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ASYLUM REPORTS.
1571 slight dulness
on
the
right
side and
a
trifling
variation in the breath
sounds, but as this condition of things is commonly enough found on the right side, on account of the over-development of the muscles on that side, he treated it as negligible and based his diagnosis on the fact that there was undoubted three-inch expansion of the chest, equal on
Looking Back.
both sides. The usual procrastinations of legal process resulted in a FROM postponement of the -trial till November, 1902. At this stage all the medical men were finally agreed that the right apex was damaged. There were impaired movement, dulness, increased fremitus, loud breathing, and an occasional click. For the plaintiffs it was conNow commenced the legal tug-of-war. tended that the condition was one supervening on a pneumonia contracted in December as a direct result of exposure to coal-gas FOREIGN DEPARTMENT. inhalation. In support of this contention counsel quoted the " cherrycoloured" blood seen by Mr. Morgan four days after inhalation and they asserted that this peculiar colour was due to the carbon monoxide ARCHIVES GENERALES.-OCT. 1824. and to that only. They referred to the fact that despite several Recent observcz ions on the PLICA of countries. examinations-of the sputum no tubercle bacillus had yet been found, and, finally, they referred to the Blue-book on Water Gas, in which Dr. J. J. VIREY, M.D. of at the By J. S. Haldane states that amongst the after-effects of gas inhalation Medicine, 7th, 1824 ) is found. pneumonia or that and knows that the To this the defendants replied that Dr. Haldane had proved by experiments on himself that after severe poisoning by coal gas and excessive elongation of the hair of the head, or of the hair removal into fresh all the carbon monoxide was air, subsequent, entirely on other parts of the was for a time consideredIn face of this fact it was absurd for the elimilla’e,1 in six hours. virus, plaintiff’scounsel to ccntend that the plaintiffs blood was "cherry- as a peculiar disease, and was attributed to a This which was called coloured" four days after inhalation, and in the absence of cherrycoloured blood how could the pneumonia of Dec. 28th be definitely has been also STABEL, FIDBR, RICHTER, &c., connected with exposure to gas on the 24th ?? It was true certain modern as LAFONTAINE, ALIBERT, that gas poisoning was sometimes followed by pneumonia others but these cases were very rare and of very great severity; KUSTER, FRANK, and WOOLFRAMM. they were cases where the poisoning just stopped ehort of death have this disease amongst the most destructive to theand the unconsciousness induced by the gas merged into severe human race after It has to others to pneumonia. But in the present case the poisoning was of so mild a be It appears, however, to have nature that not only was the alleged unconsciousness open to serious contagious and into Poland the question, but the patient actually walked over half a mile within three been first Tartars, hours of his discovery. Such a fact was inconsistent with serious gas about the close of the thirteenth century. It has been and as for the was such a unknown as an poisoning, hemoptysis, sign a few years since that the has been renewed,. indication of gas inhalation. The symptoms pointed much more DAVIDSON in the seventeenth century, directly to influenzal pneumonia or to the haemoptysis and catarrh of before phthisis. True, there was no tubercle bacillus in the sputum but, such that was only the result of treatment and negative evidence was of no value in excluding tuberculous disease from the diagnosis. Dr. Heron was called to speak as to the condition of the patient I in November, and he gave it as his opinion that the signs pointed more The Times of Dec. 2nd, 1902, contains the clearly to phthisis than to anything else. He further said that he could excerpt from its issue of Dec. 2nd, 1802 :— not associate the pre-ent state of things in any way with an exposure "The Danish the result of their to gas 11 months previously ; and, further, he thought that a dormant the of tuberculous condition of the lung might not have been discoverable in the most July (that is, five months before his examination). He insisted that the benefits of the Vaccine Inoculation, his toone-sidedness of of the chest indicated a tuberculous the the affection Princess caused his encourage this attack and he would have expected any irritation caused by gas SOPHIA WILHELMINA, to