This

abuse of the powers vested in magistrates by Lord Mayo's Act. act will be no credit to the statute book as long as it remains unrepealed, and we hope that some of our Irish brethren will bring it under the notice of the Association at this year's meeting in Dublin. Nothing can be more repulsive to our modern ideas than sending a poor creature afflicted with disease under police escort to an hospital. The number thus admitted in 1873 (under the name of "Dangerous Lunatics," but treated in their transit as if criminals) amounted to the enormous total of 1,226. It says little for the patriotism of Irish Members that they do not take steps to obtain a repeal by the Government of this Act. If Jane Smith becomes the subject of the physical disease termed insanity, she is quietly taken in a fly to the county asylum, accompanied by the relieving officer and a female nurse. If, however, poor Biddy O'Callaghan becomes the subject of the same disease, she is given into "custody" to two police constables in uniform, with their bayonets hanging from their belts, placed on an outside jaunting car, and driven through the streets, it may be, of a populous town to the district Hospital for the Insane, to which she is. "committed" as a "dangerous lunatic." And how injurious, too, must such a spectacle be to the poor inmates who can see a car such as we describe passing the windows of their day-room! We can easily imagine one whose mind has begun to resume its functions, asking herself "Was I brought here by the police, like that?" That the evil is of great magnitude, warranting our dwelling on it so long, will be granted when we state that the report before us shows (v. p. 190) that in the year 1873 no less than 102 of the women admitted into a single asylum-the metropolitan one in Dublin-had to pass through the streets of that city under police escort! Why should Irish Biddy be thus treated as if she were a criminal, while English Elizabeth, when affected in an exactly similar way, is taken to the county asylum as decency suggests and humanity commands? Let every nationalist M.P. keep on asking and asking again this question in the House of Commons, till the Act 30 and 31. Vict., c. 118, is erased from the statute book.

We observe that the Inspectors have omitted to give two tables of considerable interest which appeared in their report for 1872. We allude to those showing the time relapsed cases had been absent previous to their last admission and subsequent to their discharge as "recovered." We may here remark that, excluding transfers, the relapsed cases were in the proportion of 18.88 per cent. of the total number admitted in 1873. The proportion in England was 14.83 per cent. during the same year in the public asylums.

The recoveries during 1873 in the Irish District Hospitals were more numerous in proportion to the admissions than was the case in either England or Scotland. The ratio in each country was as follows:-In England, 33.95 per cent.; in Scotland, 41-41 per cent. ; and in Ireland, 45-27 per cent. of the admissions. We are sorry to

find the Inspectors advocating the calculation of recovery percentages on total numbers under treatment. Such a method would be obviously unjust to the older institutions; for the longer an asylum is in existence the larger must be the residue of incurable, or more correctly chronic cases. No one who has the most superficial acquaintance with the subject of insanity statistics could be guilty of the "fallacy" they refer to " of supposing that the recoveries had taken place exclusively among the admissions." The great object we aim at in deciding on the method of calculating percentages is the avoidance of the greatest error. The question was exhaustively discussed by the Association's Committee appointed for the purpose, and the conclusion arrived at was in favour of the method now almost universally adopted, involving as it does less error than any other. We hope the Irish Inspectors will lend us their valuable support, as have already the English Commissioners, in endeavouring to get the statistics furnished by all public asylums drawn up in a similar manner. It is a pity that Ireland has remained so long the "silent sister" in this respect. We feel sure, however, that if the Inspectors were to append to their next blue book a copy of Appendix K of the English Commissioners' Twenty-second Report, and suggest the adoption of the forms therein contained for the annual tables published by each district asylum, there would hardly be found a single superintendent who would object to the additional labour involved in such a contribution to science, onerous though their ordinary duties are.

The mortality during 1873 in the district asylums was low, being only at the rate of 9.86 per cent. of the average numbers resident. The proportion in England in the public asylums during the same period was 10.70 per cent. In Scotland it was only a little over 8 per cent. If, however, we calculate the ratio on the total number under treatment during the year, the percentages will be :-For Ireland, 7.06; for England, 8.31; and for Scotland only 6.21. In the Cork District Insane Hospital there seems to be a singular idea of the meaning of the term "Death from natural causes.' ." Last year we remarked on the inconsistency between the figures given in two of the blue-book tables, owing to this peculiar mode of interpretation. The same thing has occurred again in the present blue-book, and in a similar way. At page 183 the Cork establishment is not credited with any deaths "from accidental causes;" whereas at page 201 three deaths are set down as having arisen from "accident, violence, or suicide." And yet at page 37 the Inspectors thus say, decidedly:-"We are happy to report that no death occurred through accidental or violent means during the year, which is all the more gratifying taking the crowded state of the asylum into consideration, and many of the patients having suicidal and dangerous tendencies." Do they still look upon "nervous decay " in Cork as a cause of death to be classified with "accident, violence, or suicide ?" If so, it would be advisable to get the heading in the table altered. However, we

may take for granted that no suicide took place in the Cork District during 1873, and thus we arrive at the fact that only six out of the 665 deaths were due to casualties. All of them were males. One fell accidentally out of a window, four committed suicide, and one was strangled by a fellow patient during the night in a six-bedded dormitory, which had a window of communication between it and the attendants' room.

care.

