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jB12.—Widow, aged 56, of L.R.C.P., L.R.C.S. Irel. Unprovided for athusband’s recent death, and hopes to support herself by receivingboarders. Children only able to give very slight help. Voted .810.—Daughter, aged 51, of L.R.C.P.Irel. Has always been in feeble health.and is now incapacitated by a chronic complaint for which she has beenpromised admission to a hospital. Voted JS5 now and 25 on leaving thehospital.—Daughter, aged 67, of late M.D. Edin. Used to have a smallincome, but was obliged to mortgage the property from which it wasderived, and now receiving nothing owing to foreclosure by themortgagee. Voted .812.—Daughter, aged 65, of late M.R.C.S. Was
comfortably provided for by her father, but lost everything throughthe dishonesty of her trustee, and is now dependent on a smallpension from another society. Itelieved twice, .E36. Voted JE12.—Daughter, aged 62, of late M.R.C.S. Has had a school for several years,but now owing to competition finds it very difficult to meet her
expenses and is obliged to maintain two mentally afflicted sisters.Relieved once, .810. Voted .812.—Deserted wife, aged 46. Sincehusband’s disappearance a few years ago has supported herself indifferent ways, but is now in difficulties which she quite hopes will betemporary. Relieved once, .810. Voted .810.—Widow, aged 70, ofM.R.C.S. Since husband’s death 30 years ago has kept a lodging house,but now owing to failing sight and chronic rheumatism finds it verydifficult to do the necessary work. Only income a few shillings a weekfrom savings which have been invested. Relieved once, B12. Voted,5 and to be advised to apply for an Old Age Pension.-Daughters,aged 60 and 55, of late M.R.C.S. Entirely dependent on lettinglodgings and both in feeble health. Relieved eight times, .E96. Vot’:djB12.—Daughter, aged 66, of late M.R.C.S. Was fairly provided for atfather’s death but made most unfortunate investments which nowyield only about 5s. a week. Relieved twice, .836. Voted .812.—Daughter, aged 44, of late F.R.C.S. No income and health so
indifferent that it is impossible to keep any post even when obtained.Relieved 14 times..8117. Voted JE12.—Widow, aged 63, of M.R.C.S.Quite unprovided for at husband’s death several years ago and owingto a deformity has never been able to obtain regular work. Slight helpfrom children. Relieved nine times, .8106. Voted B12.—Daughter,aged 61, of late M.R.C.S. Has suffered for many years froma chronic complaint and been obliged to spend her capital bothfor treatment and maintenance. Relieved twice, .E24. Voted £ I2.-Daughter, aged 56, of late M.R.C.S. Health too feeble for anythingbut light work and has to help support two sisters who are unfitted forany occupation. Relieved four times, 272. Voted .818.—Widow, aged64, of M.D. Lond. After husband’s death, about ten years ago, starteda boarding-house at a seaside place, but lost all her capital, and is nowunable to obtain suitable employment. Relieved twice, .824. Voted.812.—Widow, aged 57, of L.R.C.P. Edin. Slight help from childrenand lets lodgings. Relieved three times, JE32. Voted .E2, and case to bereconsidered.—Widow, aged 44, of M.B., C.M. Glass. Quite un-
provided for at husband’s death a year ago, after a long illness, andobliged to endeavour to keep a home together because of her threeyoungest children, aged 10 to 4; slight help from elder children.Relieved once, .E12. Voted .820.—Daughter, aged 35, of L.S.A. Hasbeen offered a situation abroad, but requires a little help for un-avoidable expenses. Relieved once, .E1O. Voted .85.
MEDICO-PSYCHOLOGICAL ASSOCIATION
OF GREAT BRITAIN AND IRELAND.
THE quarterly meeting of this association was held at theDarenth Industrial Colony, Dartford, on Feb. 20th, underthe presidency of Dr. J. G. SOUTAR.
Presidential Remarks: the -1"Jfental Deficiency Bill.
