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cold kills the native and the heat kills the European soldierserving in India. If the expeditionary force has to campaignin the mountains and valleys during the winter season acertain number of cases of frost-bite may also be expectedto occur. But it may be taken for granted that every effortwill be made to push the forces on to their destination beforea,ny extreme cold has set in.We have received from India a copy of the medical

arrangements for the Tirah expeditionary force, dealingwith the organisation and administration of the hospitalservice, and including the arrangements provided forcorps-units, field and general hospitals, field medical storedepots, lines of communication, &c. It consists of a brief i

pamphlet of eleven pages, issued by Surgeon-Major-GeneralGore, principal medical officer of Her Majesty’s forces, withthe approval of H.E. the Commander-in-chief in India.Under the head of organisation it gives the compositionof the different brigades of the main and of all the-other columns making up the expedition as a whole,with the various sections of field hospitals, British andnative, attached to and accompanying the different brigades.’We may premise that a Field Service Medical Codewas drawn up a few years ago and waa, issued withthe authority of the Government of India in the militarydepartment for the information and guidance of every-body concerned, in which everything connected with thesubject is fully detailed. This code of regulations, whichstrikes us as extremely good, is in the hands of all concerned,and medical officers and others are, of course, supposed to bewell acquainted with it and to act upon it. The field hos-pital system in India has been drawn up with specialreference to the exigencies of service in that country,although it is based upon the same principles as

those of the British service at home and, indeed,of most continental armies. The field hospitals inIndia are equipped for 100 beds each, and divisible intofour sections each complete in itself. These hospitalshave distinguishing numbers and the sections are dis-tinguished by letters above the number of the hospital towhich they belong. This appears to us a very good andsimple arrangement, and capable of making the hospitalprovision practically adapted to almost any occasion thatcan arise. To return, however, to the pamphlet under ournotice, it lays down the number of hospitals and the sectionsthereof accompanying the various columns, divisions, andbrigades, and those for the lines of communication, togetherwith the general hospitals, British and native, at thebase-viz, at Rawal Pindi, Nowshera, and Kohat, for thereception of the sick and wounded coming down fromthe various forces in the field. These hospitals provide accom-modation for about 2000 patients. The principles governingthe organisation of a field medical service are pretty wellknown. Briefly stated they are to provide for the immediaterequirements of the force and to relieve it of all non-eftee-tives ; to transfer the sick and wounded (trifling cases ex-cepted) in the direction in which they must eventually go-namely, to the base of operations-and to apportion thehospital establishment and equipment to the requirements ofthe force as a whole. The medical units employed in theoperations against the Mohmands are directed to concen-trate at Peshawar on the conclusion of that service. Itwould be impossible, of course, to enumerate the variousprovisions that have been made, but, speaking generally, thearrangements seem on paper to be very good and to have beenwell and carefully thought out. The conditions and circum-stances of the expedition are of an exceptional character and,we need scarcely add, do not admit of a provision being madeon the scale and of the nature employed in European warfare.As regards administration, the following principal medicalofficers have been appointed :-For the Army Stuff : Sur-geon-Colonel (with temporary rank of Surgeon-Major-General) G. Thomson, C.B., Indian Medical Service. Secre-

tary : Surgeon-Major W. A. Morris, Army Medical Staff.First Division : Surgeon-Colonel E. Townsend, ArmyMedical Staff. Second Division : Surgeon-Colonel G. McB.Davis, D.S.O., Indian Medical Service. Line of communica-tions : Brigade-Surgeon-Lieutenant. Colonel (with temporaryrank of Surgeon-Colonel) W. E Saunders, A.M.S. PeshawarColumn: Brigade-Surgeon-Lieutenant-Colonel R. G. Thom-

sett, A.M.S. Kurram Movable Column: Brigade-Surgeon-Lieutenant-Colonel W. R. Murphy, D,S.O., I.M.S. TheRawal Pindi Reserve Brigade : While at Rawal Pindi themedical administration will be conducted by the PrincipalMedical Officer of that district.

METROPOLITAN HOSPITAL SUNDAYFUND.

IN the absence of the Lord Mayor Sir SYDNEY WATBSLOWpresided over a meeting of the Council of the MetropolitanHospital Sunday Fund on Wednesday, Oct. 27th, which

I assembled in the Venetian Parlour of the Mansion House toreceive a special report from the Distribution Committee inreference to out-patients.

Sir SYDNEY WATERLOW said he could not commence thebusiness without expressing his own and their deep sense ofgrief at the loss which Her Majesty the Queen and thenation had sustained by the sudden death of the Duchess ofTeck, who had always been ready to assist the cause ofcharity in every possible way.

