52 even more prevalent than in the north, the incidence I amongst the population being about 14 per cent. It issuggested that schools could do a great deal of valuable work in ascertaining more details about the i distribution of physopsis. Schools should be pro- r vided with samples of snails and a record could be I kept by the headmaster of such streams and swamps i in which these snails were found by the children. Gonorrhoea is so prevalent and primary syphilis so I rare in this community that it is concluded that some I factor is at work which either does not permit S. pallidum to cause infection or prevents syphilitic sores of the genitals from assuming a characteristic I form. Lesions affecting the soles of the feet were I found, due to the aftermath of a previous yaws i epidemic, while no less than 297 cases of fluid eruption of secondary yaws were seen. I I General Observations. i This important work ends with a survey of general i questions. An opportunity arose of making a i re-survey of the village of Kaiyima, where extensive sanitary reforms had been undertaken as the outcome of a previous report in 1923-1924. It is satisfactory i to note that the sanitary improvement carried out i Iat Kaiyima, combined with the activities of the medical officer, have caused a diminution in the goitre percentage from 41 to 23 in males, and from 72 to 52 in females. A diminution in the schistoso- miasis evidence could also be recorded, giving a positive percentage of 42 as compared with a percentage of 65 in 1923. A well-deserved tribute is paid to the Paramount Chief who, alone of all the Chiefs, has fulfilled his promise of trying to make his I town healthy. In the survey of the Central and Southern Provinces, it was observed that far more persons of advanced age were seen at examination, and that large numbers of persons with congenital and other abnormalities appeared to survive. In every village there were found people who understood English and were familiar with several European drugs. Their superior economic status and their better and more varied dietary presumably increases their resistance to disease, for generally speaking the disease incidence was less than in the Northern Province. In conclusion it is strongly advocated that aspirants to the posts of Paramount Chief, Chief, and Sub Chief, should be required to show some know- ledge of, or evince some interest in, the measures by which the health of their people could be improved. PUBLIC HEALTH SERVICES MENTAL HOSPITAL REPORTS. THE LEICESTER CITY MENTAL HOSPITAL at WEST HUMBERSTONE had 976 patients in residence on March 31st last, and the accommodation for recent and acute cases has now become inadequate. A new nurses’ home is being built and the committee are considering the provision of a reception hospital. The recovery-rate for the year was 39-26 per cent. and the death-rate 7’15 per cent. This is a slight decline in the former and increase in the latter, both accounted for by the admission of chronic and unsatisfactory cases from the North Evington Infirmary. The cause of death was verified in 86 per cent. of cases by post-mortem examination. There was a mild outbreak of dysentery among the women in October, but no deaths resulted, and otherwise the general health was good. Parole is allowed to 60 per cent. of the men and 38 per cent. of the women, and during the year leave of absence was granted to men on 3576 occasions and to women on 1474 occasions, while 77 per cent. of the patients were ’, usefully employed. General paralysis is treated by I malaria ; during the year 15 patients were inoculated, of whom five died and four have been discharged. Since the treatment was .first introduced in 1924, 81 patients have been treated, with a discharge-rate of 24’7 per cent. and an improvement-rate of 18-5 per cent. In addition to the work with malaria and with the dysentery outbreak, the pathological laboratory carried out a large number of routine observations and investigated the Vernes test. The visiting dentist performed 351 operations, and inspected 40 patients, whose teeth were in good condition. The arrears of dental disease before a dental clinic was held have now been overtaken and no patient’s health or happiness is burdened any longer by a septic mouth. Of the 114 male and female nurses, 24 men and 25 women are certificated or registered; five members of the staff obtained their certificate during 1930. An out-patient clinic is held weekly, and the com- mittee are considering the appointment of an after- care officer. The LEICESTERSHIRE AND RUTLAND MENTAL HOSPITAL at NARBOROUGH had 747 patients on its register at the end of last year. The recovery-rate was 34-6 per cent. and the majority of those recovered were first sent out on trial. The death-rate was 8’2 per cent. and the cause of death was verified by examination in 86’4 per