1722 ] IRISH MEDICAL SCHOOLS AND GRADUATES’ASSOCIATION.-LOOKING BACK.

referred to a list of cases he had published in whichmorphine was the proximate cause of insanity, and statedthat the forms of insanity met with in native races were

those mostly due to drugs or those which had a toxicorigin ; and that the highly evolved forms of insanity, suchas systematised chronic delusions, were uncommon. He dis-cussed the interesfing suggestion thrown out by Dr. Ellis’spaper as to the rarity of general paralysis in negroid races,although the incidence of syphilis was common.-Dr. W. L.ANDRIEZEN gave an interesting summary of the literature onthe subject and showed that the inhabitants of the fenlandin the Thames Valley had discovered centuries since thevirtues of opium as a prophylactic against malarial fevers.-The PRESIDENT summarised the discussion and Dr. ELLISreplied.

Dr. F. G. CROOKSHANK read an interesting paper on theStudy of Evolution in Relation to Psychiatry and discussedthe association of mind and matter. He pointed out thedifferent modern views of this relationship and suggestedthat with further knowledge some theory might be dis-covered which would better explain the interdependencethan those hitherto advanced.-Dr. ANDRIEZEN contendedthat the line of progress would not in future run upon the

metaphysical basis but upon purely practical and biologicallines.-The PRESIDENT expressed the thanks of the associa-tion to Dr. Crookshank and hoppd that members would soonhave the opportunity of reading the paper in the Journal ofMental Science.

Dr. GEORGE WATTERS GREENE read a paper uponPrognosis in Dementia Paralytica. He had divided casesof general paralysis into groups according to the weight ofthe brain and also according to convolutional pattern. Hehad also further inserted a group according to whether thepupil was fixed or reacted to light, also according to age andthe condition of stress.-Dr. YELLOWLEES spoke of the

apparent change in the form of general paralysis withinhis own experience. As was the case in normal facultiesand organisms, so also in disease there appeared tobe cycles and variations. His experience pointed out thatgeneral paralysis in duration was much more protractedthan was the case in his early experience.-Dr. H. F. HAYESNEWINGTON referred to the rarity of general paralysisamong ladies of the higher classes and he also referred tothe change in type and suggested that lesions not essentialto general paralysis were now probably described as varietiesof the disease.-Dr. T. B. HYSLOP referred at length to thevarieties described as

" pseudo-general paralysis. "-Dr.W. J. MICKLE, Dr. JONES, Dr. BRISCOE, Dr. BEDFORDPIERCE, Dr. ELLIS, and others took part in, and the PRE-SIDENT summarised, the discussion, thanking Dr. Greene forhis paper.

IRISH MEDICAL SCHOOLS ANDGRADUATES’ ASSOCIATION.

THE autumn general meeting of the above association washeld on Nov. 28th at the Hotel Cecil, London. The chair,in the absence of the President (Sir William Whitla),was occupied by Dr. J. H. Swanton, chairman of council.There was a very large attendance of members.The council reported that it had under consideration the

removal from the roll of members of the names of all thosewho were two years and upwards in arrears. The list to be

published with the forthcoming annual report would there-fore not contain such names unless cause for delay wereshown in the meantime by defaulters. The names now onthe roll number upwards of 850.The members and their friends, to the number of 233

(including 67 ladies) subsequently dined together in theGrand Hall of the Hotel Cecil. There were but two toasts.That of " The King " was received with marked enthusiasm,Dr. Macan taking the solo in ’’ Good Save the King."

