541

useful for mental symptoms as well as for those of

pulmonary tuberculosis.Royal -Edinburgh Asylum at 21forningside (Annual Report

for the Year 1910).-The average number resident duringthe year at this asylum was 752. The total number ofadmissions was 195. Alcoholic excess appears to haveexisted as an etiological factor in 12-3 per cent. of theadmissions. Among males the percentage of so-calledalcoholic insanity was less than it has ever been before,although among females it has steadily risen during thelast three years, and last year was 11’ 2 of the total admis-sions of women. Dr. G. M. Robertson, the physician-superintendent, notes that, in spite of the acute politicalexcitement of recent years, no cases can be attributed to it.

" Judging by their effects on the brain of the ordinary man.the interest taken in politics, and the disturbance it produces,must both be of the most shallow and superficial nature."Seventy patients were discharged recovered and 59 un-

recovered, the recovery rate being 36 per cent. of the totalnumber of admissions. The deaths numbered 60, whichis 8 per cent. of the average number resident. Post-mortemexaminations were made in 36 instances. In administrativematters Dr. Robertson has endeavoured to remove all features

peculiar to asylums and to convert the institution into a

hospital for the treatment of a special disease. Insanity isvery frequently associated with physical exhaustion, and itstreatment should therefore be conducted by a staff and bymethods similar to those employed for the treatment of otherdiseases.

Brighton County Borough Asylum at Haywards Beath

(Annual Report for the Year 1910).-The average dailynumber resident was 842. Admissions numbered 259, ofwhom 117 were males and 142 were females. Ninety personswere discharged, of whom 35 were males and 55 werefemales. Of the males 17 had recovered, being a percentageof 30’ 4 on the admissions. Of the females 26 had recovered,being a percentage of 31-7 on the admissions. Thedeaths numbered 51, the rate on the average daily numberresident being 6’1 per cent. The mean age at death forboth sexes was 58’ 7 years-for males 55°0, and for females61’ 8. In only 50 per cent. of the deaths were post-mortemexaminations held.

Cumberland and Westmorland Lunatic Asylum (AnnualReport for the Year 1910).-The daily average number of

patients resident at this asylum during 1910 was 853.179 patients were admitted, of whom 174 were directadmissions. Twenty-eight of those admitted had been pre-viously treated in the asylum, and 24 of these had recoveredat the time of their last discharge. The average time thesehad remained away from the asylum was 4 years 11 months.In causation, heredity was the commonest factor and wasascertained in 38 cases, or, including epileptic heredity, in41 cases. Alcoholic excess was a factor in 21 cases, andmental stress preceded the attack in 16 cases. Dischargesnumbered 105, there being 68 recovered, 20 relieved, and 17not improved. The recovery rate on the direct admissionswas 39’1 per cent. Of the recovered, 17 were at the asylumfor less than three months, 23 from three to six months, 6from six to nine months, and 11 for more than a year. Fifty-three of those who recovered were brought to the asylumwithin three months of the onset of the attack. Dr. W. F.Farquharson,, the medical superintendent, points out that theearlier a patient is brought under treatment, removed to anew environment where he can have the services of speciallytrained nurses, and withdrawn from the well-meant attentionof relatives and neighbours, the more speedily does recoverytake place. Seventy-eight patients died during the year andthe rate, calculated on the daily average number of patientsresident, was 91 per cent. In every case a post-mortemexamination was made.

THE BRITISH FIRE PREVENTION COMMITTEE.-Aspecial commission of officers of this committee has leftLondon for Paris to study the fire preventive and fire servicearrangements of the French capital and its suburbs. Thecommission, for whom an extensive programme of work hasbeen prepared by the French Government, comprises thechairman, Mr. Edwin 0. Sachs, Mr. Ellis Marsland (honorarysecretary), Mr. Horace Folker (honorary treasurer), LordLondesborough, Mr. H. Dyer, Mr. Percy Collins, LieutenantSpencer, R.N., and Mr. Boyce-Podmore.

Public Health.ANNUAL REPORTS OF MEDICAL OFFICERS OF HEALTH.