be inoculated with Vaccine matter inhalation to have been bilateral. " Tne defence produced evidence from the Water Gas Blue-book, based well at few ago ; all on Dr. Haldane’s actual experiments, which showed that four and a half cubic feet of gas, containing 13 per cent. of CO, might escape into a 2000 cubic feet room for eight hours or more without producing a dangerous atmosphere-viz.. one containing more than 0 05 per cent. of CO. They showed that on a cold night, such as the one in question, convection currents would be freely set up at the cooled windows, and an exchange of air would take place very rapidly, so that once an hour, if not more often, the air of the room would be completely changed. London Cane-hill for the year Professor Vivian Lewes of the Royal Naval College, Greenwich, ertded March 31st, average number of gave this evidence and attributed the plaintiff’s illness to an resident the year was 2180, 934 males and accumulation of the products of incomplete combustion in the cold chimney. Such fumes were highlv poisonous and were formed when 1246 temales. The admissions during the year amounted to a stove had not a sufficient supply of gas (as was the case in this 186 males and 188 females. Of these 329’ 3i4, instance) ; the flames got over-cooled and noxious gases were formed. were first admissions. the medical Mr. James M. Professor Lewes said that such gases would lodge in the chimney and states in his report that the percentage of that when the stove was turned out they would cool and slowly descend into the room. As to the escape of gas he said that he would not mind deemed curable on admission was low. the sleeping himself in such a room with four and a half cubic feet of gas admissions 26 males and three females were from an hour escaping into it. of the insane and 12 males and 17 femalesFurther medical evidence was called to corroborate the evidence that of The number of dishaemoptysis was not a sign of gas poisoning and to show that no man were the who had been "gassed " to unconsciousness could possibly walk half a as recovered the year amounted to 124-viz., mile within three hours of his discovery in the poisonous atmosphere. 57 males and 67 females, or 5-7 per cent. of the averageThe learned judge summed up strongly in the plaintiffs’ favour, the year amounted to ignored the technical side of the case. commented severely on the number resident. The deaths medical conflict. and directed the attention of the jury to the face Of or 6.9 cent. as calculated on the same basis. 150, that the plaintiffs had been poisoned and were therefore entitled to these deaths two each were due to carcinoma of the stomach damages. 10 toThe jury found for the plaintiffs with £ 520 damages. The plaintiffs and colitis, seven to bronchitis, nine to and 10 to cardiac disease, 13sought in their statement of claim to recover oC2200 pneumonia In giving judgment his lordship refused to grant special costs to the to senile 20 to 21 to disease of the plaintiffs to cover the expenses of their medical evidence, saying, "I of the insane, and the rest to brain, 36 to general will not give you anything for the medical witnesses." The counsel for the plamtiffs were Mr. Marshall Hall, K.C., M.P., other causes. Post-mortem examinations were made in 134 Mr. Gerald Holiler, and Mr. Pitman. For the defence they were Mr. The number of casualties the year caes of death. M. Mr. Mr. Boxall, Bray, K.C., K.C., Reginald Boydell Houghton, amounted to 14 and consisted of fractures of bones more or and Mr. S. Ingleby Oddie.
THE LANCET, SATURDAY, DEC. 4, 1824.
different Royal Academy
(Read
Sept. Every one
entangling
pliccL,
long
body,
specific opinion, supported professed
trichomatique.
by by
by
physicians,
Many
again
placed
syphilis. epidemic. brought
appeared
by
Mongol
opinion
only
suggested by plica. negligence.
improper
-
followingThursday, Physicians having by experiments, given King irrefragable proofs Majesty, daughter, practice,
a
promises
days
present."
ASYLUM REPORTS.
County Asylum,
(Report
1902).-The
during
patients.
comprising
comprising
Moody,
superintendent, patients
Among
suffeiing
general paralysis subjects charged
epilepsy. during
patients
during
per
epilepsy,
broncho-pneumonia, decay, phthisis, paralysis
organic
during
TAKING
THE
OATH.-In
a
recent
case
at the
Bristol Police-court the medical officer of health (Dr. D. S Davieh) took the oath with uplifted hand instead of kissing the Testament. His Honour Judge Austin remarked that he wished more people would be sworn that way.
