872 ASYLUM REPORTS.-VITAL STATISTICS.

Miller, the medical superintendent, states in his reportthat among the admissions were the following incurablecases-viz., 13 idiots, 17 epileptics, 11 general paralytics,and 28 cases of chronic insanity. ’’ It will be seen

from the above figures that one-third of the number ofcases admitted had no chance whatever of recovery and

naturally among the remainder a large number willturn out incurables." Dr. Miller adds that "idiots and

epileptics should certainly never be received into countyasylums to associate with curable cases. What can be moredetrimental to recovery from mental disease in pregnancythan the constant and trying association with patients such asthe above ? The number of patients discharged as recoveredduring the year amounted to 72-viz., 37 males and 35 females,or 7’5 per cent. of the average number resident. The deaths

during the year amounted to the same number-viz., 72,composed also of 37 males and 35 females, or 7 ’5 per cent as

calculated on the same basis. Of the deaths three were dueto senile decay, eight to pneumonia, nine to cerebral hremor-rhage, nine to phthisis and other forms of tuberculosis, 12 togeneral paralysis, 16 to epilepsy, and the rest to othercauses. A plan for two isolation blocks for male and femalephthisical patients having been sanctioned by the Commis-sioners in Lunacy the buildings are in process of erection.The asylum has acquired recently an adjoining farm on a longlease and has been able to improve the dietary of the

patients as regards vegetables and eggs. At the time of the

report in the preceding year 11 male attendants of the

asylum staff were out at the front in South Africa; since thenseven have returned and good accounts have recently beenreceived of the rest. "Entering on the twentieth year of myservice in the asylum," says Dr. Miller, " I am naturally ableto look back on many changes. Great sanitary improve-ments have been effected and important additions have beenmade to cope with the increasing number of cases comingunder our care. But the most important question I feelbound to ask is : What advancement has been made in ourcurative methods and what have been their effect on the

recovery-rate ? "

Thirty years ago, when asylum buildingswere certainly not what they are at present and the amount ofpersonal comfort supplied was far less, the average recovery-rate, as shown in the reports of the Commissioners in

Lunacy, was 11 per cent. of the average number of patientsresident. To-day it is barely as much, being but 9¼ per cent."New drugs have certainly been tried by the score ; ......

baths, massage, and electricity have all been successfullyused in their turn, and yet our results are no better thanat the commencement of the period....... Personally, I amled to think," concludes Dr. Miller, "that there will beno material increase in the number of recoveries until thereis a more general provision for treating special forms ofmental disease in separate buildings. Epileptics, idiots,imbeciles, senile and other incurable cases should be keptapart from the recent and curable cases. The latter classshould certainly have buildings set apart for their receptionand managed rather on the lines of a hospital where treatmentcould be carried out under the most favourable surroundingsand where patients ...... would not be living in associationwith those incurables to whom I have alluded." The

Asylums Committee state that the weekly charge for main-tenance has been raised from 8s. 9d. per head to 9s. 0½d.since June 30th, 1900. The Commissioners in Lunacy state intheir report that the wards were bright and cheerful, thedormitories were clean and in good order, and the medicalcase-books were perfectly kept.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 33 of the largest English towns 6261 births and 3704deaths were registered during the week ending Sept. 21st.The annual rate of mortality in these towns, which hadbeen 21-0, 194, and 18-3 per 1000 in the three precedingweeks, further declined last week to 16 ’8 per 1000. In Londonthe death-rate was 15’6 per 1000, while it averaged 17’7in the 32 large provincial towns. The lowest death-rates in these towns were 11 ’2 in Bristol, 11 ’6 in Swansea,11-8 in Derby, and 12-2 in Birkenhead ; the highestrates were 20-7 in Bolton, 22-7 in Gateshead, 25’2 in

Burnley, and 25-6 in Sunderland. The 3704 deathsin these towns last week included 733 which were

referred to the principal zymotic diseases, against1506, 1256, and 971 in the three preceding weeks ; of

t these 733 deaths, 491 resulted from diarrhoeal diseases,e 70 from "fever" " (principally enteric), 49 from diph-, theria, 41 from whooping-cough, 40 from measles, 391 from scarlet fever, and three from small-pox. The lowestf death-rates from these diseases last week were recorded ini Bristol. Cardiff, Swansea, and Leicester; and the highest1 rates in West Ham, Salford, Burnley, Sunderland, and1 Gateshead. The greatest proportional mortality from scarlet

fever occurred in Derby ; from whooping-cough in Swansea ;3 from "fever in Plymouth, Nottingham, Salford, Hudders-

7field, Hull, and Sunderland ; and from diarrhoeal diseases insBurnley, Sheffield, Hull, Sunderland, Gateshead, and New-i castle. The mortality from measles showed no marked ex-, cess in any of the large towns. The 49 deaths from diphtheria

included 27 in London, three in West Ham, two in Halifax,, two in Sheffield, and two in Hull. Three fatal cases of small-; pox were registered in London, but not one in any other of the 33 large towns. There were 153 cases of small-pox. under treatment in the Metropolitan Asylums hospitals on) Saturday, Sept. 21st, against 74, 92, and 137 on thethree preceding Saturdays ; 37 new cases were admitted

during the week, against 52, 31, and 62 in the three preced-ing weeks. The number of scarlet fever patients in thesehospitals and in the London Fever Hospital, which had

