39

VIENNA.

(FROM OUR OWN CORRESPONDENT.)

Annual Report of the Ambulance Corps.THE Vienna " Rettungs-gesellsehaft," or first-aid

ambulance corps, which is a private institution sup-ported by voluntary contributions, was founded 40years ago, after a theatre fire in which, owing to thelack of organised first aid, several hundred personslost their lives in the burning building or died fromtheir injuries. Since that day the " Rettungs-gesellschaft " has become a distinctive feature in the lifeof the city and has taken over all the duties performedin other cities by the hospital or police ambulances.In 1921 the corps was called upon in 15,018 cases ofaccidents and conveyed 10,635 cases to hospital ; itsmembers answered on an average more than 80 callsper day, of which about 42 per cent. were accidentsoccurring in the streets or in dwelling-houses. Over20 per cent. were injuries sustained in workshops, infactories, and at public meetings; 30 per cent. werecases of attempted suicide. The corps deals only withliving persons, not with the bodies of those found deadon the arrival of the motor ambulance car. Of lateyears a very complete outfit has been carried by theambulances ; it includes all antidotes against poisoning-which is a favourite means of suicide amongstfemales in Vienna-and a small but very efficaciousapparatus for use against irrespirable gases. Thecorps is, however, financially handicapped at present ;last year the expenditure on cars, fuel, lighting,salaries and wages amounted to more than 150million kronen. Lectures and first-aid classes havebeen discontinued ; the corps is negotiating with the ’,Government and with the municipal authorities in I,order to obtain grants to carry on this notable featureof its propaganda work. It may be remarked thatthe organisation of this corps has served as a modelfor numerous other cities on the continent ; in pre-wartimes it rendered assistance in great’ public disastersin Italy and Switzerland.

Present Situation of the General Practitionerin Austria.

The Austro-Hungarian Empire had more doctorsthan were strictly required in accordance with thestandard of life of the population, but they had alarge field for practice ; a man knowing two or moreof the national languages could settle and make aliving practically anywhere. But in the AustrianRepublic, specially in Vienna and the larger citiesthere is now a serious disproportion, particularly ofolder medical men, partly because the late armydoctors are so inadequately pensioned that they areobliged to turn to private practice, and partlybecause a large number of doctors who practised inthe health resorts and spas of the so-called SuccessionStates have now been expelled from these placesowing to their nationality. Younger practitioners,who can find no openings in Austria, are now turningtheir attention to emigration. A considerable numberof doctors have accepted appointments in the Dutchcolonies ; the Dutch Government encourages such

emigration, especially of well-trained specialists, andpathologists, surgeons, and oculists have been acceptedright away from the hospitals. Russia, the Ukraine,and Albania also afford openings for the competentdoctor; the Governments of the two last-namedcountries have advertised in the Austrian medicalperiodicals, offering young doctors excellent payment.Numerous medical men are prepared to go there inspite of the unsettled conditions of these countries.Those who remain in Austria have to face the difficul-ties arising out of the slow but steady disappearance ofthe private patient from their consulting rooms. Heis replaced by the members of one of the numeroussick clubs, which are gradually extending theirmembership to the entire population of the country.With the inclusion of the municipal officials and theirfamilies in a sickness insurance scheme, another part

of private practice disappears, and so the country isdrifting into socialisation of the medical profession.With the exception of the rural population, there willsoon be no more private patients. The conditionsprevailing amongst the specialists are a little better ;the latter can command larger fees, and they alsohave foreign patients, who make adequate paymentfor services rendered.

Examination of Blood in Surgical Cases.At a recent meeting of the Vienna Medical Society,

Dr. Stein reported on his systematic investigationsconducted on 250 patients of the surgical clinic inthe General Hospital within the last two years. Heselected all cases where a prolonged stay could beexpected, and made regular microscopic examinationsof the blood before, during, and after operation,laying special stress on the total number of leucocytesand the relative numbers of the different kinds. Theresults obtained by this work can briefly be noted asfollows : Cases of latent perforated ulcer, rupturedspleen, without manifest symptoms, and intra-peritoneal injuries almost always showed a high totalleucocyte figure ; typical operations followed by anormal uninterrupted recovery without complications-showed a marked leucocytosis after operation, mostmarked after four to six hours, which in extreme casesreached 60,000 leucocytes, and gradually subsided.A corresponding fall in the neutrophile polynuclearswas observed at that time. The eosinophiles dis-appeared from the blood soon after operation, butreappeared after two to three days. In cases ofappendicitis, perforated ulcus ventriculi, or per-forated gall-bladder, the marked leucocytosis existingmostly before operation went down rapidly, and theeosinophiles reappeared on the second or third day.If complications occur, however, this picture is altered,even before such complications are clinically manifest.If the number of leucocytes goes up after operationand the eosinophiles remain absent, a grave prognosismust be given. Retention of pus and abscess forma-tion are also manifested by an early increase ofleucocytes. Dr. Stein therefore emphasises thenecessity of exact blood examination in all surgicalcases, as results thereby obtained may have a greatbearing on indication for or against operation, andmay also enable an early search for complicationsotherwise remaining unnoticed until they have becomedangerous. The blood picture is even better than thetaking of the temperature as a means of early detectionof danger.June 15th.

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IRELAND.

(FROM OUR OWN CORRESPONDENT.)

illedical Ol’ganisation in Ireland.THE movement for improved medical organisation

in Ireland has been for some months at a standstill.

This is, perhaps, just as well, for during the earlymonths of this year discussion on the subject hadtaken a somewhat acrid turn, which was more likelyto lead to disruption rather than unity. The fact is,that at the moment the minds of members of theprofession are too much occupied with extra-medicalaffairs to be able to devote the requisite time andattention to medical organisation. For the past threeyears a scheme has been before the profession inIreland for the formation of an Irish Medical Union,which would contain as a nucleus of membership thecombined membership of the two existing associa-tions, the Irish Medical Association and the BritishMedical Association. While this union should beautonomous in Ireland, it was intended that it shouldhave an " external association " with the BritishMedical Association. Such association was, no doubt,necessary and advisable as long as the Governmentof Ireland was conducted from Westminster, but withthe transfer of the seat of government to Dublin the