VACCINATION
RETURNS.-During
the 12 months
ended Sept. 29Lh last 3069 successful primary vaccinations and 747 successful revaccinations were performed by the public vaccinators of the Bristol union. For the preceding year the figures were 2484 and 27 respectively.
less severe in character. Eight of these were accidental and due to falls, five were sustained by patients striking each other, and one was due to a murderous assault upon one patient by another, in which the victim received a compound fracture of the skull from which, however, he made a remarkable recovery. There was not a single case of suicide during the year. The general health of the inmates has been good except for the prevalence of influenza in the spring and autumn. The Commissioners in Lunacy state in their reports that all parts of the asylum continued to be maintained in excellent order, that the wards are bright, cheerful, and comfortable, and that the medical case-books and other records are well and intelligently kept. The sub-committee of management states with regret in its report that
1572 male patient committed a severe assault upon Mr. Moody, average residents. The Commissioners in Lunacy state in the medical superintendent. Proceedings were taken against their report that the patients were neatly dressed and in satishim before the magistrates and he was after trial ordered factory personal condition, that the rooms and dormitories to be detained in a criminal lunatic asylum during His were in very good order, and that the medical case-books Majesty’s pleasure. In consequence of the prevalence of and other records were well kept. The committee of tuberculosis among the cows it was decided that the stock management states in its report that the sum of £,6729 has and all cows purchased in future should be subjected to the been received as payments for patients maintained during tuberculin test. The expenditure on repairs, alterations, and the year, being a considerable increase over the receipts of improvements during the year amounted to £ 6099. any previous year. A sum of .61799 19s. has been received -London County Asylum, Claybury (Report for the year from endowments and other sources. The total disburseended March 31st, 1902),-The average number of patients ments amounted to £ 832’7. resident during the year was 2431, comprising 1015 males Glasgnrv District Asylum, Woodilee (Report for the year and 1416 females. The admissions during the year amounted ended May 31st. 1902).-The average number of patients to 426-viz., 131 males and 295 females. Of these 364 were resident during the year was 854, comprising 445 males and The admissions during the year amounted first admissions. Dr. Robert Jones, the medical super- 409 females. males and 139 females. Of these 239 were to 164 in 303-viz , states his that the character intendent, report general of the admissions was unsatisfactory as regards prospect of first admissions. Dr. Hamilton C. Marr, the medical superrecovery. 38 per cent. of the admissions were over 60 years intendent, states in his report that 20 per cent. of the patients of age and over 16 per cent. of the males were suffering admitted " had previously been in this or some other asylum which seems to bear on the face of it the implication from general paralysis. 14 per cent. of the males and 9 per This concent. of the females were admitted suffering from alcoholic that insanity is really rarely recovered from." recurrence, Dr. Marr points out, is due to the insanity, "although as a predisposing cause the percentage dition ofoflife which a discharged patient has to undergo after is probably higher." It is interesting to notice, adds Dr. stress he leaves the classes furnished asylum on recovering from a first attack of that the two which the Jones, greatest number of male admissions were described as "clerks" insanity. Alcoholic excess was found to be the chief cause patients admitted during the year, this cause - and "persons of no occupation." The number of patients of insanity in traceable in more than 20 per cent. Dr. Marr clearly discharged as recovered during the year amounted to 148, being also that shows which existed in 6 per cent. of the males and or cent. of epilepsy, 52 S6 6’ females, 1 per comprising the average number resident. The deaths during the year admissions, could in several instances be traced to paternal amounted to 201, or 8’27 per cent. as calculated on the intemperance. 