253ASYLUM REPORTS.-VITAL STATISTICS.

33 were 70 and upwards. 36 were epileptic, 16 were con-

genital idiots, and 24 were general paralytics. In fact, only94 of the cases admitted were regarded as recoverable and ofthis number 58 were discharged during the year. The

asylums committee deplores the fact that unsuitable

patients are sent to its institution and calls the attentionof the unions interested to the matter. The chief causesof insanity do not appear to vary in the experienceof this asylum ; it is stated that hereditary taint and

congenital defect become more marked every year; they weretraced in about 31 per cent. of the patients admitted which,however, is below the experience of many other asylums.Various forms of worry accounted for 20 per cent. andalcoholic intemperance for about 18 per cent. Variousdiseases, not specified in the table of causation, were

causative in 35 of the cases, as to which further informationwould be of interest. Of the 197 discharges 126 leftrecovered, the recovery-rate being 38’39 per cent. of theadmissions. The deaths numbered 133, the chief cause

being general paralysis which accounted for 21. The death-rate amounted to 9’ 88 per cent. of the daily averagenumber resident. It is distressing to note that of1341 patients remaining at the close of the year only46 were regarded as having a fair chance of recovery.A case of attempted suicide in a male patient presentsfeatures of interest. This man, who was not regarded assuicidal, was found hanging by the neck from a rafter,having been out of supervision for only a few minutes. Hewas cut down and brought round sufficiently to be removedto the ward where he relapsed into a semi-comatose state.The head and neck were greatly congested. He was bled tothe extent of 20 fluid ounces, regained consciousness, andmade a good recovery. He retained no recollection ofthe act. The accommodation on the male side is deficient, 50cases being boarded out as well as ten idiot children.

Joint Counties Asyl1wl, Carmarthen (Ann11{Û Reportfor the Year 1905).-The admission-rate for the year

was lower than usual of late years, 105 patients beingreceived. The average number daily resident was 664.The numbers resident increase steadily but slowly. Therecovery-rate, reckoned on the admissions, was the satis-factory one of 46 31 per cent., having been 44 per cent. for1904. The proportion of deaths to the average number

daily resident was the low one of 8’ 58 per cent. Themedical superintendent, Dr. E. Goodall, having measuredout the accommodation available on the basis of the presentrequirements of the Commissioners in Lunacy, finds that onthe female side the patients are in excess-though not

greatly so-of the day and night space available, whilst onthe male side the day rooms are somewhat overcrowded, butthere is night space for some ten additional patients. 12 ofthe cases admitted died within a few weeks of admission from

exhaustion, of which four were cases of acute delirium. Dr.Goodall states that it is very difficult, if not impossible, togive cases of this disease that unremitting attention whichthey need under the usual conditions of a county asylum, inwhich the proportion of nurses to patients is low, and heconsiders that such cases illustrate the advantage of the"acute hospital" system for asylums. It may be addedthat they also afford a strong argument in favour ofthe system of receiving recent and curable cases ofmental disease into suitable wards attached to generalhospitals. A history of insanity or allied disorders waspresent in 50’ 5 per cent. of the admissions, and even

this high figure is regarded as an under-statement. Itis observed that comparative statistics as to the exist-ence of insane and neurotic inheritance in the generalpopulation on the one hand, and the population of asylums(including persons who have been in asylums) on the other,would be instructive as throwing light upon the real valueof the hereditary factor in the causation of insanity asdistinct from the environmental factor. Alcohol onlyaccounted for 12 per cent. of the admissions, a low figurecompared with that shown by asylums which serve exclu-sively urban districts. The religious "revival" in Wales wasresponsible for the mental disorder in 16 cases ; these weremostly individuals predisposed by inheritance to insanity.14 of the patiems admitted were aged 60 years and upwardsIt is observed that there appears to be an increasing unwillingness on the part of Poor-law guardians throughoutthe country to make adequate provision for the aged ancharmless insane in workhouses. This asylum makes n(

adequate provision for the segregation of consumptivesduring the day these are, so far as possible, segregated ii