" The Prosperity of the Association " was proposed by SirDyce Duckworth who said that he was greatly in favour ofsuch societies. This particular association had done goodservice in many ways amongst which he placed very highlyt,he example it set in introducing ladies to their socialgatherings. One of our greatest observers of characterhad said that the Irish were sent,imental and emotional,the Scotch sentimental but not emotional, and theEnglish neither one nor the other. A gathering such

as he was joining in that eveuing was useful to thoae

present who belonged to all three nationalties just as hefelt when a member of the General Medical Council howmuch brighter was the atmosphere of the council chamberowing to the presence at the side of stolid Englishmen andmore stolid Scotchmen of genial spirits like those ot the lateSamuel Haughton and Rawdon Macnamara. He concluded

by echoing from his heart the sentiment contained in themotto of the association " Floreat Hibernia Semper."-TheChairman (Dr. P. S. ABRAHAM), in replying, said that SirWilliam Whitla, their President, had telegraphed to say howmuch he regretted that he was at the last moment detainedin Belfast.An entertainment of a very varied character followed.

Ventriloquism and thought-reading, short stories by Mr.

Upton, and a very clever exhibition of living mario-nettes were interspersed between songs, duets, &c. (sellti-mental and otherwise), and a performance on the violinby Miss Ernestine Mac Cormac who had a very heartyreception, owing partly to her relationship to one of themost prominent members of the association when it wasfirst founded (nearly 30 years ago), but principally to themarvellous skill with the instrument which she seemed sothoroughly to understand. There was a unanimous expres-sion ot opinion that much praise was due to Mr. CannyRyall, the entertainment secretary, for the great success ofthe evening.

Looking Back.FROM

THE LANCET, SATURDAY, Dec. 8th, 1827.

The influence of journals, and public opinion, act recipro-cally upon each other ; but the influence of journals, or

journalism, as this power is now designated by a people whoare beginning to reap its inestimable benefits, commonlygives the first impulse and direction to public opinion.While we acknowledge the powerful aid and co-operationof ne Times, and other journals, it is a source of honestsatisfaction to ourselves to reflect, that our own exertionshave contributed in no slight degree, to bring the questionof medical reform to a crisis. Low as the medical pro-fession stands in the estimation of The Times-degradedas we are compelled to admit it to be, through the in-fluence of a corrupt oligarchy, it was in a state of stillmore deplorable debasement, when THE LANCET commencedits labours. Its members were then not only degraded,but subjugated ; not only oppressed, but reduced to a

state of abject submission to their oppressors. Destitute ofa rallying point, they were at once trampled upon, andinsulted by the corruptionists, who have since characterisedthe state of torpor into which the profession had sunk,as a state of respectable repose—ubi solitudinem fccciunat,pacem appellant. By establishing a free medical press,THE LANCET gave the first blow to this system of tyranny,cupidity, and corruption; we roused the profession to asense of the injuries and indignities which have been heapedupon them, and to a spirit of resistance, which mustterminate in the overthrow of an oligarchy, now as crest-fallen and feeble, as it was then insolent and overbearing.Another fact from which we augur the speedy triumph of

the cause of medical reform, is the unanimity with whichthat reform is desired by the great body of the profession.In this respect, the task of removing medical abuses presentsmuch less difficulty than that which reformers generallyhave to encounter. Parliamentary reform has never mademuch progress in this country, because the body sought tobe reformed has never seriously desired to effect its ownamelioration. It is a hard matter to deal with a patientwho refuses to take the only remedy that can cure hisdisease, especially where, if the smallest violence be usedto compel the swallowing of physic, the patient is strongenough to throw his surgeon out of window. In the caseof medical reform there are no such difficulties to contendwith ; the public desires to see the cure effected, the

surgeon is willing to administer the remedy, and the patientis both ready and anxiour. to take it. It is not necessaryto prove directly that the great body of the medical pro-fession are friends to reform ; but we may show, e converso,

1723ASYLUM REPORTS.-VITAL STATISTICS.

bytaking a glance at the tail of the profession, that the anti-reformists are confined to that unseemly excrescence ofthe body medica1.1

ASYLUM REPORTS.