12 per cent. of the admissions were senile same basis. "Asylum dysentery attacked 40 males and 81 patients and many of these were in a feeble or dying state. females, and was responsible for 21 deaths, or over 10 per Inherited mental instability was ascertained in 14 per cent. cent. of the total deaths." Death was due to cancer of the of cases, while in 9 per cent. the cause of insanity was put stomach in six cases, renal disease in seven casep, epilepsy down to immorality. In 11-5per cent. of the admissions The number of in eight cases, pneumonia in 14 cases, senile decay in 15 the causation could not be ascertained. as recovered during the year amounted in cardiac in colitis 21 disease 24 patients discharged cases, cases, pulcases, monary and other forms of tuberculosis in 25 cases, general to 116, or 13.3per cent. of the average number resident. The deaths during the year amounted to 76, or 8’8 per cent. paralysis of the insane in 50 cases, and other causes in as calculated on the same hasis. Of the deaths five were due the rest. Two patients who were pregnant upon admission were safely delivered. There has been, with the exception of to epilepsy, seven to cardiac disease, eight to senile decay, - colitis, no outbleak of zymotic disease during the year. The ten to pulmonary, and other forms of, tubErculosis, 16 to Commissioners in Lunacy state in their report that thp wards general paralysis of the insane, and the rest to other causes: The institution has been free from any outbreak of epidemic were in excellent order, that the day-rooms were comfortable Electric lighting was inand cheerful, that the dormitories were clean and well aired, disease throughout the year. and that the medical case-books and records were very well augurated in October, 1901, and since then much convenience kept. The sub-committee of management states in its and comfort have been experienced with the new as compared report that owing to the drought the crops and farm pro- with the old lighting arrangements. The Commissioners in cluce showed a considerable falling off during the year. The Lunacy state in their report that the pa’ients were quite sum of .69320 was spent during the year upon improvements, orderly, that their physical condition was satisfactory, that the wards and dormitories were clean and in good alterations, and repairs. order, and that the medical case-books and post-mortem Warneford Asylum, Oxford (Annual Report for 1901).- records were kept in a manner highly creditable to the This asylum is intended for private patients of the middle medical staff. and upper classes. The average number of patients resident during the year was 97, comprising 48 males and 49 females. The admissions during the year amounted to 13-viz., 9 VITAL STATISTICS. males and 4 females. Of these 12 were first admissions. Dr. James Neil, the medical superintendent, states in his HEALTH OF ENGLISH TOWNS. report that voluntary boarders are received at their own IN 76 of the largest English towns 7812 births and 5433 request and if the mental condition is not sufficiently unsound to permit of certification. Some of the admissions deaths were registered during the week ending Nov. 29th. were transfers from other asylums. "There is no doubt," rhe annual rate of mortality in these towns, which had says Dr. Neil, "that a considerable number of chronic, been 17-3, 17 4, and 169per 1000 in the three preceding incurable patients derive at least temporary benefit from weeks, rose again last week to 19’1per 1000. In London new surroundings, and when they become discontented and the death-rate was 19’4 per 1000, while it averaged 18 9 per fretful it is a good plan to give them a change of asylum."" 1COO in the 75 other large towns. The lowest death-rates This plan has been followed in the case of patients with in these towns were 7.7 in Ipswich, 8’5 in Bournemouth, delusions of suspicion who got into the habit of complaining 9’2 in Reading and in York, 9 5 in Croydon, 10’2 in of various unreal grievances and the results have been, at Coventry, and 11.1 in Leyton ; the highest rates were 23’4 least temporarily, satisfactory. The total number of deaths in Wolverhampton, 23-6 in Rhondda, 24’2 in Oldham, Two of the deaths 25-5 in Liverpool, 27 2 in Newport (Mon.), 29-1in during the year amounted to five. occurred in male patients about a week after admission. One Tynemouth and 29 2 in Hanley. The 5433 deaths in these of these was admitted in the last stage of general paralysis, towns last week included 531 which were referred to and the other, a young man, aged 25 years, was suffering the principal infectious diseases, against 558, 509, and 511 from acute delirious mania and sank irom exhaustion. A in the three preceding weeks; of these 531 deaths, 186 patient who had "practically recovered and was absent on resulted from measles, 92 from diphtheria, 79 from probation"committed a murder and then killed himself. diarrhoea, 68 from whooping-cough, 63 from scarlet fever, ’ Those who are conversant with the care of the insane are 42 from "fever" (principally enteric), and one from well aware," adds Dr. Neil, "that the best forethought and small-pox. No death from any of these diseases was the most careful precautions will sometimes prove ineffectual registered last week in Brighton, Bournemouth, Northto prevent such tragedies. If patients are to be discharged at ampton, Ipswich, Smethwick, Aston Manor, Leicester, all a certain number of unexpected and sudden relapses must Barrow-in-Furness, Rotherham, or York ; while they caused take place and these relapses must occaionally be attended the highest death-rates in Hastings, Hanley, Walsall, West and by risk." The number of patients discharged as recovered Bromwich, Liverpool, Wigan, Salford, Tynemouth, during the year amounted to six, or 6 2 per cent. of the Rhondda. The greatest proportional mortality from measles
a
......
