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Messrs. Le Brasseur and Oakley for the London and and dissertations must be delivered at the College not later than 4 o’clock P.M. on Dec. 1914. Counties Medical Protection Society, on Thursday, 31st, appeared The first award of the Sir Gilbert Blane medal under the behalf of the plaintiff, and the society, as well as revised regulations was made to Surgeon G. F. Syms, R.N. Mr. are to be the Keats, congratulated upon complete The financial statement shows that the gross income of the vindication of the latter’s character thus achieved College, exclusive of the income from trust funds, amounted after prolonged litigation. to .626,833, an increase of Z819 on the amount for the previous year, while the expenditure in respect of revenue amounted to .621,425, a decrease of .6836 on the previous in connexion with ROYAL COLLEGE OF SURGEONS OF year. The receipts and expenses the trust funds are placed this year in a separate account. ENGLAND. While it is evident that the College is in a good financial position at the present time the Council consider that ANNUAL REPORT OF THE COUNCIL. it is most important to add to its invested funds for THE annual report of the Council of the College, which is several reasons. Among these may be mentioned: (1) the to be presented to the annual meeting of Fellows and insecurity of the income derived from examination and the continued increase in rates and Members on Thursday, Nov. 19th, has now been published, diploma fees ; (2) taxes; the of the museum and and and contains a record of the work accomplished by the (3) growth library consequent increase in cost of the in College in its various departments during the year ending upkeep ; (4) probability that, course of it will become to make extensive August lst, 1914. The resolutions which were carried at the time, necessary additions to the at a last annual meeting are recorded, together with the replies College buildings, large capital outlay, to further accommodation for the museum and of the Council. At the meeting of the Council in March a provide library. the the number of issued was motion was brought forward to the effect that the time had During year diplomas as arrived when steps should be taken to enable Members to follows : Membership, 408 (including 8 women); Fellow. vote for the election of a limited number of members of the ship, 71; Licence in Dental Surgery, 110 ; Diploma in Public 62 5 in Council, but after a prolonged discussion this was negatived Health, (including women) ; Diploma Tropical 4. by a large majority. In February the Council were asked Medicine, On 9th Sir William Watson was elected to take part in a deputation to the Government on the July Cheyne President of the and Sir Frederic Eve and Sir position of medical officers of health as regards security of College, tenure and superannuation. While declining this invitation Anthony A. Bowlby Vice-Presidents. the Council asked the President to consult with representa- Four years ago the Council sanctioned a scheme for tives of the Society of Medical Officers of Health, and after the recataloguing and rearrangement of the entire patho- this had been done a letter was addressed to the President logical collection in the museum. The work of revision in of the Local Government Board dealing with the question the section of general pathology, to which Mr. Shattock and solely from the point of view of public advantage. After his assistant, Mr. Beadles, first devoted themselves, has now impartial consideration of the arguments against the proposed proceeded far enough to make this part of the museum of medical and change the Council stated that these were not in their opinion particularly worthy study by practitioners strong enough to outweigh those in favour of the request by students. As now arranged the collection of general patho- 32 and four more will be added. medical officers of health for security of tenure with a corre- logy occupies cases, The sponding system of superannuation. Much dissatisfaction report contains a list showing the main contents of each case, while attention is drawn to the and having been expressed by medical men with the suggested em- changes, improvements, additions which are carried out in the ployment of non-qualified persons for the purpose of medical being physiological section which is the of the series illus- treatment under the National Insurance Act, a protest was really counterpart The various donations of submitted on behalf of the College to the English Insurance trating general pathology. speci- mens made to the museum the are referred to in Commission. This protest and the reply to it are printed in during year the and the of the more of the report. During the year Mr. F. Richardson Cross, Mr. report, significance important these is out. It is noted that the number of visitors D’Arcy Power, and Mr. S. G. Shattock were appointed by pointed to the museum has which is the Council to give evidence before the Royal Commission on considerably declined, partly the taken to admit those who Venereal Diseases : Mr. Cross giving evidence as to the explained by precautions only come for the of serious or effects of upon the eyes ; Mr. Power on the general purpose study enlightenment. syphilis the under review the of books and effects of syphilis; and Mr. Shattock upon the remote During period supply pathological effects of syphilis, the Wassermann test in the periodicals to the library was well kept up. The volumes in diagnosis of late effects of syphilis, and the latent dis- the library were counted early this month and were found to tribution of syphilis. number 66,525. The tracts and pamphlets bound in volumes The first annual Congregation of the American College of of from 10 to 20 each are estimated at about 45,000, of which number two-thirds are Surgeons at Chicago on Nov. 