The Journal of Mental Science (volume 22) (2024)

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Volume 22

THE JOURNAL OF MENTAL SCIENCE

(Published by Authority of the Medico- Psychological Association).

EDITED BYHENRY MAUDSLEY, M.D.,ANDTHOMAS S. CLOUSTON, M.D."Nos vero intellectum longius a rebus non abstrahimus quam ut rerum imagines et radii (ut in sensu fit) coire possint. "FRANCIS BACON, Proleg. Instaurat. Mag.VOL. XXII.LONDON:J. AND A. CHURCHILL,NEW BURLINGTON STREET,MDCCCLXXVII." IN adopting our title of the Journal ofMental Science, published by authority of the Medico- Psychological Association, we profess that we cultivate in our pages mental science of a particular kind, namely, such mental science as appertains to medical men who are engaged in the treatment of the insane. But it has been objected that the term mental science is inapplicable, and that the terms,mental physiology, or mental pathology, or psychology, or psychiatry ( a term much affected by our German brethren) , would have been more correct and ap- propriate; and that, moreover, we do not deal in mental science, which is pro- perly the sphere of the aspiring metaphysical intellect. If mental science isstrictly synonymous with metaphysics, these objections are certainly valid, foralthough we do not eschew metaphysical discussion, the aim of this Journal is certainly bent upon more attainable objects than the pursuit of those reconditeinquiries which have occupied the most ambitious intellects from the time of Plato to the present, with so much labour and so little result . But while we ad- mit that metaphysics may be called one department of mental science, we main- tain that mental physiology and mental pathology are also mental science under a different aspect. While metaphysics may be called speculative mental science ,mental physiology and pathology, with their vast range of inquiry into insanity,education, crime, and all things which tend to preserve mental health, or to pro- duce mental disease, are not less questions ofmental science in its practical , that is, in its sociological point of view . If it were not unjust to high mathematics to compare it in any way with abstruse metaphysics, it would illustrate ourmeaning to say that our practical mental science would fairly bear the same rela- tion to the mental science of the metaphysicians as applied mathematics bears to the pure science. In both instances the aim of the pure science is the attainment of abstract truth; its utility, however, frequently going no further than to serve as a gymnasium for the intellect. In both instances the mixed science aims at,and, to a certain extent, attains immediate practical results of the greatest utility to the welfare of mankind; we therefore maintain that our Journal is not inaptly called the Journal of Mental Science, although the science may only at- tempt to deal with sociological and medical inquiries, relating either to the pre- servation of the health of the mind or to the amelioration or cure of its diseases;and although not soaring to the height of abstruse metaphysics, we only aim at such metaphysical knowledge as may be available to our purposes, as the mecha- nician uses the formularies of mathematics. This is our view of the kind ofmental science which physicians engaged in the grave responsibility of caring for the mental health of their fellow men, may, in all modesty, pretend to cultivate; and while we cannot doubt that all additions to our certain knowledge in the speculative department of the science will be great gain, the necessities of duty and of danger must ever compel us to pursue that knowledge which is to be obtained in the practical departments of science, with the earnestness of real workmen . The captain of a ship would be none the worse for being well acquainted with the higher branches of astronomical science, but it is the practical part of that science as it is applicable to navigation which he is compelled to study. ”—J. C. Bucknill, M.D., F.R.S.THE JOURNAL OF MENTAL SCIENCE.[Published by Authority of the Medico- Psychological Association. ]APRIL, 1876. VOL. XXII.No. 97. NEW SERIES,No GI.PART 1. -ORIGINAL ARTICLES.Reflex, Automatic, and Unconscious Cerebration: A History anda Criticism. BY THOMAS LAYco*ck, M.D., &c. Physicianin Ordinary to the Queen for Scotland, and Professor ofthe Practice of Physic and of Clinical Medicine in theUniversity of Edinburgh.(Continuedfrom Vol. xxi. , p. 498).VIII. -Turning from the living mechanism and its energies,to the energies derived from without that move it-the" strings ofthe puppet" -to use the mechanical phraseology,we come upon another class of words and phrases which areambiguously used in the " old metaphysics," but which havea definite and wholly different meaning in studying theorganic bases of mental life . These are such words as impression, irritation, suggestion, and the like. I may be permitted to state, somewhat dogmatically, what is now admittedgenerally, that all changes in the constituent matter ofliving things result from the operation of physical or molecular energies therein. This being so, the cerebral seriesofchanges involved in mental states of the individual, andconstituting the process termed cerebral reflex action, are dueto as purely physical causes as those on which spinal reflexaction depends. And this is true, not less as regards feelingslike corporeal pain, and sensations, than as regards thehighest work of the intellectual faculties. This operation ofphysical energies, however, was not recognised by MarshallHall and Dr. Carpenter in 1838, nor, indeed, by physiologistsin general. One source of the difficulty experienced in doingthis is in the imperfect appreciation of what is physicallyincluded under the word impression. Thus, an anonymousdefender of the views of the eminent physiologists namedobserves, in 1846, in opposition to my views-(RECAP)XXII.5031.2211876-77)12 Reflex, Automatic, and Unconscious Cerebration. [ April,"Dr. Layco*ck mentions that the sight and hearing of certain thingsexcite reflex actions of the brain. Will he maintain the absurdity thatin hydrophobia the impinging of the sound upon the auditory nervesproduced in the utterance of the word water ' makes an impressiondifferent from the sound of any other word, and which is carried byan incident and reflex action to the vocal organ?" (" Vindex" inLancet, 2nd May, 1846.)The answer to this objection is simple. In cerebral reflexaction, as in the " true spinal" kind, it is only certain kindsofexcito-motor or excito- sensory impressions, and these actingon certain kinds of nerves going to certain centres, that canexcite cerebral reflex actions and conscious states, whetherthey be instinctive, sensational, emotional, or volitional.Hence, I have named this class affinitive impressions. Wordsand like signs of ideas, whether of writing or of speech, arethe result of the consensual actions of certain muscles, and,as such, are in excito-motor and excito-sensory affinity withthe respective substrata upon which they depend; and so theynot only make manifest the corresponding states of consciousness of the individual, but are affinitive excitors of corresponding states in others. It is thus that the signs of emotionsin an individual are the excitors of emotions in others.Upon this law the arts of the orator and actor are founded.According to this, also, sympathies and antipathies areexcited, even by a tone of voice or a glance; and to carrythe analogy into the highest development of the humanmind, it is by the same law that speech and writing, theaffinitive signs of conscious states, as knowledge, act uponthe hemispheres and excite therein the organic conditions ofthose conscious states as knowledge. Dr. Carpenter hashimself witnessed how the notion of personal identity ofpersons in mesmeric sleep can be at once changed byspoken words to that effect. But this, according to the wellknown law of pathology, is only an " abnormal" manifestation of the " normal," for in all the business of life mankindare thus subject to the influence of words and phrases in exciting thought and volition.This affinity of impressions with their corresponding locusin quo of reception suggests the analogy of chemical affinity;but the reader to whom the physics of impressions arewholly new, will be better able to understand them if he willapply the principles of optics and acoustics to the solution ofthe problems, and bear in mind what wonderful mechanicaladjustments of the optic and auditory apparatus are needed,to constitute the vibrations of sound and the undulations of1876.] by THOMAS LAYco*ck, M.D. 3light into auditory and visual impressions. On this point theresearches of Helmholtz are very instructive. It has recentlybeen shown by calculation that, in hearing, the adjustments,by means of the muscles and the bones of the ear, are sominute as to be invisible to the highest microscopic powers.Then he has to consider how minute impressions, such as aglance ofthe eye in fencing, or in discourse, will excite an instantaneous thought or volition in adaptation to an end.It is, therefore, to the reflex action ofthe cerebrum, thus excited through the recipient organs of those affinitive impressions which are the signs of feeling and thought, that theprocesses termed suggestion and direction of attention aredue, whether they arise in ordinary life, or during mesmericmanipulations . Equally, too, the higher phenomena of clairvoyance and thought-reading are but exalted manifestations,due to an exaltation of recipient and reflex function, ofwhat is normal and conscious. All men, and even dogs andchildren (and perhaps all animals), are character andthought-readers, i.e., recognise the intentions or feelings orthoughts of those about them by the signs of their mental states. Intentional production — as imitation of themuscular acts which are the signs of sentiments in others,has been used to discover those sentiments by thus producing cerebro-mental states like those of the person tested.In like manner the volitional production of morbid states isa method of fraudulent production of mesmeric phenomenato which I long ago called attention.---"There cannot be a question that the O'Keys [the subjects of Dr.Elliotson's experiments at the time of writing] thus excited realphenomena ( Lancet,' vol. ii. , 1837-38, and of Sept. 8th) , just ashysterical girls can bring on convulsions at will, and anybody ideas,sensations, and emotions, with more or less facility. Consequently,there can be no question of the possibility of voluntary common somnambulism. 'We can excite a sensible degree of the passion ofanger in our own breasts by imitating the looks and gestures whichare expressive of rage' (D. Stewart, on the Active and Moral Powers.Edinburgh, 1828, p. 119). This is one of the secrets of good acting."(My Essay in Edinburgh Medical and Surgical Journal, July, 1839,p. 25.)There is, however, an involuntary and unknowing-or, asDr. Carpenter would say-an " unconscious " imitation orreflex production of these phenomena by affinitive impressions, of much wider manifestation than the preceding,and which deeply influences man's physical and moral nature.Sometimes this imitation is manifested knowingly, yet reflexly4 Reflex, Automatic, and Unconscious Cerebration, [ April,and unvoluntarily, because the acts imitated cannot berestrained, although recognised . Hence the individual cannothelp imitating the manner of speech, gestures, and otheractions of those about him. It is a very common instinctiveprocess in lower animals. Looking at the so-called imitationas a manifestation of cerebral reflex function, I may beexcused saying that perhaps there is no more importantchapter in biology and in mental science than this whichhas to demonstrate the excitor-influence of external impressions, considered as energies, upon the forms and habits ofanimals in general, and especially on man's moral constitution. It includes all unconsciously operating moral as wellas physical influences from society and Nature. As a law, itcertainly extends to the lower animals, as manifested in theso-called disguises of nature, in which there is an assimilation-as to the colour and form chiefly-of surrounding things.M. Pouchet read, at Brighton, in 1873, an account of someexperiments he had made on fishes which change theircolour to that of the river bed on which they rest, whichclearly showed that the changes are due to impressions ofreflected light received from the surrounding media throughthe optic nerves.*These remarks refer, however, to only one portion of thegreat question involved-the external relations of the humanconsciousness; another, and not less important one, is theregion of internal relations and internal impressions. Thisregion is, as yet, almost wholly untouched by physiologists;nevertheless it contains some of the most elementary questions of mental science. The fundamental law is, that livingthings come into immediate adaptive contact with living things-corpuscle with corpuscle-cell with cell-protoplasm withprotoplasm-their relations being regulated by fundamentaldivisions of the nervous system, named the trophic. I markedout the operation of a law of reflex nutrition and development thirty-five years ago, and gave illustrations fromthe physiognomical signs of the sentiments and propensitiesas denoted, not only by the facial expressions due to consensual muscular action, but also by features considered as thespecial forms into which facial bones and muscles and wrinklesare cast. †IX.-Other instructive illustrations of the causes of mis-

• See also Comptes Rendus, 28th Dec., 1874.

See a letter to George Combe, 7th April, 1845, in Lancet, vol . ii . , 1845,p. 258; also my chapter on "The Vivifying and Co- ordinating Action of the Contenta of Cells and Vessels, " in Mind and Brain, vol. ii. p. 218.1876.] by THOMAS LAYco*ck, M.D. 5understanding which I have pointed out are to be found in theopinions either expressed by Dr. Carpenter, or implied inthe context, that cerebral reflex action, automatic action ofmind, and unconscious cerebration , are the correlatives, inphysiology, of Sir William Hamilton's doctrine of " MentalLatency," as developed in his Lectures on Metaphysics. Andhere, for the better understanding of this point, I must notea verbal inaccuracy of Dr. Carpenter's. Hamilton, so far asI can find, never uses the phrase or means to denote " LatentThought," as stated by Dr. Carpenter. The proper synonym,would be Latent consciousness or Knowledge. * But Dr. C.shall give his opinions on this point in his own language:-6"The psychologists of Germany, from the time of Leibnitz, havetaught that much of our mental work is done without consciousness;but this doctrine, though systematically expounded by Sir W.Hamilton, under the designation Latent Thought,' has only of lateattracted the attention of physiologists . Though foreshadowed byDr. Layco*ck, in his memoir of 1844, on the Reflex Action [ Function ]of the Brain, ' it was not expressed with sufficient clearness to obtainrecognition on the part of any of those who studied that essay withthe care to which its great ability entitles it . Some years afterwards,however, Dr. Carpenter was led, by considering the anatomical relationof the cerebrum to the sensorium, or centre of consciousness, to theconclusion that ideational changes may take place in the cerebrum ofwhich we may be at the time unconscious, through the want ofreceptivity on the part of the sensorium, just as it is unconscious,during sleep, of the impressions made by visual images on the retina;but that the results of such changes may afterwards present themselves to the consciousness as ideas, elaborated by an automatic process of which we have no cognizance . This principle of action wasexpounded by Dr. Carpenter, under the designation UnconsciousCerebration, ' in the fourth edition of his Human Physiology,' published early in 1853. . . . . The lectures of Sir W. Hamilton nothaving been then published, none but his own pupils were aware thatthe doctrine of Unconscious Cerebration ' is really the same as thatwhich had long been expounded by him as ' Latent Thought.'" "—(Quarterly Review, Oct. , 1871 , p. 317.)66This statement has reference to the subject of Sir W.Hamilton's 18th Lecture, in which he proposes to solve thequestion-" Is the mind ever unconsciously modified?"Substitute the word brain for " mind," and that is theproblem of cerebral physiology. But then he goes on at theonset to say that the question refers " in particular to thegreat phenomena of memory and association," and adds-

• I have discussed this question in " Mind and Brain," Vol. i. , chapters headed " Unconscious Existence" and " Latent Consciousness," p. 160 seq.

6 Reflex, Automatic, and Unconscious Cerebration, [April," The question I refer to is, whether the mind exerts energies,and is the subject of modifications of neither of which it isconscious p" Substitute, again, the word brain, or man, for" mind," and the word the individual for " it" in the question, and that again is the question we have to deal with asphysiologists. This substitution may often be usefully madein reading philosophical works, as I pointed out long ago. *And I would here suggest, that if Dr. Carpenter had realised the ambiguities and false resemblances which lurk in theterms of the metaphysician , he would have seen that what hedesignates unconscious cerebration is more correctly, eitherinvoluntary or unknowing cerebration or involuntary andunknown mental activity as regards the individual. I thinkin all Dr. Carpenter's illustrations the individual is in somestate of consciousness, albeit not in a particular knowingstate, or as having knowledge. To understand Hamilton'sviews, therefore, in reference to brain-function, it isnecessary to bear in mind that he uses the words mindand consciousness sometimes synonymously to denote thesame abstract thing, sometimes to denote a state of theindividual as to mental activity. Mind may also beused synonymously for brain, as denoting a thing, andconsciousness as denoting a state or condition of the thing,mind. But consciousness is chiefly used to denote thestate of knowledge or of knowing. Hamilton, moreover,used the words mind and consciousness in the sense either ofan energy, or as a manifestation (phenomenon) of an energy,upon which continuous mental life depends, and variouslynamed mind, soul, &c. It was with these varying meaningsattached to terms that he discussed two distinct problems;the one being whether consciousness, held to be both a generalstate and the cause of mental life, ever ceased. This he answers in the negative, maintaining, both from arguments andexperiments on himself, that consciousness continues even during the most profound sleep. The other question is, virtually-although not put in that form by him-whether consciousness as knowledge, and as an energy, ever becomes latent, inthe sense in which the physicists use the word in the phraselatent heat. This problem he also endeavours to solve by observation; and it is as to this kind that he " adduces someproof," by cases detailed, " of the fact that the mind [physio-

• "Even Locke scarcely ventured to refer to the brain and nervous system;

but it is not a little curious that brain may be substituted for mind in numerouspassages of his works. He speaks constantly of the mind as the organ; and of the will and of understanding, or perception, as the agents." —(My Essay, in Edinburgh Medical and Surgical Journal, July, 1838, p. 8.)1876.] by THOMAS LAYco*ck, M.D. 7logically the brain] may, and does, contain far more latentfurniture than consciousness informs us [i.e. , all mankind]that [he or] it possesses. To simplify this discussion I shalldistinguish three degrees of latency. "* The first of thesedegrees of latency includes ordinary memory as to knowledge, and habitual or acquired consensual acts as to will,The second I give in his own words-"The second degree of latency exists when the mind containscertain systems of knowledge or certain habits of action which it iswholly unconscious of possessing in its ordinary state, but which arerevealed to consciousness in certain extraordinary exaltations of itspowers. The evidence on this point shows that the mind [brain]frequently contains whole systems of knowledge, which, though in ournormal state [ of brain ] they have faded into absolute oblivion, may incertain abnormal states [ of brain], as madness, febrile delirium,somnambulism, catalepsy, &c. , flash into luminous consciousness. Forexample, there are cases in which the extinct memory of wholelanguages was suddenly restored, and, what is even more remarkable,in which the faculty was exhibited of accurately repeating, in knownor unknown tongues, passages which were never within the grasp ofconscious memory in the normal state." ( Lectures, vol. i, p. 340.)Hamilton then proceeds to narrate illustrative cases, including insanity, febrile delirium and somnambulism. Hequotes, among others, the case of the well-known Germanmaid-servant, who, when in the delirium of fever, " was incessantly talking Latin, Greek, and Hebrew in very pompoustones." The two degrees of mental latency, as defined, obviously correspond to the organic substrata of the memory ofthe individual as distinct from ancestral memory, and acquiredduring the current life-time.†The third degree of " mental latency" is more abstract andis physiologically ancestral. It is that which alone, Hamiltonremarks, has been hitherto argued by philosophers. Thisbeing so, he adopts a certain method-viz., he considers itin itself and in its history; and this he does "because theprincipal difficulties which affect the problem arise from theequivocal and indeterminate language of philosophers.""The problem, then, in regard to this class is-Are there, in ordinary,mental [cerebral ] modifications, i.e. , mental [ cerebral] activities andpassivities of which we are unconscious, but which manifest theirexistence by effects of which we are conscious? . . . . . In the

• "Lectures on Metaphysics, " vol. i , p. 339.

+ See my chapter as already cited, " Journal of Mental Science, " July, 1875,p. 158, et seq.8 Reflex, Automatic, and Unconscious Cerebration, [April,question proposed, I am not only strongly inclined to the affirmativenay, I do not hesitate to maintain that what we are conscious of isconstructed out of what we are not conscious of-that our wholeknowledge, in fact, is made up of the unknown and the incognisable."-(Lectures, vol. i . , p. 347.)It ought to be noted, to understand this, that Hamiltonincludes the origin of our " activities, " considered as modesof energizing our " conations "-in the same origin as our"passivities" or states of feeling and knowledge. Physio- logically, the problem includes those mental states whichhave led Leibnitz and many others to the hypothesis of the pre-conscious existence of the soul. I have classedthem in the chapter referred to under ancestral substrata,and made their origin evolutionary.Hamilton's views will be more clearly understood if we readbetween the lines what were the practical questions he wasthus endeavouring to solve, and at the same time bear inmind that to attain this end he used that speculative methodwhich he clearly describes in the next (19th) Lecture aswholly excluding all physical and physiological research. *About the time he was appointed to the chair of Logic andMetaphysics in the University ( 1836) , he was much interested in animal magnetism, and many experiments were madein his house. Another period of excitement began in 1850,when at least three of his colleagues in the University weremaking inquiries into mesmeric-magnetic phenomena. Atthat date the late Dr. Gregory, Professor of Chemistry, wasan ardent disciple of Reichenbach, who, he believed , had discovered a new force in nature, which was named " od " force,and published a translation of Reichenbach's book in 1850.In 1851, Gregory published his " Letters to a Candid Inquireron Animal Magnetism. " At this same time two of Hamilton's other colleagues-Simpson and Hughes Bennett-testedthe phenomena of animal magnetism by the physiologicalmethod, and showed that when not fraudulent, they weredue to known causes and conditions of the nervous system. †

• Lectures, vol. i. , p. 364, " Difficulties and Facilities of Psychological Study. "

+ Aconjuror, calling himself Barnardo Eagle, but said to be a Yorkshire stable boy, whom I knew well, and who explained to me his method, performed clair- voyance publicly in York as an exposure of the tricks of the mesmerizers, to- gether with other conjuring tricks, his daughter acting as his medium or sub.ject." But honesty, in this respect, was not the best policy. " Barnardo" be- came embarrassed; his apparatus was seized and sold; and after practisingsleight-of - hand in a humble way in York, he appeared at the date in question in Edinburgh with his daughter as a real clairvoyante, receiving five guineas a"séance" for their united services.1876.]9by THOMAS LAYco*ck, M.D.During the summer of 1851 I reviewed the whole subject for Dr. Carpenter, at that time the Editor of the Brit. and For.Med. Chir. Review, and took for my illustrations the writingsof Reichenbach, Gregory, Herbert Mayo, J. Hughes Bennett,Braid, and Dr. Alex. Wood. This article appeared in thenumber of that Review for October, 1851. At this time,as in 1836, Hamilton was in the thick of the " mesmericmania," as Hughes Bennett termed it.It would be a mistake, however, to conclude that Hamilton's researches were conducted solely by the speculativemethod. His examination of the claims of phrenology in hiscontroversy with George Combe shows that he could workwell by the physiological method. And in investigating thefunctions of the cerebellum, he came to the conclusion thatit "is the intracranial organ of the nutritive faculty " and"the condition of voluntary or systematic motion. "* Now,if"trophic centre of the body " be substituted for " intracranial organ of the nutritive faculty," the doctrine is thatwhich I have worked out and applied to practice for severalyears past (Mind and Brain, 1860, vol. ii. , p. 452. § 1008) .Hamilton was not merely more thoroughly acquainted withthe literature of mental physiology than the majority ofmodern physiologists, but he made, also, more extensiveand more accurate experimental researches and observations."His tables," as he states, " extended to 1,000 brains of 50species of animals, accurately weighed in a delicate balance.tHe conducted very numerous experiments with his own handon the brains of living animals, and had a constant successionof the latter in his house for this purpose. And he was wellqualified to do this, for he had studied medicine during severalyears both at Edinburgh and Oxford. His researches intocerebral function led him to take great interest in thetranslation I was making in 1850 of Unzer's Erste Gründe,in which work are evolved the doctrines of reflex function as to the energies at work, and he certainly had readmy early papers on the subject. The following letter, addressed to me at this date by Sir William Hamilton, is conclusive evidence as to his physiological pursuits, and hisspecial interest in the phenomena of animal magnetism: —

• Lectures, appendix, vol. i. , p. 410; and Munro's Anatomy of the Brain, p. 7.

Edinburgh, 1831 .† See Medical Times, May, June, and August, 1845, for his papers on the Frontal Sinuses."Life," by Veitch, p. 117.10 Reflex, Automatic, and Unconscious Cerebration, [ April,North Berwick, 12th Sept., 1850.My Dear Sir, Mr. Colquhoun was here yesterday, and broughtthe " Artz," which I send you, along with Albinus. . . . I send only the first volume-there are four in all-as that volume contains hisdoctrine on the nervous system. You will find an extract made byme from other notes taken by an anonymous auditor of Albinus ofanother and earlier course of lectures on physiology by Albinus.Since I wrote last I have read your article with much interest andinstruction, and also large portions of your book. From this I findthat you are the author of some papers in the [ Edinburgh] " MedicoChirurgical Journal," which I was much struck with at the time Iread them, touching the tendency to concealment-the cunning ofbirds in the breeding season, with the deceits practised by their femalepatients on the doctors . Mulieri, ne quidem mortuæ, credendum. Ihope you will find matters of interest in the " Artz." It seems an amusing farrago. Mr. Colquhoun tells me that before animalmagnetism was heard of, Unzer, from his own experience, professedhis belief in the fact of a transference of perception. Have you seenHerbert Mayo's late work in approbation of mesmerism? I have not;but Mr. Colquhoun says he goes the whole hog. -Believe me, my dearsir, very truly yours, W. HAMILTON.It would be a wearisome iteration to show how Hamiltondisposes of Leibnitz's " obscure ideas, " " insensible perceptions," "perceptions without apperception or consciousness,"which constitute his third degree of " mental latencies. "Nor need I quote his discussion as to the origin of " AcquiredDexterities and Habits" (the consensual actions of Dr.Carpenter) , nor his criticisms of the " mechanical theories"of Hartley and Reid. Those who are interested may see inthe original that all this part of Dr. Carpenter's doctrine ofunconscious cerebration is, in truth, a child of the old metaphysics, with all their ambiguities of terms. Unconsciouscerebration, as applied to the explanation of table-turning,might be named unknowing conation, a useful term appliedby Hamilton (after Cudworth) to denote both the act and theconsciousness of the act of energising. ( Lecture 11. )So far, then, we may conclude that if the word consciousness be used, in the physiological sense, to include allstates of feeling, as of pain and pleasure, and all sensa-

• Mr. Colquhoun (a member of the Scottish Bar), who thus favoured me with rare books from his library, was on very intimate terms with Sir Wm. Hamilton,

and assisted him in experiments on animal magnetism. His Isis Revelata(1836) is an interesting history of animal-magnetic and mesmeric phenomena.He published also " Lectures on Somnambulism " and an " Exposure of Phreno- mesmerism."1876.] by THOMAS LAYco*ck, M.D. 11tions referred to the body as their seat and point of origin, aswell as all propensities, desires, emotions, the higher sentiments, and the intellectual capabilities-and as to all thesethat they are, physiologically, coincident conditions of the individual-unconscious cerebration is not proved. If, however, the word consciousness be used to denote a cause of theactions ofwhich the individual may or may not be knowableor cognisant, then it is proved.X. -This paves the wayfor the consideration ofthe questionwhether consciousness of any kind is ever a cause of processesincluded under the phrases in question. Can cerebral reflexaction be proved by direct observation and experiment,taking the physiological definition of the term consciousness? Undoubtedly, the proof is most difficult, because ofunavoidable difficulties in the way of accurate observation.The primary and most important difficulty is that none exceptthe individual, who is the subject of inquiry, can say whether,when he did any particular act at a particular time, he was inany state of consciousness at the time. I say at the time, forthe inquiry must always be as to acts done in past time. Isubjoin an illustrative example:A gentleman of highly cultivated intellect, when he was in advanced years, consulted me as to an urinary disorder, the chief troubleof which was that he had paroxysms of intense pain-" attacks ofgravel" -so-called . Mr. Syme was consulted as to the source ofthe pain; and since he found no calculus in the bladder, it was concludedthat a renal calculus was the cause of the misery. After two yearsor more of this kind of suffering at intervals of varying duration, mypatient became the subject of defective brain-nutrition, and finallypassed into a state of such extreme senile dementia, that he had no memory and no knowledge of those about him, or of his home. Oneday, when visiting him, while yet at a distance, I heard him uttering the most dreadful cries , and found him just passing out of a paroxysm of pain such as he had formerly had. Within two minutes after hiscries had ceased, and while his features still bore the traces of suffering, I asked him if he had suffered pain just now? " Pain? pain?" hereplied, impatiently, "No! none whatever!"This case might be held as substantiating the conclusionthat the feeling termed corporeal pain is not the cause ofthecries, writhings, and other signs of the feeling, if we adoptedthe dictum of the speculative method which affirms that aman cannot feel and not know it. * And even the physiolo-

• "Can I know without knowing that I know? Can I desire without knowing that I desire? Can I feel without knowing that I feel? This is impossible."