Lanark District Asylum, Ilartyvood (Report for the yearending May, 1905).-From the report of the medical super-intendent, Dr. Neil T. Kerr, it appears that during theyear 212 patients were admitted, 143 were discharged,and 76 died. The average daily number resident was 897.The admissions include 37, and the numbers resident 139, out-county cases. It is considered that senile cases are oftensent unnecessarily to asylums because the friends shirk theslight discomfort and anxiety which home nursing wouldentail. Of causes of insanity alcoholic intemperance andheredity are the principal but neither appears particularlypotent if, as is stated, the former occurred in 33 of theadmissions (about 15’6 per cent.) and the latter in 22

(10’ 4 per cent.). These are low figures, the latter extremelyso, when it is remembered that many asvlums record from40 to 50 per cent. of heredity of insanity and allied neuroses.It should be defined what is meant by heredity. The

recovery-rate reached the satisfactory figure of 49’ 2 percent. of the admissions. Two males recovered after

having been insane for more than six years ; the mentalsymptoms in each case disappeared after a severe attack ofpneumonia. It is well known that acute insanity often dis-appears after attacks of physical disease but the reason isobscure and this matter is well worth investigation. Thedeath-rate amounted to 8’ 4 per cent. on the average numberresident. Pulmonary tuberculosis and general paralysisare stated to account for the low proportion of 11 and eightrespectively of the 76 deaths, but on looking up the Causesof Death!Table we find that tuberculous disease was presentin two more cases, making 13 in all. A sanatorium for 26tuberculous patients is to be erected. The report of one ofthe Commissioners in Lunacy (two visited the asylum) statesthat the rate of discharge of improved patients to domesticcare is very small, and active efforts in this direction arerecommended. The supineness of asylum and parochialauthorities in this matter is stated in the Commissioner’s

report to be one of the main factors in causing the increasein asylum populations. This statement agrees with the views

expressed by the Scottish Commissioners in Lunacy in theirlast report.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 76 of the largest English towns 7730 births and 5005deaths were registered during the week ending Dec. 2nd.The annual rate of mortality in these towns, which had been15 - 6, 15 5, and 17 9 per 1000 in the three preceding weeks,declined again last week to 16’ per 1000. In London thedeath-rate was 18 1 per 1000, while it averaged 16’ 1 per1000 in the 75 other large towns. The lowest death-ratesin these towns were 5’2 in King’s Norton, 6’9 in Grimsby,8’7 7 in Bournemouth, 9. 5 in Devonport and in Barrow-in-Furness, 9’ 6 in Ipswich, and 10’ 0 in Southampton andin Wallasey ; the highest rates were 21. 1 in Wigan, 21’ 3 inLiverpool, 21-6 in Gateshead, 21’8 8 in Derby, 22.5 inWolverhampton, 22 - 6 in Merthyr Tydfil, 23’ 3 in Tynemouth,24.1 in Bootle, and 26 - 6 in Rochdale. The 5005 deaths inthese towns last week included 385 which were referred to theprincipal infectious diseases, against 371, 338, and 355 in thethree preceding weeks ; of these 385 deaths, 118 resulted frommeasles, 81 from whooping-cough, 56 from diphtheria, 55from scarlet fever, 49 from diarrhoea, and 26 from "fever" (principally enteric), but not any from small-pox. No deathfrom any of these diseases was registered last week inHornsev, Brighton, Southampton, Burton-on-Trent, WestBromwich, Grimsby, Nottingham, Bury, Barrow-in-Furness,Huddersfield, Stockton-on-Tees, Tynemouth, or Newport(Mon.); the highest death-rates from the principal infectiousdiseases were recorded in Wolverhampton, Bootle, Rochdale,Blackburn, Preston, Rotherham, Middlesbrough, West Hartle-pool, and Gateshead. The greatest proportional mortality