During the morning members inspected the various centresof activity in the colony, including the female and maleworkshops and wards for adult imbeciles, for the feeble-minded section, and for imbeciles under 16 years of age, threeseparate classifications of cases. At the luncheon whichfollowed the PRESIDENT thanked, on behalf of the asso-
ciation, Mr. E. H. Helby, the chairman of the councilcommittee, and Dr. A. Rotherham, medical superinten-dent, for the cordial welcome which had been extendedand the interesting manifestations of good trainingwhich were so abundant in the institution. What wasto be seen at Darenth was an eye-opener to many,even of those who knew something of such work.He thought that if Dr. Rotherham could only see
his way to admit, for the remainder of their shortrecess, the members of the Cabinet and others inthe House, to the institution, that House wouldrapidly pass, through all its stages, the Mental De-
ficiency Bill, for they would see that it would conferupon thousands of neglected persons the boons receivedby the inmates of Darenth Colony. He regarded it as
one of the centres of education in the country, and muchof that done here might well be copied by the publicschools of the country, for here the limitations and
potentialities of the pupil were ascertained, and theeducation directed accordingly. What tears, difficulties,and miseries would thus be saved I-Dr. ROTHERHAM brieflyreplied to the President’s remarks, praising highly the
capacity and efforts of the insbructional staff, who were all
skilled in their work before they took up the posts.-Mr.HELBY admitted that during the last nine years he had foundgreat delight in doing what he could for the special class ofcase under care and training in this colony, and in theinterests of the ratepayers of London. That it had beensuccessful was due to the continuous and harmonious effortsof the medical and instruction staff. A few weeks ago hewas a member of a deputation which attended before theHome Secretary. It was received by Mr. Ellis Griffiths, andhe told that gentleman that if only a committee of the Houseof Commons would spend three hours at Darenth Colony itwould do more good than three or four weeks’talking bypeople who, for the most part, had no real practical know-ledge of the subject. He concluded by reading the
following extract from the last report of the Commis-sioners in Lunacy, issued a few weeks ago : "We cannotconclude without expressing our pleasure and satisfac.tion with all we saw and learned during our visit of
inspection, and we desire to record our impression thatthe work of the institution is being carried out on well-
planned lines and with much skill and thoughtfulness inorganisation, and that the object in view-namely, theadequate training and occupation of the imbecile class-is being attained in a most satisfactory and gratifyingmanner. "
The meeting passed the following resolution on the subjectof the detention of criminal lunatics in county and boroughasylums :-That the Parliamentary Committee consider it is most undesirable
that criminal lunatics be sent to county and borough asylums, andrecommend to the council that the Association be asked to express thisopinion to the Home Secretarv.
A number of members were appointed to form a deputationon the subject.The PRESIDENT alluded, in fitting terms, to the decease
of Dr E. M. Courtenay (many years inspector of lunaticsfor Ireland), Mr. Joseph Bayley (48 years superintendentof St. Andrew’s Hospital, Northampton), and Mr. S. G.Longworth (Distrct Asylum, Melton, Suffolk), and the
meeting authorised messages of condolence to the respectiverelatives.
Treponema Pallidum in the Brain in General Paralysis.A very important communication by Dr. GEORGE M.
ROBERTSON, of Edinburgh, on a demonstration by Noguchiof the Treponema Pallidum in the Brain in cases of GeneralParalysis, was communicated to the meeting by Dr.WINIFRED MUIRHEAD. It showed that Noguchi found thespirochaste of syphilis in the brains of 12 out of 70 cases ofgeneral paralysis of the insane. The discovery was held to layat rest much that had long been debateable. A section ofthe cortex, sent from Dr. Noguchi at Johns Hopkins Hos-pital, Baltimore, was on view under Dr. Muirhead’s care.In all the cases the organisms seemed to have wanderedinto the nerve tissues ; they were not found in the vesselsheaths.
