899

visit is referred to as being from lid. to 8d., the figures mostfrequently quoted being 2d. to 3d. If we take 3s. 6d. as themean subscription per head per annum and 4d. as the meanvalue per visit, this gives 10 5 visits per member perannum.

In certain cases the actual numbers of members of clubsand the consultations given and visits paid are stated.These numbers when totalled amount to 52,551 members whorequired 226,446 attendances, or an average of 4’30 attend-ances per member. These numbers are not absolutelycorrect, for in the case of Hull the numbers are only givenin round thousands, and in the case of Northampton thenumber of members is an estimate only. The difference inresult between these two methods of calculating is somewhatlarge, but it is probable that the true average lies somewherebetween the two, and probably nearer to the lower figurethan the higher, and it would probably be safe to put thenumber at six visits per member per annum.

In order to pay 2s 6d. per visit on this basis the capitationfee would have to be 15s.

I am, Sir, yours faithfully,Ramsgate, March 25th, 1912. FRANK MILTON.FRANK MILTON.

MANCHESTER.

(FROM OUR OWN CORRESPONDENT.)

The Need and Advantages of I I School Clinios."AT the annual meeting of the Manchester, SIford, and

District Branch of the National Union of Woman Workers,which was held in Manchester on March 19th, interestingpapers on school clinics were read. Miss McMillan, speakingon "Education and Nurture," said that the need for schoolclinics rested on the fact that the majority of the children ofworking people were not sufficiently nurtured. This was not

entirely due to poverty, but partly to the condition ofindustrial life in this country, which had devastated homelife and destroyed the arts and crafts of motherhood.School clinics, said Miss McMillan, provide a new agencyin substitution to some extent for the p°ivate nursery.Mr. R. H. Tawney, in the course of an address on

"School Clinics," pointed out that we are putting an im-possible task on the teachers when we send the childrento school in an unhealthy condition. The Manchesterschool returns showed that one-third of the children haddefective eyesight at the school-leaving age. These diseasesincreased between 5 and 13, and it was obvious that thisevil was not to be remedied by leaving it alone. In the

majority of cases the parent3 were not in a position to secureproper medical advice and treatment, and the only effectiveway of dealing with the children was to establish schoolclinics in the city. The cost of two clinics larger than theone at Bradford would not amount to more than -15th to

- ls-th of a penny rate per year. In connexion withthe cost there must be taken into account the presentheavy loss of grants caused by the absence of childrenfrom school through illness-a loss which would beconsiderably reduced by the work of the clinics.A conference on "School Clinics," which was largely

attended, was held here on March 21st, when Dr. L°wisWilliams described the work that is being done in Bradford,and Mr. W. Jones gave an account of what is done inregard to the preservation of the teeth of school children inCambridge. Manchester so far has not adopted any systemof school clinics, chiefly because of the lack of anycompensatory grant from the Government. Dr. Williamspointed out that even to the untrained eye it was obviousthat a large number of scholars were being allowed to growup more or less physically deformed, and with the prospectof their future careers seriously threatened by the unenviablepossession of one or more of the defects so common duringschool life-such as defective vision, defective hearing,stammering, spinal curvature, decayed teeth, or adenoids, anyof which must interfere with the child’s capacity as a wageearner in adult life. Indeed, some defects debarred thementirely from certain occupations. Speaking of the establish-ment of a school clinic, he asserted that it should be adminis-tered by the education authority, if the three followingnecessary conditions are to be obtained : (1) The submittingof the children to treatment ; (2) their regular attendance

during treatment ; and (3) their speedy return to school aftertreatment. Mr. Jones stated that bad teeth undermined thehealth and happiness of 85 per cent. of school children.

Children’s Hospital and the Act.The yearly meeting of subscribers to the Manchester

Children’s Hospital was held on March 20th, when the annualreport was presented. The report states :-The passing of the Insurance Act has given rise to much-anxiety on

the part of voluntary hospitals, because it is feared that charitablydisposed persons may think that there is no longer any necessity fortheir support. When, however, it is realised that on the one hand themedical benefit given bv the Act does not in any way meet the cases ofthe vast majority of the inmates of hospitals, and will not lessen thedemands upon or the need for the work of such institutions, while onthe other hand the Act does not give the hospitals any right to a sharein public funds, it is to be hoped that the stream of private benevolencewill not be permanently affected....... But whatsoever view may betaken as to general hospitals, it should be remembered that the case asregards children’s hospitals is different. They do not cater for insuredpersons. The Act makes no provision for sick children beyond thepossibility that in some consumptive cases the children of insuredpersons may be admitted to sanatoria. If the support given to suchhospitals falls off, children will suffer just as they would have done Ifthe Act had not been passed.March 25th.