13th, 1913, was attended by catalogued. the President, Sir Rickman Godlee, and an address of con- ANNUAL MEETING OF FELLOWS AND MEMBERS. gratulation from the English College was presented. Sir A meeting of Fellows and Members will be held at the Rickman Godlee also visited where the of Toronto, degree College in Lincoln’s Inn Fields on Thursday, Nov. 19th next, LL.D. was conferred and on his from upon him, departure at 3 o’clock P.M. The report of the Council, of which copies New York he was with the medal of the presented gold can be obtained on application to the secretary, will be laid National Institute of Social Sciences, of which he was made before the meeting. Motions to be brought forward at the an member. In connexion with the fifth annual honorary meeting must be signed by the mover, or by the mover and session of the Clinical Congress of Surgeons of North other Fellows and Members, and must be received by the America held in London at the close of last demon- July secretary not later than Nov. 9th. A copy of the agenda will strations at the were Professor Arthur College given by be sent on application after Nov. 16th. Keith, Mr. S. G. Shattock, Sir Rickman Godlee, Mr. J. F. Colyer, and Mr. Arthur H. Cheatle, while a reception for the LECTURE ARRANGEMENTS. members of the Congress was held in the College on the The Bradshaw Lecture for 1914 will be delivered by Sir afternoon of July 29th. Frederic Eve on Pancreatitis on Tuesday, Dec. 15th, at With regard to the Licence in Dental Surgery, it is 5 P.M. announced that examinations will be held in future thrice The Hunterian Oration for 1915 will be delivered by Sir instead of twice a year. The examination for the Diploma William Watson Cheyne on Monday, Feb. 15th, at 4 P.M. in Tropical Medicine and Hygiene, granted jointly by the The Hunterian Lectures will be delivered as follows :- College and the Royal College of Physicians of London, Professor H. Blakeway : One lecture on the Treatment of will in future be divided into two parts, and amended Hare-lip and Cleft Palate, Feb. 17th, at 5 P.M. Professor regulations have accordingly been adopted. The Jack- F. C. Pybus : One lecture on Some Infections of the Tonsil, sonian prize for the year 1913 was awarded to Mr. J. Howell Feb. 19th. at 5 P. M. Professor Arthur Keith : Six lectures on Evans. The subject for the year 1915 is Congenital the Anatomy and Mechanism of the Alimentarv Canal, Dislocations of the Joints, their Pathology and Treatment. Feb. 22nd, 24th, 26th, March lst, 3rd, and 5th, at 5 P.M. The subject for the present year is the Pathology, Professor W. Sampson Handley: One lecture on Entero- Diagnosis, and Treatment of Trigeminal Neuralgia, colic Ileus, March 8th, at 5 P.M. Professor J. Howell 1061

Evans: One lecture on Some Congenital Lesions of the based their statistics, must of necessity lead to very Small Intestine, their Origin, Clinical Bearings, and Treat- unreliable conclusions. The number of deaths was 77 ; and ment, March 10th, at 5 P.M. Professor Rupert Farrant: in every case the cause of death was verified by post-mortem Two lectures on the Effect of Toxins on the Tissues, examination. The average death-rate was 8’ 95 per cent. March 17th and 19th, at 5 P.M. Heart disease was the cause of death in 20 cases and The Arris and Gale Lectures will be delivered by Professor phthisis in 7 cases. David Waterston : Two lectures on Further Recent Investiga- Royal Edinburgh Mental Hospital, Morningside (annual of the Human March 12th tions in the Development Body, Report for the Year 1913).-The total number of cases and Dr. F. Wood Jones : and 15th, at 5 P.M. ; by One under treatment during the year was 1022, the average lecture on the Influence of the Arboreal Habit in the Evolu- daily number resident being 773. The admissions numbered March at tion of the Reproductive System, 22nd, 5 P.M. 238, and in 40 per cent. of these hereditary influences were found to be present. Senile decay was also a very noticeable feature among the admissions. Nearly 1 in every 9 ASYLUM REPORTS. admitted was over 70 years of age. Alcohol was believed to have been the exciting cause in 12’5 per cent. of the County and City of Worcester Asylum (Annual Report for the male cases and in 11’ 5 per cent. of the female cases. The cause of to be Year 1913-14).-The total number of cases under treatment fourth most frequent insanity appeared which in the case of men a was 1221, the average number resident being 1069. There syphilitic infection, occupies second to and in were admitted 142 patients, of whom 121 were direct admis- position only hereditary influences, equal sions. Mr. G. M. P. Braine-Hartnell comments on the fact importance to alcoholic excess. Dr. George M. Robertson, the refers to the informa- that in only 14’9 per cent. of the cases was a history of physician-superintendent, surprising tion that has been obtained from the routine examination of heredity obtained. Mental stress was noted in 15-7 per cent., senility in 10’7 per cent., and alcohol in 4’1 per cent. nervous and mental cases by the Wassermann method. In an examination of 200 cases of mental under- Sixty-six patients have been discharged, with a percentage deficiency, of 32’2 of recoveries on the direct admissions. The taken by Dr. Kate Fraser and Dr. Watson, it was found that more than half of of of suffered deaths numbered 86, of which 22-1 per cent. were caused by these, every grade severity, from The nature of this revelation heart disease, 17’4 per cent. by phthisis, and 15’1 1 per cent. syphilis. astounding by general paralysis. Mr. Braine-Hartnell remarks that the can be judged by the fact that if any standard work on mental be consulted the statement is made that deaths from general paralysis have increased from 7’5 per deficiency cent. in 1912 to 15’1 1 per cent. in 1913. Post-mortem this disease is not an important cause of idiocy or imbecility, and that 5 cent. would more than cover the cases to examinations were made in 85 per cent. of cases. per be Bootham Park Hospital for the Insane,.. York (Annual attributed to it. The discharges numbered 59, with a rate of 25 cent. on the total number of Repo’l’i for the Year 1913).