Bombay.-According to the report on public health adminis-tration in Bombay for 1910, presented by Dr. J. A. Turner,the executive health officer, there has been a notable improve-ment in respect to the mortality from plague, cholera, andphthisis, though a slight increase has occurred in the numberof deaths under the heads of small-pox, measles, fevers,diarrhoeal and respiratory diseases. The total number ofdeaths was 34,933, giving a death-rate of 35 72 per 1000 ona population of 977,822 ; this was the number of inhabitantsas determined by the census of 1906, and no correction hasbeen applied for any increase in the five years that havesince elapsed. After deducting deaths of new arrivals, andadding deaths in sanatoriums outside the city of personsbelonging to Bombay, the corrected death-rate is 35-13 per1000. The actual number of deaths is, indeed, smaller thanin any year during the past decade, with one exception,the main cause being decrease in plague mortality. Out ofthe total ratio of 35-72, the most important item isthat of respiratory diseases, causing 8-39, comparedwith a ratio of 10-30 for 1900-1909; plague caused 3-73,a notable reduction on 14 17, the decennial average ; feversaccounted for only 3-18, also a satisfactory figure comparedwith 5’37 for the decennium; phthisis (2-33) and diarrhoea(2-20) were also less fatal. The zymotic death-rate of 9-89compares favourably with that of the preceding three years(11-90). and still more with that of the decennium (24-33).There was a considerable increase in small-pox and measlesover the preceding year, but variations from year to year areof small consequence unless maintained. Amongst thevariety of races inhabiting Bombay a considerable differenceaxists in regard to mortality ratios; compared with thegeneral rate of 35-72, we find for Mussulmans it was 51-10,for native Christians 48’73, and for Jews 36 33; while forEurasians it was 32-47, Buddhists 31 69, Hindus 32-41, andfor Parsis only 27-30. The European ratio of 18 50 is

obviously hardly comparable, as the conditions of life here areso different. The high mortality among Mussulmans (chieflyfrom phthisis, respiratory and nervous diseases) is ascribed totheir density of population, their ill-ventilated houses, andthe purdah system of seclusion for their women. NativeChristians suffered especially from fevers, diarrhoea! and

respiratory diseases, and small pox. The most noticeablefeature of the public health during the year was thereduction of plague mortality to 3-73 per 1000, thelowest ratio since 1896 ; the disease has not decreased invirulence, as the case-mortality stands at 88 - 52 per cent., afigure exceeded in three years only since 1896. March, April,and May were the months of chief incidence (915 deaths inApril) ; in December there were only 32 deaths. Small-poxwas epidemic from February to May, its spread as usualhaving been aided by continual importations from outside,especially by pilgrims returning from Jeddah. Arrangementshave now been made to vaccinate pilgrims, when possible,before leaving India for Mecca, and a specially trainednurse has been deputed to vaccinate females. Great benefitwill doubtless result from this important step in advance.A great deal of anti-malarial work has been carried out, inthe way of inspection of wells, applying pesterine, and insome instances filling in or closing them; stocking withsmall fish to eat the larvaa has been tried, but withoutsuccess, though further trials are to be made. The matteris a difficult one to deal with as religious prejudices in manycases come in the way. Malarial fever accounted for 293deaths, a ratio of 0 - 29 per 1000, being slightly in excess ofthe quinquennial average (0.26).1 Among the chiefadministrative measures undertaken were anti-plague inocula- ions, of which 5043 were performed ; the destruction ofmore than half a million rats ; and the formation of semi-permanent health camps. Dr. Turner advises the municipalityto erect suitable refuse destructors ; the rapid disposal of townsweepings is of the greatest importance in eastern cities, andthere can be no doubt that Bombay would be well advised totdopt this method. Motor vans forthe removal of town refuse

1 In addition 2630 deaths are returned under "Ague and RemittentFever." What are these, if not malarial? And what does "malarialfever" include without them ?