on
the
right
side and
a
trifling
variation in the breath
sounds, but as this condition of things is commonly enough found on the right side, on account of the over-development of the muscles on that side, he treated it as negligible and based his diagnosis on the fact that there was undoubted three-inch expansion of the chest, equal on
Looking Back.
both sides. The usual procrastinations of legal process resulted in a FROM postponement of the -trial till November, 1902. At this stage all the medical men were finally agreed that the right apex was damaged. There were impaired movement, dulness, increased fremitus, loud breathing, and an occasional click. For the plaintiffs it was conNow commenced the legal tug-of-war. tended that the condition was one supervening on a pneumonia contracted in December as a direct result of exposure to coal-gas FOREIGN DEPARTMENT. inhalation. In support of this contention counsel quoted the " cherrycoloured" blood seen by Mr. Morgan four days after inhalation and they asserted that this peculiar colour was due to the carbon monoxide ARCHIVES GENERALES.-OCT. 1824. and to that only. They referred to the fact that despite several Recent observcz ions on the PLICA of countries. examinations-of the sputum no tubercle bacillus had yet been found, and, finally, they referred to the Blue-book on Water Gas, in which Dr. J. J. VIREY, M.D. of at the By J. S. Haldane states that amongst the after-effects of gas inhalation Medicine, 7th, 1824 ) is found. pneumonia or that and knows that the To this the defendants replied that Dr. Haldane had proved by experiments on himself that after severe poisoning by coal gas and excessive elongation of the hair of the head, or of the hair removal into fresh all the carbon monoxide was air, subsequent, entirely on other parts of the was for a time consideredIn face of this fact it was absurd for the elimilla’e,1 in six hours. virus, plaintiff’scounsel to ccntend that the plaintiffs blood was "cherry- as a peculiar disease, and was attributed to a This which was called coloured" four days after inhalation, and in the absence of cherrycoloured blood how could the pneumonia of Dec. 28th be definitely has been also STABEL, FIDBR, RICHTER, &c., connected with exposure to gas on the 24th ?? It was true certain modern as LAFONTAINE, ALIBERT, that gas poisoning was sometimes followed by pneumonia others but these cases were very rare and of very great severity; KUSTER, FRANK, and WOOLFRAMM. they were cases where the poisoning just stopped ehort of death have this disease amongst the most destructive to theand the unconsciousness induced by the gas merged into severe human race after It has to others to pneumonia. But in the present case the poisoning was of so mild a be It appears, however, to have nature that not only was the alleged unconsciousness open to serious contagious and into Poland the question, but the patient actually walked over half a mile within three been first Tartars, hours of his discovery. Such a fact was inconsistent with serious gas about the close of the thirteenth century. It has been and as for the was such a unknown as an poisoning, hemoptysis, sign a few years since that the has been renewed,. indication of gas inhalation. The symptoms pointed much more DAVIDSON in the seventeenth century, directly to influenzal pneumonia or to the haemoptysis and catarrh of before phthisis. True, there was no tubercle bacillus in the sputum but, such that was only the result of treatment and negative evidence was of no value in excluding tuberculous disease from the diagnosis. Dr. Heron was called to speak as to the condition of the patient I in November, and he gave it as his opinion that the signs pointed more The Times of Dec. 2nd, 1902, contains the clearly to phthisis than to anything else. He further said that he could excerpt from its issue of Dec. 2nd, 1802 :— not associate the pre-ent state of things in any way with an exposure "The Danish the result of their to gas 11 months previously ; and, further, he thought that a dormant the of tuberculous condition of the lung might not have been discoverable in the most July (that is, five months before his examination). He insisted that the benefits of the Vaccine Inoculation, his toone-sidedness of of the chest indicated a tuberculous the the affection Princess caused his encourage this attack and he would have expected any irritation caused by gas SOPHIA WILHELMINA, to be inoculated with Vaccine matter inhalation