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insanity had lasted over 12 months when the patients wereadmitted. It would appear that alcohol was the cause of theillness in 25 4 per cent., mental stress and poverty in 23’ 6 percent., hereditary predisposition in 14’8 per cent., old age in7 1 per cent., and influenza in 4’ 1 per cent. of the admissions.Eighty -seven patients were discharged, and of these 72 wererecovered, being 42 - 6 per cent. of the direct admissions. In93 per cent. of the recoveries the duration of the illnessbefore admission had been under three months. There were78 deaths, being a percentage of 9- 5 on the average numberresident. Nineteen deaths were from general paralysis and18 from phthisis. Post-mortem examinations were made in93 per cent. of the deaths.

Staffordshire County Lunatic Asylum at Stafford (AnnzccclReport for the Year 1910).-The daily average numberresident was 874. At the end of the year there were novacancies for women patients, and it appears that further,accommodation will soon require to be provided. Therewere 241 admissions, and of these 11 men and 16 womenhad previously been under care. The discharges numbered134, of whom 33 men and 31 women had recovered, givinga percentage of 31-68 of the cases admitted. There were101 deaths, giving a percentage of 11-55 of the averagenumber resident. Twenty patients died under three months’residence. Post-mortem examinations were held in 63cases.

Staffordshire County Lunatic Asylum at Burntrwood, nearLichfield (Annual Reportfor the Year 1910).-The number ofpatients received at this asylum, together with the low death-rate, has obliged its authorities to transfer some of the

patients to the other asylums of the county, but, neverthe-less, there are 26 patients in excess of the number for whichthe asylum provides statutory accommodation. The averagedaily number on the registers was 889. Admissionsnumbered 281. One hundred and fifty-seven persons weredischarged during the year, and of these 71 were recovered.There were 84 deaths, giving a percentage of 7° 31 of thetotal number under treatment.

Staffordshire County Lunatic Asylum at Cheddleton(Annual Report for the Year 1910) -The average daily

, number on the registers was 977. At the end of the year the. female side of the asylum was full. There were admitted’_ 269 cases, of whom 185 were already chronic. Among-

the non recoverable cases there were 33 general paralytics,as against 20 admitted during the previous year. Eightv-three persons were discharged, and of these 57 were recovered.

’

Deaths numbered 125, 32 being from tuberculosis, 13 from’

general paralysis, 15 from pneumonia, 15 from dysentery,1 from enteric fever, and 37 from chronic degenerative dis-orders. Dr. W. F. Menzies, the medical superintendent, is of

. opinion that the type of dysentery obtaining at the asylum isacquiring increased virulence. A common predisposingcause has been observed to be sudden changes in tempera-ture, for warm weather preceded by cold disposes to

. bacteriological changes in food-stuffs, while cold weatherafter warm tends to produce chills among the patients. The

vogue of open windows, however advantageous to the

general asylum population and to tuberculous cases in

particular, is bad for dysenterics. It is certain that a largenumber of persons are carriers, and it will probably besome time before these are all discovered by bacteriologicaland clinical research. During the year all the dysentericcases have been examined bacteriologically, and perhaps the

- outstanding result has been the variety of micro-organismsfound. The Flexner bacillus proved to be the organismmost commonly present. As regarding treatment, sera andvaccines have been used, but it is plainly too early to form ajudgment of their value. Dr. Menzies is now treating thepatients by draughts and enemata of potassium permanganatesolution.

West Sussex County Asylum at Chichester (Annual Reportfor the Year ending 1910).-The average daily number on thEregisters was 763. There were 154 admissions. Of thefemales admitted 53.8 per cent. were regarded as possible,rr probable recoveries, while of the males admitted ir65 56 per cent. the chances of recovery were con.

sidered to be very remote. Of etiological factor!heredity, so far as could be ascertained, was presentin 39. 74 per cent. of the cases. Sixty-three patientiwere discharged, of whom 42 were recovered, the rate on thedirect admissions being 30’65 per cent. In nearly all threcoveries the duration of the attack on admission was lesJ

than six months. There were 80 deaths, and necropsieswere held in all cases except two. The death-rate on thedaily average number resident was 10’ 48 per cent Seventeendeaths were due to tuberculous disease and 18 to generalparalysis.