(Sir W. Hamilton, Lectures on Metaphysics, vol . i, p. 158.)12 Reflex, Automatic, and Unconscious Cerebration, [ April,gist might be led to the same conclusion if he did not bearin mind what are the cerebral conditions for knowledge; yet I think such conclusion would be erroneous. The state ofthe higher strata of the convolutions was in this case suchthat the sufferer probably did not know what I meant by theword pain; or (which is equally probable) such that noconservative memory, as synesis, was possible, and consequently no knowledge as reminiscence. This defect of memoryrenders it difficult to say whether patients suffer pain if undergoing a painful operation when anæsthetic from chloroform.They groan, and their groans differ in cases of amputation asdifferent parts are divided--are louder, for example, when the bone is being sawn. But I can vouch that a draught of Letheis a blessing in these cases. Anyhow, it gives a "sweet obli- vion," as Milton terms it.Sir Wm. Hamilton encountered a similar difficulty in hisattempts to prove that a man (or, as he phrased it, themind) is conscious even in profound sleep. He had himselfrepeatedly awakened out of sleep, and he always found thata state of dreaming preceded full consciousness; this he, therefore, thought the normal state in sleep. But, then, this issimply the transition degree to consciousness from unconsciousness; and it is certain that a dream, although apparently of several minutes' duration, may not occupy as manyseconds. Ifthe " conscious subject" could always rememberhis, or its, state there would be no difficulty in solving theproblem from clinical observation . It is not an uncommonevent for certain epileptics to utter a loud cry of fear or horrorjust previously to a fit; but it is very rare to meet with a casein which the patient has the knowledge of having had a fit,and that he thus cried out, much less that he can say whetherhe experienced a feeling of mental pain or the emotion ofterror at the moment of the cry. I had, however, a case ofan epileptic brought under my notice in consultation withmy friend Mr. Trotter, of Stockton- on- Tees, of this kind, inwhich the cry was not always followed by a fit, and thepatient did not become unconscious. He was thus aware ofthe cry, and of the alarm it gave his friends, more especiallyhis wife. But he told me in her presence that the cry meantjust nothing; he was in no fear or pain at all, but he couldnot help it.When my correspondence on the subject with GeorgeCombe and Professor Reid was published in the " Lancet" of1845, in which I maintained that the states of consciousness named sensations are not causes, my late friend, Dr.1876.] by THOMAS LAYco*ck, M.D. 13Cowan, sent me an illustrative case of another kind, asfollows:-"Having seen some of your thoughts on reflex cerebral acts , andbelieving your views to be substantially, if not theoretically, correct, itstruck me that any confirmative fact might, in this early stage of yourinquiries, prove interesting. I am now attending a lady who evincesthe reflex visual and auditory phenomena very strikingly. Theshadow of a bird crossing the window, though the blinds and bedcurtains are closed, the displacement of the smallest portion of thewick of a candle, the slightest changes in the fire-light, induce asudden jerking of the spinal muscles, extending to the arms and legswhen violent, and this without the slightest mental emotion of anykind, beyond the consciousness of the movement. At times the vocalorgans are implicated, and a slight cry, quite involuntary, takes place.I have no doubt that the slightest conceivable influences affectingeither the eye or the ear, under the circ*mstances I have described ,do induce, apart from all pain or mental intervention , sudden contractions of the spinal muscles in a perfectly similar manner to thecontractions following the application of a stimulus to a paralyzedlimb. She, of course, both sees and hears, and is conscious of [ orknows] the source of impression; but, as I have before said, the effectis clearly independent of any conscious bodily or mental sensation."(Lancet, vol. ii . , 1845, p. 364.)I have, since that date, had opportunities of examiningseveral similar cases with the same results. The acts forwhich I was consulted, and which annoy the patient, arethose that are the natural signs of the feelings, termedemotions; but they are manifested without such feelings, andin spite of all attempts to restrain them.Another group of signs under this head are the laughterand weeping which often constitute a part of the hysteric paroxysm. It is difficult, by cross-examination, to arrive atsatisfactory information as to the state of consciousness at themoment in these paroxysms, but there are other paroxysmalcases in which laughter alone occurs at regular periods , andwhich occurs not only independently of the will, but cannot berestrained by volition-yet in which there is nothing " in themind" to excite laughter. Whenthe feet are tickled laughterwith convulsive jerking of the legs occurs in some persons.If, however, in certain kinds of spinal palsy, the lower limbsand the feet be tickled, there is no laughter, although thelimbs jerk. In this case the patient feels neither the ticklingnor the jerking, nor laughs, because disease of the cord14 Reflex, Automatic, and Unconscious Cerebration, [April,has stopped the upward course of impressions to the encephalon.Experiments innumerable have been made on lower animals,especially on frogs, to solve the question; but they are all ,without exception, fallacious, because we know that in manmere adaptive movements do not necessarily imply eitherthe antecedence or the coincidence of consciousness, and neednot therefore necessarily denote states of consciousness inlower animals . Professor Pflüger, of Bonn, experimentingon a headless frog, found that if it was hindered in itsattempts to retract the one foot which he irritated, it usedthe other to remove the cause of the hindrance to retraction, or of the irritation; hence he concluded that the spinalcord of a frog is endowed with sensation and consciousadaptation, and then extended the conclusion to the cord ofman. But, even if Pflüger's facts proved what may possiblybe true, that the headless frog is conscious, and intentionallyadapts its limbs to remove an irritating thing, a man withhis head on is surely too widely unlike a frog with its headoff to be included in the deduction. In fact, however, weknow that if the conducting function of the spinal cord ofa man be wholly destroyed near the axis-vertebra, he has nosensation in all the parts below. On the other hand, the samekind of reasoning which leads Pflüger to conclude that theheadless frog has the endowments he attributes to its spinalcord, would be available to show that all living things whatever are conscious, since all equally display a like adaptivity.Perhaps they are, but they alone can know that they are conscious.[Since writing this sentence, I have read Dr. Lauder Lindsay's interesting essay on "Mind in Plants." I observe heseriously concludes from a sentence in a previous paper ofmine, in which I meant to say that cerebral processes, whenconsidered as vital processes, may be compared with vitalprocesses in plants, that I entertain the "fancy " thatplants have something like brains. This is a curious illustration of the strange inferences which may follow on ambiguities of language. I do not know on what authority Dr.Lindsay attributes to the late Dr. Forbes Winslow certainopinions contained in a review of Sir B. Brodie's " Psychological Inquiries," published in " The Journal of Psychol.Medicine," for Oct., 1854 (vol. vii) . It is right, however, thatI should correct this statement, since I amthe author of that1876.] by THOMAS LAYco*ck, M.D. 15review, and responsible, therefore, for all that is contained inthe extract from it which Dr. Lindsay gives. ] *XI.-- So far, then, it is certain that self-examination insome form is essential to solve the problems in question; but then it is self-examination conducted in relation to themechanism . And this method serves as to all states ofconsciousness whatever. It must be remembered, however,that the method implies the knowledge that we have brains,and so use them in our most profound speculations that without them, or without the use of those portions available tospeculation, we cannot speculate at all. So that, even to speculate satisfactorily, we need always to bear these facts inmind. That, however, is not the method of speculativephilosophy, nor that which Dr. Carpenter adopts when heentirely agrees with the method of an eminent dignitary of the Roman Church. He says:-"The writer entirely agrees with Archbishop Manning in maintaining that we have exactly the same evidence of the existence ofthis self-determining power within ourselves that we have of theexistence of a material world outside ourselves. For, however intimatemay be the functional correlation between Mind and Brain—andAbp. Manning seems disposed to go as far as the writer in recognizingthis intimacy-for he says, [ in Contemp. Rev., Feb., 1871 , p. 469] -' There is another faculty and another agent distinct from the thinking brain. That we are conscious of thought and will is a fact ofour internal experience. It is a fact of the universal experience ofall men; this is an immediate and intuitive truth ofabsolute certainty.I may, therefore, lay it down as another maxim, sideby side with that of Dr. Carpenter, that the decision of mankind,derived from consciousness of the existence of our living self, orpersonality, whereby we think, will, or act, is practically worth morethan all the arguments of all the logicians who have discussed thebasis of our belief in it.'-(Mental Physiology, p. 6.)•The Cardinal herein states alleged facts and draws inferences. It is probably true that every man who is capable

• As I have reason to suppose that a like error has been current in respect to other unsigned articles in that journal which I wrote, and which contain

practical applications of my views, either to method or to practice, I may here name as amongst these-in Vol. iv (1851), " Woman in her Psychological Rela- tions," and " Sleep, Dreaming, and Insanity." In Vol. v (1852) , "The Over- worked Mind." In Vol. vii (1854) , " On some of the Latent Causes of Insanity;"Review of Dr. Noble's " Correlation of Psychology and Physiology; " " Modern Demonology and Divination;" and " On Demoniacal Societies and Literature. "In Vol. viii (1855) I name "Oinomania," and also Further Researchesinto the Reflex Function of the Brain, " which first appeared in the " Brit. andFor. Med. Chir. Rev.," for July, 1855...16 Reflex, Automatic, and Unconscious Cerebration, [April,of abstract thought as to his living self (but all menare not capable-indeed, comparatively few men are) , willrecognise the origin in consciousness of the notion that he isin act and fact a living self-a person, an individual, or oneorganism. But how do all men get at the other notion-theinference-that the energy or cause by which they thus thinkor know, and act individually, thinks and acts independentlyof the living self? The Cardinal says it is " an intuitivetruth," which means that it is knowledge acquired independently of experience, i.e. , is an innate conviction or belief.This being so, the belief is of absolute certainty.91We can examine this conclusion physiologically. Thephysiological basis of all states of consciousness (as Dr. Carpenter assumes that the Cardinal admits) being brain-activity,it follows that all states of both belief and doubt have thisbasis. Here, therefore, a doubt arises, and we need to inquirewhether " intuitive" belief, as so dependent, may ever beerroneous-whether there may not be physiologically “ intuitive" errors? It is not a conclusive answer to say that whatall men believe must be true. As to this point the readerneeds only to be reminded of the firm belief in the motion ofthe sun in space and of the fixity of the earth still prevalentalmost universally amongst untaught men, and for controverting which, as alleged truths of both theology and cosmogony, an infallible authority as to truth had Galileo imprisoned. This conviction of absolute certainty as to notionsis truly compared with the conviction of absolute certainty asto perceptions of the external world, which the Cardinal alsoholds to be of undoubted authority; that is to say-that aman can infallibly rely on the testimony of his senses-asthus I certainly see the sun move- I certainly feel that I amstationary, and that the earth is solidly fixed-ergo , the suncertainly moves, and the earth is fixed. It is precisely thisbelief in the infallibility of their perceptions which inspiresthe delusive methods of "the spiritists," zoists, mesmerists,mystics, credulous enthusiasts, et hoc genus omne.

Now the facts collected by the physiological method showwhy it is that our perceptions and beliefs and intuitions areso often erroneous, and why we cannot implicitly trust oursenses. Knowing that whether we think, or doubt, or believe,we need to use our brains, the inquirer asks what part dothese same brains of ours play in perceptions, intuitions andbeliefs? Many mental physicians, having to deal with theunalterable beliefs and convictions of the insane, however1876.]17 by THOMAS LAYco*ck, M.D.absurd, learn the fallacies of brain-work; and every theologian might equally know them, if he would study thecerebral relations of beliefs, and doubts, and perceptions inthe insane, or even in himself, if he dream; and thusknowing those relations, he would certainly acquire salutarydoubts as to the infallibility of his senses and of his perceptions and beliefs, and so gain freedom from error.ABut what are the results to Christian faith and morals ofthis method? For that is a test of its practical value.detailed answer to this question would show that incessantstrife as to dogmas and grossly erroneous beliefs as to theSupernatural have resulted from its use. So that the methodhas not been found available for ascertaining the truth as tothe order of nature in thought and belief, and in faith in God.Practically, men are so constituted that they are much moreready to believe than to doubt; there is little fear, therefore,of the mass of mankind becoming "sceptics," or inquirers.Doubt, as distinct from belief, is, however, the first step toknowledge; and verification, the process whereby we test ourbelief or conclusion as to what appears to be true, is thesecond step. But, for all this work, healthy, well- trained,well-developed brains are necessary, and this is the practical lesson of " unconscious cerebration."Theologians agree that the truths of science and of religioncannot differ; a truism, provided the truths be discovered.If, however, the methods used for attaining to a knowledgeof truth (which, as to the present subject, is in science theknowledge of the order of nature, and in theology the knowledge of the order of Divine Providence) be wholly different,how can it be reasonably expected that the conclusions reached as truths will be similar?It is , then, by a combination of methods that the twodepartments of knowledge can be made to harmonize. Andsince this great end is a special object of theologicalscience, it is clearly the business of the theologian either toinvestigate the order of nature according to the scientificmethod, for himself, or, failing in this obvious duty, soto examine and verify the investigations of others.XXII. 218 [April,The Hypodermic Injection of Morphia in Insanity. By JOHNM. DIARMID, M.B., C.M., Assistant Physician, PerthDistrict Asylum.In 1843 the subcutaneous injection of morphia was introduced into this country by Dr. Alex. Wood, of Edinburgh,as a means of treating nervous disease. He found it remarkably efficacious in relieving neuralgia, but believed its actionto be almost, if not entirely, local. His results as to therelief of pain have received almost universal confirmation;but subsequent experiments have shown that the drug actson the nerve-centres, and thus indirectly soothes the pain ofan irritated nerve, and not by causing direct anesthesiaof the seat of pain. To Dr. C. Hunter is due the credit ofhaving first demonstrated that local injection is not necessaryfor the relief of local pain. He employedthe hypodermicinjection of morphia very successfully in controlling thespasms of chorea, in subduing the excitement and overcoming the sleeplessness of Delirium Tremens and AcuteMania, and in alleviating the restless wakefulness of traumatic inflammation. (His experiments were published inthe " Med. Times and Gazette," for 1859.) Two years later,in 1861 , Dr. W. C. McIntosh, now Superintendent of thePerth District Asylum, then Assistant Physician of Murray'sRoyal Asylum, Perth, employed morphia, subcutaneously, inalmost all forms of insanity, and found it, to use his ownwords, " a sedative to the furious, a calmative to the depressed and despairing." His observations were publishedin the " Journal of Mental Science " for 1861; and althoughthis mode of using morphia rapidly became known, employed,and esteemed in many asylums, and by many alienists, theresults, so far as I am aware, were published only as isolatednotes till Dr. J. B Ward's paper appeared in the " WestRiding Asylum Medical Reports " for 1871.By most alienists, opium-or its alkaloid, morphia-is regarded as distinctly the most reliable of hypnotics andsedatives in one or more forms of mental disease. Cullen,Ferriar, Van Sweeten, Valsalva, Morgagni, Guislain, Odlir,Esquirol, Brandreth, Pliny Earle, Pritchard, Halloran,Seymour, Shute, and hosts of other physicians have given itas a hypnotic and sedative in mania, and as a tonic andcalmative in melancholia; and all concur in giving it theplace of honour. Dr. Bucknill calls it " the right hand of1876. ] The Hypodermic Injection of Morphia in Insanity.""19the physician in the treatment of insanity"-"a true balm tothe wounded spirit, a sedative in mania, a restorative in melancholia.' The same eminent writer calls the " skilfuland discriminating use of opium the sheet-anchor of the alienist physician. ' Schroeder Van der Kolk bears similartestimony in favour of opium and morphia, as sedatives in melancholia and mania.ووThe concurrent opinions of those men-many of them mosteminent alienists, and all of them quite competent to judgeof the value of a remedy-thus establish the usefulness ofopium too securely to be overthrown by a few isolated attacks.But there remains the objection that, given by the mouth,opium and its alkaloids are exceedingly apt to cause " nausea,dryness of the mouth, loss of appetite,"" and and constipation.The experience of Drs. Bucknill, Hunter, McIntosh, andWard has been that, by administering morphia subcutaneously, there is very little tendency to loss of appetiteor constipation.Constipation is produced in either of two ways, viz., byparalysis of the nerves which govern the peristaltic actionof the intestinal canal, so that its lumen becomes dilatedand blocked up by masses of fœces; or by suppression ordiminution of the secretion of the digestive and mucousglands of the stomach and intestine. Now morphia has, asis well-known, a local anesthetic action,* and by contact withthe gastric and intestinal glands, may, and probably does,act on them so as to check the production of their lubricantand softening secretions, and thus cause constipation.The condition of the tongue and mouth is always diagnosticof the state of the stomach; and when we have a parchedmouth and a furred tongue, as after stomachic doses of opiumand morphia, we may reasonably infer that the stomach is in thecondition which, considering its functions, is analogous. It isvery probable that a furred tongue is nothing but the resultof a morbid secretion from the glossal mucous glands, due toreflex irritation from, or in sympathy with, the gastric tubulesor intestinal mucous coat. † By the subcutaneous injection ofmorphia, we avoid any possibility of local interference with thegastric functions; and that there is great probability of the

• E.G. Its value (as suppositories), in relieving irritability and pain of the rectum, and in checking "emotional" diarrhoea.

+ It (the hypodermic method) has the advantage of disturbing the stomach and parching or furring the tongue much less than when morphia is given bythe mouth.-Bucknill and Tuke, p. 727.20 The Hypodermic Injection of Morphia in Insanity, [April,topical action of this drug being the cause of its producingconstipation, is indicated by its influence in controllingdiarrhoea, which can likewise be checked by direct astringents,such as logwood and catechu.The difference between the action of morphia taken by themouth, and introduced into the system by the cellular tissue,in tending to produce constipation, cannot be due to differenceof effect on the nerve- centres; for, in whatever manner the druggets into the blood, its effects must be uniform . We mayreasonably conclude, then, that the loss of appetite and constipation, apt to occur from the stomachic use of morphia,are, to a great extent, due to local action. Nor is this advantageconfinedto the hypodermic administration of morphia alone;for experiments (Dr. Lente) with quinine in intermittent feverhave proved that, when given subcutaneously, it does not interfere so materially with digestion, nor so readily cause vomiting,as when administered by the mouth; and Dr. John Duncan, ofEdinburgh, has found that the secondary effects of mercuryseem to disappear more quickly when introduced by thecellular tissue.* Dr. Lente also found that where the use ofquinine by the stomach was precluded by constant vomiting it acted well subcutaneously. He notes that it caused muchless cerebral disturbance, and acted more rapidly, byhypodermicinjection. Dr. C. Hunter also found in some cases where morphia,given in the ordinary way, caused vomiting, that no such resultfollowed the hypodermic injection of a similar dose.In some cases of melancholia, where I found morphia veryuseful as a sedative, there was a condition of great gastric andintestinal irritability, as shown by alternating constipation,diarrhoea, and vomiting; but the risk of local aggravation ofthe state of the digestive organs was avoided, and the beneficialeffects were obtained by subcutaneous administrations.Again, when morphia is given by the stomach, it runs considerable risk of being altered, and having its virtues impaired,bythe gastric secretions, or the constituents of food; it maynot be wholly, or not at all, absorbed, or its absorption may bedelayed, and thus its influence may be diminished or lost . Theefficacy of morphia given by the mouth thus depends on thecondition of the stomach; but, when employed subcutaneously,its action is independent of any such probable source of de- terioration.Even if it has escaped the action of the gastric juice, and has

• "British Medical Journal," vol. ii. , p. 795, 1874; " Medical Times and Gazette," vol. i. , p. 573, 1874.