cent. of cases. The general health was good during the year and there was no epidemic disease. The institution, like so many others, is overcrowded, and the committee is taking steps to provide accommodation for quiet senile cases in a " poor-law " institution. Unfortunately, mental defectives are still housed in this mental hospital, and the proposed colony will not be available for them for some time. Great improvement has been brought about by the provision of a bread-slicing machine and a butter-pat-making machine ; instead of the thick slabs of bread spread with margarine hours before it was eaten, each patient now receives two slices of nicely cut bread and two pats of mar- garine (10 per cent. butter), kept in the cold room until a few minutes before the meal. Not only do the patients greatly appreciate this, but at least two hours of a nurse’s time is saved in each ward, and the new system ensures that every patient gets a correct ration of fat. The uniform of the staff has been changed to a modern type, which greatly pleases the wearers and helps to increase the " nursing " atmo- sphere. The laboratory started to function at the close of the year, and clinical rooms have been provided. Cases of general paralysis-of which only three were under treatment this year-have been treated by sulpharsenol, but malaria inoculation will be used in future. A dental surgeon has been appointed, and members of the staff of the Leicester Royal Infirmary act as consultants when required. A cinematograph machine was provided during the summer, to the great delight of the patients. The use of parole has been extended. The CUMBERLAND AND WESTMORLAND MENTAL HOSPITAL had 854 patients resident on Dec. 31st last. The recovery-rate was 43 per cent.-58 per cent. for the males=and the medical superintendent attributes this gratifying figure largely to judicious granting of parole and trial visits. The death-rate has dropped from 8’4 to 6’2 per cent. and the phthisis rate has also fallen. There was one case of para- typhoid fever, but otherwise the health of the com- munity was good. The medical superintendent pleads for the provision of an admission block arranged on modern lines and for the appointment of a social worker. He is also anxious to introduce an occupation centre. A laboratory is being estab- lished. The staff are prepared for the R.M.P.A. examinations.
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52
even more prevalent than in the north, the incidence Iamongst the population being about 14 per cent. Itissuggested that schools could do a great deal ofvaluable work in ascertaining more details about the idistribution of physopsis. Schools should be pro- r
vided with samples of snails and a record could be I
kept by the headmaster of such streams and swamps i
in which these snails were found by the children.Gonorrhoea is so prevalent and primary syphilis so
I
rare in this community that it is concluded that some Ifactor is at work which either does not permitS. pallidum to cause infection or prevents syphiliticsores of the genitals from assuming a characteristic
I
form. Lesions affecting the soles of the feet were Ifound, due to the aftermath of a previous yaws iepidemic, while no less than 297 cases of fluid eruptionof secondary yaws were seen. I
IGeneral Observations. i
This important work ends with a survey of general iquestions. An opportunity arose of making a ire-survey of the village of Kaiyima, where extensivesanitary reforms had been undertaken as the outcomeof a previous report in 1923-1924. It is satisfactory ito note that the sanitary improvement carried out i
Iat Kaiyima, combined with the activities of themedical officer, have caused a diminution in the
goitre percentage from 41 to 23 in males, and from72 to 52 in females. A diminution in the schistoso-miasis evidence could also be recorded, giving a
positive percentage of 42 as compared with a
percentage of 65 in 1923. A well-deserved tribute ispaid to the Paramount Chief who, alone of all theChiefs, has fulfilled his promise of trying to make hisI town healthy. In the survey of the Central andSouthern Provinces, it was observed that far morepersons of advanced age were seen at examination,and that large numbers of persons with congenital andother abnormalities appeared to survive. In everyvillage there were found people who understoodEnglish and were familiar with several Europeandrugs. Their superior economic status and theirbetter and more varied dietary presumably increasestheir resistance to disease, for generally speakingthe disease incidence was less than in the NorthernProvince. In conclusion it is strongly advocated thataspirants to the posts of Paramount Chief, Chief, andSub Chief, should be required to show some know-
ledge of, or evince some interest in, the measures bywhich the health of their people could be improved.
