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Scotland has always been to the forefront in lunacy adminis-tration and in all that pertains to the advancement of ourknowledge in the pathology and treatment of insanity.Bangour village is well equipped in every respect for carryingont its high and humane purpose and the chief feature in itsscheme is the avoidance, so far as possible, of everythingsuggestive of restraint.We congratulate the ’’ City Fathers " of Edinburgh and the

Commissioners in Lunacy on their work, and if it shouldoccur to the minds of some people that the initial expendi-ture of its construction has been a trifle costly, even to excess,who will blame the lunacy authorities if they think the littleadditional comforts advisable for their patients ? Nay,rather would we, with Dr. Clouston, have it " counted tothem for righteousness." In this connexion the thoughtmust be ever uppermost in our minds that just as it is theduty of a father and mother to do their utmost for theweaklings of their family so must the public accept andcarry out its pecuniary responsibilities for the care of theinsane to whom it stands in loco parentis.

THE ANNUAL REPORT OF THE MEDICALINSPECTOR OF PRISONS FOR THE

YEAR 1905-06.

THE annual report of the Commissioners of Prisons andDirectors of Convict Prisons for the year ended March 31st,1906, contains inter alia the report of the medical inspectorwith the usual statistical tables regarding the health of theprison population.The total number of prisoners (including debtors and

persons committed in default of sureties) received into thelocal prisons of England and Wales during the year was217,326, being 2603 less than the figure for the previous year.The daily average population was 18,288-viz., 15,377 malesand 2911 females. 8241 prisoners, being 3.8 per cent. ofthe total number received during the year, were treated inhospital and a further 17,426 were under continuous medicalcare out of hospital for periods of seven days and over. Thetotal number of deaths in the local prisons during the yearamounted to 112, of which 85 were due to natural causes,the balance being made up by 16 judicial executions, ninesuicides, and two deaths ascribed to non-natural causes, onebeing due to accident and one resulting from poisoning byphosphorus taken with suicidal intent prior to imprisonment.Of the 85 deaths from natural causes, 69 were of males and16 of females. Calculated per 1000 of prisoners receivedthis gives a death-rate of 0.37, which is the lowest yetrecorded. The most considerable individual cause of deathwas pulmonary tuberculosis, which accounted for 16 cases,this being rather below the number recorded last

year but approximating pretty closely to the averagefigure for the preceding 16 years. In all but three ofthe cases the presence of the disease was recognised whenthe individuals were received into prison. During the year89 prisoners were released on medical grounds, the bulk ofthem being women in an advanced stage of pregnancy. Thehumane practice of releasing women in this condition andso averting from the children the stigma of prison birth is

highly to be commended. In this connexion it is pointedout by the medical superintendent of Holloway prison, asa singular and regrettable anomaly, that while advancedpregnancy is accounted by the Secretary of State a sufficientreason for the release of a convicted criminal it does notappear to be always regarded by magistrates as adequateground for bailing an untried prisoner ; in two instances ofchild-birth in the above-named prison last year the motherswere unconvicted defendants remanded from the policecourts.In the course of the year 35 cases of infectious disease

were reported in the local prisons-viz., 21 cases oferysipelas, six of enteric fever, four of scarlet fever, threeof diphtheria, and one of mumps. In 14 of the cases oferysipelas the disease appeared to have originated afterreception into prison, and as six of these cases occurredin Wandsworth prison, special attention has been paidto the sanitation of that institution and steps are beingtaken to bring it up to date. Most of the other casesof infectious disease were proved to have been infectedprior to their reception into prison. The very lowdeath-rate in the local prisons and their relative freedom I,

from infectious disease reflect great credit on the medical. department, especially when it is borne in mind that the, majority of these prisons date from a time when sanitary

science was still in its infancy, and when, moreover, as Dr.3 H. Smalley aptly points out, it was apparently supposed that

the moral reformation of the prisoner was asisted by stint-ing him of light and air.The number of prisoners certified insane in the local

L prisons during the year amounted to 129, giving a rate of. 0’59 per 1000 received. Of these prisoners, 73 were found, to be mentally unsound on admission and 27 more exhibited

symptoms of insanity within a month of reception. This, fact may be taken to show that under existing conditions

imprisonment has no detrimental effect on the mental healtht of the criminal population, and that such insanity as occurs

during incarceration is mainly attributable to the morbid! predisposition of the individuals affected. And this view, itl may be noted, is also supported by the facts regarding; suicide ; thus, of the nine prisoners who committed suicide

during the year, three were on remand, and of the othersall but one killed themselves within a month of conviction.While these facts are very satisfactory as a proof that thesystem of penal discipline at present in force does not

involve any risk of inducing insanity, they suggest, on theother hand, that the mental condition of accused personsought to be investigated more carefully before they arebrought to trial.