, been 3008, 2994, and 3064 at the end of the three pre-ceding weeks, had further risen to 3098 on Saturdaylast ; 427 new cases were admitted during the week,against 303, 346, and 457 in the three preceding weeks.The deaths referred to diseases of the respiratory organsin London, which had been 124 and 116 in the two pre--ceding weeks, rose again last week to 124, but were

48 below the corrected average. The causes of 45, or 1.2per cent., of the deaths in the 33 towns last week werenot certified, either by a registered medical practitioner orby a coroner. All the causes of death were dulycertified in West Ham, Bristol, Nottingham, Leeds, and in12 other smaller towns ; the largest proportions of uncerti-fied deaths were registered in Birmingham, Liverpool,Preston, Sheffield, and Gateshead.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,which had been 17 ’8 and 17 ’5 per 1000 in the two precedingweeks, further declined to 16 ’2 per 1000 during the week end-ing Sept. 21st, and was 0-6 below the mean-rate duringthe same period in the 33 large English towns. The rates inthe eight Scotch towns ranged from 7’9 in Perth and11’3 in Dundee to 20’9 in Aberdeen and 21’3 inGreenock. The 517 deaths in these towns included 53which were referred to diarrhosa, 13 to whooping-cough, six to I fever," five to measles, four to diphtheria,and two to scarlet fever. In all. 83 deaths resulted from these

principal zymotic diseases last week, against numbers

decreasing from 174 to 74 in the seven preceding weeks.These 83 deaths were equal to an annual rate of 2’6 per1000, which was 0-7 below the mean death-rate last weekfrom the same diseases in the 33 large English towns.The fatal cases of diarrhoea, which had declined from129 to 38 in the six preceding weeks, rose again lastweek to 53, of which 24 occurred in Glasgow, 10 in

Edinburgh, six in Dundee, five in Aberdeen, four in Leith,and three in Paisley. The deaths from whooping-cough, whichhad been 13 and 10 in the two preceding weeks, roseagain to 13 last week, and included seven in Glasgow,three in Edinburgh, and two in Leith. The fatalcases of "fever." which had been six and 12 in thetwo preceding weeks, declined again last week to six,of which five were registered in Glasgow. The deaths frommeasles, which had been eight in each of the two precedingweeks, decreased to five last week, and included two, inGlasgow and two in Edinburgh The four fatal cases ofdiphtheria, two of which were registered in Glasgow,showed a slight increase upon .the numbers recorded inrecent weeks. The deaths referred to diseases ofthe respiratory organs in these towns, which hadbeen 60 and 79 in the two preceding weeks, furtherrose last week to 81, but were 20 below the numberin the corresponding period of last year. The causes of 24,or nearly 5 per cent., of the deaths in these eight townslast week were not certified.

HEALTH OF DUBLIN.

The death-rate in Dublin, which had been 23’5, 20’6,and 22-2 per 1000 in the three preceding weeks, further

873THE SERVICES.-"WAS LUIGI CORNARO RIGHT?"

rose to 234 per 1000 during the week ending Sept. 21st.

During the past four weeks the death-rate has averaged224 per 1000, the rate during the same period being16-8 both in London and in Edinburgh. The 168deaths of persons belonging to Dublin registered during theweek under notice were 8 in excess of the number inthe preceding week, and included 30 which were referredto the principal zymotic diseases, against 35, 35, and25 in the three preceding weeks ; of these, 20 resultedfrom diarrhoea, four from whooping-cough, three from"fever," two from diphtheria, and one from scarlet fever.These 30 deaths were equal to an annual rate of4’2 per 1000, the zymotic death-rates during the sameperiod being 2-6 per 1000 in London and also in Edin-

burgh. The fatal cases of diarrhoea, which had been

28, 29, and 22 in the three preceding weeks, furtherdeclined last week to 20. The deaths from whooping-cough, which had been one, two, and one in the three pre-ceding weeks, increased to four last week. The mortalityfrom fever" exceeded that recorded in any recent week.The 168 deaths in Dublin last week included 47 of childrenunder one year of age and 32 of persons aged upwards of0 years ; the deaths both of infants and of elderly personsshowed a slight excess over the respective numbers in the pre-ceding week. One death from violence and five inquest caseswere registered during the week; and 59, or more than a

third, of the deaths occurred in public institutions. Thecauses of six, or nearly 4 per cent., of the deaths in Dublinlast week were not certified.

THE SERVICES.

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

geon H. S. R. Sparrow to Pembroke Dockyard. Staff Sur-

geons : W. G. K. Barnes to the J/ormidable and J. Donnellto the Empress of India and to the Cvsar on recommission-ing. Surgeons: A. F. Fraser to the Formidable ; W. R.Center to the Ra1fâllies; and R. Kirby to the ChathamlIospital. Civil Practitioner J. Owen to be Surgeon andAgenfat Goodwick.