to have been bilateral. " Tne defence produced evidence from the Water Gas Blue-book, based well at few ago ; all on Dr. Haldane’s actual experiments, which showed that four and a half cubic feet of gas, containing 13 per cent. of CO, might escape into a 2000 cubic feet room for eight hours or more without producing a dangerous atmosphere-viz.. one containing more than 0 05 per cent. of CO. They showed that on a cold night, such as the one in question, convection currents would be freely set up at the cooled windows, and an exchange of air would take place very rapidly, so that once an hour, if not more often, the air of the room would be completely changed. London Cane-hill for the year Professor Vivian Lewes of the Royal Naval College, Greenwich, ertded March 31st, average number of gave this evidence and attributed the plaintiff’s illness to an resident the year was 2180, 934 males and accumulation of the products of incomplete combustion in the cold chimney. Such fumes were highlv poisonous and were formed when 1246 temales. The admissions during the year amounted to a stove had not a sufficient supply of gas (as was the case in this 186 males and 188 females. Of these 329’ 3i4, instance) ; the flames got over-cooled and noxious gases were formed. were first admissions. the medical Mr. James M. Professor Lewes said that such gases would lodge in the chimney and states in his report that the percentage of that when the stove was turned out they would cool and slowly descend into the room. As to the escape of gas he said that he would not mind deemed curable on admission was low. the sleeping himself in such a room with four and a half cubic feet of gas admissions 26 males and three females were from an hour escaping into it. of the insane and 12 males and 17 femalesFurther medical evidence was called to corroborate the evidence that of The number of dishaemoptysis was not a sign of gas poisoning and to show that no man were the who had been "gassed " to unconsciousness could possibly walk half a as recovered the year amounted to 124-viz., mile within three hours of his discovery in the poisonous atmosphere. 57 males and 67 females, or 5-7 per cent. of the averageThe learned judge summed up strongly in the plaintiffs’ favour, the year amounted to ignored the technical side of the case. commented severely on the number resident. The deaths medical conflict. and directed the attention of the jury to the face Of or 6.9 cent. as calculated on the same basis. 150, that the plaintiffs had been poisoned and were therefore entitled to these deaths two each were due to carcinoma of the stomach damages. 10 toThe jury found for the plaintiffs with £ 520 damages. The plaintiffs and colitis, seven to bronchitis, nine to and 10 to cardiac disease, 13sought in their statement of claim to recover oC2200 pneumonia In giving judgment his lordship refused to grant special costs to the to senile 20 to 21 to disease of the plaintiffs to cover the expenses of their medical evidence, saying, "I of the insane, and the rest to brain, 36 to general will not give you anything for the medical witnesses." The counsel for the plamtiffs were Mr. Marshall Hall, K.C., M.P., other causes. Post-mortem examinations were made in 134 Mr. Gerald Holiler, and Mr. Pitman. For the defence they were Mr. The number of casualties the year caes of death. M. Mr. Mr. Boxall, Bray, K.C., K.C., Reginald Boydell Houghton, amounted to 14 and consisted of fractures of bones more or and Mr. S. Ingleby Oddie.
THE LANCET, SATURDAY, DEC. 4, 1824.
different Royal Academy
(Read
Sept. Every one
entangling
pliccL,
long
body,
specific opinion, supported professed
trichomatique.
by by
by
physicians,
Many
again
placed
syphilis. epidemic. brought
appeared
by
Mongol
opinion
only
suggested by plica. negligence.
improper
-
followingThursday, Physicians having by experiments, given King irrefragable proofs Majesty, daughter, practice,
a
promises
days
present."
ASYLUM REPORTS.
County Asylum,
(Report
1902).-The
during
patients.
comprising
comprising
Moody,
superintendent, patients
Among
suffeiing
general paralysis subjects charged
epilepsy. during
patients
during
per
epilepsy,
broncho-pneumonia, decay, phthisis, paralysis
organic
during
TAKING
THE
OATH.-In
a
recent
case
at the
Bristol Police-court the medical officer of health (Dr. D. S Davieh) took the oath with uplifted hand instead of kissing the Testament. His Honour Judge Austin remarked that he wished more people would be sworn that way.
