To Correspondents
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1130 works leeches, infirmary leeches, private leeches, district lepches, under leeches, and Lazareth leeches. Finally, and there be mentioned two Notes, Short Comments, Answers may practitioners described as medical candidates, comparable in status to the surgical to candidates, no doubt. One of these medical candidates Correspondents. was also professor of botany at Christiania; the other was also a private leech. The Lazareth leech was in practice THE MEDICAL PROFESSION IN NORWAY IN 1816. at Larvik, and is described in the list as a surgical candi- IN a brief but interesting account of the position of medical date and 11 physics " as well. His Lazareth or lazaretto and surgical practitioners in Norway a hundred years ago may have been either a fever hospital or a hospital for Dr. M. Soegaard gives a reproduction of the first official lepers, but it may be added that special provision was list of those then authorised to practise in that country. made for leprosy in Norway by the appointment of an The list was issued by the Third Department of the "unexamined assistant" at the Stavanger Radesygehus, Government and is dated Feb. 20th, 1816. The first or home for lepers, and a " Titular Professor," who was thing Yet that strikes the reader is its brevity ; it contains no more also chief inspector for leprosy," at Tonsberg. than a hundred names. Norway was one of the countries another professional title may be mentioned, if only for that had the misfortune to back the losers in the its grim sincerity. At Vinger there practised a " Forhen- Napoleonic wars. In 1800 the Danish Government, the vaerende Regiments Feltskjaer," or ex-regimental field predominant partner in the union of Denmark and shearer, to give a literal translation of his official title, Norway then existing, committed the Norwegians to the as though the surgery on the field of battle had con- second armed neutrality. When this was broken up sisted mainly of immediate amputations. by the bombardment of Copenhagen, Denmark and Norway supported Napoleon against both England VACCINATION ON THE FOOT. and Sweden in 1807. Rapid economic ruin was the To the Editor of THE LANCET. and in 1814 Frederick VI. of Denmark ceded result, shall be if of readers can me to Sweden. Sweden had SIR,-I glad any your give Norway previously joined the and results of vaccination on the the Allies against Napoleon; the Act of Union made particulars foot. bound I am, Sir, yours faithfully, Sweden and Norway equally independent countries, JAMES MARSH, M.B.Edin. under a in an offensive and defensive together single king 114, High-street, Atherton, near Manchester, Dec. 22nd, 1916. alliance, which survived till 1905. To return to the year 1816, it may be said that the economic condition of Norway LETTS’S "QUIKREF" DIARIES. was then deplorable; trade was bad, there was much have received some of the diaries the country was bankrupt. The popula- WE specimens published general poverty, Messrs. Cassell and Co. under the above title. The list tion numbered something over 900,000 souls, yet, as Dr. by from letters written includes books for the office, the study, the counter, and Soegaard proves by quotations by the sizes and medical men at the time, many of them found it hard to the pocket, varying accordingly, the bindings the various forms of cloth earn even a livelihood. "How I shall get on this year and from leather through to paper. in the future," writes Chief Surgeon Bencke, of Fredriks- The prices are from ls. to 16s. An accident insurance vaern, "I do not know; my time is stolen from me, I coupon accompanies each diary. For medical men a diary 7 in. in. is a week at an am a slave from morning till night. My pay is about by 3 provided, showing opening of 64 skillings a day....... I do not even know the name of civil two pages and ruled with columns for the insertion of 54 practice here." The skilling was worth nearly a halfpenny. visits to patients. Bound in cloth, with pencil, the Two medical men practised in the town of Stavanger; the price is 2s. 6d., or in French morocco, with tuck and two senior of these, Landphysicus (or chief district physician) pockets, 5s. There are intermediate prices according to Fangel, writes of his junior, the assistant physician, " he is style of binding. An excellent diary for nurses, price 2s. so good in helping the poor that with my whole heart I 6d., bound in red leather cloth, contains, in addition to wish this brave man an old age free from crushing anxiety the usual almanac, spaces ruled for nurses’ reports of the about his daily bread, for the hundred rigsbankdaler he patients’ progress and an index. The diary