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have been introduced with satisfactory results, being actuallyless expensive to work than the old bullock carts. We regretto learn that, in spite of all that has been written and saidwithin the last few years about town planning, greatnumbers of new buildings are being erected in the northernpart of Bombay in a crowded and insanitary manner, andwithout proper means of access. No protest has been madeapparently against the erection of such buildings on landwhich is not properly laid out. Bombay is now the thirdcity under British rule in point of population ; its healthconditions are a matter of imperial interest. Dr. Turnerhas a very difficult task, and we wish every success to hisstrenuous efforts for the public good.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

Is 77 of the largest English towns 7072 births and 5770deaths were registered during the week ending August 12th.The revised estimate of the population of these towns in themiddle of this year is 16,157,797 persons. The annual rateof mortality in these towns, calculated on this revisedestimate, which had been increased from 11-8 to 15.9 9

per 1000 in the four preceding weeks, further rose to 18 6in the week under notice. During the first six weeks ofthe current quarter the annual death-rate in these townsaveraged 14’0 per 1000, while in London during the sameperiod the mean annual death-rate did not exceed 13’ 6per 1000. The recorded annual death-rates in the 77 townslast week ranged from 7’3 in Barrow-in-Furnesp, 8-0 0in Stockton-on-Tees, 8 9 in King’s Norton, and 9.2 inBournemouth, to Z6 - 4 in Aston Manor, 28-0 in Stoke-on-Trent and in St. Helens, 29- 7 in West Bromwich, and 38 - 1in Dewsbury. The 5770 deaths from all causes in the 77towns last week exceeded the number recorded in the

previous week by no fewer than 830, and with one excep-tion was the highest number recorded in any week during thecurrent year. These 5770 deaths from all causes included 2103which were referred to the principal epidemic diseases,against numbers increasing from 268 to 1340 in the six

preceding weeks, and included no fewer than 1927 frominfantile diarrhoea, 60 from whooping-cough, 50 frommeasles, 24 from diphtheria, 23 from scarlet fever, and19 from enteric fever, but not one from small-pox. Themean annual death-rate from these epidemic diseases wasequal to 6’ 8 per 1000, against 2-3 and 4.3 in the two

preceding weeks. The deaths of infants under two yearsof age attributed to diarrhceal diseases in the 77 towns,which had increased from 70 to 1168 in the six pre-ceding weeks, farther rose last week to 1927, and causedthe highest annual rates of 11-7 in Wigan and in Daws-bury, 12 - 2 in West Bromwich, 12-4 in West Ham, 13.1 inStoke-on-Trent, 14 - 0 in St. Helens, and 16.0 in Aston Manor.The deaths referred to whooping-cough, which had increasedfrom 43 to 57 in the four preceding weeks, further rose lastweek to 60 ; 26 deaths were registered in London and itssuburban distIicts, 4 in Liverpool, 3 in Leeds, and 3 in Cardiff.The fatal cases of measles numbered 50, and were 3 less thanthe number returned in the previous week ; 15 deaths wererecorded in London and its suburban districts, 4 in

Liverpool, and 3 each in Wolverhampton, Nottingham,Manchester, and Salford. The deaths from diphtheria,which averaged 41 in the three preceding weeks, declinedlast week to 24, and included 9 in London and its suburbandistricts, 3 in Sheffield, and 2 each in Stoke-on-Trent,Salford, and Bradford. The 23 deaths referred to scarletfever were 9 in excess of the number in the preceding week,and included 7 in London and its suburban districts, 5 inLiverpool, 2 in Birmingham, and 2 in Coventry. The deathsattributed to enteric fever, which had been 11, 11, and8 in the three preceding weeks, rose to 19 last week,and included 5 in London, 2 in Bradford, and 2 in Leeds.The number of scarlet fever patients under treatmentin the Metropolitan Asylums and in the London FeverHospital, which had steadily increased from 982 to1433 in the 17 preceding weeks, had further increasedto 1442 on Saturday last ; 159 new cases of this diseasewere admitted to these hospitals during the week, against199, 209, and 191 in the three previous weeks. Thesehospitals also contained at the end of last week 823