VACCINATION
RETURNS.-During
the 12 months
ended Sept. 29Lh last 3069 successful primary vaccinations and 747 successful revaccinations were performed by the public vaccinators of the Bristol union. For the preceding year the figures were 2484 and 27 respectively.
less severe in character. Eight of these were accidental and due to falls, five were sustained by patients striking each other, and one was due to a murderous assault upon one patient by another, in which the victim received a compound fracture of the skull from which, however, he made a remarkable recovery. There was not a single case of suicide during the year. The general health of the inmates has been good except for the prevalence of influenza in the spring and autumn. The Commissioners in Lunacy state in their reports that all parts of the asylum continued to be maintained in excellent order, that the wards are bright, cheerful, and comfortable, and that the medical case-books and other records are well and intelligently kept. The sub-committee of management states with regret in its report that
1572 male patient committed a severe assault upon Mr. Moody, average residents. The Commissioners in Lunacy state in the medical superintendent. Proceedings were taken against their report that the patients were neatly dressed and in satishim before the magistrates and he was after trial ordered factory personal condition, that the rooms and dormitories to be detained in a criminal lunatic asylum during His were in very good order, and that the medical case-books Majesty’s pleasure. In consequence of the prevalence of and other records were well kept. The committee of tuberculosis among the cows it was decided that the stock management states in its report that the sum of £,6729 has and all cows purchased in future should be subjected to the been received as payments for patients maintained during tuberculin test. The expenditure on repairs, alterations, and the year, being a considerable increase over the receipts of improvements during the year amounted to £ 6099. any previous year. A sum of .61799 19s. has been received -London County Asylum, Claybury (Report for the year from endowments and other sources. The total disburseended March 31st, 1902),-The average number of patients ments amounted to £ 832’7. resident during the year was 2431, comprising 1015 males Glasgnrv District Asylum, Woodilee (Report for the year and 1416 females. The admissions during the year amounted ended May 31st. 1902).-The average number of patients to 426-viz., 131 males and 295 females. Of these 364 were resident during the year was 854, comprising 445 males and The admissions during the year amounted first admissions. Dr. Robert Jones, the medical super- 409 females. males and 139 females. Of these 239 were to 164 in 303-viz , states his that the character intendent, report general of the admissions was unsatisfactory as regards prospect of first admissions. Dr. Hamilton C. Marr, the medical superrecovery. 38 per cent. of the admissions were over 60 years intendent, states in his report that 20 per cent. of the patients of age and over 16 per cent. of the males were suffering admitted " had previously been in this or some other asylum which seems to bear on the face of it the implication from general paralysis. 14 per cent. of the males and 9 per This concent. of the females were admitted suffering from alcoholic that insanity is really rarely recovered from." recurrence, Dr. Marr points out, is due to the insanity, "although as a predisposing cause the percentage dition ofoflife which a discharged patient has to undergo after is probably higher." It is interesting to notice, adds Dr. stress he leaves the classes furnished asylum on recovering from a first attack of that the two which the Jones, greatest number of male admissions were described as "clerks" insanity. Alcoholic excess was found to be the chief cause patients admitted during the year, this cause - and "persons of no occupation." The number of patients of insanity in traceable in more than 20 per cent. Dr. Marr clearly discharged as recovered during the year amounted to 148, being also that shows which existed in 6 per cent. of the males and or cent. of epilepsy, 52 S6 6’ females, 1 per comprising the average number resident. The deaths during the year admissions, could in several instances be traced to paternal amounted to 201, or 8’27 per cent. as calculated on the intemperance. 