__________________

SCOTLAND.

(FROM OUR OWN CORRESPONDENTS.)

Bequest by Lord Lister to Edinburgh University.AT the monthly meeting of the Edinburgh University

Court, held on March 18th, it was intimated that the lateLord Lister had made certain bequests to the University ofEdinburgh. These included the insignia of the PrussianOrder of Knighthood and of the English Order of Merit; themedals received since his studentship from the Royal Societyand other learned bodies; diplomas, &c., conferred byscientific bodies, and various honorary gifts and distinctions.Among the latter are the caskets containing the freedom ofthe cities of London, Edinburgh, and Glasgow, and of theMerchant Taylors’ Company, and the trowel presented to himwhen opening a new nurses’ home at Montreal, together withhis portrait in oils. The Court resolved to record their highappreciation of the bequest as a testimony of Lord Lister’saffection for the University and city in which he began hisprofessional career, and of his having chosen the Universityof Edinburgh as the depository of these memorials of his fameand of his place in history as one of the great benefactors ofmankind.

Diploma in Psyohiatry.At the meeting of the Edinburgh University Court, held

on March 18th, it waR resolved to admit women medicalpractitioners to the University course on physiology of thebrain and nervous system for the diploma in psychiatry.

Royal Edinburgh Hospital for Sick Children.The fifty-third annual general meeting of the contributors

to the Royal Edinburgh Hospital for Sick Children was heldon March 20th. The directors’ report stated that the indoorcases during the year numbered 2031, as compared with 2034in 1910. Of these cases 1391 were medical and 640 surgical.In the out-patient department 24,513 cases had been treated,as compared with 28,315 in 1910. The ordinary income was5987 8s. 8d., while the ordinary expenditure had been.B8465 17s. 7d. As regarded the convalescent home thedirectors were satisfied that the cost of its maintenance,amounting to £777, was more than repaid by the benefit thepatients derived from residence there. During the year179 patients had been sent to the convalescent home fromthe hospital. The medical report drew attention to the factthat nearly half the out-patients were children under twoyears of age, which accounted for the fact that fully one-third of the beds in the hospital had to be relegated to thetreatment of infants. The staff suggested that it wasdesirable to consider the advisability of adding a milk dep6&to the therapeutic resources of the hospital, and the chairmanof the directors, in moving the adoption of the report, pointedout the need for further contributions if the scheme were tobe carried out, and a proposed balcony accommodationprovided.

900

Anmtallleport of the Crichton Royal Tnstititti(in, Dumfries,for the Year 1911.

At this institution the average daily number on the

registers was 865 - 8. During the year there were 202admissions, of which 159 were certificated and 38 voluntarypatients. Of the cases admitted 25 had had one or more

previous attacks of insanity, while 100 were suffering fromtheir first attack of mental disorder. The mean age onadmission was 45’ 2, the youngest being a girl of 15 and theoldest a man of 82. The exciting causes of the attacks,apart from distinctly nervous constitutions, inherited or

acquired, were most commonly of the nature of worry,affliction, shock, and similar psychical factors and variousantecedent bodily illnesses. It is reported that 35 personsadmitted were in fair bodily health, 70 were in poor bodilyhealth, and 20 in a weak physical condition. There were129 discharges representing 124 persons, 87 of whom had beencertificated and 37 voluntary patients. The recovery rate of thecertificated patients, based on the receptions, was 47’2 percent. The forms of mental affection recovered from werechiefly in order of frequency, melancholia, delusionalinsanity, mania, and confusional insanity. In 74 per cent.of the recoveries the mental illness had lasted in all less than a year. The deaths numbered 43 certificated patients and2 voluntary boarders ; the death-rate of the former, based onthe average resident population, was 5-2 per cent. Theprincipal causes of death were affections of the heart in 12cases, exhaustion from melancholia and mania in 7 cases,senile decay in 5 cases, and general paralysis in 4 cases.Only 2 patients died from tuberculosis. Necropsies were heldin 79 per cent. of the deaths. Dr. 0. C. Easterbrook, thephysician superintendent, writes that it is difficult to say towhat extent the far-reaching and unwieldy NationalInsurance Act, 1911, will apply to the institution. Shouldthe Act apply it will be an egregious burden and hardship,for it will ensure only a modicum of the benefits at presentenjoyed by those employed on the permanent staff, theinstitution officials being pensionable and receiving duringillness full wages in addition to medical treatment andattendance, and the wives and children of married men

living on the estate being also, during their much morefrequent illnesses, attended by the resident medical staff.March 25th.

__

IRELAND.

(FROM OUR OWN CORRESPONDENTS.)