the airing-courts under verandahs. The proportion of deathsfrom tuberculous ditease of all sorts was 17 5 per cent. 0:15all deaths, as against 25, 23, and 28’ 6 per cent. for the-previous three years, the last-mentioned figure being thatfor 1902 ; and the mortality from this dibease per 1000inmates was 15, as compared with 17’ 9 in the preceding.year. These are gratifying reductions, bringing the institu-tion into line with other asylums of similar size, and it ishoped that time may show that the improvement is trace-able to various measures which of late years have been takento provide for the stricter isolation of the tuberculousand for the disinfection of their environment. Inquiryhas been made into the history of the cases which,have relapsed during the past 12 years with a

view to acquire information as to the durability of re-

covery after discharge. During this period 143 patients wereadmitted who had had previous attacks, and of these 121-had relapsed once. Of the latter 18 had kept well forfrom three to six years and 29 for from six to 33 years. Th&

remaining 74 remained well for varying periods to a,

maximum of three years only. Dr. Goodall is of opinion.that these results are probably much inferior to what might.be looked for from the returns of institutions receiving thebetter educated and more comfortable classes. This question,of the durability of recovery in mental cases merits furtherinquiry. Of 64 cases of first attack only 33 were receivedwithin three months of the commencement of the illness.The general health of the institution was satisfactory. TheCommissioners in Lunacy in the course of their annual reporton the institution refer to a regrettable dispute which egists-between the three local authorities owning the asylum as to>

quotas payable towards the upkeep of the building andwhich is of some years’ standing, the practical consequence-being that administrative reforms which are required in theinterests of the patients are delayed.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 76 of the largest English towns 8717 births and 3650-deaths were registered during the week ending July 21st.The annual rate of mortality in these towns, which haddeclined from 13’ 2 to 11-7 per 1000 in the four precedingweeks, rose again last week to 12’ 0 per 1000. Duringthe past four weeks the death-rate has averaged 12’1.per 1000, the rate in London during the same period being11’ 9 per 1000. The lowest death-rates last week in the 7&towns were 4’ 7 in Hanley, 4’ 9 in Handsworth (Staffs),5 4 in Rochdale, 5’ 7 in Leyton, 5’ 9 in Reading, and 6’2in Cardiff ; the highest rates were 16’ 5 in Liverpool, 17’ Q:iin Huddersfield, 17-4 in Merthyr Tdnl, and 17-8 in

Stockport and in Burnley. The 3650 deaths registeredin the 76 towns last week were 94 more than thenumber in the previous week, and included 424rwhich were referred to the principal epidemic diseases,against 373, 406, and 361 in the three preceding weeks; 9of these 424 deaths, 165 resulted from diarrhoea, 104-from measles, 59 from whooping-cough, 43 from diphtheria,38 from scarlet fever, and 15 from " fever " (principallyenteric), but not any from small-pox. The deaths from these-epidemic diseases were equal to an annual rate of I - 4 per1000 in the 76 towns and to 1 - 5 per 1000 in London. No.death from any of these diseases was registered last week inSouthampton, Coventry, West Hartlepool, or in ten other

smaller towns, while they caused the highest death-ratescin Norwich, Birkenhead, Liverpool, Wigan, Salford, Burnley,

Huddersfield, and Rotherham. The greatest proportiona)mortality from measles occurred in Salford, Burnley, and-

i Huddersfield; from whooping-cough in Birkenhead, York,i and Swansea ; and from diarrhoea in Willerden, Norwieh,’ Birkenhead, Liverpool, St. Helens, Wigan, Salford, Burnley,; and Rhondda. The 43 deaths from diphtheria included tea. in London, three in Liverpool, and two each in Croydon,9 Walthamstow, Plymouth, Bristol, Birmingham, and Derby t-; of the 38 fatal cases of scarlet fever 12 occurred in. London, four in Liverpool, three in Birmingham, three. in Manchester, and two each in Hornsey, Bristol,- Leicester, and Leeds ; the 15 deaths from " fever" includedt six in London and two each in West Ham and Wigan.1 No fatal case of small-pox was registered in any of the 7&o towns during the week. The number of small-pox patients;in the Metropolitan Asylums hospitals, which had declinedon from 13 to five at the end of the four preceding weeks, had

