1113SWITZERLAND.-ITALY.

Menstrual Irregularities Symptomatic of Tuberculosis.Dr. Joseph Holl6s has made a special study of menstrual

disturbances, and his experience acquired during the pastfive years has led him to conclude that in the majority ofcases menstrual irregularities are in fact toxic symptoms dueto latent pulmonary tuberculosis. The importance of thisdiscovery is very great both from a therapeutic andfrom a diagnostic point of view. The toxic phenomenain question consist of subjective signs and functionaldisturbances, such as headache, fainting, insomnia,nervousness, palpitation, vasomotor troubles, night-sweats,and pains in the joints. These disorders of menstruationmay occur simultaneously with the symptoms of tuberculosis,but they sometimes precede the latter and are the pre-monitory signs of a latent tuberculosis. The most note-

worthy among such disorders of menstruation is dysmenor-rhœa, which may occur with the first menstruation, withtoxic or other symptoms, pointing to the tuberculous originof the malady. Dr. Grafenberg, of Kiel in Germany, hasalready acknowledged the correctness of the theory of Dr.Holl6s. He also recommends treatment for pulmonary tuber-culosis in cases of primary dysmenorrheea, but, on the otherhand, he does not consider pulmonary tuberculosis tobe the cause of secondary dysmenorrheea. The cases

relied on by Dr. Holl6s, however, prove that thereis no difference at all between primary and secondarydysmenorrhoea from an etiological point of view. Duringhis search for the cause of disorders of menstruation Dr.Holl6s made records of 712 cases. Pronounced dysmenor-rhoea was observed in 270 cases. Out of these menstruationwas painful from the very beginning in 138 cases, while inthe other 132 the pains presented themselves only after oneor more years. He found amenorrhoea in 64 cases. Treat-ment with tuberculin and other antituberculous remedieswas given for at least two months to 188 women ; of thesepatients 156 recovered to the extent that they were freedfrom menstrual disturbances, 37 were improved, and thecondition of 24 was unchanged at the end of the treatment.During these observations the response of the clinical mani-festations to the tuberculin and immune body treatmenthas led him to believe that in cases of tuberculosis thetoxic symptoms which are present are dependent on

a certain degree of the lytic immunity of the system. Some-where in the organism, most often in the lungs or peri-bronchial glands, there is a formation of a focus or foci oflatent tuberculosis, which foci ’slowly but permanently renderthe system immune by the action of their toxic product.This immunity is not, however, complete. In the variousorgans and also in the blood itself there is a circulation oftoxins which irritate the nervous system and the differentorgans. By the increase of the "lytic immunity" thebodily sensitiveness to these toxins increases and the systembegins to react on them. The various toxic symptoms andalso the disorders of menstruation are simply the spontaneousreaction of the system—i.e., sensitiveness to poisons-againstthe chronic poisoning. On account of the immunity therebyestablished this condition may last for many years with-out any clinical evidence of pulmonary tuberculosis. Ifthe original focus has in the meantime become completelynon-pathogenic, then the toxic symptoms also completelydisappear, especially if they have not lasted very long. Inthe latter case chronic changes which are capable of pro-ducing certain permanent symptoms may develop in some ofthe organs, as shown also by Poncet’s school. Partly on theground of pathological researches and partly by clinicalobservations Poncet and Leriche have come to the conclusionthat in the etiology of all menstrual disturbances tuber-culosis plays the principal part. They have been able to findlocal changes in the internal sexual organs in every singlecase of tuberculosis, and Poncet called this condition" tuberculose inflammatoire," " meaning thereby chronicinflammatory changes, which, although of tuberculous origin,do not exhibit any of the macroscopic or microscopic specificlesions of tuberculosis. On the ground of these data Dr. Holl6srecommends the application of antituberculous treatment inall such cases of dysmenorrhoea and other disorders 01menstruation in which the etiological factor cannot b(

precisely ascertained, and in which, for the reasons alread3set forth, the physician is justified in concluding thaia latent tuberculosis is responsible for the diseases ir

question.Oct. l2th.

SWITZERLAND.

(FROM OUR OWN CORRESPONDENT.)

Sanatoriums for Consumptives.THE official report of the Swiss sanatoriums for poor con-

sumptives (Volkslteilstatten) for 1911 has just appeared inprint. Eleven sanatoriums accommodate 860 patients. Duringthe year 1911, 2052 patients were treated during more thanfour weeks. The average stay was four and a half months(132 days). 1635 patients, or 80’7 per cent., were dis-charged as improved ; 364, or 18 per cent., showed no

improvement; 28, or 1, 3 per cent., died. Of the dismissedcases, 13 per cent. had fever ; 87 per cent. were free fromfever. The importance of treatment in as early a stage aspossible is proved by the fact that in the first stage (Dr.Turban) 96’ 8 per cent. were improved, whereas only 85. 3 percent. in the second and 61 per cent. in the third stage wereimproved. The percentage of working capacity differed

greatly according to the stages of the disease, being88’ 5 per cent. in the first, 63 per cent. in the second, andonly 36 per cent. in the third stage. The movement for

founding special hospitals to accommodate incurableinfective patients in the third stage is gaining ground.

Private Asylum.On Oct. 19th a private asylum, Hohenegg, situated ten

miles out of Ziirich at an altitude of 540 metres, on a

beautiful and isolated plateau in the midst of pasture andwoodlands, will be inaugurated. It owes its erection to theefforts of a committee of six Zurich gentleman (chairman, Dr.Theodor Zangger) whose appeals for funds have been wellresponded to by the inhabitants of the Canton of Zurich. Itfills a great want, as the public asylums are overcrowdedand there is no proper accommodation for unruly first-classpatients..624,000 were contributed by voluntary contribu-tions, S30.000 were advanced on mortgage. The asylum isto be self-supporting. The surplus payments of the firstclass, who pay 12s. to 15s. a day, are to cover the deficit ofthe second and third class, who pay 4s. and 2s. 4d. a dayrespectively. Five buildings have been erected to accom-modate 110 female patients, and later on three more buildingswill accommodate 110 male patients. Two experiencedalienists, Dr. Escher, of Miinsingen, and Dr. Miller, ofGeneva, are resident physicians. There is a staff of 20nurses.

Ziirich, Oct. 12th. __________________

ITALY.(FROM OUR OWN CORRESPONDENT.)

Open-air School in Florence.A SMALL open-air school was started last spring on a piece

of land, formerly a fruit garden, on the Viale del PoggioImperiale, a shady road upon a hill on the south side ofFlorence. The initiative was due to the Società Fiorentina,Umberto I., Contro la Tuberculosi, and the realisationwas made possible by the public spirit of the Commune,which agreed to treat the school as one of its own systemand pay such proportion of the expenses as an ordinaryschool of the same size would involve. In addition, it madeitself responsible for the rent of the land, about one or oneand a half acres in extent, and made the few structuralalterations necessary in the buildings upon it. The societymade a grant of £82 ; with the addition of about an

equal sum from other charitable sources the school hasmade a prosperous start, and is now, it seems, a permanentinstitution. Provision is made for 30 boys of from 9to 11 years of age, drawn from the district of San Frediano,the poorest quarter of Florence. The boys are chosenby doctors from the Children’s Hospital, and are selectedon account of delicacy of constitution, previous illness, orunhealthy home surroundings. The school is situated some 10to 15 minutes’ walk from the centre of this district. Schoolhours are from 9 to 4 in winter and 9 to 6 in summer. Onlysome four hours of this time are set apart for lessons, therest being for recreation or gymnastics. On arrival a mealof bread and hot milk is served, each child having his ownnumbered cup. At middav they are given bread, meat, and