TNz 0 84 MADnCA&1 BRITiSxJOURNALLI . [AUG. 15 1903. only prevailed to any large extent in I asylum, and that thej to those who had throughout all his years of office responded recently-opened one at Winwick, near Warringtoni. The table so ungrudgingly to his repeated appeals for lielp, lie indicated on page 383 slhows the total number of deatlhs from diarrlhoea that even greater liberality would be acceptable, and would and dysentery in a few of the asylums wlhere they most pre- enable him, ere his day was quite done, to realize some of the vailed. They include in some instanices cases returned un-der still unfulfilled dreams for a wider scope to the charitable the head of " colitis," " enteritis," etc., which were not side of their work which lie had for long cherished. e(rntered in the registers of dysenitery anid diarrhoea. He expressed his keen sense of appreciation of the kind- In the county anid borouglh asylums of and Wales ness of his colleagues, and assured them that the address in I892, the proportion of deaths froiii tuberculous diseases to which had just been handed to him would ever remain one deaths from all causes was liearly 17.0 per cenit. ; in the of his most valued possessions. He was now retired from the ,general populatioin in I900 it was 10.4 per cenit. (63rd Annual Council of the British Medical Association, on which he had Report of Registrar-G'eneral); wlhilst for the salmle periods in served for upwards of 40 years, and the greater leisure thus Iasylums these deatlhs were equal to 18,203 per million, or acquired would enable him to devote. himself more energetic- iiearly ten times the mortality amonigst the population ally than ever to the affairs of Epsom College. generally, whlichl (in T900) wvas reckolned at I,899 per million. We who know the devoted service rendered for many years by The dealtlhs referred to plhthlisis amiiounted during the year Dr. Holman to the British Medical Association naturally feel to 1,348, and those to otlher forms of tuberculosis to 115, the a peculiar gratification in seeing his work in a different though total number of innmates resideint beinig 80,371, and the deaths cognate sphere so well appreciated. Throughout his public from all causes 8,6I9. The tuberculous deatlh-rate was higher career Dr. Holman has worked with absolute unselfishness, thlani in I901, bein1g I8.2 per I,ooo, as against 15.8 in that year; and with the most strenuous endeavour for the benefit of his time proportioni to total deathsDoeiiig 17.0 per cent., as com- professional brethren. Under his wise management the most pared witlh 15.8 per cent. important of our medical charities has been carefully nursed to a condition of comiiparative financial stability, and Epsom AVERAGE WEEKLY COST. College has taken a high place among the public schools of The average weekly cost of maintaining the patients in the the country. By their recognition of their Treasurer's single- county and borough asylumns for the year ending March 3ISt, hearted efforts to promote the efficiency and prosperity of the 1902, exclusive of building repairs, additions and alterations, admirable institution which they govern, the authorities of was as follows: Epsom College have honoured themselves as well as Dr. s. d. Holman. In counity asyluins ...... 9 In borouglh asylums ...... Io 62 In botlh taken togetliei.i. ... IO 0 COUNTY SCHOLARS. This is a reduction of 4d. per lhead per week on the average THE Technical Education Board of the London County weekly cost of the pr-evious year. Council has published the reports of its medical officers- Drs. Leslie Thorne Thorne and May Dickinson Berry-on their physical examination of the county scholars elected EPSOM COLLEGE. during the year 1902-3, and from this report the table below PRESENTATION TO THE TREASURER. has been compiled. It shows the number of deviations from AT the last meeting of the Council of Epsom College the the normal noted, and requires very little explanation. The Govemors paid a graceful and well-deserved compliment to heart abnormalities nioted are all definite lesions, and not their Treasurer, Dr. Holman, whom they presented with an merely haemic murmurs. Visual acuity was judged by the illuminated address expressive of their gratitude for the excel- army standard, and the figures indicate the number of cases lent and unwearied work he had done for the College through- in which vision was inferior to this standard. The figures out a long series of years, and also with an enlarged photo- against "Urine" shew the number of cases in which albu- graph of hiimself to be hung on the walls of thle Council Room minuria was found to be present. The spine figures refer to as a permanent memorial of the services he lhad rendered. crooked backs, and " Nervous System " covers cases of bad The following is the text of the address: stammering. To Conlstantine Holoman, M.D., Treasurer of the Royal Medical Benevolenit College. Total Males. 443. Total Femiiales, 3I0. W'e, your colleagues OTn the Council of the Royal Medical Benevolenit College, desire to take the presenit opportuniity, wlen we have just celebrated, under the piesidenicy of His Royal Highlness the Prince of 'c' ~* Total 'Wales, the miost successful festival dinner that the College has ever had, Defects Noted. N1 ',9 9 Defects. of expressing our sense of the great anid valuable services you hlave

