216 REPORT OF THE COMMISSIONERS IN LUNACY FOR THE YEAR 1892.

help regarding the more simple and reasonable method ofprocedure adopted in this country as a more effective oneand, under all the circumstances, as the best that can befollowed in the interests of all concerned.The time is now fast approaching when the cholera returns

from all parts of the Continent of Europe will be scrutinisedwith anxious care, for epidemic manifestations of the diseaseare most likely to occur, if they occur at all, within the nextten or twelve weeks.The steamer Bl7te Jacket, from Marseilles, was boarded at

Cardiff, on the 19th inst., by some sanitary officials. Therewere two cases of cholera on board Other members of thecrew had suffered slightly from diarrhoea, but had recovered.The patients were removed to the isolation hospital on theFlatholm and the ship is to be kept under observation andthoroughly disinfected.

REPORT OF THE COMMISSIONERS INLUNACY FOR THE YEAR 1892.

THE forty-seventh report of the Lunacy Commissionersjust published shows that in England and Wales the lunatics,idiots and persons of unsound mind under their cognisanceon Jan. lst last were 89,822 in number, being an increase, ascompared with Jan. 1st, 1892, of 1974. The followingsummary shows their distribution :

This total was composed of 8200 (4036 males and 4164females) of the private class ; of 80,893 (36,102 males and44,791 females) who were paupers ; and of 729 (544 malesand 185 females) who were criminal patients. These figuresshow an increase for the year of 2055 (1146 males and 909females) amongst the pauper class-a total decrease of 73amongstthe private class and a decreaseof 8 amongst the crimi-nal patients. The net increase of the year of 1974 patientsrepresents an increment of 2 ’25 per cent. upon the figures ofJan. lst, 1892. The Commissioners point out that this isa higher ratio of increase than has been usual of late years,though it has been exceeded upon several previous occasions.The admissions during 1892 exceeded those of 1891 by 445only, a lesser increment in the number of admissions than hadtaken place in either of the preceding two years. The lowerrecovery- and death-rates of last year account for upwards of450 of the increase ; but the two sources of increase alludedto still leave 1079 of the total increase unaccounted for.The Commissioners offer an explanation of the residual

increase in the following terms. "It is important to statethat these annual increases, which have been subject to con-siderable fluctuations, take place almost entirely amongstpauper patients living in asylums, and there can be no doubtthat, apart from and beyond the additional new cases broughtevery year under official cognisance, there are constant influ-ences conducing to the annual increases in the number of theinsane shown in our tables. Among these influences themost potent would appear to be—(1) the large proportion ofincurables among the admissions-i.e., patients who do notrecover and are not discharged, but remain under care untilthey die; (2) the difficulty of obtaining homes for cases of asomewhat more favourable type among the admissions, who

also do not recover, but so far improve that their continued resi-dence in asylums would not be necessary if homes could be foundfor them elsewhere. As a rule the friends are too poor to takecharge of them and the Poor-law guardians are reluctant orrefuse to receive and retain them in workhouses, where,without the 4s. Parliamentary grant, the cost of their main-tenance would generally equal, if it did not exceed, that ofkeeping them in the asylum. Further, the confidence whichthe public has learned to place in the management of theseinstitutions has no doubt conduced to the placing in them ofmany persons, also incurable, but above the status of paupers,their relatives reimbursing the guardians the cost of theirmaintenance. Owing to these causes and circumstances thenumber of recoveries, discharges and deaths falls short of theannual admissions, with the result of a yearly accumulation ofchronic cases in the wards of county and borough asylums."During the past year the proportion of existing and reporte1

lunatics &c. has diminished, as regards the private class, from2 ’82 to 2 76 per 10,000 of the general population, but hasincreased as regards pauper lunatics from 26’81 to 27’21 per10,000. The proportion of total lunatics to population hasincreased from 29-88 in 1892 to 30’21 per 10,000. The generalrate of recovery for both sexes, as compared with theadmissions, was for 1892 38’94 per cent., against 41’04 percent. for 1891 ; and the death-rate for the same year, -

calculated upon the daily average number resident, was

9’98 per cent., as compared with 10’19 per cent. for 1891.The Commissioners note that in Table X. the figures showthroughout the whole period, from 1859 to 1893, takenquinquennially, a progressive increase in the proportionmaintained in asylums, and a corresponding decrease in the ,

ratio kept in workhouses and resident as out-door paupers. ;

The deaths by suicide that took place during the year were ‘17 in number. The deaths of 16 persons, due certainly or

-

most probably to suffocation in epileptic fits, were notifiedto the Commissioners during the year 1892. Fifteen of theseoccurred in county and borough asylums. The Commissionerssay that it is many years since they have had to record somany deaths from epileptic suffocation, the greatest numberof such deaths during any one of the previous five yearshaving been ten.