In addition to those certified insane, 354 prisoners werel found to be so defective mentally as to be unfit for the, ordinary prison discipline. Cases of this sort are treated. under special rules which are described as working satis-: factorily, but Dr. Smalley is careful to add that such

prisoners cannot be properly dealt with in institutior sI intended for sane offenders and that in their own interest to! less than in that of scciety some more rational way should

be found for disposing of these criminal defectives.With regard to the class of juvenile offenders whose treat-

. ment has latterly been the object of special attention it is, mentioned that a scheme has been devised for recording

systematic observations as to the physical and mentalcharacteristics of all prisoners received between the ages of 16and 21 years. This scheme has not yet been in operation long

, enough to warrant any positive conclusions from the datathat have been ascertained, but so far as the indications canbe made out they show that the adolescent criminals are, onan average, below the physical standard of the populationat large, and that in a remarkably high percentage ofthem there is an alcoholic, epileptic, or insane taint in thestock. It is satisfactory to note that the medical officers ofthe several prisons where juvenile-adult offenders are treatedunder what is known as the Borstal system are able to

report that the ample diet, the regular industrial training,the daily drill, and the other sound hygienic influences whichare essential features of this regimen are found to produce arapid and considerable improvement in the physical andmental development of these youths.

In the convict prisons the daily average population duringthe year was 3135, 2994 males and 141 females, and the totalnumber of deaths during the year was 18, 16 males and twofemales. One death was due to accident and the remaining17 to natural causes, thus giving a death-rate of 5’4 per 1000of the daily population. 19 convicts were certified insane.There were no deaths from suicide.

MEDICINE AND THE LAW.

Advice Gratis Refused.AN amusing dialogue recently took place at the North

London police court between Mr. Fordham and an applicantwho sought his advice. Medical practitioners are so fre-

quently the victims of those who are well able to pay fortheir aid, but who endeavour to obtain it without doing so,that they will appreciate the motives which led the learnedmagistrate to adopt an unsympathetic attitude. The

person who thought himself entitled to an opinion handedup a document addressed to himself with the suffix"Esquire." This caught Mr. Fordham’s eye at once.

"I I think," he said, " that an esquire should pay forlegal advice. I only sit here to give advice to the

poor." This produced a protest that the applicant was notrich and Mr. Fordham read the document further, only to

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discover that it related to the alleged sale of a phonographcosting 4 guineas. He cautiously inquired whether thiswas an investment with a view to earning money with whathe justly described as an expensive toy, and on beinganswered in the negative he refused to go further into thematter, saying that the man who could afford such a luxurycould afford half a guinea for a solicitor. Solicitors will nodoubt be grateful to the magistrate and medical men willwish that the purchaser of the 4 guinea phonographmight find it as difficult to procure medical assistance gratisas he did to obtain an opinion upon his legal position.

Two Important Cases in the Criminal Courts.Two trials are likely to take place in the near future

involving points of considerable interest to readers ofTHE LANCET. In the one the editor of a newspaper hasbeen committed to take his trial at the Central CriminalCourt in respect of a charge of indecent libel founded uponthe advertisements appearing in his paper, the allegationbeing not that these were in themselves of an indecentcharacter but that they related to matter of an indecentnature and did so in such terms as to render the editor re-sponsible. In the other case referred to, a coroner’s jury hasfound a verdict amounting to one of manslaughter againsta parent whose child was stated to have died withoutmedical aid, owing to the parent professing what is knownas " Christian Science." This case also should in due coursebe tried at the Old Bailey.

ELECTION OF DIRECT REPRESENTATIVESUPON THE GENERAL MEDICAL

COUNCIL.

WE have received the following communications with arequest for their publication. The return" " given belowis that foreshadowed in the circular addressed to theChairmen of Divisions of the British Medical Associationin England and Wales, which was published in THE LANCETof Sept. 8th, p. 670.

GENERAL MEDICAL COUNCIL ELECTION.

To the Editors of THE LANCET.1. Dr. L. S. MacManus.2. Dr. Langley Browne.3. Dr. H. A. Latimer.

In issuing the above return the scrutineers desire to pointout that the candidature of Dr. Morrison was not beforethe electorate in full.

HUGH R. KER, HUGH WOODS, A. G. BATEMAN,Scrutineers.

To the Registered Medical Practitioners of Fngland and.