renidered to the College for so many years, for sixteetn of wlicll you ~~~~ "'~~~~~~F liave held tlle important office of Treasurer. We are senlsible of the amount of time anid work wlhieh have been so iiigrudgingly given by you, and to wlicll the College so largely owes its Lungs ...... 2 0 0 0 0 0 present satisfactory positioin. Heart ...... 30 4 I 2 1 0 38 We desire to offer our best thanks for all that you lhave done and are Spine ...... 0 I 0 28 I 0 30 doing, and to express our that us Colour vision ... 8 2 0 0 0 0 I0 hope you may lonig be spared to aInd Visual ... to the College. acuity 7I 31 2 39 9 9 I6i Hearing ..... 72 23 2 9 I 0 107 The address was signed by the President of the College Adenoids ... 20 5 0 I 0 0 26 and by all the members of the Couneil. Tonsils . .. 103 29 3 I0 4 0 149 Urine ...... 52 I8 3 o6 4 4 117 In asking Dr. Holman's acceptanice of these token-s of Nervous system 3 3 0 0 0 0 6 thie esteem and veneration in which he was held by all coIn- Miscellaneous 2 0 1I 4 0 7 nected with Epsom. Sir Joseph Fayrer, the Chairmani of Council, referred to the long period of his association with Totals 363 iI6 12 129 20 I3 653 the College; to the arduous nature of the duties lie lhad been Percentages ... 104 I6I% 50% 525 % 68 % 38 % 85% called upon to perform, and the difficulties lie had to over- _ 2_.8_ come; to the success wlhich lhad attended hiis filnancial ad- I05% 52 ministration; and to the universal esteem in which lie was held, not by the members of the governing body only, but by It can scarcely be said that this return presents a very every one wh1o was concerned in the welfare of the institu- pleasant picture of the physical development of the cleverest tion. young people in the public schools of the administrative In his reply, Dr. Holmain acknowledged that tlle success County of London. Without discussing the table at great of Epsom College was a question whichl had laini very near length, one or two salient points maybe noted. The girls, his heart since the day wlhein lie first became a meniber of curiously enough, are much less physically imperfect than Council. During the long period of his treasurership lie had the boys, having among them only 52 per cent. of defects constantly endeavoured to promote time interests botlh of the against IO5 per cent. among the boys. In other words, sup- school and of the charity. As regards the schlool, lie thought posing the defects in each sex to have been as far as possible lie might safely say that it lhad been an unqualified success, equally distributed among individuals, every boy had more and was now firmly established as one of the important than one, while every other girl scholar was free from any public sChools of the country. The chlarity still required physical deifect at all. This is a curious result, because the dt;.Jstance, and, though Dr. olman declared hlis gratitude number of crooked backs among the junior girls points to B 385 AmU. 15,ig3j190 THE PREVENTION OF CONSUMPTION. 385[n .$~~ ** weak muscles, and shows that they do not get as much phy- DURHAM.- sical exercise as they ought.- The' number of cases of The fourth annual report of the dxeneral Committee. of the albuminuria-over i8 per cent. of all the scholars-is also re- Society for the Prevention and -Cure of Consumption in. the markable. The vision defects noted in 21 per cent. of all'the County of Durham, h0ld at Stanhope Sanatorium on June pupils are comprehensible and point to the necessity of 13th? 1903, stated that the Committee had continued to dis- better lighting of schools and more careful attention to the seminate knowledge whereby the disease might be stamped height of desks and forms. out: (i) By addresses and lectures to various public bodie& Perhaps the most cnrious point of all is the large amount of and general audiences, (2) by distributing throughout the deafness shown to exist. It is well known that deafness is countynearly 2,000 copies of the Society's pamphlet on " Con-' one of the chief retarding influences in school life and pro- suimption, its Prevention and Cure." The sanatorium con- gress, so that if deficiency in hearing exists in 14 per cent. of tinued to act as an isolation hospital, and the treatment there the most successful pupils of the year, what must the per- taught the patients and their friends how to prevent the centage be among the unsuccessful majority? The very great spread of the disease. In addition to the boroughs of Sunder- difference in this respect between the boys and the girls almost land and Gateshead, Jarrow had adopted voluntary notifica- suggests that the same tests cannot have been applied, and in tion. The Committee regretted, however, that the County this connexion it may be remarked that it would make appre- Council and the local authorities, with the exception ciation of a future report easier if the sections on the two sexes of four, had not yet given them that practical support were drawn up in exactly the same form and covered precisely which the importance of the question demanded. The Com- the same ground. mittee urged again upon sanitary authorities that the time was now fully ripe to take another step forward. Although volun-, tary notification, by-laws against spitting in public places, THE PREVENTION OF CONSUMPTION. and the strict supervision of the milk supply, if alopted, of all AND CORNWALL. would do much good, yet perhaps the most important A SPECIAL meeting of the governing body of the Devon and means of prevention was the establishment of homes for Cornwall Sanatorium for Consumptives at Didworthy, South advanced cases of the disease. Such homes were absolutely Brent, was held on August 7th at Plymouth. The Secretary necessary if the disease was to be stamped out. They should read the report, which stated that during the last three be provided by the sanitary authority to avoid the stigma of months one patient had died. Those then under treatment the workhouse. and they need not be far from, towns. Friends were progressing satisfactoril . There were then no should be allowed to visit the patients, and the cost-equiva- patients in bed. Five would be leaving on August 17th and lent to a rate of about iId. in the £-would be amply repaid two on August 27th, after completing three months' treat- by the lives saved. As regards 'the cure of consumption inent. With one exception, all