After noting the additions, alterations and improvementsthat have been made at various asylums, the Commissionersgo on to speak at some length of the insufficiency of the pre.sent asylum accommodation, and they give particulars ofbetween twenty and thirty counties where the accommoda.tion is quite inadequate and where there is consequent over.crowding or boarding-out of patients. It is satisfactory tolearn that although in some asylums diseases suggestive of

imperfect sanitary conditions appeared during the past year,in no instance did they assume an epidemic character.

There were 38 deaths from misadventure of various kinds

(not suicides) or attended with injuries in the 67 county andborough asylums. In 18 of them the deaths or the injurieswhich had been sustained prior to death were apparentpurely accidental and indicated no want of care on the parof those who were in charge of the patients. In fifteeninstances death resulted from suffocation in epileptic fits.

During the year three prosecutions were instituted by theCommissioners and two by visiting justices for the ill-treat-ment or the wilful neglect of patients by attendants. X’

grave consequences resulted to any of the patients, and thlcases were all dealt with by the imposition of fines.During the year ended March 31st, 189Z, the average

weekly cost of maintenance of patients was in county asylums8s. 115/8d. ; in borough asylums, 10s.: in both taken together.9s. 2d. These figures show an increase as compared withthose for the previous year, and are, indeed, higher than i.

any year since 1884.

REPORT OF THE MEDICAL OFFICER OFHEALTH OF THE ADMINISTRATIVE

COUNTY OF LONDON.

THE first part of this report deals with the subjects of c’disinfection and destruction of infected articles and c’

shelter of persons during the disinfection of their homesthe several districts of the country. After pointing out’requirements of Section 59 of the Public Health (LondtAct, which renders it imperative for every sanitary authorityto provide within or without their district proper premi"’"

217RETURN OF STILLBIRTHS IN CANADA AND IN OTHER COUNTRIES.

apparatus and attendance for the destruction and for thedisinfection, and carriages or vessels for the removal, of

articles (whether bedding, clothing, or otherwise) whichhave become infected by infectious disease, the provisionwhich the several sanitary authorities in London have madefor the carrying out of the Act are described from informa-tion supplied by medical officers of health. Thus it appearsthat in sixteen districts disinfection is carried out by steam,in fourteen it is effected by dry heat, whilst in eleven instancesthe sanitary authorities have arranged with a contractor forthe performance of the work by whom steam is used. The

parishes of Charlton and Eltham destroy articles instead ofdisinfecting them.

After referring to the well-known experiments of Dr.Parsons of the Local Government Board in regard to theprocess of disinfection by dry heat and steam respectively,Mr. Shirley Murphy points out that dry heat is not onlymuch less destructive of pathogenic organisms than steam,but that, its power of penetration being far inferior, consider-able uncertainty must attend its use as a disinfecting agent.Moreover, the time required for the process is tedious,and the working capacity of dry heat apparatus is very smallas compared with that of steam. In support of this statementattention is directed to the replies of Dr. Parkes, medicalofficer of health for Chelsea, and Dr. Lovett, medical officerof health for St. Giles. In the Chelsea dry heat apparatus areather bed is left in the oven between six and seven hoursand the centre of the bed does not attain a higher tempera-ture than 120°F., whilst in the St. Giles’ steam apparatus abed is left in for only thirty minutes, by which time thetemperature in the centre of the bed has reached 250° F.

Whilst not disputing the fact that disinfection may beproperly done by contractors, Mr. Murphy is not inclined toiook with any degree of favour on the contract system. Healso suggests that two or three laundries should be erectedin London whither sanitary authorities could send articles ofclothing, which could be boiled and returned to their ownersin a clean condition. Such laundries might also be made useof by those who retain their infectious sick at home.The various methods adopted for the destruction of

infectious articles are to burn them either in destructors, orin furnaces, or in heaps at the vestry wharves, or in openyards, or on ground adjoining the disinfector, or to have themdestroyed by contractors.By Section 60 of the Public Health Act every sanitary

authority is required to provide accommodation free of

charge for those persons who have been compelled to leavetheir dwellings in which any infectious disease has brokenout in order to allow the sanitary authority the opportunityof disinfecting these places. Where this has been done theprovision consists either of one or two rooms or in some casesof small houses set apart for the purpose. In many casesaccommodation has only been provided for the day, aterm which is of course inadequate. Further, it is stated,great difficulty is experienced in getting people to go to theseplaces, Mr. Murphy also suggests that baths should be

provided for persons coming from infected houses.For the disinfection of rooms sulphurous acid still holds

its own, whilst for the disinfection of excreta carbolic acid

appears to be the favourite agent, other substances, such asperchloride of mercury, sulphate of iron, Calvert’s powder,Sanitas, Condy’s fluid, sulphates of zinc, copper and man-ganese, St. Bede’s disinfectant, Burnett’s fluid, Jeyes’ fluidand chloro-naphthalene, also being’ in use. The diseases afterthe occurrence of which sanitary authorities carry out dis-infection are usually those which are notifiable ; but in a fewcases houses are disinfected by request after measles, röthelnand whooping-cough. By some authorities disinfection is

practised after the occurrence of erysipelas only in the eventof the case having been a severe one.

