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blocks connected to an administrative building by opencorridors. The blocks are one storey in height. Theadministrative department has a second storey containingbedrooms for nurses. The structure of the building is ofcorrugated iron and wood with a brick foundation; the innerwalls are lined with "compo boarding and are painted in dis-temper. The buildings are arranged one on each side and onebehind the administrative block. All the wards face thesouth. The block behind the administrative departmentconsists of two wards, each containing 12 beds. The totalnumber of beds in the reception house is 62, and the cubicspace allowed for each is 1500 cubic feet. The two other

buildings have each one ward of 12 beds, one ward of sixbeds, and three single rooms. All the wards and rooms are

provided with French windows and round the sides of eachblock there are verandahs. The beds can be wheeled fromthe wards to the verandahs with the greatest ease. Specialprovision has been made against fire. There are no fires inany of the wards and the heating is by water under a lowpressure. Each ward has attached to it a bathroom and thenecessary lavatory and water-closet accommodation. All thebaths are so arranged that they can be used for the electricaltreatment of the patients.

Reference has been made to the upper storey of theadministrative block in which nurses’ rooms are situated.The lower storey consists of a reception room, bathroom,and examination room for newly admitted cases, a room wellfurnished with the latest electric therapeutic apparatus,medical officers’ quarters, kitchen, scullery, and dining hallfor the staff. The verandahs, which are on the south, east,and west sides of the wards, were purposely introduced. Forseveral years previous to the erection of the reception houseand sanatorium newly admitted and phthisical cases werekept as much as possible in the open air with manifest

advantage. It was thought that the extensive use ofverandahs would, in the prevalent climatic conditions, affordthe greatest facility for carrying out the open-air treatment.In practice this has actually occurred. Since the openingof the reception house the freest use of open-air treatmenthas been employed, not only for the consumptive but for allthe newly admitted cases.

1425 patients (737 males and 688 females) have beenadmitted since the reception house was opened. It hasnot been necessary, on account of inability to deal withthem, to admit any of the patients to the main asylumor remove them shortly after admission from the recep-tion house to the asylum. This is more remarkable inview of the fact that the reception house does not

possess the means of restraint or seclusion. No daynurse has keys, and the ward doors are open all day.The windows are open night and day. All patients onadmission are bathed and subsequently examined by themedical officer and by medical clerks who are senior studentsof medicine. The patients are kept in bed until their con-dition has been diagnosed. As a rule they are then removedto the respective buildings in the asylum which are most Isuited for their condition ; thus, an infirm or senile Icase is sent to the ’infirmary of the main asylum;the phthisical patient is sent to the sanatorium ;chronic cases with fairly good physical health are, in thefirst place, admitted to the wards of the main asylum wherethey are placed at occupations suited for their conditionboth of body and mind, and from there they are drafted tothe farms where, if they do well, they may ultimately beboarded out in the country. In this way, from the point ofclassification, the reception house has many advantages.From the points of diagnosis and treatment the conditionsare, in my mind, ideal. No patient is removed until a com-plete report of the physical and mental characteristics ofhis.case is detailed in the case-books of the asylum and thecourse of care and treatment decided. Those patients whohave a likelihood of early recovery are detained in the

reception house until convalescence has been established.The number of patients who have been discharged recoveredin this way is 216 (108 males and 108 females). There arethree bedrooms in each of the southern blocks which areused in several ways. Any patient who is very excited andrestless is placed in one of them with a nurse. The beneficialeffects of this treatment have often been noticed. Therooms are also used for the moribund, and when availableone is given as a privilege to a convalescent. These roomsare bright and attractive and so situated as to give themaximum amount of peace and quietness.The nursing of the patients is mainly done by women. I

have seen nothing to prevent the whole of the nursing beingdone by women, but I think this would be objectionablebecause we have not yet reached, nor shall we probably reach,the stage when all the patients in asylums will be nursed bywomen. I think it only fair to give male attendants, whohave charge of working parties of patients, all facilities inthe early stages of their asylum career for acquiring a soundknowledge of their profession, and adapting this knowledgeto the advantage of the patients of whom they may ulti-mately be in charge at outdoor work. In the receptionhouse I have followed the practice I have been accustomedto in the asylum hospitals for men. Two male attendantsare regularly on day duty and two on night duty. The

object I have in mind is thus acquired. Many objections towomen nursing male patients, especially newly admittedmale patients, have been urged. None of these will be foundin practice, though experience has taught me to exercise thegreatest care in the selection of nurses to male patients.This has reference solely to matters of staff discipline anddoes not affect primarily the welfare of the patients.The following are some extracts from reports by His

