1302 LOOKING BACK.—ASYLUM REPORTS.—VITAL STATISTICS.

that " They were not qualified to say whether the doctor wasnegligent or not." The judge sent them back, and after sometime they returned with a verdict against the medical manand f.25 damages. On Nov. 5th an application for a newtrial was heard by the judge. He refused the application onlegal grounds, saying that he thought it fair to say that if thedecision had rested with him he would unhesitatingly havedecided in the medical man’s favour. The practitioner in

question, who was defended throughout by the London andCounties Medical Protection Society, received hard measure.

Looking Back.FROM

THE LANCET, SATURDAY, Nov. 8th, 1828.

Upon the umbilical cord we sometimes meet with knots,.and, if I may confide in reports received, sometimes two orthree knots may be found upon the cord at once. Mr.Rogers, an American, and a student at these Hospitals,informed me, that at New York, a case had occurred wherethree knots were on the funis, and yet, notwithstandingthese knots, injection could be thrown from one end of thecord to the other without difficulty. To Dr. Hunter I mayrefer you for a very plausible explanation of the formationof these knots when single, for he has suggested, that theumbilical cord, at birth, may perhaps form a coil round themargin of the os uteri within, and that the foetus, in passingthe orifice of the uterus, may, at the same time, passthrough the loop, carrying the umbilical extremity of thecord along with it, in the way here shown, so as to form theknot at the very moment when the body passes into theworld. Observe the demonstration. And this explanationenables us to understand well enough how a single knot maybe formed; but then how is it that two or three knots areproduced ? how that a knot may be found on the cord in theearlier months, though the foetus has never left the cavity ofthe uterus ? Really the solution of this knot may remind oneof that of Gordius, or of the knot scarcely less notorious, knitby the hand of Obadiah, fated to bring to light that com-prehensive code of imprecations, the contents of which hisliberal master so generously showered downupon every partof his person.The origin of the cord is the navel ; its termination is the

placenta, where its insertion is commonly central, though itsometimes unites with the placenta at the margin, or inter-mediately. And this I the rather wish you to notice, becausewhen the insertion of the cord is marginal, as in this pre-paration, you might be led to imagine that one-half of theplacenta had been torn away, the other half still remainingin the uterine cavity.An eccentric insertion of the cord at the abdominal

extremity is more rare, and yet now and then even this

variety is observed, the cord springing, as in this preparationshown, from the one or other side of the abdomen. The

point is curious, but in a practical view it seems to be ofsmall obstetric import.1

REMARKABLE CASE OF RABIES IN A WOLF.

A she-wolf was lately killed in the Departement de laMeurthe, apparently with all the symptoms of rabies, afterhaving bitten about thirty sheep, a dog, and two men; itsviscera, on examination, were found in a healthy state,except the intestinal canal, the mucous membrane of whichwas violently inflamed. As the two wounded persons, oneof whom was most shockingly lacerated, got perfectly well, itwould seem that the animal was not labouring under truerabies, and that its fury was produced merely from theirritation of the inte,tines. A very remarkable circumstancein the examination of the animal was, that a musket-ball wasfound imbedded in the substance of the heart, and coveredby a whitish and very firm cicatrix.—La Clinique.

1 Excerpt from "Lectures on the Gravid Uterus, and on the Diseases of Women and Children. Delivered at Guy’s Hospital by Dr. Blundell.Lecture III."

ASYLUM REPORTS.

Nottingham City Asylum (Report for the year 1905).-During the year 1905 there were 163 patients admittedto the asylum (74 males and 89 females). Of these,the medical superintendent (Mr. E. Powell) considered,35’ 6 per cent. were incurable on admission. Com-