THE TREATMENT OF WOUNDEDSOLDIERS IN TIME OF

INVASION.

WE have received from a correspondent at the recentmanoeuvres of the 2nd London Division of the TerritorialForce at Shorncliffe the following interesting and instructiveaccount of the working of the medical arrangements, withpertinent remarks on a few lessons to be drawn therefrom.Our correspondent writes :-

The -Fo?’0es Engaged in the Sham lights.Few medical men have any clear idea of how wounded

soldiers would be treated in this country in the event ofinvasion, and therefore an account of what might bedescribed as as a full dress rehearsal, which recently tookplace at Folkestone, may be of special interest to membersof the medical profession, as it was on a much larger scalethan has ever yet been attempted. The 2nd LondonDivision of the Territorial Force, some 11,000 strong, underMajor-General Vesey Dawson, C.V.O., were encamped inthe neighbourhood of Shorncliffe, and as on several daysthere were sham fights it was decided to have a greatmany imitation casualties on one day, to give practice to a

field ambulance and the members of any voluntary aidcletaeliments (V.A. IJ. -8) wno might be willing to cooperate.A field day had been arranged for Friday, August 18th,between two forces—"White land" and "Greenland"—inthe neighbourhood of Caesar’s Camp. As the " Whites wereon the south near Folkestone it was decided to fall out thecasualties from this force. "White," as a matter of fact,was defeated, and the number of casualties, if bullets hadbeen used, would have been at least as many as were actuallydealt with. Colonel Andrew Clark, K.H.S., administrativemedical officer 2nd London Division, was in charge of

arrangements of the R.A.M.C. (T.) and Lieutenant-ColonelJ. W. T. Gilbert, of Folkestone, of the V.A.D.’s. Each

casualty, as he fell to order, was to have attached to him atally giving a brief description of the injuries he hadreceived, and although this arrangement was not carried outquite as it was intended, nearly 100 officers and men becamecasualties.

Field Ambulance Work.The wounded received first aid from the regimental

stretcher-bearers, superintended by the regimental medicalofficers. They were then carried back (or walked back ifthe injuries described permitted it) until the bearers of the6th London Field Ambulance were met with. These tookover the cases and proceeded to one or other of the twoadvanced posts of the ambulance, which were situatedrespectively at Wingate Farm and the 11 Valiant Sailor."Here they were attended to by the medical officers and menand, when necessary, given beef-tea, &c. They were thfnplaced in the ambulance wagon and a spare motor-car, andtaken to the Tent Division (formerly called the Field Hos-pital) of the Field Ambulance, which was situated about amile in the rear at Lime Kiln Farm, where there were afully equipped operating tent and a few bell tents. Herethe patients were placed in the bell tents, and urgent opera-tions would have been performed if necessary.

.Rest Camps.Information was then received that severe fighting was

proceeding elsewhere, and the Field Ambulance was orderedto evacuate all wounded and march. In the same field asthe Tent Division, but at a supposed distance of three miles,there was established the first rest camp of the V.A.D.’s,whence the men of the male V.A.D.’s set off with stretchersto fetch in all serious cases, the others walking (as theywould have to do on active service). As the woundedarrived they were taken charge of by a medical manand members of the female V.A.D.’s. Their dressingswere readjusted if necessary, and they were taken bycarts to the second rest camp, where bivouacs were

erected and where they remained until transport was

790

available. The third rest camp was established at theBlack Bull-road Board School, and was of the nature of atemporary hospital. An excellent operating theatre fullyequipped was established, and the class-rooms were turnedinto wards. A careful examination of this rest campshowed that nothing had been neglected ; the sanitaryveniences were excellent, and the way in which beds andoperating theatre had been improvised showed that we canplace great reliance on some, at least, of the V.A.D.’s.Each detachment appeared to have its fully trained nurse,and the members carned out her directions faithfully. Therewas a lack of medical men present, but no doubt plentywould be available if the occasion were a real one. Therewas no lack of trained cooks, and even every visitor wassupplied with hot soup.