12 per cent. of the admissions were senile same basis. "Asylum dysentery attacked 40 males and 81 patients and many of these were in a feeble or dying state. females, and was responsible for 21 deaths, or over 10 per Inherited mental instability was ascertained in 14 per cent. cent. of the total deaths." Death was due to cancer of the of cases, while in 9 per cent. the cause of insanity was put stomach in six cases, renal disease in seven casep, epilepsy down to immorality. In 11-5per cent. of the admissions The number of in eight cases, pneumonia in 14 cases, senile decay in 15 the causation could not be ascertained. as recovered during the year amounted in cardiac in colitis 21 disease 24 patients discharged cases, cases, pulcases, monary and other forms of tuberculosis in 25 cases, general to 116, or 13.3per cent. of the average number resident. The deaths during the year amounted to 76, or 8’8 per cent. paralysis of the insane in 50 cases, and other causes in as calculated on the same hasis. Of the deaths five were due the rest. Two patients who were pregnant upon admission were safely delivered. There has been, with the exception of to epilepsy, seven to cardiac disease, eight to senile decay, - colitis, no outbleak of zymotic disease during the year. The ten to pulmonary, and other forms of, tubErculosis, 16 to Commissioners in Lunacy state in their report that thp wards general paralysis of the insane, and the rest to other causes: The institution has been free from any outbreak of epidemic were in excellent order, that the day-rooms were comfortable Electric lighting was inand cheerful, that the dormitories were clean and well aired, disease throughout the year. and that the medical case-books and records were very well augurated in October, 1901, and since then much convenience kept. The sub-committee of management states in its and comfort have been experienced with the new as compared report that owing to the drought the crops and farm pro- with the old lighting arrangements. The Commissioners in cluce showed a considerable falling off during the year. The Lunacy state in their report that the pa’ients were quite sum of .69320 was spent during the year upon improvements, orderly, that their physical condition was satisfactory, that the wards and dormitories were clean and in good alterations, and repairs. order, and that the medical case-books and post-mortem Warneford Asylum, Oxford (Annual Report for 1901).- records were kept in a manner highly creditable to the This asylum is intended for private patients of the middle medical staff. and upper classes. The average number of patients resident during the year was 97, comprising 48 males and 49 females. The admissions during the year amounted to 13-viz., 9 VITAL STATISTICS. males and 4 females. Of these 12 were first admissions. Dr. James Neil, the medical superintendent, states in his HEALTH OF ENGLISH TOWNS. report that voluntary boarders are received at their own IN 76 of the largest English towns 7812 births and 5433 request and if the mental condition is not sufficiently unsound to permit of certification. Some of the admissions deaths were registered during the week ending Nov. 29th. were transfers from other asylums. "There is no doubt," rhe annual rate of mortality in these towns, which had says Dr. Neil, "that a considerable number of chronic, been 17-3, 17 4, and 169per 1000 in the three preceding incurable patients derive at least temporary benefit from weeks, rose again last week to 19’1per 1000. In London new surroundings, and when they become discontented and the death-rate was 19’4 per 1000, while it averaged 18 9 per fretful it is a good plan to give them a change of asylum."" 1COO in the 75 other large towns. The lowest death-rates This plan has been followed in the case of patients with in these towns were 7.7 in Ipswich, 8’5 in Bournemouth, delusions of suspicion who got into the habit of complaining 9’2 in Reading and in York, 9 5 in Croydon, 10’2 in of various unreal grievances and the results have been, at Coventry, and 11.1 in Leyton ; the highest rates were 23’4 least temporarily, satisfactory. The total number of deaths in Wolverhampton, 23-6 in Rhondda, 24’2 in Oldham, Two of the deaths 25-5 in Liverpool, 27 2 in Newport (Mon.), 29-1in during the year amounted to five. occurred in male patients about a week after admission. One Tynemouth and 29 2 in Hanley. The 5433 deaths in these of these was admitted in the last stage of general paralysis, towns last week included 531 which were referred to and the other, a young man, aged 25 years, was suffering the principal infectious diseases, against 558, 509, and 511 from acute delirious mania and sank irom exhaustion. A in the three preceding weeks; of these 531 deaths, 186 patient who had "practically recovered and was absent on resulted from measles, 92 from diphtheria, 79 from probation"committed a murder and then killed himself. diarrhoea, 68 from whooping-cough, 63 from scarlet fever, ’ Those who are conversant with the care of the insane are 42 from "fever" (principally enteric), and one from well aware," adds Dr. Neil, "that the best forethought and small-pox. No death from any of these diseases was the most careful precautions will sometimes prove ineffectual registered last week in Brighton, Bournemouth, Northto prevent such tragedies. If patients are to be discharged at ampton, Ipswich, Smethwick, Aston Manor, Leicester, all a certain number of unexpected and sudden relapses must Barrow-in-Furness, Rotherham, or York ; while they caused take place and these relapses must occaionally be attended the highest death-rates in Hastings, Hanley, Walsall, West and by risk." The number of patients discharged as recovered Bromwich, Liverpool, Wigan, Salford, Tynemouth, during the year amounted to six, or 6 2 per cent. of the Rhondda. The greatest proportional mortality from measles
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