PUBLIC HEALTH SERVICES
MENTAL HOSPITAL REPORTS.
THE LEICESTER CITY MENTAL HOSPITAL at WESTHUMBERSTONE had 976 patients in residence on
March 31st last, and the accommodation for recentand acute cases has now become inadequate. A newnurses’ home is being built and the committee areconsidering the provision of a reception hospital.The recovery-rate for the year was 39-26 per cent.and the death-rate 7’15 per cent. This is a slightdecline in the former and increase in the latter, bothaccounted for by the admission of chronic andunsatisfactory cases from the North EvingtonInfirmary. The cause of death was verified in 86 percent. of cases by post-mortem examination. Therewas a mild outbreak of dysentery among the womenin October, but no deaths resulted, and otherwisethe general health was good. Parole is allowed to60 per cent. of the men and 38 per cent. of the women,and during the year leave of absence was granted tomen on 3576 occasions and to women on 1474occasions, while 77 per cent. of the patients were ’,usefully employed. General paralysis is treated by Imalaria ; during the year 15 patients were inoculated,of whom five died and four have been discharged.Since the treatment was .first introduced in 1924,81 patients have been treated, with a discharge-rateof 24’7 per cent. and an improvement-rate of 18-5per cent. In addition to the work with malaria andwith the dysentery outbreak, the pathologicallaboratory carried out a large number of routineobservations and investigated the Vernes test. Thevisiting dentist performed 351 operations, and inspected40 patients, whose teeth were in good condition. Thearrears of dental disease before a dental clinic washeld have now been overtaken and no patient’s healthor happiness is burdened any longer by a septicmouth. Of the 114 male and female nurses, 24 men and25 women are certificated or registered; five membersof the staff obtained their certificate during 1930.An out-patient clinic is held weekly, and the com-mittee are considering the appointment of an after-care officer.The LEICESTERSHIRE AND RUTLAND MENTAL
HOSPITAL at NARBOROUGH had 747 patients on itsregister at the end of last year. The recovery-ratewas 34-6 per cent. and the majority of those recoveredwere first sent out on trial. The death-rate was8’2 per cent. and the cause of death was verified by
examination in 86’4 per cent. of cases. The generalhealth was good during the year and there was noepidemic disease. The institution, like so manyothers, is overcrowded, and the committee is takingsteps to provide accommodation for quiet senilecases in a " poor-law " institution. Unfortunately,mental defectives are still housed in this mentalhospital, and the proposed colony will not be availablefor them for some time. Great improvement has beenbrought about by the provision of a bread-slicingmachine and a butter-pat-making machine ; insteadof the thick slabs of bread spread with margarinehours before it was eaten, each patient now receivestwo slices of nicely cut bread and two pats of mar-garine (10 per cent. butter), kept in the cold roomuntil a few minutes before the meal. Not only do thepatients greatly appreciate this, but at least twohours of a nurse’s time is saved in each ward, and thenew system ensures that every patient gets a correctration of fat. The uniform of the staff has beenchanged to a modern type, which greatly pleases thewearers and helps to increase the " nursing " atmo-sphere. The laboratory started to function at theclose of the year, and clinical rooms have been provided.Cases of general paralysis-of which only three wereunder treatment this year-have been treated bysulpharsenol, but malaria inoculation will be usedin future. A dental surgeon has been appointed,and members of the staff of the Leicester RoyalInfirmary act as consultants when required. Acinematograph machine was provided during thesummer, to the great delight of the patients. The useof parole has been extended.The CUMBERLAND AND WESTMORLAND MENTAL
HOSPITAL had 854 patients resident on Dec. 31st last.The recovery-rate was 43 per cent.-58 per cent.for the males=and the medical superintendentattributes this gratifying figure largely to judiciousgranting of parole and trial visits. The death-ratehas dropped from 8’4 to 6’2 per cent. and the phthisisrate has also fallen. There was one case of para-typhoid fever, but otherwise the health of the com-munity was good. The medical superintendentpleads for the provision of an admission blockarranged on modern lines and for the appointmentof a social worker. He is also anxious to introducean occupation centre. A laboratory is being estab-lished. The staff are prepared for the R.M.P.A.examinations.