1876.] by JOHN M. DIARMID 21 , M.B.passed into the blood (as all such crystalloid solutions aresupposed to do) , it has to go the round of the portal circulationand to pass through the liver cells. And even if the hepaticstructures have no effect on it, it may have a prejudicial actionon them, just as alcohol and other substances have; whileopium is well known to check the secretion of bile, an actionwhich may not be desirable at a time when its other propertiesare useful.We can accurately observe the amount of morphia introducedinto the system subcutaneously and with exactitude estimatethe results, for, once in the cellular tissue, it must be absorbed;whereas we can never tell the exact amount which is absorbedin the alimentary canal, because we cannot detect how muchmay pass away with the foeces .We can, also, give a definite dose subcutaneously to a patientwho refuses to swallow medicine, and to whom it can begiven by the mouth only after a struggle (in which part is oftenspilt); and the same objection applies to its administration infood artificially introduced into the stomach, with the furtherone of its interfering with the digestive process, it may be,where there is great need for aiding digestion, as in melancholics. At any hour of the day, to the patient most averse totake remedies, morphia can be be given subcutaneously withease at the most suitable time, and almost without a struggle.And, as is well- known to experimenters, many substancesproduce their effect much more rapidly when given subcutaneously than when given by the mouth; and speedy action isfrequently most desirable in insane paroxysms. Substanceswhich act as nervines or through the nervous system act morerapidly when employed subcutaneously, e.g. , apomorphia.Tartar emetic, which seems to act as a direct irritant to thestomach, on the other hand, acts much more speedily whengiven by the mouth.It is held by many, if not all, physiologists that painnecessarily implies coexisting impairment of nutrition , painbeing an indication of irritation, and irritation depressing vitality.It cannot be denied that much impairment of the nutrition ofthe nerve-centres exists in melancholia, nor that the morbidfears of the melancholic are as much a symptom of irritationand depression of the brain as neuralgia often is of a similarcondition of a sensory nerve. It is undeniably established thatof all remedies the hypodermic injection of morphia is preeminent in soothing neuralgia. Indeed, Anstie says, "thesupreme utility of the hypodermic method is due to the22 The Hypodermic Injection of Morphia in Insanity, [ April,certainty with which, in moderate doses, it will cut short thepain." It is probably on account of its rapidity of actionthat morphia is so useful an anodyne when administered hypodermically in neuralgia. Hence, as the influence of any agenton the brain-pressure, for example-is in proportion to its rapidity of action, rather than to its force, a smaller dose ofmorphia hypodermically has a greater effect than a larger dosebythe stomach, but the influence of which is spread over a longerperiod. This potency makes the hypodermic method mostvaluable, but at the same time increases the danger attachedto the use of opiates in any form. Hence more caution is required with the hypodermic than the stomachic use of morphia.All powerful remedies have, however, an element of risk intheir use, and the value of a soporific or sedative is in inverseratio to its perfect safety.It would thus follow that the hypodermic injection of morphiashould have analogous usefulness from the certainty with whichit could alleviate brain-pain or melancholic depression. Theargument is strengthened by the fact that many attacks ofneuralgia are centric in reality, although the pain is referred tosome peripheral nerve.I gave morphia hypodermically in eight persons sufferingfrom melancholia-two males and six females. In no one casedid the treatment fail in having a beneficial effect. It was themost certain hypnotic, the best and most prolonged sedative,and almost invariably had a good influence on the appetite,partly through the recuperative aid of sound sleep, and partlyby soothing the constant, gnawing misery which took awaythe desire for food, and (in some cases) the ability to sit stillsufficiently long for a proper meal to be taken. Nor did I findit tend to cause constipation; for where the motions wereregular before the hypodermic treatment, they remainedso during its continuance, and after it was stopped.In one case I injected morphia upwards of 40 timesfrequently daily on 4, 5, and, at one time, on 9 consecutive days. On each of these 40 days, the bowelswere moved, and the appetite was unimpaired. Generally theintelligence of such patients is sufficiently acute to enablethem to judge which sedative affords them most ease. Two ofthe eight (the men) distinctly preferred the subcutaneous administration of morphia to any draught, whether cannabisindica, chloral, or an equivalent dose of Liq. Morphiæ Mur. Onealways asked for a " strong dose," and the other said he got"twice as much sleep" with the hypodermic treatment as with-1876.]23 by JOHN M. DIARMID, M.B.out it; and both were constantly begging for it, until one didnot require it, by recovery, and until it was discontinued in theother, lest the opium habit should be acquired . Neither of thetwo men required a dose of medicine for constipation; and inthe case of the man who recovered, a night of sound sleep wasalways succeeded by increased cheerfulness and an improvedappetite next morning. All the six women, but one, frequently refused to swallow medicine; and it was found mucheasier to use the hypodermic than the stomachic mode of administration . I must, however, add that of the directly tonicproperties of morphia, apart from the restorative effects of soundsleep and calm of mind, I have never been able to detect any distinct trace.In acute mania, this method of treatment was found mostuseful. Many writers agree in praising the efficacy of opium,given by the mouth, in subduing the excitement and removingthe sleeplessness of the maniacal. When given by the cellulartissue, morphia has all these virtues of opium, and is "morerapid, pure," and powerful in its action. Dr. Hunter foundthatgr. of morphia given by the mouth, to a patient suffering from acute mania, had no effect until the lapse of an hour;the same dose, administered subcutaneously, caused sleep in fiveminutes. Inthe same patient the dose by the mouth securedonly an hour's sleep; that by the cellular tissue was followedby a sleep of 12 hours' duration. In another similar case, gr.morphia, subcutaneously, was succeeded in an hour by sleep of6 hours' duration; administered in the ordinary way, it wassucceeded by furious excitement. Many more similar instancesmight be adduced from his experiments. In my own experience, I have found and gr. of morphia followed by soundsleep in a quarter of an hour, or twenty minutes, after injectionduring the uncontrollable excitement of general paralysis.Rapidity of effect is always most desirable in any sedative orhypnotic given in maniacal paroxysms. The advantages therebygained are, that the exhausting cerebral action is speedilychecked, that the restorative processes are more quickly broughtinto play, that nurses and attendants are saved trouble, and (itmay be) danger, and that the chances are lessened of patientsbeing excited by seeing or hearing another in a paroxysm.I tried the method in eight patients labouring under acutemania. Of these, six have recovered, one is convalescent, butis not yet discharged; and one has passed into a chronic, andtherefore doubtful, condition. In all , morphia was given subcutaneously for excitement and restlessness . The hypnotic24 The Hypodermic Injection ofMorphia in Insanity, [April,effects in all but one were most satisfactory, and the subsequent sedative influence in all was most beneficial. The exception to the soporific action was a female suffering from puerperal mania, who seemed to have an idiosyncracy to morphia,as it caused vomiting, but very little sleep. In another female,who had slept very little for two weeks previous to admission,and was very little in bed on the night after, the result wasmost encouraging. She was very excited, excessively restless ,refused to take food, and constantly denuded herself. gr. ofmorphia injected at bedtime, on the second night after admission, caused sound sleep. She slept well for the succeeding fivenights; and on a recurrence of the excitement and sleeplesscondition, gr. proved effectual as a calmative and soporific, itssedative results extending over next day. Afew days afterwardsshe began to work, and was convalescent in two weeks fromher coming under treatment. The influence of the hypodermictreatment in controlling the excitement of acute mania waseven more strikingly exhibited in the behaviour of a young man who had shown homicidal tendencies before admission.On the night after admission, he was very restless and excited;and during the succeeding day was greatly excited, danced onthe chairs and tables, and denuded himself. At 7.30 p.m. hehad gr. of morphia injected; shortly afterward he becamequiet, and was sound asleep at 9 p.m. He has slept well everynight since ( a period of rather more than two months) , wasquiet and composed next day; began to work in three days, andfive days after was employed cleaning windows. He has continued in well- doing, and is to be discharged ere long . In thesetwo cases morphia had an alterative as well as hypnotic andsedative action on the brain. The alterative action may havebeen indirect, due to the recuperative effect of sound and prolonged sleep, or may have been directly tonic. Dr. McIntosh'spaper records similar instances in which this alterative influence of morphia was manifested.As might be expected from the utility of the treatment inacute mania, it is strikingly efficacious in mitigating, and sometimes even seems to cut short, a paroxysm of excitement,whether it appears as recurrent mania, or occurs in the courseof chronic mania or dementia. Three patients suffering fromrecurrent mania, five labouring under chronic mania, and threedements, had attacks of restlessness, with loss of sleep andgreat excitement, treated with morphia subcutaneously. Thetotal number of injections was 111; the doses varied from toof a grain of morphia; and the successful injections were1876.] by JOHN M. DIARMID, M.B. 2592. The narcotic was either given in the morning as a sedative,or in the evening as a sedative and hypnotic. Frequently,when the sedative action of a morning dose was not wellmarked during the day, the hypnotic effects were satisfactoryat night; and often, when an evening dose failed in causingsound sleep, its quieting influence was noticeable next day.Another marked characteristic of the hypodermic treatmentwas the invariable improvement of appetite which followed asuccessful dose in a case of chronic mania, and in one of dementia. Both patients, when excited, refused food, except in smallquantities, and at considerable intervals. gr. of morphia,subcutaneously, generally sufficed to give sound sleep, temporary or continued improvement of conduct and appetite.Elaterium in gr. doses was given to both on various occasions, but never succeeded so well as the morphia. The dementhad a most fœtid breath when excited, but it became perfectlysweet after a few doses of the sedative. In the homicidalparoxysms, the value of the hypodermic method has often beenproved. Dr. McIntosh once injected 1 gr. of morphia into thecellular tissue of a most " dangerous" and " furious" maniac,who " had just torn a canvas dress to fragments, and wasmeditating further mischief. " In an " hour he calmed," andwas set to work a few hours after. The same patient frequentlytore his blankets to pieces; was in the habit of beating himself,tearing his face, throwing stones; and without any provocationused to attack patients and attendants with hands, feet, andteeth. He was, perhaps, the most troublesome patient everat Murthly. During his paroxysms of excitement, whichoccurred at irregular intervals-from a week to a month-hesuffered from obstinate constipation, for which doses ofof elaterium and 2 m of ol. croton were given frequently.The depressing and derivative action of the purgatives had not such a beneficial influence on his conduct as gr. to 1 gr. ofmorphia. Indeed, a powerful narcotic was the only safeguard for his fellows .gr.Many patients, during a period of excitement, refuse medicine, and decline a meal, rather than take food which they suspect to be drugged. Sedatives can be given, where this occurs,with the greatest ease by the subcutaneous method. Thedement referred to can never be persuaded to take medicine bythe mouth; and as he rarely takes anything but milk during anattack, it has frequently been found impossible to give himsedatives, such as cannabis Indica, in the ordinary manner.He makes little or no resistance to subcutaneous injection .26 The Hypodermic Injection ofMorphia in Insanity, [April,The beneficial results of the hypodermic treatment have beenmore marked where the destructive attempts and homicidalassaults have been of the nature of sudden impulse; less successful where those efforts were the manifestations of a sullen,obstinate, and savage disposition. Where the impulse wassimply destructive, morphia was more satisfactory as a sedativethan in curbing homicidal tendencies.The moral influence which this method has on the conduct ofsome patients is remarkable. For example, A. R., chronicmania, with paroxysms of excitement, and destructiveness.This is a man of a most fiery disposition, who, during the six months preceding last Christmas, had nine maniacal outbursts .While suffering from these recurrences, he used to threaten themedical officers, and frequently assaulted the attendants. Hewould take no medicine, broke his bedstead, the door of hisroom; and was in the habit of denuding himself and tearing his clothes to pieces. He had delusions as to his being a wildanimal (e.g., a bull, an otter, a stag, etc.) , possessed of unusualstrength; and, acting on this idea, defied everyone. Onthe 23rdof last December, after he had been unusually violent anddestructive, gr. of morphia was subcutaneously injected. Thiswas in the afternoon, and he remained quiet for the rest of theday, after the operation. Next day he piteously begged not tobe injected; and, instead of blustering and bullying, cringed,and almost cried. From that day to the present time (a periodof seven months) he has never once denuded himself, never once threatened a medical officer or attendant, never once committed an assault or torn his clothing; and although he has hadseveral attacks of excitement, he has been obedient as a child.The sight of the injection syringe, or of another patient undergoing injection, stops any tendency to bluster; and yet his delusions are as vivid as ever.The restraining influence which the knowledge that medicinecan be adminstered to them, whether they are willing or not,exercises over many of the insane is very potent; while thedefiant and triumphant attitude of mind which such patientsfrequently assume after an ineffectual attempt to give drugs bythe mouth, is most subversive of the quiet and order of anasylum.In a case of general paralysis in which laudanum by themouth increased the restlessness, from which, together withsleeplessness, the patient was suffering, Dr. McIntosh foundgr. of morphia, subcutaneously, followed in a hour and a half'stime by sleep of ten hours' duration. Dr. Ward also secured1876.] by JOHN M. DIARMID, M.B. 27several nights' rest to a patient suffering similarly, by gr. eachevening, after hyoscyamus, digitalis, and chloral had lost allefficacy.In three cases of general paralysis which have come under myobservation 1 administered morphia subcutaneously 84 timeswith most successful results.The first is a chronic case, the patient being at present ableto walk about vigorously after three years' duration of themalady. After three days of great excitement, with restlessnights, he had gr. injected on two successive evenings. Thehypnotic effects were manifested in an hour's time with sedativeaction lasting 24 hours after. During the three days of excitement he refused food, and was constipated . After each dose ofmorphia, he took food well next day, and his bowels were moved.The next case was of a more acute nature, lasting only abouta year. He was under observation for 174 days, and an exactrecord was kept of the diurnal phenomena. This patient exhibited all the restlessness and sleeplessness characteristic ofgeneral paralysis. He had morphia administered to him subcutaneously, in doses of to gr, 70 times; bromide of potash, in40gr. doses, was given twice; 30grs. of chloral once. Tincture ofcannabis Indica in 3i doses four times; and 30 m of chlorodyne once. The cannabis failed as a hypnotic and sedativeevery time given; the bromide failed once as a sedative, and thechlorodyne and chloral had no effect. Warm baths were followedby sound sleep, seven out of eleven times, exhibited alone.With cannabis ( m 60) a bath was unsuccessful. With morphiawarm baths were successful five out of six times. Of the 70hypodermic injections, 55 were followed by strongly markedhypnotic and sedative action. Of the 55, 48 were unsupplemented by baths or cannabis; two were successful ( gr.) ,aided by tincture of cannabis Indica (mxx. and mxxx) . Oncean injection of gr. was unsuccessful, although supplementedby mxxv. tincture of cannabis indica. The addition of 4gr. tothe gr dose caused sound sleep when injected next evening.Of the 174 nights, if we subtract the last six of his life, when hewas too feeble to be restless, as he was dying from cerebral exhaustion and pneumonia, and if, likewise, we subtract 89 onwhich he had some form of hypnotic or sedative, there remain79 nights on which he had no drug nor other stimulant to sleep.Of these 79 nights, 33 were spent in wandering about hisdormitory (except when held in bed) , and disarranging his bed- clothes. Of the 70 nights on which he had morphia subcutaneously, 15 only were spent in unrest.28 The Hypodermic Injection ofMorphia in Insanity, [April,Frequently, however, when the drug failed to give sleep atnight, its action was only delayed, and almost invariably heslept by snatches on the day following. Such was rarely thecase when he had no sedative on the preceding evening. Atone time he was watched for 14 successive nights withouthypnotics, and on seven of these he never closed an eye. Whenhe did not sleep his dormitory was invariably wet and filthy;when he did sleep it was seldom in either condition, and, stillmore rarely, when he slept under the influence of a soporific. *So great was the improvement in cleanliness at night in thispatient by the hypodermic treatment, that we were prompted to extend it to some patients of incorrigibly filthy habits. Wetried it in four chronic dements, one male and three females.It was completely successful in one young woman, whosehabits during the summer and autumn, and until the verycold weather in December, had been cleanly. After she was found wet on four or five successive mornings gr. ofmorphia were injected one evening; her bed was found dry thetwo succeeding mornings. Of the next 16 nights she was dryfour. During the next 40 days she had morphia six times, and wasdry on the night after each injection . Of the remaining 34 nights she was dry twice on nights, each second to that of aninjection . Unfortunately, vomiting almost always occurredafter each administration, although the dose was diminished to1th of a grain. Tonics (iron, quinine, and strychnia†) were given without any reformation of her habits. As the weatherbecame warm, in last April and May, she began to improve incleanliness, and, by the beginning of June, a complete amend- ment had occurred. The next case-a female-was describedby the head attendant as the filthiest patient in the house. Onthe first four nights on which morphia was administered, shewas simply wet. Whenever not injected she was wet and dirty.Of the four subsequent injections, two were successful. The third patient had been dry only one night for two years. Shewas twice injected (gr. ), and was dry once. In these threecases the degraded condition was simply due to habit, as thebodily organs and functions were healthy. No improvementhad followed night nursing. In the male, as was afterwards

• The third case is a male suffering from frequent violent paroxysms which are easily controlled by doses of gr. of morphia subcutaneously.

Dr. Kelp found, in a young woman suffering from melancholia, and in an imbecile, that incontinence of urine (lasting from childhood) was cured in the one, and checked in the other, by subcutaneous injections cfe to gr. of strychnia. Strychnia given internally had no effect. " Brit. Med. Jour. ,"vol. i , p. 278, 1875 .1876.] by JOHN M. DIARMID 29 , M.B.discovered, the condition is due to weakness of the bladder,and, of course, the hypodermic treatment had no effect, asneither dietetic nor medicinal regimen hitherto has had.As is well known, the closure of the apertures of the rectumand bladder by the sphincters is purely involuntary; but theopening of these is more or less voluntary in the normal condition. Hence, when the ideo-motor centres are under theinfluence of morphia, the sphincters voluntarily remain closed,and prevent either micturition or defecation. In the youngerfemale referred to, I am convinced the wet habits were purelyvoluntary, and were due to a reluctance to expose herself nakedto the cold wintry air; but when narcotised she was prevented,by involuntary action, from wetting her bed.Dr. Ward found that during eighteen months an epileptic,who was injected nightly, never had a fit. This patient wassubject to violent paroxysms of excitement, headache, andconstipation. In two cases which came under my observation,morphia was given subcutaneously to soothe the irritability andcalm the excitement which succeeded a prolonged series of severe fits . The sedative and hypnotic effects were wellmarked, but no great influence on the recurrence of the attacks could be detected . Indeed, a fit once occurred two hours afterthe administration of the morphia, and when its action waswell pronounced. It is very probable that in Dr. Ward's casethe fits were caused by reflex irritation, which the morphiasoothed. The headaches would indicate this view.In a case of puerperal mania Dr. Ward noticed that the actionof morphia, instead of becoming apparent in from a quarter-ofan-hour to an hour's time, was deferred for eight or twelve hours.Some of the cases observed at Murthly exhibited this peculiarity. It was noticed in a case of puerperal mania, one ofchronic melancholia, and in one of general paralysis. At onetime the writer was inclined to attribute the delayed action tofaulty absorption from a fatty and thickened condition of thecapillaries (such a condition being found in general paralysis) ,because a crystalloid solution, like that of morphia, would takemuch longer to pass through a fatty than a colloid septum,such as a normal capillary wall. It is true that the melancholicreferred to has dilated capillaries and a diseased heart, yet thedelayed action does not always happen; and the patientsuffering from puerperal mania is young and healthy, so thatthe hypothesis is not very tenable. A careful considerationof the instances, however, show a preponderance of evidencethat the delay is due to a nervous cause, to some condition of30 The Hypodermic Injection ofMorphia in Insanity, [April,the brain. Probably the hypnotic effects of the drug arepossible only after the cerebral condition causing excitementhas been modified by its sedative properties. In the case ofpuerperal mania there was often rapid action on the excitomotor centres (as shown by contracted pupils and vomiting) ,while the effects on the ideo-motor centres came only after aconsiderable interval.For When morphia is long in being followed by sleep, variousadjuncts may be advantageously employed in some cases.rapid and safe action, a warm bath is pre-eminent. In melancholia, acute mania, and general paralysis, warm baths areoften most efficacious calmatives and soporifics, being stimulants to the skin, lungs, kidneys, and bladder, and dynamictonics to the nervous system. Sometimes however, nayfrequently, they are ineffectual in themselves, and not seldomdo they increase the excitement of maniacs and generalparalytics, more especially after a continuance. When combined with the subcutaneous use of morphia, they invariablyact like a charm, even when the dose is insufficient in itself.In melancholia this combination is very successful and veryspeedy in bringing about a calm condition of mind, quicklyfollowed by sound sleep . Tincture of cannabis Indica in smalldoses ( mxx. to xxx. ) is a useful supplement to an insufficientor delayed dose of morphia. Chloral, likewise, acts well withmorphia, but has the grave disadvantage of depressing the heart'saction, just as the latter narcotic frequently does. CannabisIndica, on the other hand, raises the pulse, while acting as asoporific and sedative, and this counteracts the most objectionable, while aiding the desirable properties, of morphia. † Whenany patient has an idosyncracy to vomit after the injection ofmorphia, or suffers from a weak heart, a safe plan is to give asmall dose subcutaneously, and then to administer a small doseof cannabis.In a continuance of the hypodermic treatment, just as whenopiates are given by the mouth, it is necessary steadily toincrease the dose, as the nervous system becomes habituated .From observing the doses which proved sufficient and thenwatching how long each remained so, I am inclined to estimatethe rate of habituation to be between and gr. of

• The trophic centres may also be in an anaesthetic condition during the paroxysms of excitement of general paralysis and acute mania, and the depres- sion of melancholia; and the absorptive processes may thus, for a time, be in

abeyance or retarded.Tea and coffee aid the action of cannabis and are antagonistic to that of morphia on the heart.1876.]31 by JOHN M. DIARMID, M.B.morphia daily, that is, in the generality of individuals. Theloss of tolerance or habituation (during intermissions of theopiate) in the cases observed seemed to be at the same rate asthe acquiring. Hence it is always necessary to increase thedose gradually during a continuance of the drug, and todiminish it to a very considerable extent (to avoid narcotism)whenrecommencing it, even after a lapse of only a few days.It is alleged by some as a grave objection to the hypodermicadministration of morphia in insanity, that it causes constipation. After a close observation of the effects of 289* injections in 37 persons, comprising three general paralytics, eightmelancholics, three cases of recurrent mania, eight of acutemania, five of chronic mania, three of dementia, three ofepilepsy, treated for excitement or loss of sleep, and fourdements treated for filthy habits, it may not be presumptuousin me to deny the assertion that morphia, employed subcutaneously, induces constipation. While, from the little experience I have had, I am unable to confirm Dr. Bucknill'sstatement that in some cases of melancholia opium " not onlydoes not tend to constipate the bowels, but that it regulatesand promotes their evacuation, " I can affirm that in no onepatient, where the bowels were regularly moved previous toinjection, was this condition interfered with by the hypodermictreatment. Indeed, in two cases, one of melancholia, and oneof general paralysis, smart diarrhoea occurred during the timethey were under the subcutaneous administration of morphia,and did not seem the least influenced by it. Strange as it mayseem, severe purging may even be caused by morphia introduced into the body by the cellular tissues. In the experiments on the antagonism of drugs, carried on under ProfessorBennett's directions, it was observed, after one of the dogs had1 gr. of meconate of morphia injected subcutaneously, that" restlessness, nausea, vomiting, diuresis and diarrhoea followed." A somewhat similar series of phenomena came undermy observation. A stout, hirsute female, of 30 years of age,weighing about 9 stones, suffering from chronic dementia,with paroxysms of excitement, had, for violence, at 11.30 a.m. ,one day, about gr. of morphia injected. At 12.30 p.m.she had nausea and slight vomiting, which were checked bystrong coffee. She, however, became quiet, instead of beingThe paper is based on a record of 413 injections, of which 124 were per- formed by Drs. McIntosh, Cruickshanks, and Gunn. To the last-namedgentleman I am much indebted for a careful description of 118 injections. All the 37 patients who were under treatment came under my own observation.32 The Hypodermic Injection ofMorphia in Insanity, [ April,excited, like the dog. At 6 p.m., immediately after takingsupper, she vomited violently, and half-an-hour later sufferedfrom profuse purging. Such coincidences are curious. *Vomiting is the most unpleasant sequence of administeringmorphia by this method. If vomiting occurs, it generallytakes place within the first two hours after injection; but, attimes, it may be delayed for six or seven hours, and then mayhappen immediately after food is taken. From a consideration of the comparative frequency, it would appear that generalparalytics are least liable to suffer from vomiting, 84 injectionsin this class of patients never once causing it. † Melancholicsrank next in rarity of vomiting, five instances having occurredin 122 injections. One female, who once vomited after asubcutaneous injection of gr. , frequently vomited independently of morphia, being of a very bilious habit, and subjectto alternating constipation and diarrhoea. Three vomitingshappened in a man who had frequently borne gr. with impunity, but was upset by gr. after an interval of time duringwhich the treatment was discontinued . The remaining occurrence was caused by gr. in a tall, stout woman, weighingnearly 12 stone. In acute mania seven vomitings occurred in72 injections; and, if we exclude five, which were evidentlydue to idiosyncracy, there were only two instances, each ofwhich was due to rather a strong dose.In recurrent mania there were three vomitings in 45 injections; in chronic mania, six in 42 injections; in dementia, 14in 43 injections; and in epilepsy, two in five injections. In atotal of 413 injections there were 37 instances of vomiting.Those patients were taken at random, without any selection,except that they required a hypnotic for restless nights, or acalmative for excitement or disturbances. Hence, the numberof vomitings which occurred may be taken as the maximum

• The violent purging may have been due to hypersecretion from the intestines, caused by irritation of the nerve- centres of secretion, followed by paralysis of the intestinal walls. Certainly it was not caused (in the lunatic's case) by dietetic conditions, for during a period of 12 months (two before, and ten after the occurrence) with an unvaried dietary , she never once has had a loose stool.

In a patient ( G. P. ) at present under treatment, there was great impair- ment of deglutition, with constant regurgitation of food after each meal, on admission. After the injection of morphia his power of swallowing was muchimproved, and he did not regurgitate. The same improvement occurred after sound sleep by other means (cannabis Indica and bromide of potash combined),and was due to the recuperation of the reflex nerve-arcs of the esophagus and stomach by cerebral rest.The vomitings in epilepsy occurred in a young man who is subject toalmost daily regurgitation of food, and to occasional attacks of hæmatemesis.1876.]33 by JOHN M. DIARMID, M.B.which may happen with ordinary attention to the dosesgiven.Vomiting most commonly occurred when the drug was administered in the morning,* about an hour after breakfast; anda dose which had no unpleasant effect when given an hourafter supper, frequently caused vomiting in an hour-and-halfor two hours when injected at 9 a.m. This difference of effectis, no doubt, due to the diurnal changes in the state of thenervous system, and also to the varying conditions of thestomach in the forenoon and evening. The stomach must bemore active, and, therefore, more irritable in the early part ofthe day, when the patient is walking about, than at night whenthe body is at rest in bed.Any disordered condition of the stomach, more especially anyhypersecretion, invariably caused vomiting with morphia. Allin whom vomiting occurred, except two suffering from acutemania, one from recurrent mania, and one from chronic mania,who had irregular appetities, were gross eaters. An exception must also be made in the case of a melancholic female, alreadyreferred to, whose appetite was very capricious . More thanonce, when vomiting occurred after a dose which usually hadno such action, it was discovered that the patient had got holdof a quantity of scraps of broken meat.Vomiting occurred six times out of 222 injections in males;31 times in 191 injections in females. Of the four men whovomited, three were gross feeders-one being in the habit oftaking all kinds of odds and ends from the refuse barrels; another ate grass, leaves, coals, etc.; while the third was seen bythe writer taking a plateful of soup, a slice of bread, and twoplatefuls of gooseberry tart (he had gr. injected four hoursbefore) , and in three- quarters of an hour was found regurgitating his dinner, but without nausea or depression.In experiments on the lower animals, it has been found thatthe action of morphia is in proportion to the weight of theanimal. Such is not the case in the insane; for a dement of12st. weight will vomit after a dose which has no such effect onan acute maniac or acute melancholic of 8 or 9st . It wouldseem that the tendency to vomit is in proportion to the deterioration of cerebral tissue-for the more the loss of intelligence,

• Of the 37 vomitings, 23 occurred in the morning. Of the 23, 22 occurred

in patients who were injected in the morning or evening, as required. Of the14 which happened in the evening, 13 were in patients who were injected only in the evening, and, therefore, their behaviour under morning administration is unknown.XXII.334 The Hypodermic Injection ofMorphia in Insanity, [ April ,generally, the more apt is this unpleasant symptom to occur.In only one case who has been discharged recovered was therevomiting; and that was once in a youngwoman of 18, weighing8st., after a two-thirds grain dose in the morning. The samedose was borne well next day, when given in the evening; andon the second evening after, & gr. had no depressing influence.Of the 37 persons experimented with, ten have recovered, orare convalescent; six of these have been discharged recovered.In all, the ten have been injected eighty-six times, and havevomited on seven occasions. Five vomitings occurred in ratheran idiosyncratic case, who had twenty-two injections. In theremaining sixty-four injections, there were only two vomitingsin nine cured or convalescent patients. Excluding the eightyfour injections of general paralysis, we have 243 injections ofincurable or doubtful chronic maniacs, melancholics, dements,and recurrent maniacs. Of these, 30 caused vomiting. Thetotal ratio of vomitings to injections in curable cases of acutemania and melancholia was about 1 to 12; in incurable cases, itwas (including dements and epileptics) 1 to 8; excludingdements and epileptics, it was about 1 to 11; in ordinarycurable cases, it was 1 to 32.The more acute and curable a case, the less tendency tovomit. In recent cases where vomiting occurred, it was manifested (except once) as the disease began to merge into thechronic state. Thus one man who tolerated gr. of morphia onadmission in acute mania, vomited after 4 gr. nine months later;and a melancholic, who was not affected unpleasantly by gr. (asa first dose) in the first month of his malady, was much depressed and vomited after 4 gr. six months later.Vomiting does not hold any definite relation to excitement;for not unfrequently does it occur in the most excited individuals, and sometimes has no material influence in subduingthis condition. Indeed, the condition of the nervous systemwhich causes vomiting occasionally seems to counteract thesedative properties of morphia; nor does vomiting necessarilyindicate general depression of the system, for the pulse andcountenance remained unchanged during its occurrence in someidiosyncratic cases. We may, then, conclude that where thereis no organic brain disease, as in acute curable cases, there isvery little irritation of the pneumogastric centres by the narcotic; or that the depressing influence is too slight to inducevomiting. In dements (not congenital) , and in chronic maniacswhere the disease has been of long standing, and, consequently, where there must be considerable cerebral degenera-1876.] by JOHN M. DIARMID, M.B. 35tion, morphia seems to act with peculiar power on the vagus. *The anaesthetic condition of the nerve-centres in generalparalysis prevents vomiting, even although the brain may belargely diseased. Conversely, it might almost be laid downas a principle that freedom from vomiting after a moderate doseof morphia is one of the most hopeful symptoms in the cases of patients suffering from acute mania.Dr. Hunter attributed vomiting to a peculiar constitution-toa highly nervous diathesis, especially in females. My experience has been that temperament has very little to do with it;and that excitable females are not more liable to vomit than thesaturnine, and are, perhaps, less so, as being less given to grosseating.Of the means employed to check vomiting, strong coffee was found the most useful. Its effects are, however, but transient;for although vomiting was always stopped immediately aftercoffee was given, it sometimes recurred some hours afterwards.Some observers recommend the combining of atropia withmorphia for subcutaneous injection, and aver that thereby allthe sedative without any of the depressing effects of the latterdrug result. Indeed, it has been stated with a fair show ofproof that atropia is an antidote in opium poisoning. † ByDr. McIntosh's advice I combined both drugs for injection insome cases who vomited after morphia. Two cases of melancholia-one of which had vomited after gr. , and the otherafter gr -were injected with gr. and gr. of morphia combined with gr. of atropia. Vomiting occurred after this administration in neither case. The atropia and morphia togetherwere given in the evening, whilst the doses of the opiate whichcaused vomiting were given in the morning. According to theresearches of the Committee of the British Medical Associationon the Antagonism of Drugs, the sulphate of atropia seems tocounteract the action of morphia within a limited area;" butthis circ*mscribed power may be sufficient to check the disagreeable effects of medicinal doses.An examination of the diet-rolls of the asylum shows thatthe kind of food which a patient takes while being treated hypodermically has no appreciable influence in inducing or pre-

• One of the males who vomited when morphia was administered six months ago is dying at present, apparently from brain disease.

