MORTALITY IN DUBLIN AND OTHER IRISH TOWNS IN 1887.

390 Council on the 19th ultimo be confirmed, with the ROYAL COLLEGE OF SURGEONS OF ENGLAND. ordinary of the amendment to the exception reply from the Council

the Privy Council, moved by Mr. Macnamara and seconded by Mr. Willett, and that such amendment be expunged from the Minutes." The votes of the Council were thereupon taken on this amendment; and on the demand of Mr. Willett and Mr. Macnamara the names of those voting for and against the same were directed to be entered on the Minutes-viz :-. Minority for the amendment, 2: Mr. T. Bryant and Mr, C. Heath. Majority against the amendment, 17: Sir James Paget, Bart., Sir T. Spencer Wells, Bart., Mr. J. Marshall, Mr. E. Lund, Mr. H. Power, Mr. J. Hutchinson, Mr. W. Cadge, Sir Joseph Lister, Bart., Mr. J. Croft, Mr. S. Jones, Sir William Mac Cormac, Mr. G. Lawson, Mr. N. C. Macnamara, Mr. 0. Pemberton, Mr. S. W. Sibley, Mr. R. Harrison, and Mr. Willett. Five did not vote: the President, Mr. T. Smith, Mr, J. W. Hulke, Mr. M. Berkeley Hill, and Mr. A. E. Durham. The amendment was consequently lost. Thus, not only were certain members of the Council opposed to the amendment to the Reply sent to the Lord President, but they attempted to suppress any official evidence that it had been brought forward. The minority reply, in our opinion, ought to have been forwarded by the Council to the Lord President. to

IT is much to be regretted that the Council of the College, when they forwarded their Reply to the Lord President of the Privy Council in answer to the statement presented to the Lord President on behalf of the Association of Fellows, did not also send with the Reply a copy of the resolution which was proposed as an amendment, and which expressed the opinion of a minority of the members .of Council. From the printed copy of the Minutes of that meeting (held on Jan. 19th) posted in the Hall of the College, we find that a most important amendment was brought forward, which we now publish in full. The reply itself will be found in the issue of THE LANCET of Feb. 4th, p. 242. It

follows :Moved as an amendment by Mr. Macnamara, seconded by Mr. Willett: "That paragraph 5 and all the succeeding paragraphs be omitted, and that in place thereof the following be inserted :-5. The Council desire to state they are in accord with the four resolutions passed at the meeting of Fellows and Members on March 24th, 1884, which are set out in paragraphs 9 to 12 of Mr. Pollock’s statement to the Privy Council. 6. The Council believe that the authority and lllfluence of the College would be enlarged and strengthened if the proposed Supplementary Charter contained clauses giving effect to thoe resolutions. 7. The Council are of opinion that the precedent established in 1843, when, in the Charter obtained in that year, provision was made for calling an annual meeting to elect members of Council, should be followed now that the Council have decided to call an annual meeting to which a report from the Council shall be presented. 8. Seeing that the practice of annual election of the President by seniority merely has ceased to exist, the present President being now in his third year of office, the Council are willing to consider whether the continuance of this altered custom should not be ensured by empowering the Fellows to elect the President and Vice-Presidents on some scheme of the candidates for these offices being nominated by the Council to the Fellows. Such a scheme, when settled, would require to be enacted in the Charter, as it would entail the calling of an annual meeting of Fellows. 9. The Council recognise the fact that, unless the calling of the annual general meeting of Fellows and Members, and the alteration in the custom of electing the President, are made obligatory by the terms of the Charter, there is a risk of these concessions becoming inoperative, inasmuch as at present their continuance depends only on the decision of the Council. 10. The Council regret that, when issuing a circular to the Fellows in 1887, with the object of obtaining their opinion on the questions of Members of the College being empowered both to vote at the election of members of Council and to be eligible for seats in the Council, they did not address inquiry to the Fellows with the object of learning their opinion as to the Fellows electing the President; but, seeing that during the four years the agitation of this subject has lasted noremonstrance from any Fellow has been received by the Council, it may be assumed the Fellows at large really desire this change. Moreover, it would appear inconsistent to speak of the Fellowship representing a higher grade than the Membership, and to admit the qualification of the Fellowship as an elective body for the membership of Council, and yet to doubt the capacity of the Fellows to elect their own President, or, if capable, to infer they are not to be trusted with the duty. The Council feel that this change will have the effect of approximating the constitution of the College to those of all the Royal Colleges of Physicians or of Surgeons in England, Scotland, and Ireland, in every one of which, under their Charters, the President is elected by the Fellows, and also in all of which, with one exception-viz., the Royal College of Surgeons of Ireland-the Fellows meet at stated periods in their respective Colleges to discuss and approve the acts of the Council." And the votes of the Council having been taken, the amendment was lost. two members onlv voting in favour thereof. From the Minutes of the ordinary meeting of the Council held on Thursday, Feb. 9th, which are also posted in the Hall of the College, we find that it was moved as an amendment to a motion to confirm the Minutes by Mr. C. Heath, seconded by -Alr. Bryant: "That the Minutes of the extrawas as

MORTALITY IN DUBLIN AND OTHER IRISH TOWNS IN 1887.