254 VITAL STATISTICS.-THE SERVICES.

further fallen to two at the end of last week ; no new casesof small-pox have been admitted into these hospitals duringthe past foar weeks. The number of scarlet fever patientsremaining under treatment in these hospitals and in theLondon Fever Hospital at the end of the week was 2942,against numbers increasing from 2225 to 2842 at the end ofthe 13 preceding weeks ; 413 new cases were admitted duringthe week, against 366, 378, and 406 in the three precedingweeks. The deaths in London referred to pneumonia andother diseases of the respiratory organs, which had been118 and 119 in the two preceding weeks, further rose to133 last week, but were slightly below the corrected averagenumber in the corresponding periods of the four precedingyears. The causes of 39, or 1 1 per cent., of the deathsin the 76 towns last week were not certified either by aregistered medical practitioner or by a coroner. The causesof all the deaths were duly certified in West Ham, Leicester,Nottingham, Salford, Sheffield, Newcastle-on-Tyne, Cardiff;and in 49 other smaller towns ; nine uncertified deaths wereregistered in Liverpool, five in London, four in Birmingham,three in Manchester, two in Bradford, two in St. Helens, andone each in 14 other towns, including Bristol, Leeds, andHull.

___

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in eight of the principalScotch towns, which had been 15 3 and 14 3 per 1000in the two preceding weeks, further fell to 13 7 per1000 last week, but was 1’ 7 per 1000 above the meanrate during the same period in the 76 large Englishtowns. The rates in the eight Scotch towns last weekranged from 10 2 in Paisley and 10 7 in Edinburgh to15-3 in Glasgow and 24 - 2 in Perth. The 470 deaths inthe eight towns showed a decrease of 21 from the numberin the preceding week, and included 12 which were referredto whooping-cough, 11 to diarrhoea, seven to measles, fiveto diphtheria, and five to "fever," but not any to small-pox or to scarlet fever. In all, 40 deaths resulted fromthese principal epidemic diseases last week, shbwing a

decline of 23 from the number returned in the previous week.The 12 deaths attributed to whooping.cough were live belowthe number in the preceding week, and included eightin Glasgow and three in Aberdeen. The fatal cases ofdiarrhoea, which had been 20, 18, and 22 in the three pre-ceding weeks, decreased last week to 11, of which sixoccurred in Glasgow and three in Dundee. The seven deathsfrom measles were considerably fewer than the number inany other recent week, and included three in Glasgow andtwo in Edinburgh. The five fatal cases of diphtheria wereslightly in excess of the numbers in the two previous weeks ;three of these deaths were registered in Glasgow, where alsofour fatal cases of cerebro-spinal fever, included under theheading "fever," were recorded. The deaths in the eighttowns referred to diseases of the respiratory organs, includingpneumonia, which had been 54 and 59 in the two precedingweeks, further rose to 66 last week and slightly exceededthe number in the corresponding week of last year. Thecauses of 16, or 3 4 per cent., of the deaths registered inthe eight towns last week were not certified, the pro-portion of uncertified deaths in the 76 large English townsduring the same period being 1’ 1 per cent.

HEALTH OF DUBLIN.

The death-rate in Dublin, which had been 16 4, 16 9, and18’ 7 per 1000 in the three preceding weeks, further roseto 20 9 per 1000 during the week ending July 21stDuring the 13 weeks of last quarter the death-rate averaged21-4 4 per 1000, against 14 8 in London and 17 1 in Edin-burgh. The 152 deaths of Dublin residents during last weekshowed an increase of 16 over the number in the precedingweek, and included ten deaths from the principal epidemicdiseases, against five, four, and 12 in the three precedingweeks ; of these ten deaths, three were referred to