+ Assistant-Surgeon G. C. Ray describes two cases of opium poisoning-one a lad of 14 , who had swallowed about 40 grs.; the other, a child of 2 years, who had taken 10 grs. , in which, after the ordinary remedies failed , injections of e gr. sulphate of atropia seemed to counteract the coma, and to have been themeans of recovery.-" Indian Med. Gaz., " July 1st, 1875.36 The Hypodermic Injection ofMorphia in Insanity, [April,venting vomiting. Those on tea and bread vomited just asfrequently and as readily as those taking porridge and milk.Even although morphia does cause vomiting, it is not to becondemned; but only on that account to be given with everypossible precaution to prevent such a contingency. Castor oilfrequently leads to vomiting, and elaterium ( gr. ) acts as anemetic far more frequently and more severely than morphia;but the use of either in insanity is not, for this cause, to bedecried.When vomiting is caused, no interference with the appetite,as a rule, follows; and often when a disturbed digestion causesirritability of temper, a good clearing out is frequently mostbeneficial to the stomach, and disposes to mental equanimity.In some cases of paroxysmal destructiveness where vomitingwas an almost constant sequence of the hypodermic treatment,elaterium, or blue pill, was found to act most satisfactorily inleading to improvement of conduct.In many patients vomiting was succeeded in an hour or twoby great increase of appetite, as might perhaps be expected .To prevent vomiting -which although, in my experience, nothurtful, is certainly disagreeable-I would recommend thatmorphia should always, where possible, be given at bedtime.If necessity requires-as in an outrageous patient -its administration during waking hours, the period immediately after orbefore a meal should be avoided.Drs. McIntosh and Ward each had a case in which dangerousnarcotic depression was produced by and gr. of morphia in awoman and man respectively. The woman had heart disease("systolic bellows' sound "), the man was 74 years of age.Both recovered by stimulating treatment. Disagreeable but notdangerous narcotism occurred in three of the cases which cameunder treatment during my experiments. One-a female5labouring under chronic mania, with paroxysmal excitement- had gr. of morphia injected at 9.20 a.m. About 11 a.m. she"became sick and vomited; her face was blanched, her pulsevery small, and her hands cold and slightly moist." Strongcoffee was given, and she speedily rallied.АThe second case is a melancholic male, who frequentlyhad gr. , and several times , without any depression. Amonth later, after an interval without morphia, less than gr. ,given at 9.30 a.m., caused narcotic depression about 11.20 a.m.The face was pallid and bedewed with sweat, the lips cyanotic,the pulse small, but there was no vomiting. Three ounces ofsherry were given, and at 1 p.m. he took his dinner as usual.1876. ]37 by JOHN M. DIARMID, M.B.The third was a female, subject to recurrent attacks of maniacal excitement. In August, 1874, she frequently had togr. of morphia subcutaneously during a paroxysm, and gr.were never known to have a depressing influence. On the 18thof November of the same year, she had gr. injected at9.20 a.m. for obstreperous conduct . At 11.40 a.m. she wasfound with contracted pupils, livid lips, pallid face, and almostunperceptible pulse. She had three ounces of sherry; and by2 p.m. was able to take a walk of a mile.What I would wish to direct attention to is that all threesuffered from attacks of syncope, during which they were asmuch depressed as by the morphia. One has an enlargedheart, with mitral disease; one died of heart disease (syncope) ,and the third has a weak heart. Those cases show how unsuitable individuals suffering from cardiac disease are for hypodermic injections on account of the depressing effect of morphiaon the heart, and because a death from syncope might be attributed to the drug. It would thus appear that the use ofmorphia hypodermically for alleviating the severe pain causedby aortic aneurism ( vide " British Medical Journal," p. 745) israther hazardous. The relief afforded by gr. in this disease,and for such a length of time as eighteen hours, shows the highvalue of the subcutaneous use of morphia in relieving pain.In the insane, I would most decidedly advise that morphiashould not be employed hypodermically in persons labouringunder heart disease, or exhibiting any symptom which indicates serious brain disease, general paralytics excepted.In melancholic females, I have found it best to begin withgr. of the acetate of morphia (equivalent to about 14 minimsof the liq. morph. acet. B.P.) , not oftener than once in every24 hours, and have never found it necessary to increase the dosebeyond gr. In melancholic males, the dose generally begunwith is gr. once a day, and all the sedative advantages of theremedy are usually gained without going beyond or gr. Inacute maniatogr. may be given for a first dose, and inrobust individuals gr. may be administered with safety. Inrecurrent mania to gr. is all that is necessary to secure quietand sleep. Inthe paroxysms of chronic mania to gr. has therequisite calmative influence. General paralytics require andbear the largest doses; and in one case I had gradually_toincrease the daily amount given to th of a grain; while Dr.McIntosh has given 14 gr. in a similar case.It must be remembered that it is very rarely necessary togive the morphia hypodermically oftener than three or four38 The Hypodermic Injection ofMorphia in Insanity, [ April,times consecutively, and only once did I require to give it onmore than nine successive evenings. In one melancholic I havegiven an injection on nine consecutive days, and in a generalparalytic on fourteen days running. Those are very exception- able cases. In melancholics, one injection every twenty-four,thirty-six, or even forty- eight hours frequently secures sleep atnight, and rest of mind during the day.From a comparison of the results obtained with the varioussedatives and soporifics employed, it would appear that tograin of morphia given subcutaneously is a more potent hypnotic, and has a more prolonged calmative influence than mxxxof tincture of cannabis Indica administered by the mouth.

1

16of a gr. of morphia gave 8 to 10 hours' sleep in some caseswhere 20 grs. of chloral, or 45 grs. of bromide of potash failedto give more than 2 or 3.* In a melancholic female a draughtcontaining 40 m of tr. of cannabis Indica and 30 grs. ofbromide of potash procured sound sleep; but was invariablyfollowed next morning by headache, a tendency to stupor, andnumbness, and weakness in the inferior extremities. Morphia( 1 gr. ) subcutaneously had equally marked hypnotic and sedative effects, but had no such disagreeable sequelæ. To thesame patient tr. was administered thrice, with much greatercalmative and soporific action than the combination of cannabisand bromide had. In a case of acute mania, where doses of40 m of gr. can. Ind. had no appreciable action, gr. of morphia secured sound sleep and quiet behaviour. The additionof 15 grs. of bromide of potash to a similar dose of cannabis,insured a sedative influence for some hours . In another case ofacute mania, in which 45 minims and 60 minims given on twosuccessive nights, had no apparent power whatsoever to calmexcitement, gr. of morphia, administered subcutaneously at11:30 a.m., was followed by a day of quiet, with sound sleepat night. On a previous admission, after zi doses of tinctureof cannabis Indica had failed in alleviating her restless condition, gr. of morphia ( subcutaneously) gave sound sleep,with quietness on the subsequent day. In general paralysis,3i. doses of cannabis had no effect whatever; while togrs. of morphia almost invariably secured sound sleep. In oneindividual, after potash bromide 30 grs. , and tr. can. Ind. 40mcombined failed in checking an attack of furious excitementin 24 hours after administration, gr. of morphia calmed theexcitement and sent the patient to sleep in less than half-an-

• Of the 17 unsuccessful injections in acute mania, 4 were insufficient from a faulty syringe, which allowed part of the intended dose to escape.

1876.]39 by JOHN M. DIARMID, M.B.hour. A similar attack of excitement was overcome, and thepatient sent to sleep in about 20 minutes by gr. of morphia.According to Dr. Hunter's experience, one-half the stomachicdose in males, and one-third in females, suffice subcutaneously.Dr. Bucknill states that he has found gr. subcutaneously actmore powerfully than double the quantity by the stomach. *My own experience of the effects of comparative stomachic andhypodermic doses is, that the latter are far more potent.Morphia in doses of to gr., was given, subcutaneously,122 times in melancholia (2 males and 6 females) , and wassuccessful as a hypnotic (5 to 10 hours' sleep) and sedative 109 times. In recurrent mania (2 females and 1 male) morphiawas injected to subdue excitement and aid sleep 45 times, indoses of to gr. , and secured the desired end 36 times. Inacute mania ( 2 males and 6 females) the opiate was administered in ,, and gr. doses 72 times-successfully 55 times;chronic mania, 42 (2 males and 3 females) -failures 9; dementia24-failure 1. In the paroxysms of chronic mania and dementia, calmative and hypnotic action resulted 56 times in 66injections of togr. , the latter quantity being rarely required.In the excitement of epileptic mania, 4 of 5 injections (gr. towere efficacious. In general paralysis, 69 of 84 administrations of to gr. doses were successful soporifics and calma- tives.In the same cases , chloral was given 15 times (by the mouth)in 20 to 30 doses, and failed 4 times as a hypnotic. It wasgiven 7 times in acute mania, and failed once; thrice in recurrent mania, and was successful twice; twice in generalparalysis, once without effect; and thrice with success inmelancholia.Tr. of cannabis Indica ( mxx. to mlx. ) failed 9 in 24 timesin melancholia; 4 in 7 ( mxl. to mlx. ) in recurrent mania; 2in 4 ( mxl. to 1. ) in chronic mania; and 13 in 30 times ( mxxx.to lx. ) in acute mania. It was of none effect in 40 to 60 minimdoses 4 in 5 times in general paralysis. In all, the failures were 32 in 70 administrations.To the same persons, bromide of potash was given 15 times,and was successful 9 times. It was given once in puerperalmania ( 60 grs.) , and had a soothing effect; 7 times in melancholia (15 to 55 grs. ) and failed 5 times; twice as a successfulsedative (40 and 50 grs . ) in recurrent mania; thrice ineffectually(30 to 45 grs) in chronic mania; twice in general paralysis (40 grs.) with one failure.

• Psychological Medicine, p. 727.

40 The Hypodermic Injection ofMorphia in Insanity, [ April,Of all the narcotics used for comparison with morphia,hyoscyamus was the most unsatisfactory, as it failed 14 in 15times, administered twice daily in mxv. doses of the tinctureto a melancholic female in whom to gr. morphia (subcutaneously) , once daily, acted like a charm. In acute mania,hyoscyamus seemed to act better, securing sleep thrice, in 30 to50 minim doses. But although it acted as a hypnotic, it wasfollowed on each occasion by most furious excitement when thepatient awakened.Of all the hypnotics and sedatives employed, morphia, hypodermically administered, was found the most certain and speedy,being successful 329 times in 394 injections, the proportion offailures being about 16 per cent. * Chloral comes next as byfar the most potent soporific, the failures being 26 per cent.Although an invaluable hypnotic, chloral has the great disadvantage of exercising no sedative action. It was, however,found to procure sleep without fail in a case of puerperal maniawhere morphia seemed to have no sleep-compelling action, this being the only instance of such results. † Tr. of cannabisIndica was a much better sedative than chloral, but exhibitedvery little soporific tendency in ordinary doses. Where therewas excitement (except of the mildest) it seemed to have littleor no calmative influence whatever. It acted best in melancholia, and showed itself to (in moderate doses) be a safe andpleasant sedative . Bromide of potash is too unreliable asedative to be used, with much benefit, in insanity . Occasionally it seemed to do well in excitement connected withmenstruation, but the trials were too few to warrant anyprecise conclusions.The smallest proportion of failures with the hypodermic treatment was in dementia ( 1 in 24); but this can be accounted forby morphia being given for the most part to subdue excitement, to secure which end much smaller doses are required thanto cause sleep. Besides, morphia acts very powerfully on the weak brains of dements. If we are to estimate a mode of

• The majority of the failures were due to the rapid habituation of the system to the doses employed.

I have more than once observed furious excitement succeed sleep securedby chloral, and recently have observed a great diminution follow its use.Dr. Clouston's favourite combination, Tr. of can. Ind. (m40) , and bromide of potash (30 to 40 grs. ) was given 11 times successfully twice it failed. It is nodoubt a very certain form of sedative, but unfortunately causes so much stupor,confusion of ideas, and such paresis of the motor nerve centres (after sleepis over) that it is a very dubious remedy in frequent doses.§ It is not usual for dements, even when excited, to suffer much from loss of sleep.1876.]41 by JOHN M. DIARMID, M.B.treatment by its success in aiding the restoration of the brainto a healthy condition, then the hypodermic method was mostvaluable in acute mania. As a sedative, its benefits were,perhaps, felt most in melancholia. Its calmative propertieswere strikingly exhibited in alleviating the paroxysms ofchronic mania and dementia, and in checking the attacks ofrecurrent mania. In general paralysis it was the " dernierresort," the indispensable hypnotic, "the sheet anchor of thephysician."The injection of morphia has sometimes led to the formationof small abscesses. My experiments were made with a solution of acetate of morphia in distilled water, acidulated with afew drops of glacial acetic acid , and having any excess of acidneutralized by liq . potas. The strength of the solution was 1 gr.to every 12 minims. The site of puncture was over eitherdeltoid, from convenience of access, and as being free fromveins. I never had more than a few drops of blood issue, and that on very rare occasions; nor did an abscess ever form inconsequence of the operation.The conclusions which seem to me to have evolved themselves from those experiments and observations are thefollowing:-1. Of all single drugs, opium, or its alkaloid morphia, isthe most potent and reliable hypnotic and sedative in the treatment of insanity.2. Morphia, administered subcutaneously, is more rapid inits action and more powerful in its effects than when given bythe mouth.3. By hypodermic injection, not only irregularity in actiondependent on gastric conditions, but digestive disorders incidentto the stomachic exhibition of morphia are avoided.4. The subcutaneous is the easiest method of givingopiates when a patient refuses to take medicine, and always the most exact.5. Of various adjuncts to opiates, warm baths are themost useful.6. Attacks of acute and recurrent mania, and paroxysmsof excitement in chronic mania and dementia, may be cutshort in the outset, or beneficially controlled, by morphia subcutaneously administered .7. In such cases (i.e. , acute mania, &c. ) , the tongue becomesclearer, and the appetite, as a rule, improved by this treatment.8. Morphia so administered has no marked tendency tocause constipation; and even in melancholia by allieviating the42 The Hypodermic Injection of Morphia in Insanity. [April,misery, and thus lessening the waste of nervous force, it predisposes to improvement in appetite and digestion.9. Vomiting, the only unpleasant symptom apt to occurwith the hypodermic treatment, is generally due to over- eatingor digestive disorders existing previous to injection, and may,by care as to the time of administration, be avoided; and whenit happens, is frequently beneficial rather than otherwise.It must, however, be borne in mind, that many of thephenomena referred to are still subjudice, and that the opinions enunciated may require considerable modification as the resultof further inquiries.On the Past and Present Provision for the Insane in theUnited States. By DANIEL HACK TUKE, F.R.C.P.As the Hospitals for the Insane in the United States ofAmerica have recently been prominently brought before themedical profession in England, it may not be uninteresting tothe readers of this Journal to have a slight historical sketchof what may be called the past asylum movement in theStates. I am not aware that this has been given before inany journal or work published in Great Britian . The peculiardifficulties of a new country, peopled by different races, andthe constantly disturbing influence of immigration, ought to be borne in mind in this narrative. These difficulties are toofrequently overlooked . In a letter I received from Miss Dixtwo years ago, she writes-" We have an amazing burden inall our charitable institutions of every class of disabledforeigners of all ages and in all stages of feeble or quite broken down conditions of health."As in England, so, no doubt, in America, frightful abuseshave existed- more than that, much remains to be done.The insane have been subjected to the same barbarous neglectand treatment as with us. Puritanism, in the first instance,was only too likely to treat some forms of madness asinstances of witchcraft, and their subjects would be punishedor put to death accordingly. Other cases would be simply referred to the cruel action of Satan upon the mind, and propermedical treatment would be the last thing thought of. Agood illustration of the belief in such diabolical influencein mental depression occurs in Cotton Mather's " Life ofWilliam Thompson. " " Satan," he says, "who had been oftenin an extraordinary manner irritated by the evangelic labours1876.] The Provision for the Insane in the United States. 43of this holy man, obtained the liberty to sift him; and hence,after this worthy man had served the Lord Jesus Christ inthe church of our New English Braintree, he fell into thatbalneum diaboli-a black melancholy, which for diversyears almost wholly disabled him for the exercise of hisministry. " " New England, a country wheresplenetic maladies are prevailing and pernicious-perhaps,above any other-hath afforded numberless instances of evenpious people, who have contracted those melancholy indispositions, which have unhinged them from all service or comfort.Yea, not a few persons have been hurried thereby to layviolent hands upon themselves at the last. These are amongthe unsearchable judgments of God." When they werereally regarded as madmen, the care and treatment of theinsane were probably neither better nor worse than in themother countries from which the early settlers came.Humanity and Science, however, attacked and at last brokethrough the strongholds of superstition, ignorance, and prejudice; and benevolent men (and women, too) exerted themselves to mitigate the unhappy condition of those who wereconfined as lunatics, and to provide for them suitable accom- modation and kinder treatment.It appears that it was from the Province of Pennsylvaniathat the first humane impulse proceeded. It was fitting thatthe State, founded by the humane and enlightened Penn,should take the lead in this work of mercy. From Philadelphia there went a petition to the House of Representatives,in which it is stated that with the increase of the populationthe number of the insane has greatly increased;"that someof them going at large are a terror to their neighbours, whoare daily apprehensive of the violence they may commit; andothers are continually wasting their substance, to the greatinjury of themselves and families -ill-disposed personswickedly taking advantage of their unhappy condition, anddrawing them into unreasonable bargains-that few of themare so sensible of their condition as to submit voluntarily tothe treatment their respective cases require, and thereforecontinue in the same deplorable state during their lives. "The House is requested to aid in founding a small provincialhospital for these and other persons labouring under disease;for it seems that in the first instance it was not designed exclusively for the insane. This, the petitioners affirm, will be"a good work acceptable to God and to all the good peoplethey represent. " This was in 1751. The consequence was44 The Provision for the Insane in the United States, [April,that the Legislature passed the necessary Act; a sum of moneywas voted, subject to an equal amount being raised by privatemeans, and the new hospital was opened at Philadelphia inthe following year. Although anticipating the course ofevents it should be added that in 1841 the patients weretransferred to the new " Pennsylvania Hospital for theInsane," near Philadelphia, of which Dr. Kirkbride was appointed Superintendent, and still holds that post.It is pointed out by Dr. Ray (to whom we are indebted forthese and other particulars*) that this Pennsylvania Hospitalhas an additional claim on our gratitude, inasmuch as it washere that the celebrated Dr. Rush obtained the materials forhis work on " Diseases of the Mind, " published in 1812. Wecordially respond to the tribute Dr. Ray pays to his memory,and this not only for the work here alluded to, but for theadmirable essays contained in his " Medical Inquiries and Observations . '66Twenty-one years later (1773) Virginia established atWilliamsburg an asylum, or, as the Americans very properly call such institutions, a " hospital," which provided for the insane only. Many years elapsed, " Dr. Ray states,"before this worthy example was followed; nor was the greatwant supplied by associations like that which founded thePennsylvania Hospital, nor by individuals, as in the privateasylums of England. The latter class of enterprises was al- most unknown in this country until the beginning of the present century; for they required a knowledge of insanity noteasily obtained by our physicians, an outlay of capital whichfew of them possessed, and a rate of prices greatly beyondthe means of our people. In process of time they made their appearance, few and far between, but their benefits were confined to the affluent classes. "In 1817 the Friends established an asylum at Frankfort,near Philadelphia, with the object of carrying out the systemof treatment pursued at the York Retreat. In the followingyear the McLean Asylum, at Somerville, Mass. , was opened.Dr. Wyman, the first physician, appears to have devotedhimself warmly to the interests of the patients. He opposedthe indiscriminate use of bleeding, purging, and low diet.The Bloomingdale Asylum (the lunatic department of theNew York City Hospital) was opened in 1821 .At oneperiod Dr. Pliny Earle, now the physician- in- chief of the

• See his " Contributions to Mental Pathology. Address at Danville, 1869."

1876. ]45 by DANIEL HACK TUKE, F.R.C.P.Northampton Hospital for the Insane, Mass. , superintendedthis asylum. The Hartford Retreat, Connecticut, opened in1824, was first superintended by Dr. Todd. He, like Dr.Wyman, objected to depletion, and employed tonics, sedatives, and a generous diet. Dr. Brigham was superintendent from 1839 to 1843. He was succeeded by Dr. Butler. In1821 an appropriation was made by the South CarolinaLegislature towards an asylum at Columbia, which was completed in 1827.It is worthy of remark that in no State in America, Virginia excepted, did the Legislature undertake wholly to provide for the insane until 1832. In that year Massachusettserected an asylum at Worcester (the first Superintendentbeing Dr. Samuel B. Woodward) , and from this time it wasregarded as a duty for the States not merely to aid-as inthe instance of Pennsylvania-the efforts of others, but toprovide the whole amount required for the erection of hospitals for the insane. The just dictum of Horace Mann thatinsane paupers are the wards of the State, is regarded byRay as having " taught the people, now and for ever, theexact nature of their relations to this class of their fellowcreatures. The example of Massachusetts, executedas well as conceived in a most generous manner, was followedby other States, one after another."•There appear to have been several causes for the movementwhich now happily commenced. One was that the experiencealready gained in the hospitals where the insane were judiciously and kindly treated, had proved that they might andought to be removed from jails and poorhouses, and placedunder proper care and treatment. For this State aid wasindispensable. Another cause was that with the Hour, therecame fortunately the Man, or rather the Woman; forat this juncture, a lady whose attention was directed to thecondition of the insane, resolved to devote herself to theirservice, and from that day to the present time, the insane, ifneglected or ill- treated, have had in Miss Dix a powerfuland untiring advocate. From his personal knowledge of thisphilanthropic lady's character, the writer can well believethe statement made by the physician already cited, that "noplace was so distant, no circ*mstances so repulsive, no lack ofwelcome so obvious, as to deter her from the thorough performance of her mission. Neither the storms of winter, northe heats of summer, could diminish the ardour of her zeal,and no kind of discouragement could prevent her from gaug-46 The Provision for the Insane in the United States, [ April,ing exactly the dimensions of this particular form of humanmisery;" and he adds, that " favoured by that exquisite tactand happy address peculiar to her sex, she overcame obstaclesthat would have defied the ruder efforts of the other sex, andthus brought to light a mass of suffering that seemed morelike an extravagant fiction than real unexaggerated truth. "Miss Dix appealed to the Legislatures of the various States topass enactments calculated to remedy this state of things,and terminate " practices that would shock even a barbarouspeople." He efforts were generally rewarded by the desiredaction being taken to provide hospitals for the insane. But even in the " go- ahead" land across the Atlantic, the intervalwhich elapsed between the decision to act and the act itself,was provokingly long, and it required the watchful eye of thepromoter of these benevolent measures, aided by a fewmedical men, to ensure their being really carried into execution. Thus, I observe that while the idea of founding a Stateasylum in Pennsylvania was projected in 1838, and an Actwas obtained, the project fell through, and it was not till1845 that a successful attempt was made to obtain anotherAct, which, strange to say, was itself not carried into effectfor years, and the asylum (at Harrisburg) was not openedbefore 1851. An insane hospital, the funds necessary forwhich were partly provided by private individuals and partlyby the State, was also opened in 1861, for Western Pennsylvania, and called the Dixmount Hospital.In 1836, or a little later, " the attention of certain philanthropic and enlightened citizens of New Hampshire beganto be turned towards some better provision , or rather towardssome provision, for its insane. The success of the StateLunatic Hospital at Worcester, in the adjoining State, wasrapidly being recognised, and the enquiries, set on foot byDr. Bell and his associates, developed an amount of sufferingbefore unsuspected. Among those who devoted themselvesto this thankless and unpopular effort to induce the community to awake from its guilty lethargy, deserve to be enumerated the names of General Peaslee, President Pierce, S. E.Cones (now of Washington) , the late Charles J. Fox, and afew others. Time after time the Legislature refused the necessary sanction for an asylum. Eventually, however, theseefforts proved successful, and resulted in the establishment,by private subscriptions and State aid, of that excellentinstitution, the New Hampshire Asylum for the Insane. ”*"American Journal of Insanity."1876.] by DANIEL HACK TUKE, F.R.C.P. 47Dr. Bell reported the number and condition of the insanein the State, and the means of providing for them; and hisReport was not only ordered to be published for distributionby the Legislature, but was reprinted in the Journals of bothHouses as worth perpetuation in the governmental history ofNew Hampshire. Shortly after he was appointed physiciansuperintendent of the McLean Asylum, Massachusetts. TheNew Hampshire Asylum was opened in 1842, Dr. Chandler being appointed Superintendent. In 1845, Bell visitedEurope, and found, as he said he had expected to find, thatgreat progress had been made in the construction of asylums in Great Britain. Of this he availed himself, and preparedplans for the erection of the Butler Hospital for the Insane,at Providence, Rhode Island, of which institution Dr. Raywas appointed the first superintendent. He had previouslysuperintended the Maine Island Asylum, opened in 1840.The New York State Lunatic Asylum, Utica, was opened in1843. The well-known Dr. Brigham was superintendentfrom its opening until his death in 1849. Dr. Gray now fillsthat office. In 1844 Miss Dix induced the Legislature of NewJersey to take up the question of provision for the insane inthat State, and to appoint a committee to select a suitable site for a building. Dr. Buttolph was appointed medicalsuperintendent.From the well-known and admirable Report on the insanein Massachusetts, drawn up by Dr. Jarvis, and presented in1855, we learn that there were at that time 1 lunatic in every427, and 1 idiot in every 1034 of the population, or 1 ofeither class in 302. There were 2632 lunatics, 1087 idiots;ofthe former, 1284 were at their homes or in town or citypoorhouses; 1141 in hospitals; 207 in receptacles for theinsane, in houses of correction, jails and state almshouses.Of the latter, 670 were supported by friends, and 417 by thepublic treasury. The pauper class of lunatics, it is stated,furnished in ratio of its numbers sixty-four times as manycases of insanity as the independent class.In 1856 Dr. Bell said in his Report, " The number of hospitals for the insane in the United States has increased during the last 19 years from 6 to between 40 and 50, and theaccommodations for patients have risen from about 500 tobetween 10 and 11,000 . Even the four larger British provincesadjoining us have caught the influence of our zeal, and each ofthem has, during that period, provided itself with a large andwell-furnished institution, essentially upon our models. "48 The Provision for the Insane in the United States, [April,(Dr. Bell wrote very strongly, I may remark, in parenthesis,against the association of the sexes, against the frequentvisits of relatives to patients, and against giving up all mechanical restraint. )We must not, however, enter into further detail. Suffice itto say that sooner or later buildings were erected in theStates, adapted for the purpose, and what is still more important, were provided with medical superintendents, devotedto their work. Among these are not a few who have distinguished themselves in this specialty, and have exerted animportant influence upon medical psychology and the juris- prudence of insanity, beyond their own immediate circle.There have been features of the American asylums, I do nothesitate to say, which have been well deserving of the attention of English physicians. The Reports of their superintendents have been and are valued by alienists in the mothercountry.Dr. Woodward, so long ago as 1833, urged that withmany, intemperance was a disease requiring special care,and the American psychologists worked at this subject untilan Act was passed in 1855 by the New York Legislature incorporating an association, with powers to carry out this view in a definite form. * They have also taken a prominentplace in the education of idiots . The late Dr. Howe, knowneverywhere as the enlightened friend of the idiot, was amember of a commission appointed by the Legislature, in1846, to enquire into the condition of the idiots of Massachusetts, and ascertain whether anything could be done fortheir relief. Dr. Wilbur's labours in the education of idiots,are also well known. He was appointed superintendent ofthe New York State Institution for Idiots, in 1852.It is admitted that the provision made for the insane, inat least some of the States of America, was recently and probably still is far from complete. We have referred to Massachusetts. In 1869 it was estimated that there were in thisState about 2000 insane or idiotic persons unprovided for. Thenumber of lunatics unprovided for in the State of New York,some years ago, and placed in workhouses and gaols, in adeplorable condition, attracted much attention and just criticism. In 1856 there were 900 insane poor in the poorhousesand gaols of this State, 300 of whom were in cells and me-

• Vide "American Journal of Insanity," July, 1856.