paring the ratio of admission to population in Nottinghamwith the rest of the country, it is found to be6 per 10,000, against 5’76. This refers to paupers only.There appears to have been no increase in the rate ofadmission to population in Nottingham during the past tenyears. As to age and civil state, 16 of the admissions wereunder 20 and 14 were over 65 years. 63 were single, 80were married, and 20 were widowed. 30 were said to haveheart disease-a very high percentage. Of the 77 dis-charges, 66 were considered recovered, giving a percentage of42 on the admissions (30 ’ 9 males and 51’ 1 females). Therewere 66 deaths (47 males and 19 females), the rate being 8 42per cent. of the average number resident, this being nearly2 per cent. lower than the average. There were 21 deathsfrom general paralysis and 11 from pulmonary tuberculosis.The medical superintendent states that in most of thetuberculous cases the disease was present on admission.Turning to the causes of insanity in the recent admissions 22were due to drink (16 males and 6 females) ; this is a per-centage of 13 - 5 (21’ 5 males and 6’ 7 females). Comparedwith other asylums this is lower in both sexes. Hereditarypredisposition was found in 23 out of the 163, which is verylow, and, as the medical superintendent states, is probablymisleading owing to the difficulty in obtaining trustworthyhistories. No suicide or fatal accidents have taken place;neither were there any cases of infectious diseases. Regard-ing the nursing staff, the male night staff has beenincreased by one. An attendant and a nurse were dismissedfor misconduct. Three attendants and two nurses obtainedthe nursing certificate of the Medico-Psychological Associa-tion. There is still considerable overcrowding in the femaledivision but a new dormitory is nearing completion whichwill relieve to a certain extent the want of room. The

weekly charge for the city patients remains at 10s. Thereare 20 male patients belonging to other counties.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 76 of the largest English towns 8305 births and 4418deaths were registered during the week ending Nov. 3rd.The annual rate of mortality in these towns, which hadbeen equal to 14’ 6 per 1000 in each of the two precedingweeks, was again equal to 14’ 6 last week. During the firstfive weeks of the current quarter the death-rate in thesetowns averaged 15 - 3 per 1000 ; the rate during the sameperiod in London did not exceed 14 ’2. The lowest death-rates in the 76 towns during the week under noticewere 6’2 in Leyton, 6’7 7 in Northampton, 7.2 in Hornsey,and 8’ 3 in Tottenham and in Grimsby; the rates in theother towns ranged upwards to 20’ 8 in Liverpool, 21 9 inMiddlesbrough, 22 - 0 in Hanley, and 23.7 in Oldham.The 4418 deaths in the 76 towns were within four of thenumbers returned in each of the two preceding weeks, and in-cluded 515 which were referred to the principal epidemicdiseases, against numbers declining from 2570 to 561 inthe eight preceding weeks; of these, so many as 214resulted from diarrhoea, while 103 were referred to measles,78 to diphtheria, 48 to "fever" (principally enteric),41 to scarlet fever, 31 to whooping-cough, and not oneto small-pox. The deaths from these epidemic diseaseswere equal to a mean annual rate of 1.7 per 1000in the 76 towns, and to 1 - 2 in London. Theseepidemic diseases caused no death last week inBrighton, Walsall, Northampton, Hornsey, or in five otherof the 76 towns ; whereas the highest death-ratestherefrom were 6.2 in Norwich, 6.3 in Bootle, 7.5 inWarrington, and 7’ 7 in Rotherham. The deaths referred todiarrhoea (mainly of infants), which had declined in theeight preceding weeks from 2342 to 292, further fell lastweek to 214, but caused annual death-rates equal to2.6 per 1000 in Rotherham, 3.1 in Middlesbrough, 3.3 inOldham, and 4’ 9 in Preston. The 103 fatal cases of measles

1303VITAL STATISTICS.-THE SERVICES.

showed a further considerable increase upon recent weeklynumbers, and caused the highest rates of mortality in Roch-dale, Bootle, South Shields, Warrington, Rotherham, andNorwich. The deaths referred to "fever" were fewer byten than those returned in the previous week, and showedthe largest proportional excess in Warrington. The 78 fatalcases of diphtheria exceeded the number in any recent week,and caused the highest rates of mortality in Aston andIpswich. The greatest fatality of scarlet fever occurred inWolverhampton, and from whooping-cough in Middlesbrough.No case of small-pox was under treatment in the