Referring to the question of out-patients the Chairmansaid that twelve months ago the Council inserted a draftparagraph in their report to the constituents of the fund, butwhen the matter came up for discussion Dr. Glover objectedto it on technical grounds stating that it was the dutyof the committee to report to the Council, and that upontheir report a report should be framed to be put beforethe constituents. The paragraph was therefore struckout and the matter referred to the Distribution Com-mittee to be considered. For several years the Committeehad had their minds very much affected by the discussionsabout the out-patients’ departments of hospitals, and asfar back as 1892 they had before them evidence withreference to the matter. Year by year a great dealof fresh information had been obtained, and especiallythis last year when they had had conferences with therepresentatives of thirty different hospitals. Therewas, however, quite a diversity of opinion among thedifferent people trom whom they had gained their informa-tion. As an example he read replies from some of the largeLondon hospitals and quoted the remarks of speakers atrecent meetings on hospital reform. He formally movedthe adoption of the following report of the Committee ofDistribution :-The committee of distribution having carefully reviewed all the

evidence received by them during the last four or five years in refer-ence to the out-patient departments of the several hospitals, andhaving recently obtained further information on this important sub-ject, are of opinion that, where no person has been already appointed,efforts should be made to induce the governing bodies of hospitals toappoint efficient persons to make inquiries respecting patients attend-ing out-patient departments with the view of preventing any abuse,and that the Council of the Hospital Sunday Fund should exercise thegreatest caution before interfering with the internal management ofhospitals.

Mr. F. C. CARR-GoMM said before the adoption of the

report was seconded he would like to point out that theredid not seem any such diversity of opinion amongst thehospitals as the Chairman had suggested. They did notadmit that abuse existed to any great extent.

Sir EDMUND HAY CURRIE, who seconded the motion, saidthat while the treatment of the in-patients was muchimproved, no such improvement had been made with regardto the out-patients. This class was chiefly composed ofwage-earning people, who were, he believed, ready to payfor treatment if allowed to do so.

Dr. GLOVER suggested that the report be entered upon theminutes. He submitted the following as an alternativemotion :-That the Council of the Hospital Sunday Fund having before it the

yearly statistics of the metropolitan hospitals and the report of theDistribution Committee on the out-patient department of hospital is ofopinion that the large and increasing number of out-patients is a

matter calling for the anxious attention of the managers ot hospitals,and that this council, while disclaiming any wish to interfere with theinternal management of hospitals, will look upon the appointment ofefficient inquiry officers and other means of curtailment as points ofmerit in administration.

After some discussion, in which Sir HENRY BURDETT, theHon. SIDNEY HOLLAND, the Rev. Dr. RIGG, the Rev. Dr.BARLOW, and the Rev. C. H. GRUNDY took part, the CHAIR-MAN proposed the following :-That that this Council recommends that at the next meeting of the

constituents in December, the following clause be added to the laws ofthe constitution: ’That where any hospital having an out-patientdepartment has appointed a special and efficient officer for detectingany abuse in that department, it shall be regarded by the DistributionCommittee as an important factor in determining the merits.’

Sir WILLIAM BROADBENT, in seconding the resolution,said that the step which was being taken to-day was a very

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important one. It would be a very efficient check upon those

hospitals which had no attached medical school but whichactuary competed with those that had for out-patients.

Dr. GLOVER was glad that the Council had taken thisstep. The very size of the meeting and the patience of itsmembers showed that they were dealing with no ordinary.question,. Whether the figures relating to the numberof out-patients were inaccurate as had been suggestedor not the fact remained that the numbers were enormous.and what struck him most was that the numbers were

increasing. Whereas in 1895 the number of out-patients was1,098,224. in 1896 they were 1,141444, or an increase in oneyear of 43,000 persons. He quoted statistics showing theindividual yearly increase in several of the large Londonhospitals and concluded by stating that the present actionof the Council would tend to raise this Fund greatly in theestimation of the public.The CHAIRMAN stated, in reply to a question by the Rev.

M. R. Nelligan, that the attention of ministers of all de-nominations would be called to the matter in the annualcircular issued to them. In answer to Sir Henry Burdett, he.also stated on behalf of the Council that there was no desireto reduce the salaries of chaplains of hospitals.The usual courtesies to the Chairman terminated the

,proceedings.

FORTY-SIXTH REPORT OF THEINSPECTORS OF LUNATICS,

IRELAND.