1876.]49 by DANIEL HACK TUKE, F.R.C.P.chanical restraint, from one end of the year to the other.My authority is the American Journal of Insanity.In 1868 the Pennsylvania Medical Society memorialised theGeneral Assembly, alleging the insufficient accommodationwhich existed in that State, and asserting that " a large proportion of insane persons are kept under conditions shockingto the dullest sense of propriety, or even ofcommon humanity,suffering from cold or heat, from bad air, or indecent exposure; chained to the floor, perhaps deprived of every meansof recreation or employment, and dying by that process ofdecay which physicians call dementia." They urged theimmediate establishment of a hospital for the district, composed of the counties of Wayne, Sesquehanna, Wyoming,Luzerne, Columbia, Montour, Sullivan, Bradford, Lycoming,Tioga, Clinton, Centre, Clearfield, Elk, Cameron, McKean,Potter, and Forest; and nine others, should the finances ofPennsylvania allow of it. The result was the erection ofthe Hospital for the Insane at Danville, Penn. , the cornerstone of which was laid in 1869, and was the occasion of theexcellent address delivered by Dr. Ray, from which we havequoted. The proper persons, we would here remark, deservingof blame for the deplorable condition of the insane, whereverit has existed or still exists in America, are not the bodyof alienist physicians, but the mass of the people themselves-these largely composed of Irish and Germans. The alienist physicians have, by their " Association," promulgatedsound principles at their annual meetings, and petitioned theLegislature repeatedly.In 1873 were published a " Report of Public Charities inPenn.," " A Plea for the Insane in Prisons and Poorhousesin Penn.," and subsequently " Addenda, " wherein evidence is given, apparently conclusive, that some at least of theinsane inmates were often greatly neglected and ill- treated.The condition of these, in fact, recalls that of the insane,before any reforms were introduced; but then the proportionto the whole number may be small. One old man is describedas starved to death, medicine being forced into him, but foodthought unnecessary; a young lady, for the last two yearsoccupying a filthy cell, resting like a beast upon her haunches,and so permanently cramped as to be only capable of frog- like movements; a " splendid old man" in chains for 40years, &c. , &c. The Report of the Board of Public Charities gives many deplorable cases of a similar or even worse character. In one almshouse we read, " We found theXXII. 450 The Provision for the Insane in the United States, [April,female insane department in a shocking condition; so badthat it would be impossible to give a description of the placeon paper. In some cells there were two or more women confined; some without any clothing, lying on the floor withoutmattress, carpet, or anything else, except an old governmentblanket. The place had a horrible putrid odour." Of anotherestablishment, the report is made, " Insane totally neglected,morally, physically, and medically; less attention is given tothem than would be given to the lowest animals." We reproduce a few of these descriptions, not from any wish to throwodium upon the people of Pennsylvania for past errors, butas historical facts which we are bound to chronicle, and alsoas forming an instructive lesson for the future, showing, as itdoes, how possible it is in the midst of an enlightened community for a fearful state of things like this to remain for solong unremedied, in spite of the protests of medical men andothers, and how absolutely necessary unremitting attentionis to the condition of a class unable to make their own wantsand sufferings known. We doubt not much remains tobe done, for at the time of which we speak ( 1873) it was stated that there were twice as many of the insane poor languishing in the poorhouses and prisons of Pennsylvania, asthere were when Miss Dix made her appeal for their relief,in consequence of which the Harrisburg Hospital was built.Still, the Report of the Board of Public Charities for 1874,published in 1875, says-"We do not propose to detail againthe sickening minutiae of our investigations. Some of these,we thankfully believe, are buried in the dead past."The same Report states that the number of indigent insanein the State Hospitals, established primarily for this class,"was, on 30th September, 1874, 764; the number of the sameclass in the poorhouses of the State and other county provision being 1,352, exclusive of 1,075 in the PhiladelphiaAlmshouse."The obvious remedy would seem to be the provision of alarger number of State Hospitals for the insane. Probablythe obtuseness of the German element of the populationhas rendered Pennsylvania slower than she otherwise wouldhave been to recognise her duties to the insane: Many ofthe citizens of Philadelphia (including Dr. Ray and Dr.Kirkbride) petitioned the Legislature in 1874, that " hospitalsenough for the care and treatment of all the insane inPennsylvania be prepared at the earliest possible time," andrepresented that the course proposed will relieve the1876.] by DANIEL HACK TUKE, F.R.C.P. 51Commonwealth of the reproach of having insane men andwomen confined in almshouses, gaols, penitentiaries, or, whatis worse often than either, put out of observation, neglectedand inhumanly treated at their own homes, or in detachedbuildings near them. "We regret that in the observations of the Board of PublicCharities this is not insisted upon. If, indeed, the hospitalsalready in existence were built for the indigent insane alone,they are right in their complaint that they are now partly occupied by those whose friends can pay for them, however moderately; or if, built for both classes, the State designed the poorto have the first claim for admission, irrespective ofcurability.The law appears on this point somewhat vague; for while itprovides that the poor are to have precedence of the rich, itrequires also that recent cases shall have precedence overthose of long standing. That it admits of the constructionput upon it-that a recent case, although not a pauper, shallbe admitted before a chronic pauper case-seems clearfrom the fact that the Board of Public Charities urges uponthe Legislature a more definite law on the subject. The mixture of different classes, however, in the same building wouldseem to be, so far, a recognised plan with the Americans;and granting this, we imagine that the question the MedicalSuperintendent has supposed himself bound to consider isWhich of two cases who apply for admission is the mostlikely to be benefited by treatment? The Medical Superintendents would seem the last persons to blame; yet, unfortunately, the tendency on the part of the Board of PublicCharities appears to be to cast the odium of the state ofthings we have described upon them. And, further, is notsome weight to be allowed to the consideration that manywho are admitted on moderate terms would become paupersin a short time if not so admitted? If the Medical Superintendents are to be blamed, should not some blame beattached also to the Board of Public Charities for allowingthe poorhouses to be in so bad a condition? Could not theirvisitation have been made more effective sooner? Ought notthe Board to have done long ago what they did in 1873?Be this, however, as it may, if their proceedings have in theend been productive of good, we rejoice, although they mayin some respects have erred in judgment. We in England,with our love of centralisation, commissioners, and so forth,would be apt to think that a distinct Lunacy Board wouldhave been found helpful in America in this and perhaps other52 The Provisionfor the Insane in the United States, [ April,instances. We are well aware, however, that our psychological friends on the other side of the water rejoice in their freedom from official interference in the form which it takesin our English Commission.In a letter I received from Dr. Ray in the summer of 1873,he states that at that time every state in the Union, excepting Delaware, and one or two of the newest States, had oneor more hospitals for the insane, and they were all liberallysupported in most respects. " Some of the officers think theythemselves are meanly paid; and I suppose they are in someWestern and in all the Southern States. The WesternOhio, Iowa, Illinois, Indiana-are steadily increasing theirhospital capacity by building new hospitals, or adding to the old ones. In them the essential objects of such institutions,I think, are pretty well obtained, though an Englishman would probably observe some laxity in the service. In theAtlantic States, excepting New England, it is impossible toobtain good attendants, and this evil seems to be increasingevery year, and the consequences are an increase of suicides,elopements, and other casualties. "And a year later the same correspondent informed me thatanother asylum had been commenced at Warren, in thenorth-west part of Pennsylvania; that in New England thehospital capacity was nearly up to the demand, and whenhospitals in building were completed, no patient need be leftin the poorhouse; that New York, hitherto delinquent, hadfive hospitals in course of construction, which, with additionsto old asylums then projected, would provide for all pauperinsane; New Jersey had added to her hospital at Trenton,making provision for between five and six hundred, and wasbuilding one of equal capacity at Maristown. Maryland hadhospital capacity enough. In the hospital at Washington,the national government provides for about five hundred insane from the army, navy, and the district. All theWestern States have, at least, one hospital; many of themmore. One of the first things provided by the new States,after coming into the Union, has been a hospital for theinsane. All the Southern States have, at least, one hospital,but they became so impoverished by the war that they arehardly able to maintain them, much less to meet the increasing demands for new ones. On the whole, therefore, thereis an onward movement, and it looks as if public opinion,enlightened by the writings of American psychologists- especially the Annual Reports of the Hospitals for the Insane,and the manifestoes of the " Association "-would demand,1876.] by DANIEL HACK TUKE, F.R.C.P. 53and be willing to support the further extension of hospitalaccommodation which doubtless is called for, although it mayonly be gradually effected . "I can at once state two facts,"writes Miss Dix to me, " concerning the state of communities in the United States, an acknowledged obligation toprovide suitably for all insane persons, whether chronic orrecent cases-for the former permanently, for the latter, till cure is advanced, or recovery established . Much is said onthe supposed rapid increase of insanity in the United States.I do not think this a sound proposition . Of course, thenumber of insane persons is vastly larger than ten yearssince, but the amazing increase of population by a continuallyinflowing immigration from Europe, with the natural increaseof native inhabitants, will create imperative need for a multiplication of hospitals for care and treatment.'"9A few words on the attitude of American physicians towards the vexed question of non- restraint.In the treatment ofviolent and suicidal patients they have,without exception, I believe, carefully avoided committing themselves to the doctrine of non-restraint, as the termis understood in England. Their views have been againand again distinctly stated by Bell, Ray, Kirkbride, andothers. Their position, succinctly expressed, is simply this-Restraint, in some form or other must be employedwhether by bricks and mortar, manual tension, or fastenings on the person, or " chemical restraint." Whichever beadopted, physical and not moral means are resorted to.To declare any one of these to be wrong, and say it shallnever be made use of, is , they maintain, uncalled for, and unwise. They admit that it should only be resorted toafter much consideration. At the same time they believethat there are, and always may be, cases in which notonly the most effectual, but the kindest method of repression consists in the imposition of certain mechanical andpersonal forms of restraint. After the subject has been foryears so thoroughly canvassed and debated, it is unnecessaryto dwell at any length upon the arguments pro and con., butso much seems due to the American alienists. It will, indeed, be said that the difference after all between Americanand English asylum practice, in this particular, is only one ofdegree-the latter resorting to it in certain cases, chieflysurgical, of dire and absolute necessity. Yet it must beaffirmed on the English side, that the adoption of the nonrestraint principle of treatment, broken, as it confessedly is,in a small number of instances, in the course of years , sets54 The Provision for the Insane in the United States, [April,forth a high standard at which ever to aim before all theofficers of the institution, and as a matter of fact does induceso considerable a difference in the resort to mechanical meansof restraint, that though it may be represented as one onlyof degree, it ends in a marked disparity in practice, when thecondition of the patients in all the asylums in the two countries is considered and compared. And in truth, it is morethan probable that the decision, arrived at by any independent medical superintendent to adopt the non-restraint principle as the rule in his asylum, will always be the result of apractical conviction that by this course, however open to thetheoretical objections already mentioned, the largest amountof personal care and attention will , other things being equal,be secured in general to the patient; and the temptation torestrain his movements, by painful bodily coercion, reducedto a minimum. Indeed, Dr. Earle, in 1857, at an annualmeeting of the American Association of Superintendentsof Hospitals for the Insane, said (what constitutes a powerful defence of the non-restraint system) that " while it isoccasionally necessary to employ mechanical restraint, yet he believed that this admission is calculated to favour a tendencyto its excessive use."I cannot conclude this paper without a brief reference toan article which appeared in the " Lancet," Nov. 13, 1875,in which the writer brought very serious charges against thecustomary treatment of the inmates of the American asylumsby their medical superintendents. It is due to these gentlemen to reproduce here a defence, in the form of a letteraddressed by my friend Dr. Bucknil to the " Lancet, " Feb.12, 1876. I deeply regret that so unqualified an attack shouldhave been made upon a body of honourable and humane men,and I am sure that the members of the Medico- psychologicalAssociation in this country will share in the regret. If thewriter had spoken strongly in reference to the condition ofthe insane in workhouses and jails, or in some of the asylums,the case would have been entirely different; the language inregard to such is not too strong I dare say; but surely theonly justification for a wholesale onslaught on the medicalsuperintendents of the asylums in the United States wouldhave been conclusive evidence of the alleged facts as a generalrule in these institutions . On the contrary, Dr. Bucknill, inthe several particulars specially mentioned by the " Lancet, 'entirely denies the correctness of the statements . To thosefamiliar with the names, writings, and deeds of Ray, Jarvis,Kirkbride, Earle, Butler, and others among living, and1876.]55 by DANIEL HACK TUKE, F.R.C.P.Brigham, Beck, Woodward, and Bell among dead medicalpsychologists in America, it sounds strange to read that66 we are almost forced to the conclusion that our friendsacross the Atlantic have not yet mastered the fundamentalprinciples of the remedial system. " And stranger still(so far as regards the men of the first class) to hear that"they adhere to the old terrorism, tempered by pettytyranny." Can we be surprised that the feelings of men engaged in a noble and arduous work-the work of their lives-should be hurt when they read such charges made by members of the same profession? With what feelings , mutatismutandis, should we read them? In the rejoinder made inthe " Lancet" to Dr. Bucknill's letter, it is said, " We donot say all American asylums are bad." Certainly, it is tobe regretted that this qualification, or rather a much largerand more generous one, was not made in the original article.Neither, on the other hand, do we say that all Americanasylums are good. We simply maintain that the sins ofsome asylum authorities, and these, as a rule, municipalrather than medical, should not be indiscriminately visitedupon the whole body of medical superintendents of hospitals for the insane. An American physician, visiting St. Luke'ssubsequently to 1840, found chains in use. Had he in consequence stigmatised the English superintendents of asylums,as a body, as being in the custom of employing manacles, hewould have committed a gross injustice, which they wouldhave instantly resented. In the same way the Americansuperintendents naturally feel aggrieved when a leadingmedical journal represents them, without (in the first instance)any exception whatever being made, as adhering to the oldterrorism, &c.; as resorting to contrivances of compulsion;as using the shower-bath as a hideous torture; and as leaving their patients to the care of attendants, while they devotetheir own energies to beautifying their asylums.Let us give credit where credit is due, and not involve inindiscriminate censure, worthy and unworthy superintendents, good and bad asylums, but if we denounce, confine our denunciation to those institutions in which ill-treatmentis known to prevail.AMERICAN LUNATIC ASYLUMS.To the Editor of THE LANCET.SIR,-I have received letters and journals from several medicalsuperintendents of asylums for the insane in the United States, calling my attention to a leader in " The Lancet" of November 13th last.56 The Provision for the Insane in the United States, [ April,My correspondents feel much aggrieved with that article, and haveasked me to publish the truth as I have recently observed it as to thetreatment of the insane in their country. I had hoped before thistime to have published some notes on this interesting and importantmatter, but ill- health has prevented me from doing so, and I feel thatno further delay should occur in my asking you to do justice to a classof highly honourable and meritorious medical men.With the general principles of your leader regarding the propertreatment of the insane, it is well-known that I entirely concur. Ihad the honour to serve under the non restraint flag more than thirtyyears ago, when the fight was hot and undecided , and I am not likelyto desert it now when the peace which follows victory has been solong established among ourselves. I think, moreover, that we have atask of duty and obligation before us in converting our Americanbrethren to our views and practice; but in order to succeed in this, itis essential that we should clearly understand and appreciate theirposition.The use of mechanical restraint in the excellent State asylums ofAmerica, and in the admirable hospitals for the insane there, is no partof a system of negligence and inhumanity, and therein it differs totocælo from its use in our country in former times, and in some foreigncountries at the present time.On this ground, therefore, I have no doubt that the adherence of the Americans to mechanical restraint in the treatment of the insaneis solely an error of judgment, and, as you so forcibly express it, " an imputation on their professional acumen and social sagacity. " Butmerely to asseverate this would be purely a petitio principii. Wemust prove it; and to do so, to change their opinions and assimilate themto ours, will, I see , be all the more difficult because the error stands somuch alone, and because their opinions on all collateral questions areso enlightened and so much like our own; as it is notorious that inthe propaganda of religious creeds conversions are most rare wherethe theological opinions and moral practices are least removed.The statement in your leader by which the American superintendents feel themselves most aggrieved is the following one:- Theyadhere to the old terrorism tempered by petty tyranny. They resortto contrivances of compulsion; they use at least the hideous tortureof the shower-bath as a punishment in their asylums, although it hasbeen eliminated from the discipline of their gaols. And, worse thanall, if the reports which reach us may be trusted, their medical superintendents leave the care of patients, practically, to mere attendants,while devoting their own energies principally to the beautifying of their colossal establishments."I have no hesitation, sir, in assuring you from my own knowledge.and observation that, in all the above respects, the reports which havereached you are not to be trusted . I visited in the spring of lastyear ten of the public asylums in the United States, and enjoyed themost ample opportunities of observing the treatment of their inmates;1876. ]57 by DANIEL HACK TUKE, F.R.C.P.and I say, most unreservedly, that I never saw the slightest indicationof " terrorism tempered with petty tyranny." The fault of the Americans does not lie in the direction of harshness, but rather in that oftimidity and fear of responsibility.It is my constant habit, when I go over an asylum, carefully toexamine all closets , bath- rooms, and out-of-the-way conveniences;and it is a singular fact that I never once found a shower-bath in any one of the asylums which I visited in the States. In some of them Imade inquiry as to the absence of this means of treatment so commonwith us, and formerly so much abused; and I was assured that it didnot exist. As an instance, Dr. John Gray assured me that, in theNew York State Asylum under his charge, there had been no showerbath in existence for eight or ten years. Of course I cannot answerfor what may be the practice in each of the numerous asylums scattered over a vast continent, but I can affirm that, in the asylums ofthe old settled States which I visited from Boston to Washington,the shower-bath is not used as a punishment, and, perhaps, too little used as a remedy.On that count of the indictment which is " worse than all," yourinformation has been certainly erroneous. So far from the medicalsuperintendents of asylums in the States leaving the care of theirpatients to mere attendants, the reality for which I vouch is that theAmerican superintendents bring themselves more constantly and intimately into personal relation with their patients than it is the customto do in our public asylums, and, moreover, they are assisted in thecare of their patients by a much larger medical staff than our institutions usually possess. I could easily name large English asylumsin which the medical care of the patients devolves entirely upon themedical superintendent and one solitary medical assistant who is alsothe dispenser; while in asylums of the same size in the States themedical superintendent would have at least two, but more generallythree or four, resident medical men to aid him in his professionalduties. Here, again, I shall cite the example of the asylum for theState of New York at Utica, where the resident medical staff consists of the medical superintendent, four assistant physicians, and aspecial pathologist-in all, six medical men to about 850 insanepatients . In the Washington Asylum, with 750 patients , the residentmedical staff consists of four physicians and, I think, a dispenser. Inthe Pennsylvania Hospital for the Insane, containing 416 patients, theresident medical staff consists of four physicians. Even in asylumsin which the management is far more open to criticism than in those Ihave named, I observed this large amount of medical element on thestaff, and in this most important matter it seems to me that we in thiscountry may well take a leaf out of the book of example which wemay find in the States.I fully admit that there are asylums in the States, the condition ofwhich is grievously bad, and I have no hesitation in stating, from58 The Provision for the Insane in the United States. [ April,what I saw, that the large asylums for New York and Philadelphiaare disgraceful to the municipal authorities of those cities . But thisis not the fault of the medical superintendents, further than it may besaid to be their fault to hold office and discharge duties under circ*mstances which give them no fair play. I pity the patients in theseasylums from my heart, but I have some pity also for conscientiousand laborious medical men, who painfully endeavour to discharge theirduties to the best of their ability under the vulgar rule of a municipality moved only by motives of party politics and unintelligenteconomy.I remain, Sir, your obedient servant,JOHN CHARLES BUCKNILL.Hillmorton Hall, Rugby, Jan. 28th, 1876 .On the Use of Analogy in the Study and Treatment of MentalDisease. By J. R. GASQUET, M.B., Lond., Physician toSt. George's Retreat.The disheartening aphorism, in which Hippocrates summedup the experience of his life-" Art is long and life is short,the occasion is fleeting, experiment is dangerous, and judgment is difficult"--is more true of the study of insanity thanof any other department of medicine. Were any proof neededof this, it would be sufficient to point to the classification ofmental diseases, the symptomatological plan adopted untilrecently corresponding to the earliest nosology of ordinarymedicine, while the schemes which task the ingenuity of aSkae or a Bucknill have a great likeness to the " Phthisiologia" of Morton, or to the nosologies of Sauvages and Cullen.But, if it be granted that our specialty is much behind theother branches of medicine, it follows that one of our principal means of advancing it will be to argue from the analogyofthe better known phenomena of other diseases to the moreobscure symptoms with which we have to deal. As Millremarked, the great value of analogy in science, even whenfaint, is to suggest observations and experiments with a viewto establishing positive scientific truths . We are all of uscontinually doing this; but it appears to me that much of itsadvantage is lost, from our having no systematic plan onwhich to work; and I have, therefore, ventured to note down,somewhat roughly and disconnectedly, such ideas as haveoccurred to me on the subject, hoping rather to lead somemore competent person to undertake it, than to bring forward1876.]59 Analogy in the Study of Mental Disease.anything very valuable myself. I shall deal, in this paper,only with ordinary insanity, excluding all mental disturbances produced by general paralysis, syphilis, and all otherforms of ascertainable brain-disease. I do so, not becauseanalogy is here inapplicable, but because it requires to beapplied in a different manner, and should, therefore, be dealtwith separately. Having said so much, it will be evidentthat we shall have to search for analogies chiefly among the"neuroses " which are most akin to insanity. Indeed, thisis a truism, so long as we use the term to include all thoseaffections of the nervous system which can be connected asyet with no special anatomical lesions.To begin with Melancholia: Leidesdorf has remarked that"the most superficial observer cannot miss seeing the analogy between this painful uneasiness of the mind, and hyperæsthesia of a sensory nerve. In both there is an exaggeratedsensibility, due to the condition of the nervous tissue itself;in both every kind of excitement is followed by a feeling ofpain, and even sensations, which would naturally be pleasureable, are changed into the reverse." In spite of this closesimilarity, the analogy between melancholia and neuralgia isperhaps less suggestive than others I shall have to refer to .The conditions under which they arise are very similar;Romberg's often-quoted remark-" pain is the prayer of thenerve for pure blood"-being as true of the one as of theother. They also occur under much the same circ*mstancesat different periods of life; the melancholia as well as theneuralgia of the young being frequently due to disturbanceof the genital organs, and being far more curable than thesame affections in later life , which, no doubt, point to somepermanent alteration of the nervous centres. I am afraidthat little is to be gained towards a better knowledge of theintimate nature of the state of the nervous centres in melancholia by a comparison with neuralgia, for the latest authorities on the subject, as Erb and Eulenburg, confess that wehave not sufficient materials to come to any conclusion uponit. But some interesting points may be noticed; for instance,the absorption in self, and utter indifference to the ordinaryduties and pleasures of life, so characteristic of melancholia,find their parallel in the anesthesia frequently observed inneuralgia. Nothnagel, who has carefully examined for this,finds that in the early stages of neuralgia, there is generallyhyperæsthesia, loss of sensibility being a later symptom. Iam inclined to think that the same holds good of melan-60 Analogy in the Study ofMental Disease, [April,cholia, but it would be interesting to have the point furtherinvestigated. Again, without being too fanciful, I think onecan compare the restlessness of melancholia with the spasms,tremors, and other motor troubles which may affect a nerveunder the influence of pain. We shall gain more practicalinformation by placing the results of treatment in both diseases side by side-thus, although the use of opium is as wellknown in one as in the other, it is worth considering whetherwe might not more speedily and decidedly relieve melancholiaas well as neuralgia by its hypodermic administration. Thenervine tonics and stimulants, which are so frequently usefulin neuralgia, are less employed in melancholia, and yet probably as much benefit would follow their use. I would particularly refer to phosphorus, which Dr. S. W. D. Williamsfound curative in certain cases of melancholia, and which Ihave also seen to produce an undoubted and speedy recovery;and to arsenic, the analogue of phosphorus, which is slowerin its action, but sometimes succeeds when phosphorus fails.Cod-liver-oil is useful (as Anstie has already noted, for neuralgia) in patients who have long rejected all fatty articles offood-a circ*mstance as frequent in the one disease as in theother. As tothe preparations of iron, it is worth rememberingthat Anstie found the sesquichloride the most useful in neuralgia, and believed it to have a specifically beneficial effecton the nerve- centres, often combining it with strychnia.Bromide of potassium he recommends, particularly in caseswhere there is a good deal of restlessness, and where theneuralgia is of uterine origin; precisely the circ*mstancesin which we find it so beneficial for climacteric melancholia.As the resemblance between melancholia and neuralgia haslong been obvious, so a similar likeness has been recognizedbetween states of mental exaltation and the motor disturbances of the nervous system. But it seems to me very unfortunate that epilepsy, from its intimate connection withmental imbecility, and with sudden explosions of violence,should have obscured the clinical kinship which exists betweenmania and the other motor neuroses. Among these, choreaappears to have the greatest likeness to mania, and, indeed,has been called " an insanity of the muscles, "" folie musculaire," by many writers, and by Dr. Broadbent more recently,"a delirium of the sensori-motor ganglia." It is impossible,in the present apparent conflict of evidence, to determine the

• I refer, in what I am going to say, exclusively to the chorea of childhood;

that of pregnancy being distinguished from it by several important characters .1876.]by J. R. GASQUET, M.B. 61seat of this neurosis, the clinical phenomena hemichorea,choreic hemiplegia, and the like, pointing to an intra-cranialorigin of the disease, while experiments* and many autopsiesseem to imply that the spinal cord rather is in fault. Wemay probably conclude that any cause which increases theexcitability of the motor centres in the spinal portion of thenervous system (viz. , from the corpora quadrigemina downwards) † may produce chorea, which would be further greatlyassisted by the removal of the inhibitory power of the cerebralhemispheres. What this change is, we cannot yet know; butmay plausibly conjecture that the vasomotor ganglion whichregulates the supply of blood to the nervous centres, undersome direct or reflex stimulus, causes the vessels of the partto dilate, and the blood to flow through it more rapidlythan usual. This would account for the increased activity ofone or more divisions of the nerve- centres, which (as Jacoudhas shown, in his masterly exposition of chorea) would besufficient to disturb the harmony and co-ordination of thewhole spinal system, and so to produce that functional motorataxia which we call chorea. A similar condition in thecerebral hemispheres would break in upon the still more complicated and highly co- ordinated system of the convolutions,and would produce the symptoms of mania. This would,then, be afunctional ataxia of the cerebral hemispheres, corresponding, in point of symptoms, to the organic ataxia produced by extensive disease of the convolutions in generalparalysis and other diseases, just as sclerosis of the posteriorcolumns of the spinal cord is related to chorea.I can only dwell upon some of the points ofresemblancebetween chorea and ordinary mania, which lead to the conclusion that they depend upon the same process affectingdifferent parts of the nerve- centres. It will be remarkedthat the usual age for the occurrence of chorea is about thetime of the second dentition, while acute mania is mostcommon between 20 and 30-in both cases that is, whenthe portion of the nervous system affected has begun to be infull work, but before its complete co-ordination has had timeto be established. The exciting causes of both affections arethe same, and both are arrested by the intercurrence of anypyrexial disease. They also correspond in their varying in-

• Chauveau found that in choreic dogs division of the spinal cord at the level

of the atlas did not check the twitchings as long as life lasted.+ Even Dr. Broadbent and Dr. Hughlings Jackson do not localize chorea any higher than the corpora striata and optic thalami.62 Analogy in the Study ofMental Disease, [April,tensity; for, just as chorea in its earlier stages, and even inslight cases throughout, is only manifested during somevoluntary movement, but gradually becomes continuous; somania may only show itself by violence and excitement,which will subside when all external stimulus is withdrawn.I cannot lay much stress on the fact that maniacal symptoms sometimes break out in the course of chorea, for thecommoner mental condition seems to be one of depressionand of weakness, probably because the inhibitory action ofthe convolutions is usually weakened before the disease canoccur.If I am correct in this view, it will evidently have an important bearing on treatment. In the first place, chorearuns usually a favourable and tolerably definite course, and,without at all denying the usefulness of treatment, it is notoriously one of those affections in which remedies have obtaineda reputation for recoveries which are due to the natural progress of the disease. I believe the same to be true also ofacute mania, where all violent attempts to cut short theexcitement do much more harm than good. And, in particular, if the intimate cause of the disease be a hyperæmiaof the nervous centres, we can understand how, by the use ofchloral (which when taken habitually, we know, renders thearterioles more easily dilatable) a brief repose is too oftenpurchased at the price of making the disease incurable.However, there are some remedies which appear to have anundoubted effect in shortening the duration, and lesseningthe severity of an attack of chorea. Some ofthese (for instance bromide of potassium) are as well recognised in thetreatment of acute mania, but others are not employed in thelatter disease. The most decidedly beneficial results of treatment in chorea that I have seen, have been obtained by theuse of ether- spray to the spine: this method is often sorapidly beneficial in chorea* that a similar application to thehead seems to deserve a more extensive trial than it has yethad in maniacal patients. The wet pack, which, according tothe latest experiments, produces first dilatation, and then contraction of the cerebral arterioles, probably acts in the sameway, but less decidedly.