-The total number of cases recovery per admissions. The test of has been a under treatment during the year was 175, the average daily recovery employed severe one. The total number of deaths was a number resident being 127, of whom 59 were males and 82, making 68 females. There were 33 direct admissions and 12 percentage of 10’6 on the average number resident. Twenty- two of the deaths were due to and 7 to voluntary boarders. There were 10 cases transferred from general paralysis Dr. Robertson then on to consider the other institutions, all of which were chronic, and most of consumption. goes as to whether or rather the to them bad cases. Dr. George R. Jeffrey, the medical super- question insanity, liability intendent, is of the opinion that change of surroundings to insanity, is increasing, basing his remarks on consideration of another asylum often greatly benefits these chronic insane the statistics of institutions and the reports of the 1911 Census. He takes into full account statistical and he comes patients. Of the patients admitted none was in good bodily fallacies, to the conclusion that there has been the last decade health. Dr. Jeffrey believes that rest in bed in the open during air is the most rational treatment for such cases. He has a proportionate increase in the number of insane persons found the open-air treatment especially valuable in dealing living the early adult and late period of life, but a de- crease the middle There is reason to believe with the noisy chronic insane. It generally does away with during period. the to suffer from mental disease the necessity of seclusion and sedatives. In 18 cases of that liability may have increased at the and late and the admissions a distinct history of mental stress was not early periods, not have diminished the of middle obtained, and in eight the age epochs were considered to be may during period age. at or causal. Several of the cases were associated with the It is this middle period that the acquired preventable insanities and therefore it is at this presence of distinct bodily conditions of disease, which were chiefly occur, period that the effects of thought to be the chief cause of the mental state-thus temperance, self-control, adequate 1 occurred during gestation, 1 during lactation, 2 with nourishment, and healthier surroundings would first appear. disease of the thyroid gland, 1 with influenza, 1 with A new departure has been made this year in the institution, which is for the of a diabetes, and 1 with syphilis. Four cases presented physical paying working expenses physician, signs of alcoholism, without which the diagnosis of alcoholic who receives a grant from the Carnegie Trust, whose sole it is to visit the homes and families of the insanity is hardly permissible. During the year 26 patients duty parochial sent to the institution. For the first time in this were discharged, with 45’4 per cent. of recoveries. There patients a detailed the were 5 deaths, the proportion to the daily average popula- country, investigation by personal inspection and of a medical man is made into the tion being 4-06 per cent. inquiries being Mental Hospital for the County Bor01lgh of Leicester, possible hereditary and environmental causes of the insanity West Humberstone (Ann1lal Report for the Year ending of the cases admitted. The importance of this measure cannot be over-estimated. March 31st, 1914).-The total number of patients under i treatment during the year was 1067, the average daily He’l’tfordshire County Asylum, St. Albans (Ann76al number resident being 860. The number of admissions was Report for the Year ending March 31st, 191,4).-The total 209. The following are the principal assigned causes of !, number of cases under treatment during the year 1913 was insanity in the admissions : heredity, 65 ; mental stress, 16 ; 1008, the average daily number on the register being 836. alcoholic intemperance, 13 ; senility, 11 ; epilepsy, 8 ; and The direct admissions numbered 152, and of these 100 were syphilis, 6. Dr. J. Francis Dixon, the medical superintendent, first attack cases, The recoveries amounted to 59, 53 of remarks, in connexion with the causation and prevention of whom had been direct admissions in 1913 and previous insanity, that the great majority of workers in this specialty years. The proportion of recoveries to the direct admis- are isolated from the general community and that their sions in 1913 was 34’ 9 per cent. The average for the last experience is largely confined to the care and treatment of 13 years has been 31’ 7 per cent. A more reliable per- mental disease arising in an environment with which they centage of recoveries is given by separating the " first attack are but imperfectly acquainted. The psychological line of cases" from the "not first attack" cases and imbeciles. inquiry into the causes of certain forms of insanity is The percentage of recoveries of the first attack cases from assuming an increasing degree of importance and the 1901 to 1913 inclusive was 30 - 6 per cent., and that of the bearing of education, occupation, heredity, environment, " not first attack " cases for the same period 46 7 per cent. and the rapidly changing conditions of life generally com- The deaths numbered 38 men and 31 women, a percentage prise fields of promising investigation. Until such trained of 8 25 on the average daily number on the register. Post- investigation becomes general the mass of information mortem examinations were made in 63 cases. Phthisis returned annually to the commissioners, upon which are accounted for 6 deaths and heart disease for 8.