Registrar-General for Ireland has just issued his Yearly Summary of the weeky returns for the city of Dublin during last year, which throws a good deal of light upon the constant and striking excess of mortality in that city compared with that which prevails in London and Edinburgh. The death-rate in Registration Dublin in 1887 was 30 5 per 1000 of the estimated population, against 19’6 in London and 19’8 in Edinburgh. The death-rate in the city THE

proper last year was 33’2 per 1000, whereas in the suburbs the rate did not exceed 21’2. The death-rate in Dublin last year exceeded the rate recorded in any year since 1880, but the mean annual rate in the ten years 1877-86 was 296, showing that this waste of life in Dublin has, at any rate, been constant during the last eleven years. The death-rate in Dublin at each age-period is excessive, but especially large is the excess of mortality among children. The deaths of infants under one year of age was equal to 200 per 1000registered births, while it did not exceed 158 in London and 137 in Edinburgh. The deaths among children under five years of age were last year equal to 102’9 per 1000 children estimated to be living at those ages, while the mean death-rate at those ages in London in recent years has not exceeded 630 per 1000. If we look to the causes of death, we find a general excess of mortality from all classes of diseases, but especially from diseases of the zymotic class. The deathrate from the principal zymotic diseases in Dublin last year was 5’2 per 1000, against 3’02 in London and 279 in Edinburgh. The most fatal zymotic disease in Dublin last year was measles, which caused a rate of 1’46 per 1000, more than double the average rate in Dublin, or the rate last year in London. The rate from diarrhoea was 1’30, and also considerably above the average; and the rate from scarlet fever (0’74) also showed a slight excess upon the average, and was. considerably more than twice the rate that prevailed in London. The rate from "fever" was 0’54, and very considerably below the average rate in the ten preceeding years, but more than three times the rate from this cause in London. It is noteworthy that, of 192 deaths from "fever" in the year, 24 were from typhus, 135 from enteric fever, and 33 from other and ill-defined forms of fever. The rate from whooping-cough was below the average, and that from diphtheria only slightly exceeded the average, both rates being considerably below those prevailing in London. Only one death from small-pox occurred in Dublin last year, and only 3 deaths from this disease have been registered in the city since May, 1881. The deaths from phthisis in the city last year gave a rate of 3 6 per 1000, the mean rate in London being 2’1; while the rate in Dublin from diseases of the respiratory organs was 6 2, against 4’4 in London. From whatever point of view the mortality statistics of Dublin be regarded, they afford the

391 conclusive evidence of a health-condition which, in the congratulated upon the erection of a building well present state of hygienic knowledge, reflects the strongest calculated to promote the efficient carrying out of a condemnation on the Dublin sanitary authority and on the difficult portion of their work. ratepayers who elect them. Dr. Grimshaw publishes in

most

Yearly Summary a continuation of his interesting table of mortality in the various occupational or social classes of the Dublin population. His table shows that the death-rate in Dublin last year ranged from 145 per 1000 in the professional and independent class, to 38’2 in the general service class, including the deaths in workhouses. It is to be regretted that no attempt is made

this

NEURO-KINESIS, NEURASTHENIA, HYSTERIA.

figures for differences of age-constitution in the various classes, which go far to destroy their value for comparative purposes. The yearly summary also contains mortality statistics for fifteen other urban sanitary districts of Ireland, from which it appears that the deathrate in 1887 ranged from 15’5 and 17’0 in the two small towns of Armagh and Lisburn, to 25’9 in Belfast, 26’0 in Waterford, and 26’1 in Kilkenny. The mean death-rate in sixteen of the largest town districts of Ireland, including Dablin, was 26’2 per 1000, against 20’8 in the twentyeight largest towns of England and Wales, affording a most unfavourable commentary on the sanitary condition of the urban population in Ireland.

THE following communication from Mr. Hovell was addressed to Dr. Gervis, President of the Hunterian Society, and is intended as a kind of postscript to his paper on " Hysteriaread before the Society a short while ago :— " Dear Mr. President,-It seems to me that some word is needed to define the condition of the nervous system whieh ensues upon shock, either physical or moral, or break-down from overstrain, more closely than neurasthenia, which may mean a natural state, or hysteria, which implies a special source or cause. This condition-which is attended by loss of physical power, paresis, &c.; by loss of moral power,

to correct these crude

irresolution, &c.;