We observed at the commencement of this review that the report before us was drawn up in a fuller and more systematic manner than previous ones. This improvement we owe to Earl Spencer, who during his Viceroyalty took the greatest pains to go minutely into every matter affecting the well-being of the insane, and was obviously impressed with the responsibility of the duty devolving on him as head of the government in Ireland. No official is vested with similar power in England as regards the insane and those connected with their The system commends itself in many ways, and it might be well for us on this side of the Channel if our machinery were assimilated. Earl Spencer seemed to have as one of his guiding principles the advantage to the insane of having everything connected with the government of the institutions for their treatment as fully as possible understood by the public. One evidence of this was afforded by his issuing a minute to the Inspectors directing them in the annual reports furnished to the Viceroy to give specific information regarding each of the twenty-two district asylums under the sixteen following heads:

The Inspectors are, therefore, now officially called upon to notice everything of importance connected with the history or management of such institution during the year. Official records of considerable value will thus be annually published of a most comprehensive kind, and at the same time easy of reference. The Inspectors, much to their credit, have shown in this their first report, drawn up according to the above plan, that they are anxious to carry out the instructions of the Lord Lieutenant, not only in the letter but also in the spirit. They allude very prominently to the advantage that would accrue to district asylums generally, if the Governors showed a greater readiness to act on the suggestions made from time to time by the Medical

Superintendents on matters of detail connected with the internal economy of such place. Their advice may be summarized thus:Give the Superintendent anything in reason he says is necessary for the proper working of the institution, and hold him accountable then in the fullest way if things do not go on smoothly. The bearing of the advice will be better understood when it is remembered that the appointment of an Irish Superintendent is held direct from the Crown, and is made by the Lord Lieutenant himself without any consultation with the Local Board. The latter have power neither to increase (except by recommendation) nor diminish his salary nor allowances, nor can they refuse to grant him a pension, the provisions of the Civil Service Superannuation Act being mandatory in that respect. The new code of Privy Council Rules-which came into operation on the 23rd of February, 1874-makes the independence of the Superintendent quite unmistakable. That official must be present during the Board's entire meeting, for by the 36th Rule he is held responsible for the "accuracy of the records in the "Minute Book." Another rule in the same code indicates that if a Superintendent looks forward to an increase of salary he must be in the good graces of the Inspectors as well as of his Board, the wording of the clause being as follows:

It shall, however, be lawful for the Lord Lieutenant in Council to increase the salary of any Resident Medical Superintendent who may have served eight years in any asylum to the satisfaction of the Board of Governors, upon the recommendation of such Board and of the Inspectors; such increase not exceeding in any case £100 per annum.

This progressive increase in proportion to length of service is a step in the right direction, and has but one fault, namely, the long time a Iman will have to wait for it. Why should it not be with Asylum Superintendents as with officers in the medical departments of other public services-the navy and army, for example-who get their salary increased at the end of five years? However, there is ground for our congratulation of our brethren in the Sister Isle for even this concession to what the Inspectors themselves designate the" claims of Resident Medical Superintendents."

We hope that many other claims of the Irish Superintendents will be urged with the same vigour by the Inspectors who, it is but justice to remark, seem anxious to do what is fair and right by those whose cause they have lately been advocating with some success. We have only space at present to draw attention to two of the most urgent of these claims as they occur to us reading with English spectacles "through the lines" of the report. It seems to us that for the benefit of the insane poor of Ireland the Inspectors ought to urge upon the Government (1) to make it compulsory on Boards of Governors to appoint an Assistant Medical Officer in every asylum having more than two hundred beds, who may very well take the place of the "Visiting Physician," according as vacancies in the

latter ornamental office occur, and (2) to grant pensions to the staff on a similar scale to that sanctioned by Act of Parliament in England.

To the first of these claims we have referred in former reviews of the Inspectors' blue-books, and only now recur to it because the new code of rules furnishes a strong argument in its support. We would here remark that the Rules are equally applicable to all district hospitals for the insane in Ireland alike, whether they have an Assistant Medical Officer, or-as in the case of the one for the counties of Tyrone and Fermanagh with its 510 beds and seventeen other district asylums-the only resident medical officer is the Superintendent. There are forty-eight County Asylums in England, and of these there are only two without an Assistant Medical Officer, and which are held up by the Commissioners in Lunacy as being thus very objectionably circumstanced. Out of the twenty-two similar institutions in Ireland there are eighteen without one.

By referring to the new Code of Rules we find that in addition to his ordinary duties as Medical Superintendent the Resident Physician of an Irish Hospital for the Insane is required to—

(1.) Issue summonses for board meetings. We see that in several asylums the number of Governors is over thirty. In two, at least, they number fortyfive.

(2.) Send to the Inspectors within four days of the meeting "a full and accurate copy of the minutes" of every Board's proceedings.

(3.) Certify to the accuracy of the quarterly accounts and estimates of expenditure and of all money demands.

(4.) Submit to each Board-the Governors meet every month as a rule-calculations as to the proportionate number of vacancies to which each division of the district is entitled.

(5.) Send to the Inspectors a copy of each such return.

(6.) Make all entries in the General Register for Admissions (vide Rule 21). (7.) Take the responsibility of making agreements as to amount to be paid by friends towards maintenance of each paying patient.

(8.) See that all the accounts of the Institution are kept in accordance with the regulations of the Inspectors.

(9.) See that bills, &c., are regularly prepared and submitted to each meeting of the Governors.

(10.) See that the correspondence of the Board is duly attended to.

(11.) "Be responsible for the disbursement of such money as may be placed in his hands by the Board" (vide Rule 38).

(12.) See to the repairs of male patients' clothing, and issue written orders (to be filed) when any articles are required from the store in lieu of bedding, linen, &c., condemned on the male side (vide Rules 78 and 85).

Not one of the above duties is ever imposed on the Superintendent of an English County Asylum. We cannot understand why Irish Superintendents should be called on to perform them. There are none of them which a Clerk and Steward could not attend to, and thus enable the Resident Physician to devote his time and energies to the treatment of the cases in the "hospital."

We observe with much satisfaction the frequent use of the term "hospital for the insane" by the Inspectors to designate the public