THE Report commences with the usual summary givingthe number and distribution of the insane in establish.ments on Jan. lst, 1896, and Jan. lst, 1897, respectively.This summary shows an increase of the insane under care

- during 1896 in all the different institutions receiving them,except workhouses, viz., an increase of 709 in district

asylums, of 2 in the criminal asylums, of 13 in privatelicensed houses and institutions for the insane ; while thenumber in workhouses has decreased by 120. The totalincrease for the year-609-was not so large as that for 1895(702) but considerably exceeded the average for the pastten years, viz., 405. It is significant that an increase hastaken place amongst the cases admitted for the first timeto district asylums-the number being 106 in excess of theprevious year-an increase in this class which has not beenexceeded since 1890. The Inspectors attribute this increaseto the transfer of cases from workhouses to asylums, as thesecases would be returned as not having been previously undertreatment in asylums and they would thus be added to thenewly-occurring cases of insanity. It seems that in Irelandthere is a large number of pauper lunatics wanderingat large or residing with relatives. In the census

returns of 1891 their number was estimated to be 4,970.The Inspectors are of opinion that the admissions todistrict asylums have been largely drafted from thisclass, and that the number of the insane under care is

likely to go on increasing until the existing body of

unregistered insanity has been absorbed. Further, theystate that it seems certain that the accumulation of the

registered insane in asylums has not yet reached itsmaximum. This is no doubt true, but all the admissionsdo not come under the category of chronic cases abovereferred to. An examination of Table V., Appendix A,reveals the startling fact that no less than 42’5 per cent. ofthe total admissions into district asylums were recent cases

I;of insanity, in which the disease originated within threemonths of admission. No statistics are given by which acomparison can be made between this percentage and thatof past years, but from a table on page 6 of the Report it isabundantly evident that there has been an almost progressiveincrease in the number of first admissions into districtasylums since the year 1880, and that the number of firstadmissions was higher in 1896 than in any year during thisperiod. In the face of such evidence it is more thanprobable that the increase of insanity in Ireland is not onlyapparent but real, and, sad to relate, it is fasteningitself on a diminishing population. The Inspectors them-selves are uncertain on the point, and cannot determinewhether the disease is actually increasing or not. Surelythey are in a position to ascertain the exact facts, and so

end the uncertainty which exists on the subject. In 1880the proportion of registered lunatics per 100,000 of the

population was 250 ; at the present time it stands at thehigh figure of 416 per 100,000 of population.There are twenty-two district asylums in Ireland. No new

asylum was opened during the year; but the Antrim andPortrane Asylums are in course of erection. The admissionsinto the district asylums numbered 3329. The greatmajority of the cases were admitted under the provisions ofthe Act 30 and 31 Vic , cap. 118, s. 10, as dangerous lunatics.The Inspectors regret that this should be so, for the procedureis cumbrous and objectionable, inasmuch as it converts thelunatic into a quasi criminal and places difficulties in theway of obtaining any contribution towards his maintenance,either out of his own property or from his friends. Therecoveries in the district asylums numbered 1217, the per-centage on admissions being 37-2 as compared with 39’3 inthe previous year. The deaths amounted to 926. -The rateof mortality was slightly under that of 1895. In only 220cases were post-mortem examinations made, a number whichcompares unfavourably with that of the preceding year.Three suicides and three fatal casualties were reportedduring the past year in district asylums. The small numberof such deaths speaks well for the care and supervisionexercised in the treatment of the insane in Ireland. On theother hand, overcrowding is general and there is a formid-able list of cases of zymotic disease due to insanitary con-ditions. Allusion is made to the reappearance of beri-beriat the Richmond Asylum, of which so much has been heardof late. The Inspectors as a rule speak favourably of themanagement of the various district asylums. The CentralCriminal Asylum at Dandrum continues to be administeredwith success. The condition and surroundings of the insanein Irish workhouses leave much to be desired.

THE ENTRIES AT THE METROPOLITANMEDICAL SCHOOLS, 1897-1898.

THE figures in the following table have been kindlysupplied to us by the deans of the various metropolitanschools in response to a circular letter from us asking thenumber of students who had entered at each school thisOctober session :-

* From King’s College Hospital and the London School of Medicinefor Women we only received exactly what we asked for—namely, thenumber of students who had embarked upon a full medical curriculum.

t Not counting men who joined for special classes. Including thesethe number would be 116.

It will be seen that at St. Bartholomew’s Hospital thereturn is made under the head of "Perpetual Students."The figures in the last two columns of the table show the