seven cases were either cured another good year's work had been done at the Stan ope or the disease had been arrested, and the patients would be Sanatorium. During the year the beds were increased from able to return to work. Appended to the report was a state- I8 to 30 by the completion of the new wing in JUly,; .IO2, ment showing that the patients had gained an average of which accommodates 9 female patients, and by the addition, from 3to 4 lb. in weight every week. The Chairman remarked in November, 1902, of a new window to each of the two north- that the increase in the weight of the individual patients east rooms in the main block, thus allowing space for an afforded striking proof of the beniefit which they were de- extra patient in each room. During the year 79 patients were riving. The business before the meeting was to consider a discharged after being treated for from 4 to 56 weeks. Of these scheme for the extension of the institution by the addition 41-32 males and9 females-showed signs of consolidation only, of a dining hall for thirty patients and of sleeping rooms for while 38-21 males and 17 females-had cavities in their fourteen. The present accommodation was for sixteen lungs, and several of the cases included under the consoli- patients. dation cases had extensive disease or were complicated with Mr. C. King produced and explained his plans of the pro- laryngitis. The majority of women patients were serious, posed extension. He said a large number of applications cases. The average stay of each patient was 15.3 weeks, and for the admission of patients had had to be refused, and the the average gain in weight by each patient was iSlb.; one Committee felt the necessity of providing further accommo- patient put on 45. lb. in twenty-five weeks. During the dation without incurring any considerable cost. The pro- three years the sanatorium had been open, out of 170 cases posed new buildings would be constructed of wood, cased discharged after treatment, ioo were still at work, 20 were at with uralite, and covered with suitable material. They home, 2 had been readmitted to the sanatorium, and.48 were would not be of a temporary character, but ought to last, dead. The results obtained were exactly what were antici- if painted periodically, for forty or fifty years. It was intended pated at the outset-namely, that the vast majority of those to provide five double rooms for ten patients, and four single admitted in the early stage recover so satisfactorily that they rooms. In view of further extensions, he had designed a were able to return to some years of employment, although dining hall for forty or fifty. If necessary, the shelters could their average stay in the institution h,ad been from three to. be increased on the same lines as those now proposed. The four months only; while of those 'admitted in an advanced estimated cost of the work, including construction, electric stage the majority died within a year or two of.their discharge, lighting, and heating, was £947. and only a minority returned to useful work for any length of The Chairman proposed that the extensions recommended time. An outdoor colony for patients leaving the sanatorium by the Subcommittee should be proceeded with immediately, was still a desideratum. No death had yet, occurred in the at a cost, including furniture, of ZI,200 or thereabouts. The institution. Almost all the patients improved, and did'so as Committee looked to the public to bear a large share of the rapidly in the winter as in the summer. expenditure, but they were willing to face the responsibility of increasing the overdraft for the sake of giving the very WEST. WALES. great additional benefit of extended accommodation. Their At a meeting of the General Committee of the West Wales present ideal was not to stop until they had 6o0beds, that Branch of the National Association for the Prevention of being the number which could be worked most economically. Cotnsumption, held recently at Carmarthen, Sir John Mr. Lopes said that if the work were carried out it was pos- Williams, M.P., in the chair, tie Sites and Building Com- sible that more difficulty would be experienced in obtaining mittee reported in favour of the acceptance of a site for a money than if an appeal were made in advance for the purpose. sanatorium at Allt-y-Mynydd, offered by Colonel Davies Many institutions of the kind were crippled by-running into Evans, Highmead (Lord-Lieutenant of Cardiganshire). The debt. With the report presented of the valuable work being General Committee after some discussion adopted the report. performed by the sanatorium they had a very strong case on The site selected possesses all the requirements of a sana- which to base an appeal. If the public failed to respond, it torium. It has a south-westerly aspect and is at an altitude would be no fault of the Committee that the accommodation of Soo ft. above sea level. It is three miles to the south-west was not extended. of Llanybythr stationi. It was; decided to ask fourwell-known The reolution was then altered, and proposed by the firms to submit plans, estimates-, and specifications for a Chairman in the following terms: movable sanatorium for 20 patients, and for two small That the extension of the sanatorium in accordance with the scheme annexes in which eight patients who could pay two or three presented by the Extension Subcommittee be approved and proceeded guineas 'a week for their maintenance andtreatment, could be with at a cost, inclusive of furniture, of 6I,200 or thereabouts, so soon accommodated. as an appeal has been made for subscriptions, and a substantial amount The Hon. Secretary reported as to ways and means. He has been received towards the extension. went on to say he thought that now they had secured a site This was unanimously agreed to. they could confidently appeal to the County Councils,