Inferring to the subject of sanitary inspectors, the presentreturn shows that with a population of 4,230,474 London isprovided with a staff of 188 sanitary inspectors, in whichnumber are included 17 temporary officers and 5 vacancies.Since 1889, the time of the last return, there has been anincrease of 58 men on the sanitary staff ; but, inasmuch asprior to the Public Health Act (1891) the abatement of thesmoke nuisance was performed by the police, whilst since thedate of the passing of that Act this duty has devolved uponthe sanitary authorities, the increase has been more apparenttmn real. In the performance of this work 48 constableswere engaged. The average number of inhabitants to eachsanitary inspector is about 23,503 ; ranging from 3409 in thecity of London to 57,831 in Newington. As the administra-

tion of the Infectious Diseases (Notification) Act, Housingof the Working Classes Act, the Public Health Act andthe Factory and Workshops Act has fallen upon sanitaryauthorities since the issue of the report of 1889, the increaseof 58 men in the sanitary staff of the whole of Londonwould appear to be somewhat small. Not only does thereport sho;v great variation in the proportion of sanitaryinspectors to the population in the several districts, butalso in the duties which devolve upon the inspectors, thelatter in some districts being provided with clerical assist-ance in the keeping of registers of complaints and proceedingsand in the preparation of notices, whilst in other districts noassistance at all is offered. Marked differences also exist asto the method in which the work of inspectors is carriedout : in some districts each sanitary inspector receives a

portion of the total area; in some special functions areassigned to each inspector ; whilst in others inspectors arelimited neither to special portions of their district nor to theperformance of any particular kind of duty. The salaries ofthese officials range from £ 62 8s. to f350 per annum.There are at present no female inspectors in London, but

the medical officer of health for Marylebone has presented areport to his sanitary authority advising the appointment oftwo female inspectors for the purpose of inspecting nightshelters for women, public lavatories for women, and work-shops in which women are employed. Women are alreadyemployed in sanitary work in Glasgow, Manchester andBrighton.

RETURN OF STILLBIRTHS IN CANADA,IN AUSTRALIA AND NEW ZEALAND,AND IN THE UNITED STATES

OF AMERICA.

e

s WE have already noticed the returns of stillbirths as given in

the Parliamentary Paper, No. 279, printed June 21st last, sof far as they relate to the United Kingdom and other Europeanr countries. It only remains now to notice that part of the

paper which refers to certain British colonies and to

1 the United States of America. As might have been

r expected, the regulations in the colonies partake some-

E what of the slackness of the mother country. Thus

in the dominion of Canada there are in Nova Scotia,Quebec, North-west Territory and British Columbia no

, regulations whatever and no information as to the number; of stillbirths buried as such. In New Brunswick it appears; that they are registered as other births and as both birthsand deaths ; but there is no local legislation and no informa-

tion available except the form used in registering a stillbirth, which is very complete, giving, besides the names of parents,

place of birth and sex of child, also the name of theaccoucheur. This form is to be carefully filled in by the

physician, parent or other person, and is then to be forwardedto the division registrar. In the province of Prince EdwardIsland the registration of stillbirths is effected under theprovisions of a system for collecting mortuary statistics incertain cities and towns of the Dominion adopted by theDepartment of Agriculture in or about 1882 and conductedunder its control. It commenced in this province (PrinceEdward Island) in June, 1883, and was continued in opera-tion until December, 1891. The system is not compulsoryand is limited to the city. The registration is carried outby the statistical officer appointed for the collection of

mortuary statistics. Stillbirths are registered separately fromdeaths, and though there is no legal definition of the term"stillborn, "practically it is " a child that has not lived tobreathe." Only two were registered in 1890. The certificateis bilingual, being both in French and English, being that fordeaths, and is very elaborate, giving in addition to the usualdetails the nationality and the religion of the deceased. InOntario and Manitoba the registration of all births, still andlive, is compulsory. The registration is in the hands of thesame authorities (municipal clerks), and stillbirths are regis-tered both as births and deaths, the Ontario RegistrationAct not defining the term stillborn child." The penaltyfor neglecting to register is the same as in other births.No special form is used nor are there any returns of still-births interred. Passing on to Australia the only part wherestillbirth registration is carried out is in Western Australia,