In actual warfare the more seriously wounded patientswould have been transferred from this temporary hospital toan ambulance train at Folkestone and sent thence to theTerritorial General Hospitals, which would be established inLondon at various institution, such as the London Univer-sity or the Prudential Buildings ; but as each general hos-pital has to have at least 520 beds the buildings which aresuitable and available are few.

Observations on Yarious Points.A rehearsal on this scale allows one to obtain some idea

as to how matters would proceed in a real action, and topoint out details in which alteration is needed. First, as tothe field ambulance : owing to lack of special knowledge ofmap-reading on the part of its officers and to the absence ofcompasses, the Field Ambulance took a wrong road, and wastherefore very late in arriving at its appointed stations.Other difficulties arose from the fact that for economy theField Ambulance receives in peace time less than one-thirdof its mobilisation equipment and forces, and even then itsgeneral service wagons and forage cart are not the real

things, but hired carts, which are much less convenient.

Again, the distribution of the available officers should besuch that at the Tent Division at least sufficient officers toundertake op erations should be present. The Territorial

Royal Engineers fixed up telephonic communication betweenthe three stations of the Field Ambulance, but as this couldrarely happen in warfare the Field Ambulances should be putin possession of better means of intercommunication than

they at present possees.Secondly, as to the V A. D.’s. It was absolutely astonish-

ing to see how well the various detachments (some St. JohnAmbulance and some Red Cross) which came from all partsof Kent worked together, and their cleverness in improvisingwhatever came to hand was notable. But a few pointsneed criticism. Four or five nurses are not required to eachcart of wounded ; men with gunshot wounds would not

usually be able to stand up to be dressed, and lightlywounded should be made to walk. But these points are, ofcourse, of minor importance.

Finally, in all cases of sham fights one or two realaccidents are to be expected, and that these may be passedback without delay to the military hospital, taking pre-cedence of imitation casualties, they should have specialtallies. On this occasion one such case was overlooked.

BRITISH MEDICAL BENEVOLENT FUND.

AT the August meeting of the committee 15 applications were considered, but only very inadequate help could begiven as the treasurer reported that the grant account wasalready overdrawn to the extent of £0. Grants amountingto £96 were made to the most distressing of the cases, so thatthe total deficit is now nearly £200, and the reserves willhave to be still further drawn upon. Numerous appeals arealways received during the last quarter cf the year, and thecommittee therefore urgently begs for support to enable themto be dealt with. Contributions may be sent to the honorarytreasurer, Dr. Samuel West, 15, Wimpole-street, London, W.Appended is an abstract of the cases assisted :-Widow, aged 44, of L.R.C.P., L.R.C.S. Edin. Husband’s savings

exhausted by a five years’ illness, ending in death, and applicant’s onlyincome is the interest on the money received from a small life policy.Tries to make both ends meet by taking boarders, but at present hasDove. Two chi dren, aged 10 and 9, the elder at an institution and theyounger recently elected to one. Voted £10

Widow, aged 47, of M.R.C.S., L.R.C.P. No income, no children, andhopes shortly to find a suitable post. Voted £5.Widow, aged 37, of M.R.C.S., L.R.C.P. Two children, aged 6and 4, and dependent on a small monthly allowance from a sister and

occasional earnings from sewing and painting. Has been obliged topart with most of her furniture. Voted £10.Widow, aged 41, of M.B., C.M.Aberd. Quite unpro-vided for at

husband’s death a few years ago. Endeavours to support herself byletting lodgings. Two children, one at an institution. Relieved fourtimes, ,c34. Voted ,c12.Daughter, aged 63, of late M.R.C.S., L.S.A. Maintained herself as a

dispenser until no longer able to find work as such, and now dependenton small occasional earnings by wood carving and slight help from asister. Relieved five times, f50. Voted ,cl0.Daughter, aged 60, of late F.R.C.S. Has acted for many years 8S

companion, housekeeper, &c., but for some time past has not been ableto obtain a suitable post, and has consequently spent her small savings.Relieved twice, £10. Voted .E2, and case to be reconsidered at nextmeeting.