Assistant Medical Offlears in Asylums.Dr. J. BEVERIDGE SPENCE read a paper entitled
"Assistant Medical Officers in Asylums." He said thathe had been for some time of the opinion that somethingshould be done to improve the position of these officers ;therefore he had been in full accord with the work of acommittee of the Association on the matter, which hadissued an interim report advocating a more advancededucation for applicants for these posts. On the questionof the facilities to continue study of psychological scienceat some centre-leave being granted for that purpose-the money factor had to be considered. It would perhapsbe really necessary to increase the rate of remunera-
tion in order to attract to the specialty the right kindof man, especially now that in other branches of theprofession young men were advertised for at salariesof ,B400 and f’.500, with greater individual libertiesthan those known to assistant medical officers of asylums.In order to collect information on the subject he hadsent out forms to the superintendents of 94 asylums,and he gratefully acknowledged the courteous responseof 92 of those gentlemen. Of these, 17 asylums hadonly one assistant medical officer. The average minimumsalary of the senior assistant medical officer was .E224, andthe average maximum .6309, exclusive of emoluments; the ’
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lowest being .6150, rising to .6200, and the highest f’.330,with a maximum of f’.430. The medical officers junior to thefirst seemed to vary from an average minimum of 160 to an
average maximum of z208 ; the highest being S185, rising to.6330, and the lowest 130, rising to f’.150. The emolumentshe found difficult of useful tabulation. In nearly everyinstance the medical superintendents approved of theirsenior assistant being a married man. Only eight regardedthe idea unfavourably, while a few thought permissionmight be granted if accommodation were provided.There seemed, however, to be a feeling against this
permission being granted to the second assistant. In23 asylums there were now-married assistant medical officers,while in 63 institutions these officers were not married. Dr.
Spence then proceeded to consider the question of accom-modation for married assistant medical officers, under threeheads : (1) those who had rooms in the asylum main build-ing ; (2) those occupying a house on the asylum estate ;(3) those who rented a house outside the asylum grounds ;and made a comparison of the conditions and salaries ofassistant medical officers of asylums with those of somewhatsimilar officers in prisons, to the advantage of the latter ;and he counselled the continued efforts of the associationto better the lot of the former, for it certainly was insympathy with the aspirations of those gentlemen. He
personally was in favour of an advance in the averagesalaries of assistant medical officers of asylums.
Darenth and its System of Industrial Training... Mr. F. O. SPENSLEY, senior assistant medical officer, con-tributed a paper on this subject. He said that 40 years ago, atHampstead Asylum, under the Metropolitan Asylums Board, anattempt was made to give the patients under 16 years of agesome instruction in music, singing, and simple work in schools.So successful was this that the Board saggested the buildingof a schoolroom and shoemakers’ and tailors’ shops. In 1874the Board purchased a site for the separate treatment ofimbecile children, meantime using the London OrphanAsylum at Clapton for the purpose, and Dr. Fletcher Beachwas its first medical superintendent. In 1876 Darenth
Training School was built. In the first year the patients’labour realised f’.66 5s. 7d. In order that the trainingmight not be thrown away it was decided to build
adjacent to the schools two blocks for 120 males and120 females, adults, the Local Government Board in-
sisting, however, on the elimination of the hopelessly"incurable," a term which the subcommittee altered to
"unimprovable." " Subsequently these two wards grew into
the adult asylum, with 1052 beds. The author tracedthe growth of the institution to its present dimensionsand many-sided activity, including mat-making, brush-
making, wire drawing, pan work, envelope and paper bagmaking, tin-smith work, carpentry, book-binding, and
printing. Drilling of the patients, of both sexes, was infull swing, to the obvious improvement of their physiquea,nd deportment. 835 out of the total of 1064 adultimbeciles were now undergoing industrial training. At
piesent a wide and clearly marked line was drawn betweenthe inhabitants of the pavilions and those of the remainderof the institution. They were admitted classified as feeble-minded, and were to be kept quite apart from the certifiedpatients. It would, the author submitted, be difficult tofind a better illustration of the impossibility of determiningan arbitrary line of demarcation between an imbecile and afeeble-minded person. Among the so-called feeble-minded inthe institution were many patients whose mental state wasfar below that of many of the certified imbeciles. Hesketched a different classification, and described the methodspursued to encourage each patient to do his best, and there-fore improve as far as possible. Mr. Bickmore was anadmirable example of what a crafts-master of such an insti-tution should be, and each tutorial member of the staff wasan efficient instructor. Last year the industries realised£12,367, an increase of .68000 per annum in five years.-Dr.G. E. SHUTTLEWORTH, in discussing the paper, alluded tcthe transfer from Darenth to Rochester House, Ealing, oj
"improvable" cases in 1900 to 1904 for the purposes oiindustrial training. He agreed that there was very littledifference between the high-grade imbecile and the ordinaryfeeble-minded person.-The discussion was continued bDr. POWELL, Dr. R. L. LANGDON-DOWN, Dr. CORNER, ancDr. FLETCHER BEACH, and Mr. SPENSLEY replied.