• Lubelski and Jaccoud, who suggest this mode of treatment, state that cure is effected in some ten days . I have had the advantage of seeing it tested by

my friend Dr. Withers Moore, in the Sussex County Hospital, who finds their statements correct if the chorea be purely spinal, but if the cranial nerves also are affected, it seems to be less useful. The spray is applied to the whole of the vertebral column for three or four minutes, once a day.1876.] by J. R. GASQUET, M.B. 63Arsenic has been long recommended in the treatment ofchorea, and possibly the disfavour into which it has atdifferent times fallen may be explained by Von Ziemssen'sremark, that it should be given in very much larger dosesthan usual. In the account which he has just publishedof chorea, he states that he has for many years ordered 8 to12 drops of Fowler's solution three times a day for adults,without ever observing any serious results. Those who haveobserved the very different effects of phosphorus in large andin small doses will be quite prepared to believe that the samemay be true of arsenic; and the tastelessness of this remedy makes it easy for any one to try it in cases of mania.The salts of zinc and copper have enjoyed a more uncertainreputation in chorea. At the present day we seldom or neverhear of their employment in mania, though they were recommended by a physician of no less eminence than Van der Kolk.I must now pass from the comparatively well-defined typesof ordinary mania and melancholia to the more confusedforms of chronic insanity. It might be supposed that theseare too imperfectly understood to afford any foundation foranalogies which must, at any rate, be of no practical utility,as chronic insanity is , on the whole, incurable. And,although I fear this is only too true, yet it should be thevery reason to lead us to search the more earnestly for freshclues to new and more successful treatment. I need hardlyremind my readers that there are good reasons for believingthat many cases of chronic insanity, which now are hopeless,might be temporarily improved, or permanently cured, if weonly knew how. The recoveries from insanity of long standing, which now and again surprise us, and the temporaryimprovement which will sometimes take place in the mostapparently desperate cases under the influence of pyrexia,of a mental shock, and of other causes unknown to us, andat the approach of death, practically testify to us that thehighest praise of the physician, as of the Roman general ofold, is that he should never despair.And, although I can produce nothing promising much immediate utility, I cannot but hope I may be able to suggestthe cases which we should select for treatment, and thedirection in which we should look for our remedies.I think it will be admitted by everyone that such cases ofchronic insanity as are still curable at all, must be due tosome local change which stops short of destruction of nerve-64 Analogy in the Study ofMental Disease, [April,tissue. The only change of this kind with which, in thepresent state of our knowledge, we are acquainted, is perverted vaso-motor action; and we have, therefore, to look foranalogues among the vaso-motor neuroses. The pathologyof these is unfortunately very imperfectly understood, owingto the crude and provisional state of our acquaintance withvaso-motor action in general; but far more is known aboutthem than about most of the chronic forms of insanity. Oneof the most instructive vaso- motor neuroses for my purposeis exophthalmic goitre (Graves' or Basedow's disease) . It willbe remembered that, however diversely the details may beexplained, the symptoms of this affection are admittedly dueto vaso-motor dilatation in the various parts concerned. Itsnon-intermittent and chronic character separates it frommost of the other neuroses, and, so far, resemble chronicmania with incoherence, to which it has another feature ofsimilarity in the persistent quickening of the pulse, which issuch a prominent symptom. Brück and Geigel have seenmaniacal symptoms break out in the course of this disease,which Jaccoud attributes to an extension of the originaldisturbance from the cilio- spinal centre to the neighbouringvaso-motor centre which governs the intra - cranial circu- lation.There is, at any rate, sufficient primâ facie evidence of alikeness between the two diseases to make it worth while totry, in chronic mania, the remedies which have been foundsuccessful in Graves' disease. Quinine, in the dose of somefive grains a day, has cured, or greatly benefitted , Friedreich'sand Traube's patients; the latter combined it with the alternative use of iron . Digitalis seems to have little or no effect,but the bromide of potassium has benefitted many cases, andsome cures are ascribed to belladonna. But the use of thecontinuous galvanic current has, so far, been attended withthe most striking results. This treatment, first employed byVon Dresch, has been carried out more systematically byEulenburg, who applies the cathode of a very weak current(six or eight elements) to the sympathetic in the neck, whichproduces a gradual falling of the pulse, almost to its normalrate, and a great relief to the mental symptoms whichpreviously existed .Another vaso- motor neurosis, which is worth consideringfrom our point of view, is hemicrania, which, since du BoisReymond's observations in his own case, is recognised asdependent on a tonic contraction of the unstriped muscular1876. ] by J. R. GASQUET, M.B. 65fibres in the part. The latest writer on the subject, Eulenburg, considers that there is an entirely opposite form ofhemicrania, due to abnormal dilatation of the vessels . Hewould distinguish these two forms by the amount of bloodnoticeable in the skin of the face, and by the state ofthe pupil, which would be dilated in the tonic, contracted inthe paretic, variety. He regulates his treatment accordingto these two varieties, giving particularly ergot, quinine andcaffein where the sympathetic seems to be paralysed, butemploying inhalation of amyl nitrite where the vessels are ina state of tonic contraction. Ergot is already known to usin the treatment of insanity, through Dr. Crichton Browne'srecommendation, although it has somewhat disappointed inpractice the expectations which were justly entertained of itsusefulness; but I do not know that quinine in rather largedoses, or caffein, have ever been tried in cases of chronicmania where there is reason to believe the cerebral vessels aredilated. Indian hemp, which is undoubtedly one of the mostuseful remedies in such circ*mstances, is also frequentlybeneficial (it will be remembered) in hemicrania. În onecase of extremely violent chronic mania, with rapid pulse anddilated pupils, I have seen more marked relief from the useof physostigma than from any other remedy.The nitrite of amyl, which relieves the opposite pathological condition, should be tried in those cases of acutedementia which seem to depend upon tonic spasm of thecerebral arterioles; probably belladonna, or the subcutaneousinjection of atropia would be less speedily, but more per- manently useful,The auditory hallucinations, which are so common andunfavourable a symptom in insanity, are probably analogousto the convulsive spasm ofthe face, neck, and tongue, produced by centric irritation of the facial, spinal accessory andhypoglossal nerves . Like these they are chronic, intermittent, and very rarely recovered from, either spontaneously oras the result of treatment, and probably they are usually produced under the direct influence of affection of the hemispheres, which seems occasionally to be the cause of convulsive tic, and of spasm of the spinal accessory.* But, unfortunately, there is little to be gathered from the treatment ofthese affections, for they are most relieved by the use of

• Erb records a case in which spasm of the tongue occurred in a person who had become insane, and apparently he considered them to stand in the relation of cause and effect.