Majesty’s Commissioners in Lunacy :-By Dr. Jonv FRASER. 5th -ttfay, 1903.-The reception house produced

a most favourable impression. Its arrangements are devoir of anyasylum features, being identical in every respect with those of a smallgeneral hospital. It is staffed by nurses and is under the charge of atrained hospital nurse. Every patient on admission is treated in thishouse and the length of residence there depends on the mental con-dition. The comfort, rest, skilful treatment, and good nursing whichnewly admitted patients receive in this house are most favourable tothe early recovery of the curable and to the well-being of those whoare incurable.

14th April, 1904.-The reception house and convalescent wards con-stitute a valuable and important advance in the treatment andclassification of the patients.By Dr. JOHN MACPHERSON. 15the Nov.. 1904.-The arrangements for

the reception, nursing, and medical treatment of newly admittedcases in this asylum are now probably unsurpassed by those in anyinstitution in this country. The facilities for the clinical investigationand the medical treatment of nervous diseases have been provided bythe district board with unstinted liberality. It is right to add that Dr.Marr and his large staff of assistants are sedulouslv observing factsand carefully recording them, and that a mass of clinical material ofgreat value is being gradually accumulated in the medical records ofthe asylum.Woodilee Asylum, Lenzie.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 76 of the largest English towns 8781 births and 5680deaths were registered during the week ending Feb. lst.The mean annual rate of mortality in these towns, which hadbeen equal to 20’ 0 and 18’ 5 in the Two preceding weeks,further declined to 18’ 2 in the week under notice. During thefirst five weeks of the current quarter the annual death-ratein these towns averaged 18’ 6 per 1000; the rate duringthe same period in London did not exceed 18’ 0. Thelowest annual death-rates in the 76 towns last week were7’3 in Hornsey, 7 6 in Smethwick, 8’7 7 in Northampton,and 9 - 7 in Barton-on-Trent ; the rates in the other townsranged upwards to 26’4 in Newport, 26’7 in Liverpool,27-7 in MerthyrTydfit, and 29-3 in Warrington. The ratein London last week did not exceed 17 - 2. The 5680deaths registered in the 76 towns during the week undernotice showed a further decline of 69 from the numbersreturned in the two preceding weeks, and included 441which were referred to the principal epidemic diseases,against 501 and 409 in the two previous weeks; of these,190 resulted from whooping-cough, 83 from measles, 66from diphtheria, 46 from diarrhoea, 35 from scarlet fever,21 from " fever (principally enteric), but not one fromsmall-pox. The deaths from these epidemic diseases in the76 towns were equal td an annual rate of l’ 4 per 1000,the rate from the same diseases in London being1-3. No death from any of these epidemic diseases wasregistered last week in Wolverhampton, Huddersfield, Wigan,Hornsey, or in six other smaller towns; the annual death-rates from these diseases ranged upwards, however, in theother towns to 3’1 1 in Bootle, in Bolton, and in AstonManor, and 7 3 in Warrington. The fatal cases of whoop-ing-cough in the 76 towns, which had been 164 and 154 in thetwo preceding weeks, further rose last week to 190; theycaused annual death-rates equal to 2 3 per 1000 in Bootleand in South Shields, 2’ 5 in Aston Manor and in Bolton, and5’1 1 in Warrington. The 83 deaths from measles showed afurther decline from the numbers in the three previous