Metropolitan Asylums hospitals during the week, no caseof this disease having been admitted thereto since the endof June. The number of scarlet fever cases under treat-ment in the Metropolitan hospitals and in the LondonFever Hospital, which had increased in the nine pre-ceding weeks from 304Z to 4066, further rose to4177 during the week under notice ; 499 new cases wereadmitted to these hospitals during the week, against566, 548, and 542 in the three preceding weeks. The deathsin London referred to pneumonia and other diseases of therespiratory organs, which had been 146 and 150 in the twoprevious weeks, further rose last week to 200, but were somany as 105 below the corrected average in the correspondingweek of the four preceding years, 1902-05. The causes of

34, or 0 - 8 per cent., of the deaths registered in the 76towns during the week were not certified either by aregistered medical practitioner or by a coroner. All thecauses of death were duly certified in Manchester andSalford, Leeds, Bristol, West Ham, Bradford, and in 52other of the 76 towns ; the proportion of uncertified deathsagain showed, however, a considerable excess in Liverpoool,Birmingham, and South Shields.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in eight of the principalScotch towns, which had been equal to 15’ 8 and 16 ’ 3 per1000 in the two preceding weeks, declined again to 16’ 0 inthe week ending Nov. 3rd, but exceeded by 1 - 4 the meanrate during the same week in the 76 English towns.The rates in the eight Scotch towns ranged from 13’ 4and 14’4 in Aberdeen and Edinburgh to 18’1 in Perthand 19’ 0 in Dundee. The 548 deaths in the eight townswere fewer by ten than those returned in the previousweek, and included but 48 which were referred to

the principal epidemic diseases, against 96, 78, and 75in the three preceding weeks. These 48 deaths were equalto an annual rate ot 1’ 4 per 1000, which was 0’ 3 belowthe rate from the same diseases in the 76 English towns,and included 19 which were referred to diarrhoea, eight to"fever," eight to diphtheria, five to measles, four toscarlet fever, four to whooping-cough, and not one

to small-pox. The deaths referred to diarrhoea, which hadbeen 56, 47, and 40 in the three previous weeks, furtherfell last week to 19, of which 12 were returned in Glasgow.All the eight deaths referred to "fever," of which five werecertified as cerebro spinal fever, occurred in Glasgow, as didsix of the eight deaths from diphtheria. Three of the fourdeaths from both scarlet fever and whooping-cough were alsoreturned in Glasgow. Of the five fatal cases of measlesthree occurred in Aberdeen and two in Glasgow. The deathsin the eight towns referred to diseases of the respiratoryorgans, including pneumonia, which had steadily increasedin the five preceding weeks from 66 to 102, declined again lastweek to 94, and were so many as 30 below the numberreturned in the corresponding week of last year. The causesof 20, or 3’ 6 per cent., of the deaths registered during theweek were not certified ; the mean proportion of uncertifieddeaths in the 76 English towns during the same week didnot exceed 0’ 8 per cent.

-

HEALTH OF DUBLIN.

The annual death-rate in Dublin, which had steadilydeclined in the four preceding weeks from 26’ 0 to 21’ 6 per1000, rose again to 27’ 4 in the week ending Nov. 3rd.During the first five weeks of the current quarter thedeath-rate in the city averaged 24 -I 1 p3r 1000, the meanrate during the same period being only 14’2 in Londonand 15’1 in Edinburgh. The 199 deaths of Dublinresidents during the week under notice showed an increaseof 42 upon the number in the previous week, and in-cluded 14 which were referred to the principal epidemicdiseases, against number declining from 52 to 15 in the

eight preceding weeks; these 14 deaths were equal to an

annual rate of 1 - 9 per 1000, against 1 - 2 2 and 0 - 6respectively from the same diseases in London andEdinburgh. These 14 deaths in Dublin included seven

from diarrhoea, three from whooping-cough, two frommeasles, one each from fever" and diphtheria, and not oneeither from scarlet fever or small-pox. The fatal cases

of diarrhoea showed a further decline from recent weeklynumbers; and the death from "fever" also showed afurther decline. Four inquest cases and one death fromviolence were registered ; and 77, or 38’7 7 per cent., of thedeaths occurred in public institutions. The causes of six,or 3’ 0 per cent., of the deaths registered during the weekwere not certified ; the percentage of uncertified causes ofdeath last week did not exceed 0’ 2 in London, while it was5’ 3 in Edinburgh.