XXII. 566 Analogy in the Study ofMental Disease, [April,galvanism, and the auditory nerves seem to be too deeply seated for a weak current to have much effect.There is one form of insanity which seems to find itsaffinities not with the neuroses, but with a very differentclass of diseases. I mean the affection called " typhomania,"or Bell's disease, the " délire aigu " of the French, which, asits name implies, has been repeatedly recognised as resembling the typhoid condition of the continued fevers . As far asI know, there are only two explanations of this state:Liebermeister considers it to be produced by a high temperature acting upon the nerve- centres; while Dr. Murchisongives conclusive reasons for rejecting this view, and for supposing that the non-elimination of the products of tissuechange poisons the blood, and brings about a condition ofthe nervous system much akin to that caused by uræmia oracute atrophy of the liver. It is probable, then, that typhomania is due to some such state of blood-poisoning, and, atany rate, it is worth while to try, in such a very critical anddifficult disease, the remedies which have been found mostuseful in the typhoid states of the continued fevers. Ofthese, digitalis has seemed to me more beneficial than anyothers my limited experience has enabled me to try; it mightalso be well to see whether belladonna was as great a specificas Dr. J. Harley's study of it would lead us to believe.I fear I have more than fulfilled my promise that myremarks would be very unsystematic and fragmentary, but my purpose will be amply served if anything I have said shouldrelieve any one else (as it does myself) from the feeling ofhelplessness which our specialty, above all others, produces.A Visit to an Insane Colony. By P. MAURY DEAS, M.B.Lond. , Medical Superintendent, Cheshire County Asylum,Macclesfield.(Read at a Meeting of the East Cheshire Medical Association, Oct. 1st, 1875.)In thinking over a subject on which to write a short paperfor this meeting, it seemed to me that it would be better toselect one connected with my own specialty, as more likelyto possess elements of interest and novelty to the members,than if I chose one out of the ordinary domain of Medicine orSurgery, in which they have a much wider field of observation than I can have.With that view, it occurred to me that some account, derived from personal observation, of a curious and unique1876.] A Visit to an Insane Colony. 67establishment for the care of the insane, which exists in aremote district of Belgium, might not be devoid of interest.At the present day, there is perhaps no more pressing socialproblem than to find out the best means of dealing with theenormous and ever increasing numbers of our insane population; and we may derive useful hints, and have our ideason the subject much modified, by studying a system of dealing with the insane which is totally at variance with thosewhich, through long habit, prevail in this country.A holiday run upon the Continent, in the summer of 1873,afforded me the opportunity, which I had long looked for, ofpaying a visit to the insane community or colony which hasbeen in existence at Gheel for many centuries.The leading principle of the system so long practised thereis, that the patients, instead of being confined in a largeasylum, under more or less unnatural conditions, are boardedout with the inhabitants of the district. They live in theirhouses, are, in fact, members of the family in every way, andare free to go out and in without any restraint. A great dealhas been written about this colony, and very opposite opinions expressed, some maintaining that it was a sort ofearthly paradise of the insane, where, under a rule of loveand kindness, they enjoyed perfect freedom and the pleasuresof family life; while others have denounced it as a sham,asserting that the liberty was more apparent than real, andwas accompanied by great abuses-such as the extensiveemployment of mechanical restraint, and the exercise oftyrannical authority, if not positive cruelty. The existenceof preconceived opinions and prejudices could alone accountfor such differences of opinion. In the account which follows,I shall simply state the results of my own observations, without any bias whatever.The first question which suggests itself to any one whoknows the instinctive aversion and prejudice with which, inall countries, the insane have been regarded, is how did thiscolony originate? how did such a system first come intooperation? From time immemorial, the insane have beenregarded as outcasts-to be shunned and avoided, or treatedwith gross cruelty and neglect. How does it come to passthat for centuries in this district the insane have been housedand cared for in the homes of the people? The answer is astriking instance of the power which tradition possessesamong a simple and primitive people, and also of the forceof hereditary instincts, and of early custom and example.68 A Visit to an Insane Colony,[April,Nearly 1000 years ago, tradition says, an Irish princess,called Dymphne, was converted to Christianity, and, to escapeher father's anger, fled to Gheel, whither, however, he pursued her, and where he beheaded her with his own hand. Intime she was canonised as Saint Dymphne, and in some wayher shrine acquired a reputation for curing the insane, whowere consequently brought on a pilgrimage from all parts.Some, it may be, were cured by the priests ' prayers , the intervention of the saint, or change of air; but many, it may bebelieved, remained unaltered.Loth to believe their maladies hopeless, and strong in faith,cases were left behind, boarded at first in a small buildingnear the church, afterwards in neighbouring cottages . Thosewho had charge of them would thus look on it as a religiousduty to be kind and attentive to those who were under thespecial protection of their patron saint; and when we add tothis the intimate knowledge of the peculiarities of the insane,which, in the course of years, would thus be acquired andhanded down, we can understand the way in which the greatessentials of the system grew up, viz . , kindness and sympathy,with confidence and want of fear.Begun in this accidental way, the colony, in course of centuries, became greatly expanded, and acquired a wide reputation. Of late years it has been taken in hand by Government, and placed under the control of a Commission or Boardof Governors.Gheel itself, which forms the centre of the colony, is asmall country town, of about 2000 inhabitants, situated in adistrict called the Campine, in the province of Antwerp, fromwhich town it is reached by train to Herrenthals, thence bya primitive, old-fashioned diligence, for about nine miles.The town is situated in the midst of a moor, from whichthe cultivated land has been reclaimed; but in the outlyingdistricts there is much waste, unproductive land. This isdivided into small plots of two to six acres, owned by cotterfarmers, living in scattered cottages of the poorest class,similar to what are found in some parts of Scotland and Ireland. The whole colony comprises about 30,000 acres, with apopulation of 11,000; and among this population are scattered about the large number of 1,300 insane, who are boardedout in about 800 houses.In the centre of the town there is a small hospital or central asylum, erected a few years ago, containing about 50 beds. The medical director of the colony resides here; and1876.] by P. MAURY DEAS, M.B. 69here all cases are received in the first instance, to be draftedoff in a few days to some portion or other of the colony, athis discretion. Here, also, serious cases of illness may besent, as well as cases which, from temporary excitement, mayhave become unsuitable to be at large. It should be addedthat only the milder forms of insanity are under treatment,as a rule, at Gheel; those decidedly dangerous to themselvesor others not being sent there.The keynote, as it were, of the system is struck in thenames given to the patient and his guardian. The latter istermed "nourricier," a nourisher or foster-father; the former,"pensionnaire," or boarder. These terms are invariably andnaturally used, and strictly express the relationship. No halfveiled aversion or dread finds expression in such terms as"lunatic," "madman," "keeper," " warder," so common,I am sorry to say, still in this country.A register of " nourriciers" is kept, on which is inscribedall householders willing to receive "pensionnaires," and whocan satisfy the direction as to their respectability. They mustalso be able to provide the accommodation prescribed, whichis a room containing 500 cubic feet for each patient, withiron or wood bedstead, wool or hair mattress, straw palliasse,bedding, &c. This is for the poor who are paid for by their commune; but there are in the colony about 100 patients,paid for by their friends, who are boarded in a similar wayin the families of well-to-do people; in some cases the accommodation being very superior, and the patients of a high class.The colony is divided into four sections, and to each ofthese there is a physician and an inspector.With one of the inspectors, or "garde de sections," Imade a tour of a portion of the colony. He was amost intelligent and superior man, understanding his workthoroughly, and possessing a good knowledge of insanitygenerally. Yet this man only had 600 francs a year, justabout half what we pay for ordinary attendants, who knowlittle or nothing.He had under his care 300 patients in 160 houses, all ofwhom he visited every week, having to go as far as four milesto visit some of them.The first day, we confined ourselves to the town itself.Here the quieter of the patients are boarded; also epilepticsand idiots, as well as most of the private patients . The townis a rambling, irregular place, composed mainly of small cot-70 A Visit to an Insane Colony, [April,tages, white and clean looking, and most of them clean andfairly comfortable inside. We entered a large number ofthehouses, inspecting the accommodation, and conversing withthe " pensionnaires" and their " nourriciers " where practicable, but many knew little French, and spoke only Flemish,or the peculiar Walloon dialect. There were mostly twopensionnaires in each house, seldom or never more, and inmany cases only one.The time of our visit was very favourable for observing theconfidence placed in the patients. The great annual festivalof the Kermesse was going on, and in many houses we foundthat the patients had been left in charge of the establishment, while the nourriciers were away at the fête. One man,a shoemaker, was thus left in charge. He was extremelyvoluble, and in a state of sub-acute mania. He showed ushis bedroom, which was up a break-neck stair, which wouldundoubtedly not be up to the requirements of official inspection in this country, but had the advantage of being homely and what he was used to. It was very clean, and containeda good bed and ample clean bedding. When we went in hewas in his shirt- sleeves, and working at his trade. Otherswhom we saw were engaged in various domestic offices. Onewoman showed us some lace made by herself, the proceeds ofwhich would be her own property. It was beautifully fineand well made. But the favourite occupation of the womenpatients was nursing the children. Nothing was more interesting in the whole place than to watch the care and interestshown for the children; and, on the other hand, the affectionand confidence which they exhibited towards the patients.In one or two instances I asked the mothers if they were notafraid. They did not seem to comprehend at first, then quitelaughed at the idea, the pensionnaire herself even appearingto enjoy the joke. Watching this, it was easy to see howthe system here perpetuates itself, and remains always successful. The children, from their earliest years, are broughtup among the patients, are taught to look upon them asmembers of the family, and thus not only have no fear of oraversion from them, but grow up looking on them as their bestfriends. Constant familiarity with their ways and peculiarities takes away the temptation to idle curiosity, or to ridicule. Brought up in this atmosphere, they are thus admirably qualified in time to become " nourriciers " in their turn,and to hand down the art to their children. I was particularly struck with the naturalness of their manner to their1876.] by P. MAURY DEAS, M.B. 71charges; no sign in it, or in their way of speaking, showedthat they had charge or authority over them. Hence the obvious confidence and mutual sympathy. Hence also, to agreat extent, the secret of their confidence being so seldommisplaced, or the liberty taken advantage of. There is, as itwere, no temptation to do things which, being never forbidden, probably never occur to them. It is the old saying,that there must be a law before there can be a transgression.What I have said may seem highly coloured, and no doubtthere must be exceptions; but from many examples it wasquite plain that it was exactly as I have stated; and that theconfidence and the liberty were both great and undoubted.We met and spoke with many walking alone in the streets;some displaying in their manner and gestures evidence oftheir malady; others presenting nothing noticeable, but allalike moving about at "their own sweet will," no one noticing them any more than other passers-by; indeed, not attracting a tenth part of the curiosity which the sight of an Englishlady and gentleman evidently aroused.One man whom we thus met, intelligent looking, and awatchmaker by trade, had lived in England for some time,and spoke English a little. He did not present anythingamiss at first, till he said he had lived near Brightonin the Palace of the Devil; that the English wanted to makehim Emperor of France; that he was specially charged toarrange intermarriages among the English, Germans, andFrench; and that he was the best watchmaker in the world.He became very voluble and excited, as he went on. Anothersaid he was anxious to go home; when asked where it was,replied, " au ciel." He had been eleven years at Brussels andfour here, but he was going " home very soon now.added, that all the people in the world, including ourselves,would ultimately be at his disposal.99 HeI mention these instances to show that those who weregoing about at large were not merely imbecile or demented,but suffering from active insanity. We visited one of the Pensions for high-class patients, with accommodation for threeor four. There were all the appointments of a good modernhouse; large, handsome rooms, almost luxuriously furnished:a fine garden, &c. There was not a sign anywhere of anything special. The owner of the honse was a most superior,intelligent man, by business a china merchant. I had a gooddeal of conversation with him. He told us of a Russianprince who had been there. For nearly a year before he72 A Visit to an Insane Colony, [April,came, he had been almost constantly restrained by the camisole, or in seclusion, and he was brought under the care offour attendants. Within a month he was living as one ofthe family; his own doctor came to see him, and was astounded to see him dining at the family table. Before longhe became well enough to return home.manThis is a striking example of the beneficial effects of the"free" system, as contrasted with the excessive use of mechanical restraint, still so much practised abroad. Even atGheel mechanical restraint is freely used in the CentralAsylum, and in spite of the striking evidence of the freedomwhich may be accorded to the insane, as shown in the colony,views of medical treatment quite at variance with this prevailin the asylum, as they do in others on the Continent, showingthat there are bad traditions as well as good traditions, andthat both are very powerful. In the asylum, containing onlysome 40 patients, I found four women and onefastened in what are called " chaises de force;" strappeddown in chairs of peculiar construction. Two of these hadalso their ankles strapped, and one was fastened by a beltround his waist. There were besides two in seclusion. Theman was a case of general paralysis of two years' standing.He seemed very quiet. The women seemed more helplessthan violent. There was no nurse to be seen near them, andone of the many evils of such restraint is that it relieves thenurses from the necessity for constant watchfulness. In thecolony the " nourriciers are not allowed to use restraintexcept by medical order; but it is used at times under thisrestriction. The chief mode is a leather band round theankles, to prevent those who have a tendency to escape fromgoing far. It allows of walking, but slowly-like a horse,when hobbled; I only saw one man in the course of my visitthus fastened.99We visited the church, which is a fine old building, datingback to the 12th century. We saw the cells which used tobe occupied by those brought to be cured by exorcism, andthe intervention of Saint Dymphne. This is still done somefew times a year, and two ofthe cells are still used, and whatis more, the old chains and gyves, by which their feet arebound together, and then fixed by a chain to a staple in thewall. They are then prayed over by a priest, who, in spite ofall the precautions, is still perched up at a safe distance in asmall gallery! They are received for nine days, then for ninemore, if wished. It seems that at the end of this time they1876.]73 by P. MAURY DEAS, M.B.usually find their way to the asylum considerably worse thanwhen they came; but occasionally they do recover rathersuddenly; then, "a miracle, a miracle" is the cry. Myintelligent guide, who gave me these particulars, was evidently not one of the " devout," and not at all a believer inthe efficacy of St. Dymphne.The shrine, said to contain her relics, is of silver, and verybeautiful. The altar piece is a fine piece of sculpture inwhite marble, representing full- size figures of the insaneappealing to the Virgin, and having gilt manacles on theirlegs, showing how common the idea of restraint must havebeen when it could be seized upon by art to indicate theperson intended to be represented.The following day I went on a tour, still accompanied bymy intelligent garde de section, through some of the moreoutlying portions of the colony. In these, as a rule, themore troublesome, noisy, and violent cases are boarded.They have the great advantage of plenty of space for exerciseon the open moor, which everywhere encroaches on thecultivated patches round the cottages, and find healthy anduseful occupation in assisting the nourricier to derive ascanty and hardly-earned subsistence from the poor soil, orin helping the wife with the cow, pigs, or in domestic work.The cottages are very poor; many of them built of clay andosiers, and thatched with heather. Not much can be saidfor their cleanliness, but they were homely, and what thepatients had been used to. The room for the pensionnairewas always the best and most comfortable, provided with agood bed, &c. , and clean . This may be partly, no doubt,due to the fact that the cottagers are very anxious to haveboarders, as the sum, small as it is, which is paid for them,and the value of their labour, are a material assistance tothem in the struggle for existence. Although the patients ,as a rule, were of a lower and more troublesome class thanthose in the town, the same salient features were observed.The patients were treated as integral members ofthe family;they appeared to be well cared for; there was the same freedom to go out and in as they liked; there was no trace ofanyharshness or ill-treatment, and they seemed, as a rule, happyand contented. Many of the cases which I saw would beconsidered bad cases, even in an asylum. Several exhibiteda good deal of excitement, but there was no restraint putupon them; they were free to come and go as they liked.Outside one cottage there were two women considerably74 A [April, Visit to an Insane Colony,excited. They were walking about; one singing and dancing; the other gesticulating and shaking her fist, and brandishing a stick, but there was plenty of room; no one to noticeher, and no one to fight with her. The nourricier and familyin this case had gone to the Kermesse, and a patient from anadjoining cottage, who was convalescent, was in temporarycharge of the establishment and the two patients . A numberwho were said to be at times much excited were employed invarious ways; churning butter, peeling potatoes, attendingto the cows, or to domestic matters. One man, a chronicmelancholic, had just got up, and the woman of the housewas dressing him. In another, a young woman was completing her toilette in her own room; and conversed affably andlaughingly with us through the small window. Everywheremy guide seemed to be a favourite, and to be received as afriend. As we walked along he gave me much general information as to the working of the colony.The payment made to the nourriciers is about 3s. perweek; and for the more troublesome cases about sevenpence a week extra. Clothes are provided by the administration, and a list kept in a small book.The dietary is usually as follows:-There are four meals aday. For breakfast coffee, with bread and butter. At noonsoup, with potatoes, or other vegetables, and a little bacon.At four, buttermilk and cakes. At night coffee again. Thebread is chiefly rye, and very black and coarse.Enquiring as to accidents and escapes, I was informedthat there had been three or four suicides in 18 years, thatserious accidents were very rare, and that the attempts atescape were not frequent. The locality being remote, thereis not much temptation; and the police of the neighbouringcommunes, as a rule, recognise them and bring them back atonce. After making due allowance for the fact that the casessent are selected to a certain extent, the freedom fromserious accidents among such a large number of insanecannot but be regarded as remarkable. From my personalobservation the selection of cases is by no means a verynarrow one.As to the number of recoveries, I could not get verydefinite information, but they do not seem to be verynumerous. My guide estimated that there were only six inhis section, containing 300 patients, who might be regardedas probably curable. On the whole the system seems bettersuited for chronic cases than for acute cases where there is1876.] by P. MAURY DEAS, M.B. 75hope of cure. There is a monotony in the life-a want ofthe variety of interest and amusem*nt which exists in a wellmanaged asylum; and above all, there is the want of immediate and constant watching of the cases, and of direction ofthe treatment by a medical man. This last seems the greatblot on the Gheel system. The china merchant, whom Imentioned before, stated most strongly that the great evil inGheel was the want of efficient medical supervision. It seemsthat the medical men in charge of the sections only visittheir patients, as a rule, once in three months. But for theintelligence and judgment of the gardes de sections, who visitthem every week, this evil would be more felt than it is; andthe person before referred to, said indeed, in answer to aremark on this subject, that the inspector was, in fact, thedoctor. Even for chronic cases, if they are at all of a superiorclass, and have much mind left, life in such a place must bedreary and monotonous. We had a striking instance of thisin the case ofa lady patient, whose acquaintance we made, andwho spent some time with us. She had lived 10 years in England, spoke English perfectly, and in the intervals of attacksof periodic mania was to all appearance quite well. She washighly accomplished; and played and sang most beautifully.It was easy to gather from her conversation , and the wistfulway in which she spoke, how dull her life was, and how cutoff she felt herselffrom the world.These considerations, however, cannot blind us to thegreat fact which faces us at Gheel, viz. , that it is possible tohave upwards of 1,000 insane persons living in a communityas part of it, enjoying the advantages and freedom of familylife; happy, contented, well- cared for, and yet under little orno restraint, controlled only by kindness and the mutualconfidence which exists between them and their guardians.This is the great lesson which Gheel teaches, and which allin this country who have to do with the insane should laywell to heart. To found anything like a Gheel in thiscountry would be utopian, impossible-such a system couldonly grow up, and that under most exceptional circ*mstances .But it is a great and important fact to know, and one whichmight be turned easily to practical advantage, that a vastnumber of the chronic insane might, under favourable circ*mstances, enjoy much greater freedom, and live a morenatural, homely life than is possible for them in any closeasylum. In a carefully arranged and supervised system of boarding out, is, I believe, a solution to be looked for ulti-76 A [April, Visit to an Insane Colony.mately for that deadlock which at present only leads to thebuilding of one huge asylum after another, with elaboratemachinery and arrangements, well adapted for recent, curablecases, or for those with strongly marked insanity; but quiteunnecessary for the majority of cases of chronic insanity.But before this can be done, public opinion needs a greatdeal of education . Many old prejudices must be done awaywith; a state of things must be brought about in which aninsane person should not be, in a special sense, merely anobject for idle curiosity and remark, but treated as one possessed of any other infirmity, such as blindness or deafness,would be, with pity and consideration; and, above all, with amanner showing no fear or aversion; treating them, in fact,as much as possible on an equal footing, as far as their faculties go. This may seem very utopian, and perhaps it is so;but I believe that a visit to Gheel would convince any unprejudiced mind that it is, at any rate, possible; as I think itwould also show them how utterly mistaken and cruel is themental attitude which the majority of people adopt in reference to the insane, not intentionally, but from habit andprejudice. Until, however, this attitude is very much altered,progress in the direction which I have indicated is quiteimpossible, and any attempt would probably end in failure.I have faith, however, myself, that a time will come whenour present ordinary ideas as to the insane will become asobsolete and seem as strange as their treatment by chainsand fetters, or the attempt to cure them by the exorcisingof a priest and the intervention of St. Dymphne.Notes on Lunacy in British Guiana. By JAMES S. DONALD,M. B., Edin. Resident Surgeon, Lunatic Asylum,Berbice.Few countries , if any, afford better opportunities for thestudy of insanity, as exhibited among different races, thanBritish Guiana. Here, gathered together in one asylum, areWest Indians, Coolies* from India, Chinese, Portuguese, andAfricans; and, although the types of insanity are very similar in all, yet there are some distinctive features, worthy, Ithink, of being noted. Many difficulties arise in investigating"Coolie " in this country is a term exclusively applied to labourers imported from the East Indies, and their descendants. Labourers from China are always spoken of as Chinese.1876.]77 Notes on Lunacy in British Guiana.the subject, owing, principally, to an inability to converse personally with some of the patients, more especially withChinese. Consequently, a refinement in classification is unattainable; the strongly-marked features of the case alonegiving an index to the form of mental disorder.To institute any comparison between this country andEngland in the proportion of insane relatively to the population is difficult, owing, mainly, to the fact that in manycases national peculiarity is mistaken for mental derangement,and also because of our ignorance of the condition of theinhabitants in districts not under mental observation. Taking, however, the population of England and Wales in 1871as 22,704,108, and of British Guiana in the same year at193,491 , and comparing the number of patients in asylumsof both countries, we find that, whereas in England andWales there was one insane person in every 388 of population,in British Guiana there is only one in every 1200, or thereabouts. In the year mentioned the ratio of lunatics to population (1000) was 2.49, while in this colony it was only 91 .Among Creoles of the West Indies the ratio was 41, Coolies82, Portuguese, principally from Madeira, 1.00, and Chinese1.59. I am unable to give the ratio per 1000 of Africans, asI have no statistics of their population. These figures,although giving some idea of the comparative extent ofinsanity in England and this country, cannot be relied uponas strictly correct, owing to the difficulties I have mentioned.About 25 per cent. of the inmates in this asylum areCreoles of the Colony and of Barbados, and are principally ofblack parentage. Among these mania prevails more thanany other form of insanity, and in a large proportion ofcases is complicated with delusions of a religious character.This may be accounted for from the fact that times of religiousexcitement are of frequent occurrence among the black population, and an increase in our inmates is no uncommonsequence to a so-called " revival " of religion . A strongreligious sentiment (to use the expression in its widest significance) exists in the mind of the negro, and it is not, therefore, a matter of surprise that when reason is unseated theprevious prominent feelings should sway the wanderings ofthe "mind diseased." In some cases religious melancholiafollows the attacks of mania, the mind of the patient becoming depressed from gloomy ideas, as, e.g., that his soul iseternally lost, thus rendering him one of the most miserable78 Notes on Lunacy in British Guiana, [April,of men. Very much akin to this religious melancholia in theblack Creole is that ofthe African when the mind is haunted,and the imagination excited, by the terrors of the mysteriousObeah. The extreme depths of despondency into which thevictim of the dread power of this malignant superstition isthrown, entirely subverts the normal condition of the mind,and drives, in some cases, the unhappy sufferer to attemptsuicide. Some years back Obeahism or witchcraft was no uncommon practice, especially in Berbice, but of recent years ithas happily decreased, and it is to be hoped that as educationamong the black population advances, it will become graduallyextinct. There is a statute in the laws of British Guiana, bywhich it is enacted that " every person practising, or pretending to practice, Obeah or Witchcraft, shall be held guilty ofa misdemeanour, " and shall be punished accordingly. Thelaw is now, however, practically a dead letter, owing to thedifficulty in defining the meaning of the term "Obeah." Agreat barrier to the diagnosis of insanity among Africansexists in the fact that we have frequently to deal with a minduneducated; and thus in many cases natural stupidity bordersso closely on imbecility, dementia, and amentia, that it isdifficult to say where a normal state ends and an abnormalone begins. The majority of Africans admitted suffer fromsenile dementia and general paralysis, and, consequently,anything but a hopeful prognosis can be recorded in these cases.Over 50 per cent. of patients admitted into this asylumare Coolies, suffering principally from mania and dementia.The mania of the Coolie is generally characterised by greatdestructiveness and impulsiveness; consequently homicidal and suicidal propensities are of frequent occurrenceamong them. While, however, such cases are dangerous,they seldom last long in the acute stage, thus contrastingstrongly with the form of acute mania met with in the blackCreole. While the percentage of admissions of East Indianimmigrants is greater than that of any other nationality represented, the number of recoveries is also relatively greater.I attribute this in a great measure to the improved dietarywhich they receive in asylums. On admission they are almostinvariably very anæmic and half- starved, owing to the insufficient nourishment which they take prior to being admitted.Thus, when under a better diet the condition of the blood andnutrition of the brain improve and a corresponding mentalamelioration frequently results . The disgusting practice of1876.]79 by JAMES S. DONALD, M.B.dirt-eating is by no means uncommon among Indian immigrants. It generally exists among those suffering from dementia, but cases are met with among individuals not confinedto lunatic asylums. Lime, clay, and burnt earth are oftensubstituted for their proper diet. If the morbid appetite benot controlled, the patient soon sinks from exhaustion, anæmia, diarrhoea, and dropsy. Referring to this subject, Dr.Thomas Murray, jun. , of Tacarigua, in a letter contained inDr. Gavin Milroy's report on leprosy and yaws in the WestIndies, remarks: -"There are two classes, I think, who eatdirt: 1st, those whose religion forbids them to eat meat (viz. ,parsons) , and yet who crave for something more than rice;and 2nd, lazy men who would rather starve than work. Theselatter generally acquire the habit in their own country."It is difficult to break them of their filthy habit, and astrict watch is necessary to prevent them indulging in thepractice.Among the Chinese inmates I have been struck with thefrequency of epilepsy and epileptic mania, and have beenequally puzzled to account for it. It is more particularlynoticeable in females, the attacks being in some cases periodicand generally very violent. It has been suggested thatopium-eating might account for it, but were this the case itwould be met with more commonly among Coolies, who arealso addicted to the use of this drug. As a rule the characteristic stolidity and impassiveness of the Chinese is littlealtered during mental aberration. The cheerless, unhappyexpression of countenance gives the patient the appearanceof one suffering from profound melancholia, and totally indifferent to anything around him. The number of Chinesenow in asylum is too small to warrant my giving any decidedopinion as to what may be considered the more prominentfeatures and nature of their mental disease. They aregenerally quiet docile patients, very amenable to treatment,and, except in the epileptic, violent symptoms are rare.There is nothing particular to note in the insanity of thePortuguese. The majority of those admitted are old andfeeble patients suffering from senile dementia and melancholia. Physically they are not robust, and very soonsuccumb to intercurrent diseases, especially diarrhoea anddysentery.Of the bodily ailments which most frequently terminatefatally among the inmates of all classes may be mentionedphthisis, dysentery, and intermittent fever and its sequela.80 Notes on Lunacy in British Guiana, [April,With regard to the etiology of insanity in this colony, Icannot say that I find it in any way depending on, or modi- fied by, the nature of the climate. One of the most fertilecauses is intemperance. I have noticed this more particularly among Creoles and Portuguese, and in many cases Ihave been able to trace alcohol as the direct agent.Among the lower classes rum is mostly used, and frequentlyin the form of "high wines, " i.e. , rum 40 over proof. It caneasily be understood that this in time seriously interfereswith the bodily health, and, acting as a poison, eventuallyproduces cerebral lesions.The practice of opium smoking and eating is frequentlymet with among Coolies and Chinese here, but it is by nomeans so common as in the East. It is laid down by allwriters on the subject as inducing in time insanity; but asI find it difficult to gather from the patients any previoushistory of opium- eating, I cannot venture any opinion on thesubject. The history of an insane person is difficult toobtain here, as it is a rare thing to see any friends who canfurnish information on the subject, and the particularssent with the patient are generally very meagre. Inmalarious and tropical countries three causes have beenespecially assigned as often inducing cerebral derangementresulting in insanity, these being sun-stroke, leprosy, andintermittent fever. The first-mentioned cause, insolation, isnot of frequent occurrence; and although well-marked casesdo occasionally come under notice, I have not seen any resulting in insanity. With regard to leprosy, my experienceis too limited to speak positively of its effects on the mentalfunctions, for as yet only one case of true leprosy associatedwith insanity has come under my observation; and in thiscase the form of the disorder is intermittent mania, theperson being during the intermissions very intelligent.From the time of Sydenham intermittent fever has beenattributed as a cause of insanity, and several cases have beenrecorded by Baillarger and Hoffman. In Sydenham's opinionlunacy thus induced is a mania peculiar to itself, and incurable. No doubt intermittent fever is closely connectedwith nervous disorders and, by producing anæmia, interfereswith the circulation and due nutrition of the brain; but thatagues are pre-eminently productive of insanity, I do notadmit. It has been argued that, were intermittent fever afrequent precursor of insanity, in malarious countries theproportion of insane would be greater than in countries1876. ]81 by JAMES S. DONALD, M.B.free from marsh miasm. This, however, is scarcely a fairargument, as in non-malarious localities other fevers fromwhich we do not suffer here, such as typhus, exist, andcause probably a larger number of admissions into lunaticasylums than intermittent fevers. It would be difficult tofind a place better adapted for the production of intermittentfever than the situation of the General Hospital and LunaticAsylum in Berbice; for, situated at the confluence of two rivers, about a mile to windward of the town of NewAmsterdam, and unprotected by any forest or belt of trees(which, as Sir Thomas Watson states, preserves the inhabitants of the town in health) , every facility is given for thefree development and access to the patients of malaria,according to the generally recognised idea of chill of Drs. Oldham and Inman, and of the " certain electricalconditions of heat acting on moisture," which SurgeonGeneral Munro considers as the hostile element in the production of intermittent fevers, cholera, yellow-fever, and heatapoplexy. Yet although intermittent fever is of frequentoccurrence among the patients, especially at spring and neaptides, and severe head symptoms frequently supervene, I havenot been able to connect together the lunacy of any patient with this as a cause. Possibly it is because I have not hadsufficient opportunity of observing quartan ague, which isuncommon here, and which, according to Sydenham, ispeculiarly obnoxious in producing mania; but should I comeacross any cases, I will be particular in my observation oftheir subsequent history. One more remark on this subjectI would make, namely, that by far the greater proportion oflunatics admitted into the asylum here are from the healthierlocalities; while it is a rare occurrence to receive one fromthe river districts, which, although in many cases havinglarge populations, are, as a rule, the most unhealty, malarious,and fever-stricken of the colony.XXII. 682 [April,Some Observations on General Paralysis. By ISAAC ASHE,M.D., T.C.D., Medical Superintendent of the Londonderry District Asylum.(Read at the Annual Meeting of the Medico- Psychological Association,held at Dublin, August, 1875.)Although we have, for some time past, begun to emancipateourselves from the idea that insanity is a disease of the mind,and admit, in theory at least, that it is strictly a disease of thebody, as much so as typhus, or any other disease involvingperturbed mental phenomena, yet we have scarcely hithertobegun to investigate the pathology of insanity from thispoint of view. Even yet we classify the forms of the diseaseby the mental manifestations it presents, and speak of mania,melancholia, dementia, &c. , when our aim ought to be todifferentiate the physical or chemico-vital somatic conditions;we describe the insanity of fear, of pride, of exaltation, &c. ,much as if we should classify ulcers as those of the hand, thearm, the leg, and the trunk, instead of attending to themore important characters of ulcers in general with theirtrue specific differences. For, I venture to think, that Professor Ferrier's researches point strongly to the view that thedifferences in direction, so to speak, taken by the mentalphenomena depend to a great extent upon the differences inthe portion of brain-tissue principally affected. The investigation of the physical causation and conditions of insanitywill doubtless be laborious and tedious work, but there canbe no doubt that the results to be obtained will more thanrepay the labour which must be expended in the investigation.It seems to me that in General Paralysis we have, as itwere, a portal to such an investigation-a sort of basis ofoperations from which our future explorations of unknownterritory may with advantage be commenced; in fact, thatthe key of the unknown region lies in a knowledge of thisdisease, its causes, pathology, and conditions.As regards the causes of this disease, two are usuallyassigned, and have almost been accepted, namely-1st, Excessive use of alcoholic liquors; and 2ndly, Immoderatesexual indulgence.But as regards the first of these assigned causes, I have tocall attention to a very remarkable fact regarding the distribution and statistics of the disease which bears very strongly1876.] Some Observations on General Paralysis. 83on this point, and is perhaps very little known. It is this:that General Paralysis is scarcely to be found in Ireland,though so common in England and Scotland. The remarkable absence of the disease in the Irish asylums with which Iam acquainted, as contrasted with those of Great Britain, haslong since pressed itself on my mind; but I have recentlyendeavoured to procure as far as I could some exactstatistics on this point. As an illustration of the vastdifferences existing between England and Ireland in thismatter, I may direct your attention to one or two particularinstances. Thus, in the Twenty-ninth Report of the EnglishCommissioners in Lunacy, just published, at p. 207 we findthe inmates of the West Riding Asylum put down as numbering 1404; and on the next page, the deaths from GeneralParalysis during the year are-males, 26; females, 9-total35, which will probably give 70, or 5 per cent. , as the numberof cases at any given date. Per contra, my friend Dr.Merrick, having charge of the Belfast Asylum, containing400 patients, writes to me-" We have no case of GeneralParalysis in the Belfast Asylum at present. " Dr. McCabe,of the Central Criminal Asylum, with 163 patients, writes-" I regret that there are no materials here; I have not hada case of General Paralysis since I took charge, three yearsago. " Dr. Atkins, the Assistant Physician of Cork, with700 inmates, writes-" One spurious case at present in theasylum." In my own asylum at Londonderry, with 250inmates, I have at present only one case; but I was fortunateenough to have another well- marked case some time ago, andI have also met the disease in private practice.I cannot but think that such a disproportion in the frequency of the disease in the two countries must be held atonce and entirely to negative the theory that its developmentis due to excess in the use of ardent spirits; indeed, I mightadd that it equally negatives the view that it is due tovenereal excesses either; for, certainly, neither in the onedirection nor in the other can it be asserted that the Irishpeasant is more abstemious than his English neighbour.And, moreover, as regards the use of ardent spirits, any oneof us in Ireland could at once count up 10 per cent. of ourasylum population whose insanity has been caused by theabuse of distilled liquors; but the disease does not take theform of General Paralysis.But it seems to me that there is a form of alcoholic indulgence in which the Englishman and Scotchman markedly84 Some Observations on General Paralysis, [April,distance the Irishman, and this is the consumption of maltliquors, of which the Irishman uses but very little, but theEnglishman and Scotchman a great deal, particularly thosewhose occupations compel them to undergo severe and continuous bodily labour, such as the colliers and ironworkers;and it is, I believe, the experience of those who have seenmost of General Paralysis that it is especially among thesehardworking operatives that this disease is to be found.Whether such a result should be regarded as due to the useof pure and unadulterated malt liquors, or is rather to beconsidered as the effect of some adulteration thereof, is anopen question. I should be strongly inclined to think thatthe latter is more likely to be the case; and of the variousadulterants, I should think that Cocculus Indicus is the onethat should most probably be credited with this dire result,since observation has shown its power of producing paralysiswhen administered in too large quantity. It seems to affectboth the nervous and muscular systems. Pereira says thatit causes staggering, trembling, tetanic convulsions, and insensibility, and that it appears to act on the voluntarymuscles. I need not remind you how frequently convulsions ,though rather of an epileptoid character, are found in thedisease under consideration. Pereira states that it seems tobe frequently added to malt liquors, and refers to a book containing trade directions for so doing.I think the remarkable absence of the disease in Ireland isquite sufficient to prove further, that even immoderate sexualindulgence is not a vera causa of the disease. Were it so, weshould undoubtedly have our share of it here. But the presenceof strong sexual proclivity during the course of the disease isundoubted, and I have myself observed it in every instance.If, then, statistics forbid us to regard it as a cause, it is clearthat we are bound to regard it as a consequence of thedisease; and this isis a matter of importance to be borne inmind in our investigation of the physiological conditions andcausation of the disease, a matter to be distinctly separatedfrom the toxic causation already referred to.I have recently sent a circular containing queries regarding the statistics and distribution of General Paralysis tonearly every physician superintendent of an asylum in thethree kingdoms, whether private or public, asking for information regarding the disease as found at present in hisasylum. I had hoped by means of the answers to thesequeries to be able to draw contrasts based upon large averages1876.]85 by ISAAC ASHE, M.D.between-1 . The inhabitants of each of the three kingdomsas such. 2. Between the Celtic population of these islandsand the Saxon. 