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medical men. The last two are interdependent, and withouteither a hospital is non-existent. But although a hospitalcannot get on without funds and subscribers it probablycould get on without a lay board of management, andthis is a fact which many boards of management seem toforget.

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THE POSITION AT THE NATIONAL HOSPITAL FORTHE PARALYSED AND EPILEPTIC.

As a result of the statement which has been issued tothe governors by the medical and surgical staff of theNational Hospital for the Paralysed and Epileptic we under-stand that a full inquiry will be instituted without delay.We have received a letter from the medical com-

mittee conveying their desire to settle the questions at ’,ssue between themselves and the board of managementwithout appeal to the public. Under these circumstanceswe refrain from publishing either the statements of the staffor the rejoinder made by the board, and content ourselvesat this juncture with saying that we trust that under nocircumstances will the staff forego their just demand forrepresentation on the governing body of the institutionwhich owes its public utility to their efforts.

THE THIRTEENTH INTERNATIONAL CONGRESSOF MEDICINE.

THE programme of fetes which we published in our issueof June 23rd, p. 1821, has been slightly modified owing tothe wish expressed by the President of the French Republicthat he should close the Congress. The programme will

therefore now run as follows. On August 2nd Dr.

Lannelongue, the President of the Council, will give anevening fete in the name of the Government of the Republic.On August 3rd members of the Congress will be invited toan evening fete by the President of -the Congress. On

August 5th the fete given by the Bureau and OrganisingCommittee of the Congress will be held in the Palais duSenat and the gardens of the Luxemburg. On August 7ththe municipal council will hold its fete in the Hotel deVille. And, finally, on August 9th the President of the

Republic will give his reception in the Elysee.

EXEMPTION OF PARALYSED LIMBS FROM THESYPHILITIC EXANTHEM.

AT the meeting of the Societ6 Médicale des H6pitaux ofParis on June 15th M. Danlos related the following case. A

man, aged 23 years, contracted syphilis. Six weeks after the

appearance of the chancre a papular eruption appeared on thetrunk, which took about three weeks to become generalised.Then the patient entered hospital with a confluent papulo-acneiform eruption which was very abundant on the trunkand less marked on the arms and left leg. The face was

only slightly affected. The right lower limb was com-

pletely free from the eruption. On the right buttock

and right side of the abdomen the lesions were numerous,but below the groin and the gluteo-femoral fold there wasnot one. In infancy the patient had suffered frominfantile paralysis and the development of the right lowerlimb had been greatly checked. It was eight centimetresless in length than the left. The knee was semi-flexed andthe foot was in a condition of equino-varus. All the tissuesof the limb were decidedly atrophied except the skin whichappeared to be normal. The temperature was lower onthe right, than on the left side. When the surroundingtemperature fell the limb readily became purple. In spite ofthis it was, according to the patient, always moist. Whenthe patient stood for a short time it became manifestlyredder than the sound limb. The immunity from theeruption evidently depended on the atrophic condition of

the limb. Similar cases have been recorded. In 1896

i M. Jolly brought an almost exactly similar case before. the society. Dr. Boulogne published a case in his. These de Lille, 1897, which differed in the fact that the. paralysis was infantile spasmodic hemiplegia, and anotherI in which the eruption was not the syphilitic exanthem but

tuberculo-ulcerative syphilides, lesions which, however, areusually localised. Immunity of paralysed limbs to specificeruptions is not constant. M. Danlos observed in a man,aged 61 years, the subject of old hemiplegia, that the

secondary syphilitic eruption was a little more abundant onthe paralysed side. In the discussion which followedM. Merklen referred to a case of small-pox in a child thesubject of infantile paralysis in which the pustules did notdevelop on the atrophied limb, and also to a case of psoriasisin which a limb, atrophied from infantile paralysis wasexempt from the eruption. As to the explanation of suchcases, nervous influence, alteration in the structure of theskin, defective circulation, and lowering of temperaturemay all be invoked, but definite proof as to the cause is

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POST-GRADUATE CLINICAL STUDY IN THEMETROPOLIS.

THE endeavour of the metropolitan schools of medicineto supply some sort of post-graduate teaching in London hasproved far more successful than was at first anticipated. Itwas felt that the patients had already reached the limit oftheir endurance in the way of examination and the teachersthe limit of their endurance in the way of teaching; forthis reason it was decided to admit qualified medicalmen to the ordinary clinical instruction and clinical

advantages of the medical schools, rather than to organisean independent post-graduate course. In this way it hasbeen possible to throw open the best clinical material of themetropolis by issuing tickets at an almost nominal fee

conferring the right to attend the practice of all depart-ments of nine of the large metropolitan hospitals. Not a fewof those who have come for a flying visit from Canada andthe United States, after testing the scheme for a period ofthree months or more, have thought it worth while to stay ayear or so as ordinary students to obtain the diploma of theConjoint Board. Detailed information and prospectus may beobtained from the honorary secretary, West Wing, Examina-tion Hall, Victoria-embankment, W.C., by letter or by inter-view between the hours of 12.30 P.M. and 3 P.M. daily,excepting Saturdays.

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THE PLAGUE IN SAN FRANCISCO.

SOME two months ago rumours were current that plaguehad broken out in the Chinese quarter of San Francisco and

reports which from time to time came to hand from thatcity, although vague, conveyed the impression that the truesituation was being concealed and that the disease prevailedmuch more extensively than was generally supposed. Owingto this belief a feeling of dread sprung up throughout theUnited States that the plague had indeed gained a footholdin San Francisco and the fear was freely expressed thatunless the most stringent measures were taken the pestilence,as in Australia, might be disseminated along the Pacificcoast. In order to ascertain the exact position of affairsand to relieve the minds of the American publicthe New York Herald induced Dr. George F. Shradyof New York to proceed to San Francisco to make acareful inquiry into the matter. Dr. Shrady, after a stayof a week in San Francisco, during which time he visitedevery section of Chinatown under the escort of the policeand health authorities, and after assisting in a necropsyon the body of a Chinaman suspected of dying from

plague, came to the conclusion that, while there could be nodoubt that the malady was, and had been, present in a