Wales.LADIES AND GENTLEMEN,—In placing my services at the

disposal of the profession in the ensuing election for DirectRepresentatives on the General Medical Council, I may beallowed to say that, in order to show that my efforts in the

past have not been confined to a narrow groove, I have beenfor many years a member of the British Medical Associationand since the Cheltenham meeting a member of its CentralEthical Committee and its Representative on the ContractPractice Subcommittee in 1905-06, that I have attended allthe Representative meetings of the Association on behalf ofthe North Manchester Division; that I am a member of theCouncil of the Lancashire and Cheshire Branch ; a vice-president and ex-president of the Incorporated MedicalPractitioners’ Association ; and have been a member of theCouncil of the Medical Guild practically since its founda-tion some 14 years ago and took an active part in its initia-tion. All this has given me considerable insight andexperience as to the difficulties and trials, as well as short-comings of everyday practice, which might prove useful inthe General Council of Education and Registration inLondon.

I have recently expressed my views in THE LANCET andother medical journals as to the necessity of lectures beinggiven to senior students on ethics to supply the deficiencycaused by abolishing the apprenticeship system and ofraising the standard of preliminary education both in artsand science before registration, which I need not repeat now.

I am also in favour of more stringent action on the part ofthe Council in any proved cases of touting for vaccination onthe part of Poor-law medical officers or their agents, even inthose employed by the guardians, and I would go so far asto consider whether proved cases of gross undersellingshould not be considered " infamous conduct in a pro-fessional respect," not only as an injustice to their fellowpractitioners, but as lowering the dignity of the professionin the eyes of the public.The craze for registration now that midwives have secured

it is certain to be attempted not only for nurses but

spectacle makers, herbalists, &c., and will require carefulwatching during the next five years, and the GeneralCouncil will require keeping on the alert, not only for theprotection of the public, but if it were possible that of theprofession as well, inasmuch as the President has statedthat the Council’s resources are not yet exhausted. Abolish-ing unqualified assistants not only benefited the public butthe profession. It has always been my endeavour, in seasonand out of season, to secure as far as possible the union andthe interests of the profession and especially by promotingnew as well as old combinations of various kinds.My personal experience of provident dispensaries and

another large provident association, when on the staff ofwhich for a few years I fought for the honour and dignityof the profession in the face of strong opponents, and formany years since leaving them, for a wage limit, is wellknown in my immediate neighbourhood. All this practicalexperience in addition to that gained as a general practi-tioner for upwards of a quarter of a century, would surelybe of use in a council composed mostly of professors andconsultants who know nothing of these matters personally,and would be of assistance in cross examination ofdelinquents when brought before it.

If it is possible in a new Medical Act to protect the publicfrom the barefaced assumption of medical titles, especiallyby companies, and from other means of deceiving it, I neednot say that it will have my hearty support. The experi-ence gained during the three years I have sat on the CentralEthical Committee of the British Medical Association, notone meeting of which have I been absent from, ought to beof some service to me if elected to the General MedicalCouncil. The reckless distribution of medical services with-out any regard to wage limit to the injury of respectablequalified practitioners should surely be adjudged "infamousconduct in a professional respect " as in any other.

RAHAVA mp Ladies and l:Pnt.laman vmira fa.ithfnllv.

G. H. BROADBENT, M.R.C.S. Eng., L.R.C.P.Irel.,and L.M.

8, Ardwick-green, Manchester, October, 1906.

To the Editors of THE LANCET.

SIRS,-It was with considerable pleasure that I read Mr.M. S. Harford’s letter in your issue of Oct. 20th re Dr.MacManus’s candidature at the forthcoming election as a

Direct Representative on the General Medical Council. Mr.Harford draws attention to the injustice of the BatterseaProvident Dispensary towards medical men practising in thedistrict, but I think his remarks are mild. He draws atten-tion to the fact that there are members who pay £35 perannum rent exclusive of taxes, and in this I am able tocorroborate what he says. I should like to add further thatthis so-called charity receives some S125 or more per annumfrom the King’s Hospital Fund. Do the people who subscribeto this Fund or those who are answerable for its proper dis-tribution know that their money helps pretty considerablymany members of the stafE of this dispensary to drive in theircarriages and motor-cars ? No ; I think not. I should likealso to ask if the medical men belonging to this huge" charity are aware of the touting that goes on to getmembers. I will give an illustration as to how it is done.A collector goes to a house, in which two or three families

may live, to collect a subscription from Mrs. A. Mrs. B,who lives upstairs, is standing at the door at the time thecollecter calls. When he has received Mrs. A’s subscriptionhe turns to Mrs. B and asks her if she is a member. Whenshe says "No," the collector in a suave way points out thebenefit of belonging to the dispensary, and she, yielding tohis persuasive manner, becomes a member, and I or one ofmy brother medicals, who is not a member of the dispensarystaff, lose another patient. I speak from personal expe-rience, although I have only been in the neighbourhood fourmonths. I should like to ask Dr. MacManus if he is in favour