53
There were 1082 patients in the COUNTY ANDCITY OF WORCESTER MENTAL HOSPITAL at POWICKat the end of last year. A day room and a dormitoryhave been redecorated and set apart for recentndmissions, and a verandah is to be added to thisdepartment. The recovery-rate for the year was34 per cent. and the death-rate 6’2 per cent. Autopsieswere held in 75’8 per cent. of cases. The generalhealth was good, except for one case of typhoid andone case of paratyphoid fever. The dentist visits oncea fortnight. Electric light is to be installed shortlyand it is hoped that a cinema, X ray and ultra-violetray plant will soon follow. During the year fivemale and five female nurses obtained their R.M.P.A.certificates.The GLAMORGAN COUNTY MENTAL HOSPITAL at
BRIDGEND was overcrowded at the end of last year byno less than 295 patients, the total in residence being2108 on Dec. 31st. The recovery-rate for the yearwas 29’7 per cent. and the death-rate 6’6 per cent.Post-mortem examinations were performed on 52’5per cent. of cases. The general health was remarkablygood considering the overcrowding, and the onlyepidemic disease, apart from influenza, was chicken-pox (four cases) and erysipelas (one case). Thedental surgeon visited fortnightly and attended I258 patients. The visiting surgeon performed three Ioperations, and 60 diagnostic X ray photographs weretaken. Over 60 patients were allowed out on trialbefore discharge, but only seven of them receivedmoney allowances. The visiting commissionersdeplore the absence of a laboratory, continuousbath, malarial treatment for general paralysis, andadequate verandah accommodation. Parole is allowedto 20 men beyond the estate and to 125 within it.Seven women nurses are employed on the male sideand 112 men and 44 women are certificated or
registered. Fifteen attendants and eight nurses
obtained their R.M.P.A. certificate last year.
MENTAL DEFICIENCY.
The ROYAL EASTERN COUNTIES’ INSTITUTION FORTHE MENTALLY DEFECTIVE at COLCHESTER has nowover 1400 patients on its books. Many improvementswere carried out during last year, at a cost of nearly27000. A new single-storey hospital has been built,with 31 beds. This left accommodation on one sideof the old hospital for the senior male patients, whoneeded a quiet place where they could do as theyliked; the oldest " boy " is 84 and the next is 77.The furniture for both these new departments wasmade by inmates, who also built two staff cottages,doing all the work except the internal plastering.Central heating has been installed at Bridge Home,where it was a necessity for the low-grade boys withpoor circulations. A wireless installation has beenbought and so also has an electric gramophone,which will broadcast to all stations in the institution.A great many other minor improvements have beenmade, the greater part of the work being done by theboys and girls themselves. During the year 58
patients were sent out on licence, bringing the totalon licence to 115. Thirty (20 per cent.) returnedduring the year ; 12 of these, however, only returnedfor holidays or illness and went out again. Onlytwo definitely came back for bad behaviour. Therewere only 17 deaths during the year, which is verysatisfactory when it is remembered that many of thechildren are physically disabled and of so low gradethat they seldom seem to know when they are ill,and only the most careful observation on the partof the staff detects the first beginnings of ill-health.The guides and brownies have now taken 420 second-class and proficiency badges and the scout troop andcubs have had a successful year, having won over ahundred second-class and proficiency badges. Therehas been a steady decline in the number of deaths fromtuberculosis; this seems to date from 1905, whenthe ventilation of the institution was remodelled.There has now been no case of diphtheria since 1925when the Schick test was instituted as a routine.Dr. F. Douglas Turner discusses the causation of
mental defects and derives hope from the generaltendency at the present time to ascribe at leasthalf the cases to disease, toxaemia, or injury. Hewelcomes the appointment of a research medicalofficer and a social investigator who are to make thefullest possible investigation into each patient andcarry out such lines of research as occur to them.Discussing the duties of local authorities under theLocal Government Act, he stresses the importance ofproviding one all-embracing colony for every type ofdefective ; the different types will live in differentclasses according to age, conduct, and mental capacity,but the colony must include all those for whom thelocal authority is responsible, except the dangerouscases.