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weeks ; this disease, however, caused a death-rate of 1’ 3 inSouthampton, 1-7 in Barrow-in-Furness, 1-8 in York, and2’ 0 in Willesden. The 66 deaths referred to diphtheria, onthe other hand, showed an increase upon recent weeklynumbers, and included 24 in London, three in Liverpool,three in Manchester, three in Reading, and two in Bury ;these deaths in the two last mentioned were equal to anannual rate of l’ 9 and l’ 8 per 1000 respectively. The46 deaths attributed to diarrhoea showed a slight increase,whereas the fatal cases of scarlet fever had slightly declined ;the highest rates from scarlet fever last week were 1’1 1 inSt. Helens and 1 - 5 in Warrington. The 21 deaths referredto "fever" were fewer than in any recent week ; four,however, occurred in Birmingham, four in Manchester, andtwo in Portsmouth. The number of scarlet fever patientsunder treatment in the Metropolitan Asylums and LondonFever Hospitals, which had steadily declined in the eightpreceding weeks from 5581 to 4044, had further fallen to3913 on Feb. 1st; during the week ending on that day 405new cases were admitted to these hospitals, against 469 and380 in the two previous weeks. The deaths in Londonreferred to pneumonia and other diseases of the respiratoryorgans, which had been 499 and 455 in the two precedingweeks, further declined to 432 in the week under notice, butexceeded by 35 the corrected average number in the corre-sponding week of the five years 1903-07. The causes of 54,or 1 ° 0 per cent., of the deaths registered in the 76 townslast week were not certified either by a registered medicalpractitioner or by a coroner. All the causes of death wereduly certified in Mancheeter, Leeds, West Ham, Bradford,Newcastle-on-Tyne, and in 45 smaller towns ; and the causesof all but one of the 1584 deaths in London were duly certi-fied. No fewer than ten of the causes of death in Birming-ham, eight in Liverpool, four in South Shields, and three inWarrington were uncertified.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in eight of the principalScotch towns, which had been equal to 24’ 3 and 22 2per 1000 in the two preceding weeks, was 22’ 3 3 inthe week ending Feb. 1st, and exceeded by 4’1 themean rate during the same week in the 76 English towns.Among the eight Scotch towns the death-rates rangedfrom 17 6 and 17 9 in Dundee and Aberdeen to 23’ 9 9in Glasgow and 25 4 in Greenock. The 785 deaths inthese eight towns exceeded by three the number in theprevious week, and included 123 which were referred to theprincipal epidemic diseases, against 158 and 142 in the twopreceding weeks ; of these, 64 resulted from measles, 26from whooping-cough, 11 from diarrhoea, eight from" fever,"seven from scarlet fever, six from diphtheria, and one fromsmall-pox. These 123 deaths were equal to an annual rateof 3’ 5 per 1000, which exceeded by no less than 2’ 1 1the mean rate last week from the same diseases in the76 English towns. The fatal cases of measles, which hadbeen 92 and 81 in the two preceding weeks, further declinedlast week to 64, of which 54 occurred in Glasgow, three inEdinburgh, three in Aberdeen, and two in Greenock. The 26deaths from whooping-cough exceeded the number in the pre-vious week by one, and included 12 in Glasgow, six in Leith,three in Edinburgh, three in Greenock, and two in Perth.The 11 deaths attributed to diarrhoea, of which seven werereturned in Glasgow, were fewer than in any recent week.Five of the seven fatal cases of scarlet fever occurred inGlasgow. The eight deaths referred to " fever includedsix certified as cerebro-spinal meningitis, and two as entericfever; four were returned in Glasgow, and three in

Edinburgh. The six fatal cases of diphtheria included twoin Glasgow and two in Dundee. The death from small-poxwas registered in Leith. The deaths referred to diseases ofthe respiratory organs in these eight towns, which hadbeen 205, 199, and 178 in the three preceding weeks, were179 in the week under notice, and exceeded by 53 thenumber from the same diseases in the correspondingweek of last year. The causes of 22, or 2’8 per cent., ofthe deaths in these towns last week were not certified ornot stated; in the 76 English towns the proportion of theseuncertified deaths last week did not exceed 1 - 0 per cent.

HEALTH OF DUBLIN.