1 Excerpt from leading article.

from measles occurred in Willesden, Birmingham, Blackburn,Preston, Middlesbrough, and Swansea ; from scarlet fever inRochdale ; from diphtheria in Bootle, Blackburn, and WestHartlepool; from whooping-cough in Rochdale, Burnley, andGateshead; from "fever" " in Wigan ; and from diarrhoeain Salford and Rotherham. No death from small-pox wasregistered last week in any of the 76 towns; and no casesof this disease were under treatment during the week in theMetropolitan Asylums Hospitals. The number of scarletfever patients in these hospitals and in the London FeverHospital, which had been 4154, 4120, and 4127 at the end ofthe three preceding weeks, had declined again to 4021 at theend of last week; 375 new cases were admitted during theweek, against 494, 425, and 470 in the three precedingweeks. The deaths in London referred to pneumonia anddiseases of the respiratory system, which had been 383, 401,and 490 in the three preceding weeks, decreased again to478 last week, and were 87 below the number in the

corresponding period of last year. The causes of 51, or10 per cent., of the deaths in the 76 towns last weekwere not certified either by a registered medical practi-tioner or by a coroner. All the causes of death were

duly certified in London, West Ham, Leicester, Nottingham,Salford, Bradford, Leeds, Newcastle-on-Tyne, and in 43other smaller towns; the highest proportions of uncertifieddeaths were registered in Portsmouth, Birmingham, Liver-pool, St. Helens, Blackburn, Sunderland, South Shields,Gateshead, and Newport (Mon.).

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in eight of the principalScotch towns, which had been 17’ 5, 17’ 5, and 21 9 per 1000in the three preceding weeks, declined again to 18’ 7 per. 1000during the week ending Dec. 2nd, but was 2’ 0 per 1000 inexcess of the mean rate during the same period in the 76large English towns. The rates in the eight Scotch townsranged from 12’ 8 in Paisley and 13’ 5 in Edinburgh to24’ 5 in Greenock and 25’ 7 in Dundee. The 628 deaths inthese towns included 33 which were referred to measles, 14to diarrhoea, six to whooping-cough, five to diphtheria,and three to scarlet fever, but not any to small-pox ordiphtheria. In all 61 deaths resulted from these principalintectious diseases last week, against 61, 64, and 84 inthe three preceding weeks. These 61 deaths were equalto an annual rate of 1 .8 per 1000, which was 0’ 5 per1000 above the mean rate last week from the same

diseases in the 76 large English towns. The fatal casesof measles, which had been 28, 34, and 48 in thethree preceding weeks, declined again last week to

33, of which 16 were registered in Glasgow, 11 in Dundee,four in Greenock, and two in Paisley. The deaths fromdiarrhoea, which had been 18, 19, and 14 in the threepreceding weeks, were again 14 last week, and includedfive in Glasgow, four in Dundee, three in Aberdeen, andtwo in Edinburgh. The fatal cases of whooping-cough,which had been seven, two, and ten in the three pre-ceding weeks, decreased again last week to six, of whichthree occurred in Glasgow and two in Edinburgh. Thedeaths from diphtheria, which had been four, four, and eightin the three preceding weeks, declined to five last week,and included four in Glasgow. The fatal cases of scarletfever, which had been three, three, and one in the three

preceding weeks, rose again last week to three, of whichtwo occurred in Dundee. The deaths referred to diseasesof the respiratory organs in these towns, which hadbeen 152, 130, and 159 in the three preceding weeks,declined again last week to 148, and were 42 below thenumber in the corresponding period of last year. The causesof 23, or nearly 4 per cent., of the deaths registered in theseeight towns last week were not certified.

HEALTH OF DUBLIN.

The death-rate in Dublin, which had been 20 1, 20’ 8, and22’ 7 per 1000 in the three preceding weeks, declined againlast week to 20 ’ 4 per 1000. During the past four weeks thedeath-rate has averaged 21 ’ 0 per 1000, the rates during thesame period being 17 - 9 in London and 16’ 0 in Edinburgh.The 148 deaths of persons belonging to Dublin registeredduring the week under notice were 17 below the numberin the preceding week and included seven which were

referred to the principal infectious diseases, against seven,five, and seven in the three preceding weeks ; of these,