ROYAL ARMY MEDICAL CORPS. ,

Captain H. L. G. Chevers, retired list, is selected forservice with the troops in South Africa. Lieutenant H. W.Long has arrived in the Eastern District for duty. Lieu-tenant W. C. Stevenson and Lieutenant M. C. Beatty areposted to the 3rd Station and Cambridge Hospital atAldershot. Lieutenant McAllum is attached to the Cam-

bridge Hospital at Aldershot for duty. Lieutenant R. V.

Cowey is under orders for India. Captain I. A. 0.

MacCarthy is transferred from the Poona District to theAden District, and Lieutenant G. E. Leary from the MhowDistrict to the Aden District. Colonel M. O’Connell,Principal Medical Officer, Peshawur District, is transferredto the home establishment. Major L. Heywood takes overmedical charge of troops, Station Hospital, &c., Portland.

Captain H. D. Mason assumes medical charge of the RoyalArtillery, Mounted Infantry, Royal Engineers, District Staff,and details, Marlborough Lines, Aldershot. Captain J. H.Power is appointed for duty with the Royal Horse Guards atWindsor.N.B.-Tbe date of the grant of the local rank of Colonel to

Lieutenant-Colonel W. A. May whilst Principal MedicalOfficer of a division in South Africa is Jan. 19th, 1900, andnot as stated in the London Gazette of Nov. 2nd, 1900.

The undermentioned officer of Lord Strathcona’s Corps is,on the disbandment of the corps. granted honorary rank inthe Army with permission to wear the uniform of the corps.Dated March 16th, 1901.Temporary Captain C. B. Keenan, D.S.O., Medical Officer,

to be Hon. Captain. -

VOLUNTEER CORPS.

Artillery: : 8th Lancashire : Surgeon-Lieutenant J. D.Wright resigns his commission.

Royal Engineers (Volunteers) : lst Middlesex : Surgeon-Lieutenant H. M. Macnaughton-Jones resigns his commission.

ARMY MEDICAL SCHOOL, NETLEY.The eighty-third session of the Army Medical School will

commence on Wednesday, October 2nd. The session willbe attended by 25 surgeons-on-probation for the IndianMedical Service and two for the Royal Army Medical Corps.The following is a list of those entering the school :-

SOUTH AFRICAN AFFAIRS.There have been several untoward events recently in South

Africa arising out of a recrudescence of highly enterprisingactivity on the part of the Boers. Whatever importancethese may have from a military point of view, they possesslittle or no medical interest beyond the fact that besidesentailing a lamentable loss of life they lead to an increasednumber of surgical cases in our hospitals and to the beliefthat every temporary success on the part of the Boers canonly have the effect of prolonging the sufferings caused bythe war. In the reverse at Blood River the losses sustained byMajor Gough’s force amounted to three officers and 17 menkilled, three officers and 28 men wounded, and five officersand 272 men captured, a total of 328. In the case of the17th Lancers the fighting was more severe and the lossesamong the troopers in killed and wounded, relatively to thenumber engaged, were much heavier.According to the last weekly report received from Lord

Kitchener the wearing-down process steadily goes on, thenotable feature being the number of Boers captured andthe losses on the part of the Boers in the way of ammuni-tion, vehicles, horses, and cattle, as compared with thenumber of Boers returned as killed and wounded or surren-dered. There are no sick returns of their forces available,and we have not, nor have we ever had throughout thecampaign, any means of knowing what their losses fromdisease have been. There is still, considering the season,much enteric fever among the British forces, however, as maybe seen from the published sick returns.

DEATHS IN THE SERVICES.Lieutenant-Colonel James Moran, I.M.S., on Sept. 20th,

in London. He entered the service in 1875 and served inAfghanistan in 1878-79 (medal). He was appointedLieutenant-Colonel in February, 1900.

Surgeon-General William Alister Catherwood recently.He was Principal Medical Officer of the Naini Tal District.

Correspondence.

"WAS LUIGI CORNARO RIGHT?"

"Audi alteram partem."

To the Editors of THE LANCET.

SIRS,-I should be gratified to think that Dr. CameronKidd is right in assuming that medical men are fully alive tothe necessity of thoroughly exercising the infant’s jaws andteeth by mastication. Be this as it may, it is certain thatthe young human does not adequately exercise his jaws ;did he do so we should not see so many cases ofdefective development. Dr. Kidd holds, and claims thatmedical men in general hold, that in order to secure

adequate exercise of the teeth we should rely on "artificialexercise of the jaws " rather than on the mastication of food.This view is, I believe, a mistaken one, though I do not for onemoment contend that the chewing of rings, corals, and thelike, may not have its use. The young human is not a rodent ;his teeth are essentially for the purpose ot biting food, andnot for gnawing hard non-nutrient substances, like a mouse ora rat. Dr. Kidd argues that the child only spends about anhour over his meals every day, and that this time is inadequatefor the proper development of the jaws. Well, an hour’s