whooping-cougb, three to diarrhoea, two to measles,one to diphtheria, and one to "fever," but not anyto small-pox or to scarlet fever. These ten deathsfrom the principal epidemic diseases were equal toan annual rate of 1-4 per 1000, the rate from thesame diseases last week being 1 - 5 5 in London and0-5 in Edinburgh. The 152 deaths in Dublin included26 of children under one year of age and 47 of personsaged 60 years and upwards. Five inquest cases and threedeaths from violence were registered ; and 59, or 39 per cent.,

of the deaths occurred in public institutions, the proportionin London being 40 per cent. The causes of five, or 3’ 3per cent., of the 152 deaths were not certified either by aregistered medical practitioner or by a coroner ; the pro-portion of uncertified deaths during the ame period being0’ 5 per cent. in London and 4’ 3 per cent. in Edinburgh.

THE SERVICES.

I ROYAL NAVY MEDICAL SERVICE.THE following appointments are notified:-Fleet Sur-

geons : J. McElwee to the President, temporary, and A.McLean to the Reno7vn. Staff Surgeon H. Cleft to theHawk. Surgeon P. H. Bannister to the President, additionalfor three months’ coarse at West London Hospital.

ROYAL ARMY MEDICAL CORPS.Lieutenant-Colonel Percy H. Johnston, C.M.G., is placed

on retired pay (dated July 13th, 1906).Colonel O. Todd has been appointed to officiate a

Principal Medical Officer, Western Command, India, viceColonel F. W. Trevor, on leave.

INDIAN MEDICAL SERVICE.Lieutenant-Colonel D. Ffrench-Mullen, Bengal, has been

appointed to officiate as Principal Medical Officer, Sirhindand Jullunder Brigades, vice Colonel H. Hamilton, C.B.,on leave.

THE ROYAL VICTORIAN ORDER.Lieutenant- Colonel Bruce Morland Skinner, R A.M.C.,

Secretary to the Advisory and Nursing Boaids of the WarOffice, has been appointed a member of the Fourth Class ofthe Royal Victorian Order.

TINNED MEAT IN PLYMOUTH GARRISON.

According to Plymouth Coast Defence Orders, datedJuly 17th, when preserved meat is issued officers com-manding units are to arrange for a regimental board ofofficers to assemble to open and to inspect all tins of meatbefore use and, where possible, the medical officer in chargeof troops will attend.

RESUMPTION OF MEDICAL CLASSES IN RUSSIA.It is announced in the l’orgovo Promysshlennaya Gazeta

that all classes in the Military Medical Academy will beginwork on Sept. 14tb this year. This may be rather a sanguineprophecy but there are other evidences that it is the in-tention of the authorities not to allow the military medicalorganisation to lapse into chaos. For example, the com-mittee appointed to draw up the new regulations for theconstitution of the military sanitary elements of the armyhas recently comi Jered the question of grades for militarymedical officers. It was agreed to be indispensable thatthese officers should be graded as generals, staff officers,and superior officers with all their prerogatives. Theywill constitute a special official corps-" the Corps ofMilitary Medical Officers "-and they will wear distioctiveuniforms and enjoy special professional as well as militaryprivileges.

SOCIETY FOR RELIEF OF WIDOWS AND ORPHANSOF MEDICAL MEN.-A quarterly court of the directors ofthis society was held on July llth at 11, Chandos-street,Cavendish-square, London, W., Dr. G. F. Blandford, thePresident, being in the chair. 14 members were present.The death of Dr. John Clarke was reported, who was electeda member in 1847 and had been one of the vice-presidentssince 1867. Four new members were elected. The sum of.,1358 10s. was voted for the half-yearly grants to theannuitants of the charity. Five letters had been receivedfrom widows of medical men since the last court asking forrelief and this had in each instance to be refused owing to thefact that their husbands had not been members of thesociety. Mr. Edward J. Blackett was re-elected secretary.The membership of the society is open to any registeredmedical man who at the time of his election is in practicewithin a radius of 20 miles from Charing Cross. Fallparticulars and application forms may be obtained from thesecretary, 11, Chandos-treet, Cavendish-square, London, W.The next election is on Oct. llth, and names of intendingcandidates must be received on or before Sept. 19th.