The annual rate of mortality in Dublin, which had beenequal to 31’ 2 and 29’ 5, per 1000 in the two precedingweeks, further declined to 25-5 in the week ending IFeb. lst. During the first five weeks of the current i

quarter the death-rate in the city averaged 27’5 per1000 ; the rate during the same period did not exceed18-0 in London and 19 - 1 in Edinburgh. The 193deaths of Dublin residents registered last week showed afurther decline of 30 from the high numbers in thetwo previous weeks, and included six which were re-

ferred to the principal epidemic diseases, against threeand nine in the two preceding weeks ; these six -deathsincluded two from measles, two from whooping-cough, twofrom diarrhoea, but not one either from scarlet fever,diphtheria, "fever," or small-pox. These six deaths fromepidemic diseases were equal to an annual rate of 0 - 8per 1000, the death-rate from the same diseases lastweek being 1 - 3 in London and 1- 9 in Edinburgh. The193 deaths in the city last week from all causes included34 of infants under one year of age and 70 of personsaged upwards of 60 years ; the deaths of elderly personswere again exceptionally numerous. Five inquest cases andthree deaths from violence were registered during the week,and 75, or 38’8 8 per cent., of the deaths occurred in publicinstitutions. The causes of 12, or no less than 6 2 per cent.,of the deaths in the city last week were not certified ; inLondon the causes of all but one of the 1584 deaths wereduly certified, while in Edinburgh 3’ 3 per cent. of thecauses were uncertified.

THE SERVICES.

ROYAL NAVY MEDICAL SERVICE.

THE following appointments are notified :-Staff Surgeons:W. R. Center to the President, additional, for three months’course at West London Hospital ; W. H. Pope to thePhilornel, on commissioning; H. P. Jones to the Topaze;M. P. Jones to the Attentive ; E..S. Tuck to the Foresight, onrecommissioning ; C. C. Macmillan D.S.O., to Malta Hos-pital ; and R. F. Clark to the Viotory. Surgeons : G. M.Eastment to the Wildfire: and C. J. O’Connell to theMagnificent.Surgeon J. H. Lightfoot has been promoted to the rank of

Staff Surgeon, with seniority of May 15th, 1907.ROYAL ARMY MEDICAL CORPS.

Lieutenant-Colonel George Coutts retires on retired pay(dated Feb. 5th, 1908).

VOLUNTEER CORPS.

Royal Garrison Artillery (Volunteers): 2nd Devonshire:George Douglas Kettlewell to be Surgeon-Lieutenant (datedJan. 1st, 1908). 1st Glamorganshire : Surgeon-LieutenantF. G. Thomas to be Surgeon-Captain (dated Jan. 9th, 1908).

Riffle 1st Volunteer Battalion, The Sherwood Foresters(Nottinghamshire and Derbyshire Regiment): Surgeon-Captain A. B. Chambers resigns his commission (datedDec. 20th, 1907).

ROYAL ARMY MEDICAL.CORPS (VOLUNTEERS).Western Command : Manchester Companies : Honorary

Lieutenant in the Army John William Smith (late Captain,Royal Army Medical Corps (Volunteers) ), to be Captain(dated Nov. 21st, 1907). John O’Sullivan to be Lieutenant(dated Dec. 19th, 1907). Captain A. T. Lakin resigns hiscommission (dated Jan. 9th, 1908). Lieutenant W. E.Rothwell resigns his commission (dated Jan. 9th, 1908).Argyll and Sutherland Bearer Company : Lieutenant W. C.Murray to be Captain (dated Dec. 25th, 1907). Lancasterand Border Bearer Company : Surgeon-Captain HenryDodgson, from the 3rd (Cumberland) Volunteer Battalion,The Border Regiment, to be Captain (dated Jan. lst, 1908).Sussex and Kent Bearer Company : Lieutenant-Coloneland Honorary Colonel J. Turton is borne as supernumerarywhilst holding the appointment of Brigade-Surgeon-Lieutenant-Colonel, Senior Medical Officer, Sussex andKent Volunteer Infantry Brigade (dated Dec. 17th, 1907).Henry Arthur Clifton Harris to be Lieutenant (datedDec. 17th, 1907).

DEATHS IN THE SERVICES.

On Jan. 25th, at the Royal Naval Hospital, Chatham,Staff Surgeon Harold Edgar Fryer, R.N. He joined theRoyal Navy in 1897 as surgeon and was promoted to StafESurgeon in 1905. The deceased, who was only 34 years ofage, had been suffering from pulmonary tuberculosis.