cases of diphtheria, 256 of whooping-cough, 238 ofmeasles, and 38 of enteric fever, but not one ofsmall-pox. The 1619 deaths from all causes inLondon last week showed an increase of 275 uponthe number returned in the previous week, and in-cluded 90 which were referred to diseases of the

respiratory system, against 115 and 91 in the two

previous weeks. The deaths attributed to different formsof violence in the 77 towns, which had been 173 and 223in the two preceding weeks, declined to 162 last week, and373 inquest cases were registered. The causes of 26, or 05per cent., of the deaths registered in the 77 towns duringthe week under notice were not certified either by a registered-medical practitioner or by a coroner. All the causes ofdeath last week were duly certified in Manchester,Sheffleld, Leeds, Bristol, West Ham, Bradford, Hull,Nottingham, and in 52 other smaller towns; the 26 un-certified causes of death last week included 6 in Bir-

mingham, 4 in Liverpool, and 2 in Grimsby.

HEALTH OF SCOTCH TOWNS.

In eight of the principal Scotch towns, having an esti-mated population of 1,710,291 persons in the middle of this-year, 793 births and 471 deaths were registered during theweek ending August 12th. The annual rate of mortality inthese towns, which had been equal to 14 9 and 13’8 per 1000’in the two preceding weeks, rose to 14 - 4 last week, andwas equal to the mean rate in these towns during the firstsix weeks of the current quarter, but was 0-4 per1000 above the mean death-rate during the same period inthe 77 large English towns. The annual death-rates in theScotch towns last week ranged from 12’ 2 and 12 5’in Edinburgh and Aberdeen to 16 0 in Perth and 21.5in Greenock. The 471 deaths from all causes in the

eight towns last week were 19 in excess of the numberin the previous week, and included 99 which were

referred to the principal epidemic diseases, against 73and 62 in the two preceding weeks ; of these 99 deaths,70 resulted from diarrhoea. 11 from measles, 9 from

whooping-cough, 5 from diphtheria, 2 from enteric fever,1 from scarlet fever, and 1 from small-pox. Themean annual death-rate from these epidemic diseases inthe eight towns last week was equal to 3-0 per 1000,the mean rate last week from the same diseases in the 77English towns having been 6 - 8. The deaths from diarrhoea,which had been 40 and 33 in the two preceding weeks,rose last week to 70, and included 59 of infants undertwo years of age ; 49 deaths occurred in Glasgow, 6 in Edin-burgh, and 6 in Greenock. The 11 deaths referred tomeasles were equal to the number in the previous week,.and included 4 in Glasgow, 3 in Aberdeen, and 3 in Leith.The 9 fatal cases of whooping-cough were 2 in excess of thenumber returned in the preceding week, and included 5 inGlasgow and 3 in Paisley. The 5 deaths attributed to

diphtheria were equal to the average in the three precedingweeks, and included 2 in Glasgow. The fatal cases ofenteric fever were registered in Glasgow and Edinburgh, thatof scarlet fever in Glasgow, and that of small-pox inDundee. The deaths referred to diseases of the respiratorysystem in the eight towns, which had been 48 and32 in the two preceding weeks, rose to 39 last week, butwas 8 below the number in the corresponding week of lastyear. Of the 471 deaths from all causes in the eight townslast week, 143, or 30 per celt., were recorded in publicinstitutions, and 22 were attributed to different forms ofviolence. The causes of 13, or 2 - 8 per cent., of the deathsin the eight towns last week were not specified or not

certified ; in the 77 English towns the proportion of un-certified causes of death during the week did not exceed0 5 per cent.

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HEALTH OF IRISH TOWNS.

In the 22 town districts of Ireland, having an estimatedpopulation of 1,149,495 persons in the middle of this year,595 births and 377 deaths were registered during the weekending August 12th. The annual rate of mortality in thesetowns, which had been 16 8, 16 4, and 16 - 8 per 1000 inthe three preceding weeks, rose to 17’ 1 per 1000 in the week

under notice. During the first six weeks of the current

quarter the annual death-rate in these towns averaged16 3, whilst the mean rate during the same period did no