Hiqh Death-rates in Ireland.THE death-rates in several Irish towns have reached

abnormally high figures in the past few weeks. In theDublin registration area, for the week ending March 16th,the death-rate was 31-8 per 1000 per annum. Curiously itwas less in the city, 31’1, than in some of the suburban

townships-Rathmines and Rathgar 36-2, and Kingstown42’4. In some provincial towns the rates were also veryhigh. Thus, in Ballymena the death- rate reached 36’7, andin Kilkenny 44 - 6.

Dublin Hospital Sunday -Pund.After some years’ falling off the Dublin Hospital Sunday

Fund last year realised £3454 6s. 9d., an increase of £113 98.over 1910. The hospital football match contributed £100.

Disgraceful Befiavio2cr at Ballinrobe.At a recent meeting of the Ballinrobe, co. Mayo, Poor-law

guardians one of the guardians proposed a motion to rescindan increase of medical salaries passed at a previous meeting.The meeting was packed with visitors armed with sticks,who violently shouted down the medical officer, the LocalGovernment Board inspector, and others who essayed to

speak against the motion, which was carried by 14 to 10. If,however, the Local Government Board had sanctioned theincrease, it could not legally be altered or reversed.

The Dental Hospital of Ireland.The annual report of the Dental Hospital of Ireland, issued

a few days ago, states that the number of cases treated

during the year amounted to 48,370. There were 2183

operations under anaesthetics. The J umber of students onthe roll of the school during the year was 48.

The Insurance Act Leotzcrca.

Some of the lecturers appointed under the Insurance Actto enlighten the public are giving very pleasing, though itmay be feared not altogether accurate, information. Forinstance, at a meeting held in Belfast on Feb. 19th, a

paid lecturer stated, according to the local papers, thatthe Act would provide from the very first sanatoriumbenefit which would remove at one stroke the whole con-sumptive population and send them back free from con-

tagious disease in a year, thus relieving the rest of the

population from danger of contamination. During 1910 thepublic health department of the city of Belfast dealt with1173 cases that were either voluntarily or compulsorilynotified as tuberculosis of the lungs It would be a tallorder to provide sanatorium treatment for them all ; and tosay that after a year’s residence in a sanatorium they wouldreturn "free from contagious disease " is absurd. It showsthe nonsense of appointing lecturers to deal with a subjectabout which their knowledge is nil.

A Libel Case.

In a libel action brought at Belfast Spring Assizes onMarch 19th and 20th, by a dairyman against the BelfastNorthern Whig, on account of an article stating that theBelfast Health Committee claimed to have found the causeof the outbreak of diphtheria in the milk coming from acertain farm, and recounting the evidence on which the com-mittee’s assertion was made, the jury, after only five minutes’absence, rendered a verdict for the Northern Whig with costs.

Down County Infirmary.From the annual report it appears that the total income

for the year ended Dec. 31st, 1911, was Z2403 15s. 8d., andthe expenditure £2444 18s. ld., leaving a balance due ofE41 2s. 5d. During the year 2027 were treated, 716 in

hospital, and 1311 in the extern department.Kitohen used as a Cow-house.

On March 21st, at Newtownstewart petty sessions, a farmersummoned a servant for leaving his work before his period ofhired service was completed. The evidence showed thatabout Feb. 18th one of complainant’s cows became sickand was brought into the kitchen, where it calved. Itremained there for nine days, when it died. The milk whichwas sent to the creamery passed through this kitchen,and the servant actually had to sleep in this kitchen. Theservant said he had not been in good health, but put up withit as long as he could. The case was dismissed, the defendantbeing allowed 10s. costs. What is the use of veterinaryinspectors when such a state of affairs is tolerated ? March 26th.

PARIS.

(FROM OUR OWN CORRESPONDENT.)

The Struggle against Alcoholism.ONE of the greatest scourges that afflict the human race in

all countries is undoubtedly alcoholism. Every day the

struggle against this plague is making greater efforts.France, unfortunately, is especially afflicted, at least in

certain regions. For many years this matter has engaged theattention of all those who are interested in public health andin the preservation of the vigour of the race. All means ofcombating it have been sought for, and undoubtedly the bestthat has yet presented itself is the limitation of the numberof liquor shops. Unfortunately, whenever this questioncomes up in the Chamber of Deputies, while every-one heartily approves of this limitation, no one daretake the responsibility of putting it to the vote, for theliquor-sellers are particularly influential in politics, so

that up to now it has been practically impossible to attack orlimit these places. The Chamber of Deputies, having thismatter once more before them, has again adjourned the voteupon it. The National League against Alcoholism held agreat protest meeting on March 17th, which drew together alarge attendance, at which all shades of political opinion