by susceptibility

to

pain, hypersesthesia,

and irritation in all forms ; by a readiness to take on perverted action, paroxysm or emotion, on the one hand, or to fall to pieces, as it were, as if the screws were loose or fallen out, prostration of power, on the other; by a loss of integrity of nerve power or of some element that is essential to itmight, perhaps, be represented by neuro-kinesis :i.e., nerve NEW WORKHOUSE INFIRMARY, BIRMINGHAM. shock or shaking, or nerve commotion. " Revision and improvement in nomenclature necessarily attend upon advance of science. No one in the present THis is one of the most elaborate buildings of the kind we would think of confusing typhus with typhoid fever, or day are acquainted with, replete with every advantage afforded of adopting in the one case the treatment suitable for the by modern knowledge, plain, substantial, and admirably other. So the emotion which so frequently ensues upon adapted to the purposes for which it is intended. Now rapidly shock is simply emotion. It is not hysteria. To call it approaching completion, it will be ready for occupation in hysteria is to attribute to a natural consequence a special which does not appertain to it. Obviously, the treatJuly, and doubtless will form an important feature in the cause of emotion per se, and that of hysteria per se, ought ment control exercised by the guardians over the sick poor of the to be essentially different. " town. Designed by Mr. W. H. Ward, architect, and built by Again, loss of power of the will, of self-reliance, irresoW. Bissett and Sons of Sheffield, it covers a site of fourteen lution, &c,, is another effect and result of shock. This conacres, arranged on the pavilion system for the accommodation dition palpably stands in need of help to restore the will of 1GOO patients, at a cost of .660,000. The pavilions areI which is in abeyance, and to rouse to resolute action the eleven in number, on either side of a central corridor 10 feet power that is temporarily prostrated and suspended. If wide and 234 yards long. Each pavilion is three storeys inthis need of aid is ignored because it is either not recognised or misunderstood, it becomes an unrelieved want, the height, a storey forming a ward 90 feet long by 26 feet wide; repeated representation of which by the patient is very will admit of 1 toeach ward, this, allowing twenty-five patients to be misinterpreted into " craving for sympathy " by liable an air space of 1000 cubic feet to each patient, and a verandah for convalescent patients; while at either end of each there is a the doctor, who thus fails to see the true state of the case. Let the patient once see that her condition is rightly underroom for cases difficult to deal with, bath-room, and lavatory, nurses’ room, scullery, and linen store. A separate building; stood, and that it will meet with attention, and this forms the nurses’ home, where each one-seventy-two in reputed craving will cease. At least, this is in accordance number-will have a room to herself, with a large recreation1 with my experience. When once hysteria ceases to be a hall in common. The medical staff have also a separate> disorder with which everyone is familiar, but which nobody the treatment will become more rational and building, bedroom and sitting-room being devoted to each, understands,’ with a common dining-room and library; a room being sett more successful. Hitherto it has represented neither the nor the art of medicine. apart also for the use of the visiting physician. The adminis"am, Sir, yours truly, trative block occupies commodious premises; and a little " D. DE BERDT BERDT HOVELL. e distance from this is a laundry and mortuary, the latter fittedi "To the President of the Hunterian Society. Feb. 10th, 1888." for are examinations. Provisions made B up post-mortem for dealing with infectious patients and their clothes in0. =*’’’=’’==’"’=’=’=: connexion with their admission to the workhouse or the WORK AT THE DALRYMPLE HOME. infirmary, in a manner to leave as little chance as of of disease the inmates. possible any spread among The ventilation arrangements are of a complete kind, warm A PAPER was read by Dr. Norman Kerr, at a meeting of air being admitted above the heads of the patients, and the Medical Temperance Association, on the 21st inst., on finding exit by gas ventilators in the ceiling, or through five years’ work at the Dalrymple Home for Inebriates, perforated zinc squares at the same level. The wards them- Rickmansworth. There had been 115 patients treated in selves are each warmed by two Manchester stoves supplied under the Home-54 Habitual Drunkards the Act, and 61 with air from outside, the products of combustion being carried downwards by a flue beneath the flooring. The privately, after an average residence of seven months; 35 walls will be painted and whitewashed, while the floors are were admitted for twelve months, 13 for six months, 19 for formed of concrete and iron laid with oak blocks. Watei three months, besides others for varying terms. The average mains and hydrants are well distributed through the age on admission was thirty-five, and the average duration building; hydraulic lifts will add to the convenience 01 ot habit eight years and a half. There were 93 cases from moving heavy articles, and a service corridor running England, 5 from Scotland, 7 from Ireland, 2 from France, under the main corridor will greatly facilitate the ad. and 1 each from Switzerland, Australia, New Zealand, Cape ministrative work of the institution. The long corridor Colony, the United States, South America, Canada, and India. spoken of is open to the air; though in fine weathe: Four had only an elementary education, but the remainder this will be an advantage, it will probably be found tha were well educated, 27 having graduated. The professions practically some alteration will be necessary to ensur, were well represented. There were 28 gentlemen of private due comfort to the residents during inclement weathei fortune. There was a history of heredity of inebriety in 20 ’The entire arrangements have been carried out wit,] cases, and of insanity in 10. In7 cases, chloral, chlorodyne, much care, and, though not without opposition in th I opium, or morphia was associated with alcohol. There were conduct of this essential duty, the guardians are to b I 22 of a phlegmatic temperament, and the rest of a nervous ,

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