shows a week gets as assistant at the hospital barely supply the first in an opening. necessities of life." The rigsbankdaler or rixdollar of 96 At a season for exchanging gifts, when necessary skillings was worth less than four shillings ; clearly this I economy and generosity are likely to clash, a diary may assistant was not one of those passing rich on (nearly) solve the difficulty. All the above-mentioned books are twenty pounds a year. It is not surprising to read that printed on good tough paper and bound with an eye to when Chief Naval Surgeon Heiberg won a large sum of hard wear. money in the of 1814 he hastened to throw Hamburg lottery PUBLIC HEALTH AND VITAL STATISTICS OF up his practice and go into business as a shipowner and wholesale merchant. But in 1828, alas, he failed, and had CYPRUS. to return to his old profession as regimental surgeon at ACCORDING to the Cyprus Blue-book for the year 1915 the Horten. Here, " separated from his family, he lived in a estimated population of the colony is 294,664. In 1915 there very small way until he was appointed district doctor at were 9141 births, the rate being 31 per 1000 ; the number of Tonset." Clearly the hundred medical men practising in deaths returned was 5473, or 18’5 per 1000. The public Norway in 1816 had a hard time of it. Yet few and ill paid as health and general sanitary condition of the island have they were they all had official titles, many of them titles as been satisfactory; there was complete immunity from magnificent as apparently empty of all save credit and plague and cholera, and no severe quarantine restrictions renown. Most of these titles had to do with surgery, and were imposed. The number of cases of typhoid fever, at least a dozen varieties of surgeons are distinguished in which in Cyprus is generally of a mild type, was 267, as the official list of 1816. Twenty-seven of the hundred compared with 341 in 1914. On the other hand, 11 cases practitioners it contains are described as " uexaminerede terminated fatally, as against 8 in the previous year. Bataillonschirurger," battalion surgeons who had not There were 9 cases of diphtheria with 6 deaths, but only presented themselves-or who had not successfully pre- 6 cases of cerebro-spinal meningitis (5 deaths). 6701 vacci- sented themselves ?-for examination. Seventeen are regi- nations were performed during the year, and there was mental surgeons, 11 are district surgeons, 6 are candidates no case of small-pox. in surgery. Others are set down as town surgeons, mine This is the third year of the campaign against malaria surgeons, senior surgeons, under surgeons, company initiated by Sir Ronald Ross in 1913, and it is satisfactory surgeons, battalion surgeons, divisional surgeons, super- that the reduction in the casea of malaria and the spleen- numerary regimental or battalion surgeons, or town and rates is considerable. There were 2083 cases less than in the district surgeons. The mere physicians are fewer than previous year, and the spleen-rate, which was returned at the surgeons in the list, but enjoy a no less copious and 22.8 per cent. in the spring of 1913, has now fallen to perplexing variety of titles. Two are described as doctors 11’5 per cent. The reduction is fairly evenly distributed of medicine, though 11 others are mentioned as hold- over the island, but the greatest decrease is shown in the ing the degree of Dr. Med.: one is a doctor of both Larnaca and Famagusta districts, which were also the medicine and surgery, and 6 are described as "Land- most malarial, and this is due in great measure to the physici," or head physicians of their districts. A extensive drainage works that have been carried out. The seventh " Landphysicus " is set down as also a cases of malaria admitted to the six district hospitals in medical candidate, as though not fully qualified, while 1915 amounted to 167, of which only 6, or 3’5 per cent., an eighth is described as " Bergmedicus " (or mine terminated fatally. medico) as well as " Landphysicus," though the distinction Further work in improving the Nicosia General Hos- between the capacities of a "medicus and a " physicus" is pital, a Government institution, has been carried out. not at once apparent. Apart from the doctors of medicine, The electric light installation is now complete, and " the medici," and the " physici," come practitioners of a an X ray apparatus has been provided. Two separate fourth description, those set down in Norwegian as wards for dealing with septic cases in the women’s " Laeger," or, in English, leeches. The leeches existed in side of the hospital have been built. The number of various capacities, and are distinguished as leeches, prac- beds remains at 53.