typhoid fever, the former detected by ’,the parasites found in the blood, the latter by the agglutina-tion reaction of Widal which was obtained at different

periods and varied in intensity from a dilution of 1 in 50to one as high as 1 in 500. It would appear in this casethat there was a tendency for the two diseases to keep them-selves distinct and independent; when one ceased the other,after a short interval, began. This alternation could havebeen due only in part, if at all, to the action of the quininewhich was not administered in sufficient doses till afterJan. 15th.

Medullary Anaesthesia.As surgeons become more familiar with the effects of

medullary anaesthesia the evidence grows that as at presentpractised-namely, with injections of cocaine or its deriva-tives-the method has certain very distinct drawbacks whichrender its general use objectionable. Bier himself whointroduced the method is of this opinion after an experienceof over 1200 cases. Lugli, who has operated at the hospitalof S. Giacomo on 75 cases, noted as immediate after-effectsformication in the lower limbs, a sense of weight there, orthe feeling that the limbs themselves were entirely gone,pallor, retching, more or less obstinate vomiting, sweating,depression of spirits, acceleration of the pulse with diminu-tion of arterial pressure, occasionally vertigo, involuntaryemissions of fseces and of wind from the bowel, tremor moreor less intense and diffused, and pain at the seat of

injection. As later effects he observed headache, usuallyfrontal, sometimes occipital, lasting not more than two daysand mostly slight ; increase of temperature for not morethan from two to three days, generally moderate, but once ortwice rising to 102&deg; or 103&deg; F. ; rarely vomiting ; very rarelyvertigo and temporary difficulty in micturition ; and fre-quently pain in the lumbar region and near the point ofinjection. The later disturbances are of no importance, butthe effects immediately following the injection, thoughusually transitory, are sometimes exceedingly severe. Inthree cases they were of the gravest and most alarmingdescription, and in one they were attended with a fatalresult. This last was in a man, 60 years of age, with ahernia which had been strangulated, and perhaps gangrenous,for over three days, the subject besides of sclerosed arteries,emphysema, and generally in a condition of great gravity,enough, perhaps, of itself to have led to the unfortunateissue. The quantity of cocaine was 16 milligrammes (abouta quarter of a grain) and death took place after four hours.

Professor Albertoni of the University of Bologna.Professor Pietro Albertoni has now been for 25 years a

medical teacher, and the completion of this long term ofacademical work was on May 31st made the occasion of aninteresting ceremony. Professor Albertoni took his degreeat the University of Padua in the year 1873, and three yearslater, at the age of 27 years, he was nominated Professor ofPhysiology at the University of Siena. In 1878 he removedto the University of Genoa, where he received offers of chairsin several universities, and eventually he proceeded fromGenoa to the University of Bologna as Professor of Pharma-cology and afterwards of Physiology, which latter subjecthe is still teaching. Among his numerous original investiga-tions mention may be made of his work on the functions ofthe cerebellum, on the action of sugars in the body, and onthe food of the Italian peasantry. His scientific -pursuits,moreover, have not prevented him from taking part inpolitics and public life, for he is a Member of Parlia-ment for his native Lombardy and a town councillorof Bologna. A numerous company was present at theceremonial of May 31st, and the mayor offered him thecongratulations of the town which is proud to own him asa citizen. He was presented by his pupils with a gold medal,the obverse of which shows his head surrounded by a

laurel-wreath; on the reverse is the following inscription:"A Pietro Albertoni ; I discepoli ; Siena, 1876-Bologna,1901." He was also presented with an artisticallyilluminated address, accompanying a volume of treatisesby several medical men who have worked in his laboratories.The Medical Society of Bologna presented him with anothergold medal which on the obverse bears emblems of medicine

and pharmacology, with the inscription, ’’ Societas Medico-chirurgica Bononiensis "; on the reverse:-

June 7th.

Petro Albertonio GazoldiensiPhysiologiae tradendae munusAnnum jam quintum et vigesimumSumma cum laude obeunti

Sodales medici.Anno MDOCCCI.

EGYPT.(FROM OUR OWN CORRESPONDENT.)

The Close of the Season.THE Cairo season is now over and nearly all the hotels

are shut except two large ones which cater for summervisitors. In spite of the South African campaign and of thenational mourning the season has been a fairly good one,for Egypt, instead of being visited by only a handful ofEnglishmen as was the case 20 years ago, has now becomea winter resort for Americans, Germans, and many others.The Americans alone run special palatial steamers duringJanuary and February from New York to Alexandria viaItaly, and though they never stay long in the country theyspend their money freely to the great enjoyment of thehotels and bazaars. As regards health the season has beenexceptionally prosperous, for it is the first time since the

beginning of the present pandemic that influenza has notbeen brought to us from England or America. There hastherefore this year been no localised epidemic, small-poxhas not been heard of among the visitors, and there haveonly been one or two cases of typhoid fever. Curiouslyenough scarlet fever, which is very rare in Egypt, has beenpresent among some of the women and children of one ofthe Scotch regiments, and last summer the matron of ahospital where scarlet fever is quite unknown contractedthe disease. It is difficult to know how these sporadiccases occur unless the infection is imported from Englandby parcel post.

Improved Steamers.

By the new express steamers which carry the Indian mailfrom Brindisi to Port Said it is possible for patients todine in London on Friday night and in Cairo on the followingWednesday. When these steamers were first started threeyears ago passengers complained bitterly of their vibration,but now the propellers have been altered and although theygo at a pace of 20 knots an hour their motion is not

unpleasant; in fact, in calm weather a sort of yachtingexcursion can be taken through the Greek Islands byCephalonia, Ithaca, Sappho’s Leap, and the Styx. Theircoal consumption is 120 tons per day, with 350 electriclights on board, and their mail capacity is 300 ton& which

represents every week 3000 bags, including 1000 for India,800 for Australia, and 300 for Egypt, besides bags for China,Ceylon, and other places. Another advantage of travelling bythis route is that there are no Customs examinations betweenLondon and Egypt and a special train now runs down toBrindisi wharf close to the steamers. Sometimes, as duringthis month when Italy is afraid of contracting plague fromIndia, the steamer and even the train have to run through inquarantine and an Italian medical man accompanies thesteamer so as to protect Europe from infection. The P. & 0.Company are obliged to pay him a fee of <&bgr;l per day.Mail steamers grumble at the vexatious quarantine laws,to which, however, they are obliged to submit. Oneof their complaints is the delay which occurs atSuez. As an instance of which they cite, the P. & 0.s.s. Australia which lately reached Suez at 6.25 P.--u., and

pratique was refused because it was after sunset, so shecould not enter the Canal until 9 A.M. next morning. Thiswas especially hard as they had spent 2250 in extra coalingin order to get mails and passengers quickly from Adento Suez.

Sanitacry Department.The budget has been increased this year by 3800, which

allows provision for the appointment of European sanitaryinspectors in Cairo, Port Said, and Suez. These posts havehitherto been filled by natives who were practically useless.Dr. Dreyer, a German bacteriologist, has now been appointedto Cairo, and Dr. Baker, an Englishman, to Port Said.Another crying want has been remedied, for the minimum