Public Health.REPORTS OF SCHOOL MEDICAL OFFICERS.
Kent County Council.—Dr. W. J. Howarth’s report of theyear 1911 is among those which have a permanent value,apart from statistics, in the building up of the system ofmedical inspection and medical treatment. The year’srecord shows not only good work done but solid foundationslaid for better. District nurses have been engaged to do,chiefly, "following-up" work. A whole-time nurse hasbeen appointed to stimulate the adoption of a higherstandard of cleanliness, and reinspection has been madedetinite and certain by the institution of a medical log-book of defective children with a continuous record ofobservations by inspectors and teachers. The attendanceofficers also assist by arranging for excluded children toattend medical inspections, and a nurse attendance officerhas proved of considerable value. The actual work of
inspection is carried out by a staff of whole-time and part-time officers arranged so as to allow of its transfer to whole-time medical officers of health as occasion presents. The
part-time inspectors are paid a fee of Is. per inspection,plus £1 for every 1000 acres in the area and P.1 perannum for each school. Total payment per child must notexceed 3s. per child inspected or 4s. in the Isle of
Sheppey. The inspectors arrange their own time for visit-ing the schools, but give a clear week’s notice to theschool medical officer of appointment suggested. The cost
per inspection works out at Is. 10d. for the salaried menand ls. 5d. for the part-time men in urban districts, and2s. 9d. per child in rural districts. The higher ratein rural districts is due to the fewer children who are
examined. Interesting tables are given showing the diver-gencies between the opinions of inspectors with regard tothe existence of defects needing attention. Records of
inspections by 20 officers are given, and with regard to teeththe percentage (urban districts) stated to be requiring treat-ment varies from 27.1 in one case to 0 - 64 in another, and inregard to visual defects (rural districts) from 15-3 per cent.in one case to 2- 9 per cent. in another. To ensure greateruniformity the school medical officer proposes to arrange aconference of inspectors for the discussion of these varia-tions. While no attempt has been made by the EducationCommittee to provide for treatment by means of clinicsor by arrangements with medical practitioners or hospitals,a fair proportion of children have been helped to treatmentby following-up methods and the work of care committees.An outbreak of scabies, however, was successfully tackledby the nurse acting under the supervision of the part-timeschool doctor. Of the cases treated it is interesting tonote that more than one-third were dealt with by localpractitioners. The steps taken to further medical treat-ment have included the issue of a circular by the EducationCommittee inviting the cooperation of school managers, and ameeting of the school managers of the Sheerness schools andthe school medical officer to discuss this circular, and a letterfrom Lord Harris offering substantial help. The possibilityof treatment has also been forwarded by the defining ofmeans available to give effect to proposals for treatment bythe Education Committee.
Manchester City Council.-The report of the schoolmedical officer (Dr. A. Brown Ritchie) for 1911 is includedas a section in the general report of the Education Com-mittee, and constitutes about one-third of a very imposingdocument crammed with information and suggestivematerial for future work. It seems a pity that the greatmass of these reports cannot in some way be boiled down tofacts and figures necessary for each locality’s work, and thevaluable ideas and suggestions for general application (whichemerge from the work of every school medical officer) madethe common property of all. From this Manchester reportmany excellent suggestions emerge, but need a large amountof digging out of the framework (laid down by the Board of
Education) in which they are embedded. We make the, suggestion with diffidence that the report should be in twosections : facts and figures for local work, and facts, figures,and suggestions helpful to other authorities. Manchester
L pays special attention to infectious diseases ; measles,German measles, and whooping-cough have now been made