THE SERVICES.

ROYAL NAVY MEDICAL SERVICE.IN accordance with the provisions of Her late Majesty’s

Order in Council of April 1st, 1881, Fleet Surgeon JameMead France has been placed on the Retired List at his ownrequest (dated Nov. 6th, 1906).Deputy Inspector-General James Porter, C.B., has been

promoted to the rank of Inspector-General of Hospitals andFleets in His Majesty’s Fleet. Fleet Surgeon William Taithas been promoted to the rank of Deputy Inspector-Generalof Hospitals and Fleets in His Majesty’s Fleet (datedOct. 10th, 1906). Staff Surgeon Arthur Gaskell has beenpromoted to the rank of Fleet Surgeon in His Majesty’sFleet (dated Oct. 31st, 1906).The following appointments are notified : Deputy

Inspectors-General of Hospitals : C. James to GibraltarHospital and W. E. Breton to Plymouth Hospital. FleetSurgeons : J. A. Moon to the Magnificent, on recommis-sioning ; W. Hackett to the Goliath ; G. Welch to HaslarHospital, for instruction of surgeons on entry ; W. W. Prynto the President, for temporary service at the Admiralty ;and G. A. S. Bell to the Irresistible, on recommission-ing. Staff Surgeons: J. A. L. Campbell to the Regnclse,on recommissioning, and T. C. Meikle to the Presi-dent, for three months’ course at Edinburgh University.Surgeons: T. E. Blunt to the Irresistible, on recommis-

sioning ; L. Warren to the Mercury, for the Hazard J.Whelan to the Orion, on recommissioning ; F. G. Goble to theAlbemarle; and G. C. Cross to the Wildfire, for disposal.Civil Practitioner: J. J. Robertson to be Surgeon and Agentat Portpatrick.

ROYAL ARMY MEDICAL CORPS.Lieutenant-Colonel C. E. Nichol, D.S.O., is appointed to

command the depot of the Royal Army Medical Corpsat Aldershot. Captain L. E. L. Parker assumes the dutiesin connexion with the Committee on Physical Training at theWar Office. Lieutenant-Colonel Edward Lewis Maunsell, onarrival in South Africa, is appointed Administrative MedicalOfficer at Bloemfontein, Orange River Colony. CaptainFrancis Stephen Irvine is selected for service with the WestAfrican Frontier Force.

ROYAL ARMY CORPS MEDICAL SCHOOL OF INSTRUCTION.To be Commandant and Officer Commanding Depot, Royal

Army Medical Corps :-Lieutenant-Colonel Thomas J. R.Lucas, C.B., R.A.M.C., (dated Jan. 29th, 1906). To beInstructors : Lieutenant-Colonel Robert H. Firth, R.A.M.C.,(dated Feb. 28th, 1906) ; Major John D. Feiguson, D.S.O.,R.A.M.C. (dated June 13th, 1905). To be Assistant In-structor : Captain Henry C. R. Hime, R.A.M.C. (datedFeb. 5th, 1906).

ARMY MEDICAL RESERVE OF OFFICERS.

Surgeon-Major Murdo Mackenzie to be Surgeon-Lieu-tenant-Colonel (dated Oct. 23rd, 1906).

VOLUNTEER CORPS.

Royal Engineers ( Volunteers) : lst Middlesex : Surgeon-Captain W. H. Bourke to be Surgeon-Major (dated Oct. 8th,1906); Surgeon-Captain T. H. Chittenden resigns his com-mission (dated Nov. lst, 1906).

Rifle: 1st Volunteer Battalion the South StaffordshireRegiment : Major C. T. Griffiths, from the StaffordshireBearer Company, R.A.M.C. (Volunteers), to be Surgeon-Major (dated Oct. 15th, 1906).

VOLUNTEER OFFICEItS’ DECORATION.

The King has conferred the Volunteer Officers’ Decoration