L.R.C.P. Edin., aged 66. Has been incapacitated by ill health forthe last two years, and is dependent on help given by a brother.Children unable to help. Relieved twice, ,c36. Voted .EI8,Daughter, aged 68, of flate L.S.A. No income and in very feeble

health. Relieved four times, ,c40. Voted dE2, and case to be recon-sidered at next meeting.Widow, aged 55, of L.R.C.P. Irel. Since husband’s death has

maintained herself by nursing, &c., but has been in bad health for sometime past; is now in arrears for rent, and has been obliged to dispose 01some furniture and clothing. Relieved twice, £ 20. Voted £5, and caseto be reconsidered in October.Daughter, aged 55, of late M.R.C.S. No income, and practically

incapacitated. Relieved nine times, .E85. Voted £12.Widow, aged 54, of L.R.C.P., L.R.C.S. Edin. Reeeives slight help

from relatives, and earns a few shillings a week by wtiting for news-papers. Two children, of whom the elder will soon be self-.supporti3ig.Relieved six times, .E62. Voted £10.

Public Health.ANNUAL REPORTS OF MEDICAL OFFICERS OF HEALTH.

The Public Health of Calcutta.-In presenting his reportfor 1910 Dr. T. F. Pearse, the health cfficer of Calcutta,mentions that in previous reports the population of the cityhad been estimated on the supposition that an increase badtaken place since the Census of 1901, and in the same ratioas in the previous decennial period. When the Census wastaken, however, in the present year it was found that actuallya considerable decrease had occurred, owing to movement ofpopulation into the suburbs. The population, as now esti-mated for 1910, is stated as 886,000, but the rates of

mortality, &c., have been calculated on the population of1901-viz., 847,796. The slight increase in the past nineyears has been due to immigration, there having been nonatural increase, but, on the contrary, an excess of deathsover births to the extent of 145,634 during the ten years. Thebirth- rate was 19-3, a very low figure compared with that forIt.dia generally (38- 64, mean of the last quinquennium), but inCalcutta females constitute only one-third of the population.The total death-rate was 27’ 9 per 1000, the lowest recordedfor over twenty years; corrected according to the new Censusreturns, it was 26-7. The reduction is chiefly due to’diminished mortality from cholera, plague, and small-pox,and applies to every district in the city. It is noteworthy,however, that the death-rate in the suburban area was 38- 0,as compared with 24. 8 per 1000 for the urban area, theformer having shared in the general improvement to a muchsmaller extent than the latter. The mortality from cholera(2-13) was the lowest recorded for ten years. Plague alsowas much less fatal than in any year of the decennium, thedeath-rate being only 1-4 per 1000. In 1909 there had beena severe outbreak of small-pox ; in 1910 the city was almostfree from this disease, only 48 deaths having been recorded.It is noted that the age for compulsory vaccinationhas now been reduced to six months, which oughtto reduce the infant mortality in the future. Beri-beri had been prevalent in 1909, and the outbreakcontinued through the spring of 1910, the total deathshaving numbered 171, of which 143 occurred in the fourmonths January to April. Hindus suffered more thanMohammedans, and females more than males. Dr. Pearsedot-s not subscribe to what he calls "the extraordinarytheory " that this disease arises from deficiency in the dietarydue to the process of milling of the rice and wheat used bythe Bengalis. " It does not explain the sudden outbreak atthe Alipore Reformatory, and its extension over the city, thesubsequent subsidence, and the sudden recrudescence of astill more severe character in the following year (1909), with