Medical DiarySOCIETIES.
OXFORD OPHTHALMOLOGICAL CONGRESS.THURSDAY, July 9th.-IO A.M., in the Department of
’ Human Anatomy, Opening Address by Mr. A. B.Cridland. Symposium on the Diagnosis of IntracranialNew Growths, by Mr. Leslie Paton, Sir Percy Sargent,Dr. H. M. Traquair, Mr. Norman Dott, and ProfA. Schuller.
FRIDAY.—11 A.M., Doyne Memorial Lecture by Mr. P. H.Adams.
ROYAL MEDICO-PSYCHOLOGICAL ASSOCIATION : AnnualMeeting at the Royal College of Physicians, Dublin.WEDNESDAY, July 8th.-2 P.M., Presidential address by
Mr. R. R. Leeper on the Progress of Psychiatry.THURSDAY and FRIDAY.-10 A.M., Papers and discussions.
LECTURES, ADDRESSES. DEMONSTRATIONS, &c.FELLOWSHIP OF MEDICINE AND POST-GRADUATE;MEDICAL ASSOCIATION, 1, Wimpole-street, W.MONDAY, July 6th, to SATURDAY, July llth.-ST. PETER’S
HOSPITAL, Henrietta-street, W.C. Wed., at 5 P.M.Demonstration of cases in the Out-patient Depart-ment and Urethroscopies by Mr. A. H. Harkness.Open to men only, free.-HOSPITAL FOR DISEASES OF THESKIN, 71, Blackfriars-road, S.E. Fri., at 6 P.M., Demon-stration of Cases by Dr. W. B. Winton. No fee.-ROYALWATERLOO HOSPITAL, Waterloo-road, S.E. Wed.,4.30 P.M., lecture by Dr. G. M. Slot on Recent Advancesin Treatment of Gastro-Intestinal Disease.-ST. JOHN’SHOSPITAL, Lewisham. A special course in Diseases ofChildren by Dr. John Gibbens. Every afternoon, andSat. morning.-PRINCE OF WALES’s HOSPITAL, Totten-ham, N.15. Intensive course in medicine, surgery,and the specialties, for two weeks, 10.30 A.M. to5.30 P.M. (first of two weeks).
WEST LONDON HOSPITAL POST-GRADUATE COLLEGE,Hammersmith, W.MONDAY, July 6th.-10 A.M., Gynaecological Ward Visit.
FRIDAY.-10 A.M., Medical Ward Visit, Skin and DentalDepartments. 12 noon, Medical Lecture. 2 P.M.,Medical, Surgical, and Throat Out-patients. Opera-tions.
SATURDAY.-9 A.M., Throat Operations. 10 A.M., MedicalWard Visit, Surgical and Children’s Medical Out-patients.
CHARING CROSS HOSPITAL MEDICAL SCHOOL POST-GRADUATE COURSE.SUNDAY, July 5th.-10.45 A.M., Mr. L. R. Broster : Surgical
Emergencies. 11.45 A.M., Dr. J. E. M. Wigley:Demonstration of Cases of Skin Disease.
ROYAL NORTHERN HOSPITAL, Holloway-road, N.TUESDAY, July 7th.-3.15 P.M. (at the Royal Chest Hos-
pital), Dr. J. Maxwell: Intrathoracic Lipiodol.ST. MARK’S HOSPITAL, City-road, E.C.
THURSDAY, July 9th.-4.30 P.M., Mr. Lockhart-Mummery:Perineal Excision of the Rectum, with cinematographdemonstration.
UNIVERSITY OF BIRMINGHAM.TUESDAY, July 7th.-3.30 P.M. (at the General Hospital),
Mr. Musgrave Woodman: Infection of the Ear inGeneral Practice.
FRIDAY (at the Queen’s Hospital).-3.30 P.M., Mr. J. N.Sankey : The Diagnosis and Treatment of Infections ofthe Hand.