3. Between the upper classes and the lower.4. Betweenthe town populations and the country. 5. Betweenthe artisan and operative classes, miners, ironworkers, &c. ,and the purely agricultural classes. The value of such ananalysis in investigating the causes of General Paralysis will,I think, be obvious. I regret to say, however, that only about25 out of 200 of these circulars have been returned to me. Iam thus only able to give you statistics based upon illustrativecases rather than on a complete average. I have, however, tothank several gentlemen for their kind assistance, and particularly those who were not deterred from replying to anyqueries by the fact that they had no information to give me,since this was the very point that I wished to elicit withregard to their asylums, namely, that General Paralysis wasalmost unknown therein. The returns which I have actuallyobtained shew that Ireland is almost entirely free from thisdisease, whether in its public or private asylums; while in theprivate asylums of England it is as rife as in the public.Thus, one gentleman, a high authority on the disease, writesto me that in his private asylum eight cases out of the lastfifty admitted have been cases of General Paralysis. Anothergentleman returns me three out of fifty-five; another one outof fifteen. I am sorry that I have no returns from the Scotchprivate asylums, but we have here sufficient proof that socialposition has nothing to say to it. Again, its absence in thelarge town of Belfast, numbering 200,000 inhabitants, and byfar the most industrial town in Ireland, proves that town lifeas such is not a cause, not even when accompanied by excessive use of spirits, for which Belfast is notorious. Again, itsabsence in the country district belonging to the BelfastAsylum, namely, the County of Antrim, proves that it doesnot depend on any difference between the Saxon and theCeltic race; for Antrim is as purely Saxon as Lanarkshire,and much more so than Cornwall or Glamorganshire, both ofwhich are indeed Celtic counties of Great Britain, andexhibit rather a proclivity towards the disease. The nonmanufacturing districts of Scotland are pretty free from thedisease, if we may judge from the return of the InvernessAsylum, where Dr. Aitken gives one doubtful case out of anasylum population of 337, and the counties of Argyll andBute, which give us three out of 300. Perth, again, givestwo out of 232. I have no reason to believe that these86 Some Observations on General Paralysis, [April,districts of Scotland are specially abstemious as regards theuse of whiskey, which seems to be pretty freely used everywhere throughout Scotland. In Cambridgeshire, again, arural population, there are but three cases out of 275. Wemay compare this with the North Riding, where out of 230males we have fifteen cases; or Lincoln, where we have fourout of thirty.Altogether, therefore, these statistics seem to point outthat as regards the lower classes the disease is principallydeveloped among the manufacturing and operative classes,particularly among those who undergo severe bodily labour,and that the agricultural populations are comparativelyexempt; but though I think that this points very distinctlyto the use of malt liquors rather than to that of spirits as acause, yet there seems to be still a residuum of unexplainedcausation behind, which I shall endeavour to reach from otherconsiderations farther on.I have referred above to the presence of strong sexual proclivity during the progress of the disease-a fact whicheveryone has probably observed in general paresis , though itwould seem to be absent in locomotor ataxy, according tosome observations with which Dr. W. H. O. Sankey hasfavoured me. I think we are fairly entitled from the abovestatistics to regard this as a consequence rather than as acause of the disease. Another well- known consequence is themarked tendency to fatty degeneration of all the tissues .Several of my correspondents-in fact, I think all who seemto have been in the habit of making post-mortem examinations-bear testimony to this. In a case of which I recentlymade a post-mortem, and of which I am able to shew yousome sections, microscopical examination shewed distinctevidence of this everywhere.The post-mortem was made eighteen hours after death.There was no rigor mortis, probably, in part at least, owing to the amount of destruction of muscular tissue that hadtaken place; a layer of fat an inch and a-half thick existedover the whole chest and abdomen; the liver was a mass ofoil globules; the muscular fibrillæ of the gastrocnemiuspale and fatty; the heart similarly affected; in the bony structure of the ribs the Haversian canals seemed almostobliterated by a mass of degenerate deposit containing oil.There were gangrenous spots on the toes and heels; thesehad appeared a couple of days before death. The brain wasin a very soft and almost creamy or diffluent condition.1876.] by ISAAC ASHE, M.D. 87This is, of course, no new observation with regard to thefatty degeneration of the tissues in cases of general paresis.Thus Dr. E. L. Ormerod, in a paper published in the " Journalof Mental Science " for January, 1871, writes on his examination of the bones of a patient who died of this disease underDr. Williams' care:-"The bones were dark, singularly wetand greasy, and, considering the short time that had elapsedsince death, unusually advanced in decomposition. On anypressure of the ribs dark blood oozed from the comparativelylarge vessels on their surface. A section of the right thickness to display the structure of a healthy bone shewednothing at all, the field was so clouded. By one means orother, at last, the oil was removed. Then . there wereminute oil globules floating all about the field . The processwas essentially one of absorption of the internal structures ofthe bone; the osseous tissue being replaced by an excessivedeposit of the fatty matter normally existing in its interior.Besides, a change seemed to have crept over the whole bone,shewing itself in the loosening of the mutual connections ofthe laminæ, and in an obscure disintegration of the osseousstructure itself. And this was accompanied by a general infiltration of oily matter into the substance which had intruded itself within the Haversian canals."• •You are all familiar with the alternations of excitementand depression in this disease, and with the epileptoid convulsions so often present. In seeking, therefore, the pathological cause or condition of general paresis, we have thefollowing indications of causation:-1. Fatty degeneration of all the tissues, the voluntary andinvoluntary muscles, the bones, glands, and brain alike giving evidence of this condition.2. Aconsiderable removal of the earthy constituents ofthebones, to which, along with the above-mentioned fatty degeneration, the great tendency to fracture of the bones inthis disease is due.3. Considerable increase of sexual proclivity.4. Epileptoid convulsions.5. Alternations of excitement and depression.Now, I suppose, there are few persons accustomed to theinvestigation of the inductive sciences who would be disposed to deny that if there be any toxic agent whose presencein the system is known to produce these effects, the presence88 Some Observations on General Paralysis, [April,of that agent may, with the utmost probability, be set downas the immediate cause and pathological antecedent of generalparesis. Now it appears to me that in the above summary wehave an exact picture of the effects of an excess of phosphorus in the system.Thus, Pereira mentions its tendency to cause gangreneand convulsive affections. Its aphrodisiac properties arewell known, and also its effect in causing temporary stimulation with subsequent depression of the entire nervous system.The well-known caries of the jaw which is found in theworkers in phosphorus very well illustrates its power of removing the earthy constituents of bone; it probably findsaccess, as Pereira suggests, to the jaw during life throughcarious teeth; to the bones in general paralysis it would, ofcourse, have universal access if diffused through the blood.Cases of poisoning by phosphorus in a diffused form arevery rare; in general it is taken in a concentrated form, andcauses death by its irritant properties before its generaleffects have had time to develope themselves; but I believethat experiments on animals have proved that when itsadministration is so managed as not to kill rapidly, butafter the course of a fewdays, universal fatty degeneration ofthe tissues, both muscular and glandular, is found.A remarkable illustrative case occurred about three yearsago in the practice of M. le Prof. Crocq of Brussels, and waspublished by him in the " Presse Medicale Belge." I shallgive some extracts from a translation of this paper whichappeared in the " Medical Press and Circular " for May 8th,1872. The case was that of a girl, æt. 23, who stated thatshe had drunk the phosphorus of an entire box of matchesdiluted in an infusion of coffee; the fatty degeneration ofmuscles, heart, and liver was well marked. M. Crocq says-"The liver was of a pale yellow, well marked on the exterioras on the interior; the kidneys were yellowish, slightly red;the heart's muscular tissue was marbled of a yellowish tint;the right heart was evidently fatty; the diaphragm presenteda yellowish colouration. I examined with the microscope thetissue of the liver and the heart, in order to know if theywere really fatty; the heart presented a great quantity offatty granulations in the muscular canaliculi themselves-thisis fatty degeneration of the second degree; the liver cellswere very much altered, going plainly to destruction—this ,again, contained at the same time a great quantity of fat;in the peripheral muscles was also a certain degree of fatty1876.]by ISAAC ASHE, M.D. 89degeneration, but much less advanced than in the tissue ofthe heart."As regards the condition in which the phosphorus in thiscase existed in the system, M. Crocq says " I believe itpasses into the circulation in the state of phosphorus; first,because of the neutral reaction of the liver tissue, and thealkalinity of the liquids contained in the pleura and themeninges of the brain; secondly, because of the slight effectof lime water in its treatment. This poison, " he says, " hadnot determined any lesion before its absorption which couldcause death. These two considerations," he continues," make me consider that phosphorus thus absorbed is nottransformed into phosphoric acid." As a parallel to this, ingeneral paralysis, we have Dr. Merson's analyses of severalcases, in the West Riding Reports of 1874, who finds thatphosphoric acid is decidedly diminished in quantity in the urine of the insane.The brain in M. Crocq's case is reported as slightlyinjected; similarly it is found somewhat congested andvascular in cases of general paralysis. I was not able toinvestigate this point in the case of which I have shewnsections of the other organs, but may refer to Dr. FranzMeschede's paper in the " Quarterly Journal of MentalScience, " No. 59, who finds the brain congested, vascular,and even violet in colour, with fatty degeneration of the nerve cells.M. Crocq considers that poisoning by phosphorus inducesfatty degeneration by means of de-oxidation of the tissues;in fact, he says, " if the albuminous substances of theeconomy suffer, by whatever cause, an arrest in their process of oxidation, or a deoxidation, they will be transformed into fat and not into fibrin." Without offering an opinionon this point, I may, perhaps , suggest that the actual depositof fat, which has been well marked in all my own cases, maypossibly be due to the fact that the muscular tissue, inconsequence of its structural disorganisation and degeneration, is no longer able to discharge its function of a furnacean apparatus for combustion of the hydrocarbons of the bodyin the development of muscular force-a function of musclewhich is, I believe, tolerably well recognised in these daysand hence the unburnt fat is simply deposited as such on thesurface of the body. This is, of course, to be distinguishedfrom the tissue degeneration spoken of above. The temperature is reported as somewhat higher than normal in cases of90 Some [April,Observations on General Paralysis,poisoning by phosphorus, and the same thing is also observedin general paralysis. In the case I have referred to of my own it was 100° to 101 °; and this is a marked differencebetween this disease and the more usual forms of insanity, inwhich the temperature is very seldom more than normal,sometimes much less-indeed, the lowest temperatures onrecord are probably those given by Lowenhardt (vide “ JournalofMental Science,"January, 1870), who has recorded 74.75° F.in an insane patient.Quite in accordance with this view of the pathologicalcausation of general paresis is the well- known fact that itsvictims-in the better classes, at least-are generally menof more than average mental endowments; that is to say,according to the views generally adopted, men of more highlyphosphorised brains than usual. It is found, I believe,usually in men who have spent a life of active brain exertionin a narrow and limited direction, men of intense applicationrather than wide culture and numerous interests; and amongsuch persons it is found after their withdrawal and retirement from the interests that have perhaps too completelyengrossed them. The merchant retired from business is,perhaps, the type of this class; and the explanation of thephenomenon is, to my mind, of the following nature, namely,that during an active life of mental energy the phosphorusof the brain is oxidised, or burnt off into phosphoric acid, byvolitional thought-processes; but that on retirement frombusiness, when the intellect, not having a wide cultivationor broad range of interests, has but little to engage itselfwith, the phosphorus is discharged into the circulation in anunoxidised condition, and general paralysis is the result. Itmay be asked how do we account for its non-appearance inthe urine in the shape of excessive phosphates? I reply thatprobably it passes off in the shape of hypophosphorous acidgas from the lungs, which is the method by which phosphorus when taken internally appears to be got rid of. Theoccurrence of the disease among persons of this class is , Ibelieve, a common observation. Thus Griesinger says it ismost frequent among the educated classes, and repeats thatit is very frequent among mentally excitable persons, such aspoets, musicians, and learned men.I think we have got a hint as to that residuum of unexplained causation which I referred to above as being indicated bythe difference of frequency ofthe disease in Englandand in Ireland. As a rule, England feeds on a more highly1876.]91 by ISAAC ASHE, M.D.phosphorised diet than Ireland. Where England consumescereals, a phosphorised diet, Ireland consumes the potato, anon-phosphorised. Hence the sum total of the causationwould stand as the product of a predisposing cause and apredisposed nervous system, in both of which elements ofcausation-if they are what I have here propounded-Irelandhas the advantage of England. And I confess I am not ableto discover, either by statistics or reflection, any otherelements of causation in which the two countries differ.CLINICAL NOTES AND CASES.The Treatment of Hematoma Auris. By GEORGE J. HEARDer,M.D., Medical Superintendent of Joint Counties Asylum,Carmarthen.The " Insane Ear " has recently had a large share of attention accorded to it by various writers, who at least agreein this that they abstain from recommending any procedurewhereby we may hope to check the disease, or prevent thewithering and shrivelling which generally remain as a permanent local record of grave cerebral disturbance.Five ofthe cases here recorded occurred in males; one, ina female who had both ears affected. In each case thetumour involved the left ear; and the right auricle becamediseased in the woman after the left othæmatoma had terminated. The form of mental disease was:-In 3 cases-Melancholia.In 1 case-Mania chronic.In 1 case-General paralysis.In 1 case-Dementia.In two instances the development of the tumour was probably assisted, or perhaps caused, by local injury.1.-S. D., female, aged 33. Congenitally weak. For 12 months restless, violent, melancholic and suicidal. On the 27th August,1874, a hæmatoma auris of the left side was observed; it increasedsteadily, became very tense and painful, and was evacuated by free incision eleven days after it was first noticed. Result-ear shrivelled,thickened, and its normal markings obliterated . On the 1st October,a hæmatoma on the right side was progressing_rapidly, the effusionfilling up the concha and fossa of antihelix. The inner surface ofthe pinna was painted over with a few drops of the acetum cantharidis.92 [April,Clinical Notes and Cases.The swelling was immediately checked, and by the 6th was subsidingmarkedly. Result-the auricle perfectly preserves its form, andappears unaltered from its healthy state; only by touch it is evidentthat the concha is permanently thickened to a small extent.2.-D. J., male, aged 53. Mania chronic. Always merry and mischievous. On the 3rd October, 1874, an othæmatoma of the leftside was noticed . The parts affected were the concha, the antihelix ,and its fossa; the tumour was half an inch thick, and steadily growing.The blistering fluid was applied to the inner surface of the pinna.Result the markings of the ear are well preserved without anyshrinking; but with thickening and increased rigidity of the parts involved.3.-D. S. , male, aged 25. General paralytic, very restless and excitable. On the 10th October, 1874, an othæmatoma of the leftside filled the concha and the fosse of the helix and antihelix, theear being quite half an inch in thickness. Acetum cantharidis wasapplied to its inner surface. Result-within three weeks, absorptionof the fluid had taken place; the outline of ear and its markings werepreserved; there was slight permanent thickening, noticeable only tothe touch, and perfect opacity when placed between the eye and thelight. The propriety of blistering this case was discussed anddoubted, owing to the tendency to sloughing in general paralysis, andthe local gangrenes the patient had already developed . The blister,however, acted effectually on the cuticle, without producing any unfavourable complication. The patient died on the 28th November,1874.4.-J. P., male, aged 56. Melancholic, acutely depressed, and incessantly and loudly bemoaning his lost condition; suffering alsofrom cardiac and arterial disease. On the 6th November, 1874, hestated that he stumbled and fell, while getting out of bed during thenight, and bruised his left ear. Two days later the ear was still discolored, and there was then evidently a layer of fluid within it, anda hæmatoma forming. The inner surface of the ear was blistered, asin the previous cases. Result-recovery, excepting slight thickeningstill observable on examination. The auricle preserves its size andshape.5.-T. J. , male, aged 25. Demented and scrofulous. On the 5thMarch, 1875, a left hæmatoma was forming, affecting the antihelix,its fossa, and helix. The swelling was about three-eighths of an inchin thickness. The inner surface of the pinna was blistered. On the19th the fluid was not absorbed, though the morbid action waschecked; and the blister was repeated . Result-size and markingsof the ear well preserved; the parts which had been affected remaining slightly thickened. The hæmatoma in this case might have hada traumatic origin, as the patient was in the habit of beating his face with his fists .6.-D. L., male, aged 54. Melancholic, quiet, intensely pre-1876.]Clinical Notes and Cases.93occupied; has abstained from food; suffers from cardiac disease. Onthe 1st February, 1876, a hæmatoma was noticed, affecting the upperportion of the left auricle. On the following day the tumour wasmuch larger, involving the entire upper half of the pinna. Theblistering fluid was applied to the inner surface of the diseased part.All morbid action was at once checked, and by the 16th the effusedfluid had been absorbed, and, save for a slight thickening of the upperportion of the helix, no malformation remained. This patient hasbeen able to leave his bed for only a few hours daily for severalmonths past; he reposes invariably on his right side; he is undermost careful supervision, and there is no suspicion of the ear havingbeen in any way injured.We have had records of six consecutive cases of othæmatoma similarly treated. In each the diseased action wasarrested on the application of a blistering fluid to the innersurface of the pinna. In all, we can trace the results of themorbid agency in permanent thickening of those parts whichhad been subject to it; but there is none of the shrivellingand obtrusive distortion which ensues when the affectionhas run its course uncontrolled, as it did in the left ear of the first case.Cases with Mental Symptoms following the Administration of Chloral Hydrate. By G. HUNTER MACKENZIE, M.B.Edin. , Resident Medical Officer, District Infirmary,Ashton-under-Lyne.CASE I. -Mrs. A., æt. 55 , married. Admitted into the Infirmary14th April, 1875, suffering from aortic valvular disease, with sequelæ .Ordered iron, digitalis , and gin, generous diet, and an unstintedsupply of fresh milk. On account of the sleeplessness and restlessness, on the 30th April, there was prescribed for her 15 grs. of choral hydrate, to be taken at bedtime. A week afterwards this wasdoubled. About the middle of May she was observed to be gettingdecidedly " strange;" the mental aberration gradually increased, andtowards the end of the month culminated in subacute mania, withhallucinations and illusions of sight. No improvement took place inthe physical symptoms.CASE II. Mrs. B. , married, æt. 25. Admitted 7th July, 1875 ,suffering from mitral valvular disease, chronic articular and muscularrheumatism, and sciatica. Treated by alkalies and a non-nitrogenousdiet. Opium by the stomach and mouth being badly borne, on theevening of the 20th July she was ordered 20 grs. of chloral hydrate.This, she stated, made her feel " drunk. " Two nights subsequentlythe dose was increased to 30 grs. with the following results:-Themedicine was given at 9 p.m., and at 10.15 p.m. she was seen by re-94 Clinical Notes and Cases [April,.porter in general convulsions-the spasms being especially prevalent in arms and face. On recovering from this attack, which she commenced to do almost immediately, she complained of a choking sensation in throat. This quantity of the medicine was not again given,but 20 grain doses subsequently made her again feel " drunk."Patient affirmed she had never previously had convulsions.CASE III. -Mrs. C., widow, æt. 60. Admitted 8th September,1875; suffering from violent choreic movements affecting wholesystem, particularly the face. Very emotional, and stupid, but tractable, on admission . Satisfactory cardiac auscultation could not beperformed. Ordered bromide of potassium and chloral hydrate, 20 grs.each, thrice daily, and once during the night, if restless, which she frequently was. On the 29th of the same month she became violentand outrageous-shouting, getting out of bed, and otherwise conducting herself in an insane manner, so as to require mechanical restraint.These symptoms continued unabated until her removal on the 1stOctober. The motor phenomena had almost entirely subsided prior to the mental outbreak.CASE IV.-D. E. , male, æt. 53. Admitted 6th October, 1875;suffering from capillary bronchitis. Treated by alcoholic and diffusible stimulants, and on the same evening was ordered 40 grainschloral hydrate, he having had no sleep to speak of for several nights.His behaviourunder chloral can be best shewn by the following extracts from the records of the case:-Oct. 9th-12th . -Has been restless at night, getting out of bed,and wandering about ward.Oct. 13th, 14th. -No draught; very quiet at night.Oct. 15th. - 40 grs. chloral hydrate produced sleep with talka- tiveness .Oct. 16th, 17th. -No chloral. Passed quiet nights.Oct. 18th.- Had draught to- night; got out of bed, and wentwandering about ward, talking to himself, &c.Oct. 19th, 20th. -No draught; very quiet, and slept well.-Remarks. The most interesting case was No. II. I hadpreviously seen chloroform administered by inhalation withbenefit in hysterical convulsions; and if the hydrate ofchloral acts, as some affirm, by being converted into chloroform in the system, it seems remarkable that its exhibitionin this case should have been so directly followed by themuscular and other manifestations of hysteria. In Case III.the only other points worthy of notice are the age of thechoreic patient, and the coincident occurrences of thesupervention of the mental, and almost complete suppressionof the motor, symptoms. In Case IV. the relation betweenthe chloral and nervous symptoms as cause and effect was veryevident.1876.]Clinical Notes and Cases.95All the patients were of a well- marked rheumatic diathesisand nervous temperament. Two of them suffered from undoubted organic cardiac disease; in the third there was astrong suspicion of the same; and in the fourth the organwas weak, with most probably a dilated right side.Suffocation by Food-Tracheotomy-Recovery. By EDMUNDBANCKS WHITCOMBE, M.R.C.S., Assistant Medical Officer,Borough Lunatic Asylum, Birmingham.F. J., an epileptic, 26 years of age, was reported by his attendant,on December 2nd, 1875, to have got a piece of crust in his throatwhile eating his dinner. He takes food ravenously, is in the habit ofsnatching it from other patients, and cramming it into his mouth, andon several occasions I have had to use a probang to remove food fromthe esophagus. I went immediately, and found him lying on hisback, on the floor, to all appearance dead; his face was cadaverous,lips livid, the lower jaw dropped; he was pulseless, and completelyinsensible; the mouth was surrounded with masticated food , there wasno attempt at inspiration.Having no other instrument at hand, with an ordinary penknife Imade an incision into the trachea, half an inch below the cricoidcartilage, large enough to admit the little finger; and then , with myleft hand, removed two large pieces of meat which were impacted inthe larynx. Artificial respiration (Silvester's method) was immediately resorted to, and in a few seconds a faint gasp was the only indication of life.As there was slight bleeding from the wound, and no satisfactoryresult from the foregoing proceedings, I put in a tracheotomy tube,continuing the artificial respiration, and in about twenty-five minutesrespiration was fairly re- established, one pulse was just perceptible atthe wrist, and the patient was able to drink a little brandy and water.The tube was now removed, the patient placed on his side in bed, andiced water applications were made to the wound. In the evening hehad completely rallied , the edges of the wound were drawn togetherby strips of plaster, and he took milk freely.On the 4th he was allowed to get up, the wound had nearly healed,he was bright and cheerful, and apparently unaffected by theoperation.He is now (December 31st) in his usual state of health, and it isnoteworthy that the record of his fits shews an unusual diminutionduring the present month.Remarks. Cases of suffocation by food are not so uncommon,perhaps, as to justify special notice of a single one; but thegreat aim of the medical profession being to save life, and ascases of recovery after suffocation are rare, I have thought96 Clinical Notes and [April,Cases.this may be of much practical value, especially to thosehaving care of the insane. The ravenous propensities ofmany of the insane, and the liability of epileptics to attacksof their malady during meals, render this class of patientspeculiarly liable to suffocation by food; and such cases willoccur in spite of the precautions taken in asylums, such asthe careful cutting up or mincing of meat, &c. , and the feeding of patients by attendants or nurses. When such a casedoes happen, it is obvious that every effort should be made toresuscitate the patient, of course within a reasonable time.The usual appearances of death (suspended respiration, imperceptibility of the heart's action, and the cadaveric hue)must not be taken as conclusive that death has actually takenplace, nor must time be lost in endeavouring to find out thatsuch is not the case; but means must be taken promptly toadmit air into the lungs. This can only be accomplished intwo ways, viz. , by removing the obstruction by the fingers orforceps, or, by admitting air through an artificial opening, bytracheotomy or laryngotomy.The latter I believe to be the safer and most efficient modeof procedure. When a mass of food is drawn into thelarynx during an inspiration, a spasm of that organ holds itfirmly and tightly, preventing the expulsive efforts of thelungs from ejecting it, and rendering removal by the fingersor forceps difficult and prolonged; but once let in more airby an opening in the larynx or trachea, the spasm ceases, andthe removal is easy and complete. Immediately this is doneartificial respiration should be resorted to, and continued uninterruptedly until respiration is restored, or until the case isproved hopeless. It is difficult to determine how long thisshould be kept up, with any chance of success, but in theforegoing case at least fifteen minutes elapsed before anygood sign was visible .Dr. Richardson, in an address before the Midland MedicalSociety, in November last, on " The Treatment of the Dying, "mentioned a case of choking in which animation was suspended for a much longer period, and which was attendedwith such success that the patient revived , although only fora short time. It must not be forgotten that fainting mayoccur, and thus enable the patient to endure for a longertime the deprivation of air.In my case I found much benefit from the tracheotomytube, which I retained until respiration was re-established,and which had the effect, also, of checking the hæmorrhage1876.]Clinical Notes and Cases. 97which took place. After its removal the bleeding returned,and I was fearful lest this should prove fatal by trickling intothe trachea; however, by placing the patient on his side-asuggestion I am indebted for to my colleague Mr. Green-theblood flowed externally.Suffocation by liquid food is fortunately of rarer occurrencethan by solid, though, perhaps, not so immediately fatal. In such cases, however, I should now be disposed to cpen thetrachea, and endeavour to remove the fluid by means of asyringe, as, I believe, by such a procedure life may occasionally be saved.I have been asked why I did not treat this case on theprinciple enunciated by Dr. Marshall Hall for the relief ofthe epilepsy. My only reason for not attempting this experiment was that the case did not appear a fair one for trial, asthe patient is hopelessly imbecile, and of such filthy habitsthat, had an artificial opening remained in his trachea, hewould have been likely to suffocate himself through it.Report of a Case of Acute Insanity ending fatally in elevendays, supposed to be due to Syphilis, and of the morbidappearances found. By CEDRIC HURFORD, B.A., M.D.,Resident Medical Superintendent, Moorcroft HouseAsylum, Hillingdon, Middlesex.In the " Journal of Mental Science," July 1st, 1875 , isrecorded an interesting case of acute insanity ending fatallyin a week, by Dr. Ringrose Atkins, of Cork. The similarityof the case to mine has induced me to place the followingbefore the profession, trusting it too may prove of some interest:-W. M., aged 21 , was admitted August 21st, 1874. Tall, darkcomplexion, thin, but body fairly nourished; is said to have always.been weak-minded; fond of pleasure and extravagant habits, whichhe indulged in freely. Maternal aunt is said to have died insane.Had no employment, the Stock Exchange being his chief resort.Contracted syphilis about 12 months ago, for which he was treated bya medical man; latterly, however, he took large doses of iodide ofpotassium on his own responsibility. About two months ago hebecame very eccentric in manner, would sit gazing fixedly for sometime without speaking, but making a peculiar grunting noise. Abouta month ago he was placed in charge of a medical man, but hismanner continued strange and peculiar, finally culminating in anattack of mania, with refusal of food, within two days of his admisXXII.798 Clinical Notes and Cases. [April,sion. On admission he was very absent in manner, and lethargic.Was with difficulty roused to answer any question, but would repeatthe question put to him. Pulse 100; weak; tongue white and furred;skin moist. No indication of syphilis, with the exception of a copious rash on the back and chest only, and this I considered acne. Heartsounds normal; respiratory system healthy. Being late in the evening when admitted , was ordered 30 grs. of chloral, and some nourish- ment. These he took.22nd. Slept about three hours, after which he became very restless ,jumped out of bed, made for the door, knocked his head violently,ram-fashion, and when restrained, threw himself violently on the floor,and rolled round and round. He was not violent to those about him,but, if unrestrained, endeavoured to injure himself. In his violentstruggles he was severely bruised about the joints and prominent partsof the hips and sacrum. Refused his food, but after a great deal ofpersuasion he took some. At times he would stand in the followingposition:-Head thrown forward, arms drawn up and thrown back,whole body rigid, eyes staring, teeth clenched, and making a peculiarnoise by drawing the air forcibly through them; he would standthus for some time, and then suddenly try and rush away from his attendants.Pulse 108, weak.23rd. - Passed a very bad night, being very restless and violent,knocking himself about the room. Refuses hisfood, and obliged to feed him with the stomach tube. This I foundgreat difficulty in doing.24th. -Passed a quieter night. Still refuses his food , and I amobliged to use the tube. Pulse weak and rapid. The joints are looking slightly inflamed.25th.-Had another restless night; occasionally dosed for a short time; is perfectly conscious of all that is said or done. When askedto take his food refuses by shaking his head and clenching his teeth.If fed by the spoon, after the mouth has been opened with the gag,he spits out whatever he gets , so that the tube has to be resorted to .Can't be got to stay in bed, and even when on the floor on a mattress,endeavours to roll off it . Bowels act regularly; passes plenty of urine;pulse weak and rapid; bruises about the body becoming inflamed,especially those situated over the joints.26th. No change; continues restless, and refuses his food, and Iagain used the tube. Towards evening he became very much quieter,and took his food.27th.- Spoke to- day for the first time since the 22nd.Askedwhether he would get well; where he was; says he remembered hisbeing violent and obstinate, and having to be fed with the tube. Nowregrets it, and says that he will do anything he is asked . Pulse veryweak and rapid; joints very much inflamed; ordered poultices.28th.-Had a restless night; complains of thirst; pulse 120;joints looking very much inflamed, especially the left elbow. In theevening the pulse was 132, and temp. 1010.1876.]Clinical Notes and Cases. 9929th.-Slept a little during the night; had a very severe attack ofdiarrhoea; pulse 142 , very weak; temp. 102°; tongue dry and furred;left elbow joint very much inflamed; oedema extending down to thewrist. Evening pulse, 142; temp. 102°; respiration, 36.30th.-Patient much worse; is conscious; pulse 142; temp. 102°.Evening, much weaker; pulse very rapid; temp. 105°; semi- conscious; respiration, 40.31st.-Patient continued to get weaker and weaker during the night,and died quietly at 7.30 a.m.P.M. ten hours after death. Body emaciated; rigor mortis complete; great ecchymosis of elbow joints; rash quite disappeared after death.On removing the calvarium found dura mater very adherent, especially along the longitudinal sinus, and rather thickened, a good deal of effusion at base of brain. On making a section of the brain,nothing abnormal was seen to the naked eye. On laying open thechest, found heart rigidly contracted, and quite empty, healthy in substance. Anterior surface of lungs anæmic; posterior portionsgorged with blood, and rather firm in consistence. Stomach distended ,chiefly with gas.The treatment consisted in allaying the excitement as far as practi- cable, and the administration of food by means of the tube. After fivedays of acute mania the patient became quiet, submissive, and rational.He was now in a low asthenic condition , almost approaching the typhoidtype, and notwithstanding all the necessary remedies having beenresorted to, he sank four days after the cessation of the mania.Remarks. -The points worthy of note in this case are -thedetermination evinced in refusing food, and in the endeavoursto injure himself; the absence of any desire to injure thoseabout him; after the subsidence of the mania, the regretexpressed at what he had done, the assurance that he woulddo anything he was told, the anxiety about himself, andfinally the extreme exhaustion which was produced, and therapidly fatal termination.Case of Death from Undetected Injuries. By Dr. FRED .W. A. SKAE.J. T., a cabinet-maker, was brought to the Asylum from Stirling by two policemen, on the 29th July, about 7 p.m. A certificate ofemergency had alone been granted, and there was no further information regarding his case in the form of admission. He was about 30years of age. He looked in bad health, exhausted, and miserable,and his head was bound up with a handkerchief. He asked the attendant to be careful in removing this, as there was a frightful gash underneath it. When it was undone, however, there was no wound to be100 Clinical Notes and Cases. [April,seen. There was a large black mark over the right side of his faceand ear, which looked as if produced by gunpowder, mixed with a littleblood. There was a drop of serous fluid in the ear. The patientanswered questions intelligently, though in a languid, dejected manner.He put out his tongue freely when asked. It was foul. Pulse was about80. The policemen stated that they had been informed he had attempted to shoot himself with a double- barrelled pistol, and that the policesurgeon who had seen him thought the pistol could only have beencharged with powder. The patient denied this, however, and said thatthe pistol had been loaded with bullets. The policemen further statedthat after apparently firing both barrels of the pistol at his head early on the morning of the 28th, he had attempted to drown himself in theriver Forth. As there was no external wound, nor any symptoms ofinjury to the brain, and as it was about 40 hours since he had attemptedto shoot himself, I concluded that he had missed his aim, and caused nothing more serious than a gunpowder mark on his face. He walked along with an attendant to one of the wards. He there conversed alittle with the attendants, as he had been doing in the waiting- roombefore I saw him, and told them a little about his history. He mentioned that he was married; that he and his wife did not agree; that he had been living away from her for some time; and that he had beendrinking pretty freely. He complained of thirst, and said he had aheadache. He drank a good deal of water. I sawhim again in about half-an-hour, and talked with him a little about himself. He lookedill and wretched, and complained of a tremendous headache. At eighto'clock he walked up stairs with the other patients, undressed himself,and went to bed in a dormitory. After going to bed he became very restless, kicked the clothes about, talked incoherently, and shouted for"John " (apparently his brother) . About 10.30 he was removed to asingle room. He walked quietly along, and got into his new bed.When visited about an hour afterwards, he was lying in bed, but talk- ing nonsense. At six in the morning the attendant went into his room to waken him. He was lying dead on a mattress on the floor,with his face downwards, his mouth and nose being firmly pressed against the mattress. I saw him almost immediately. He had allthe appearance of a person who had died from suffocation, and pro- bably in a convulsion. The face and neck were livid and swollen.The tongue was protruded between the teeth; bloody mucus was on the sheet, and seemed to have come from his mouth and nose. Αpost-mortem examination was made at the instance of the ProcuratorFiscal, by Dr. Moffat, of Falkirk, and myself, at 5 p.m., of which thefollowing is a report: —External Appearance. The body was much swollen, and emphy- sematous. There was great post-mortem rigidity, and considerablehypostatic congestion. The face was very much swollen, and of adark-purple colour, especially round the mouth, from which, as alsofrom the nose, blood and frothy mucus were oozing. On the right1876.]Clinical Notes and Cases. 101side of the face, and surrounding and involving the external ear, therewas a black mark, as if produced by gunpowder.Thorax. -The lungs were dark and congested, and crepitated underpressure between finger and thumb, and on being cut into, air andbloody mucus were emitted. The heart was healthy, and containeddark fluid blood in the right ventricle.Abdomen. The stomach and bowels were much distended with gas,and presented a congested appearance. The inner coat of the stomachwas congested, and covered with air bubbles; it was nearly empty.The liver was soft and spongy, and of a light pinkish hue. The spleenwas dark, congested, and slightly enlarged. The kidneys were muchcongested also.Head. -The dura mater was congested . On reflecting the duramater, the vessels of the pia mater were found very much injected.On removing the brain, the under surface of the middle lobe of theright hemisphere was found completely broken up, and infiltrated withblood, and this condition extended deeply into the cerebral substance.An extensive comminuted fracture of the anterior and inner portionof the petrous portion of the right temporal bone was found, whichfracture involved the condyle of the ascending ramus of the inferiormaxillary bone; and imbedded among the débris was discovered whatwas evidently a piece ofgun-wadding. Between the fracture and the external meatus of the right ears a direct communication was established .(Signed), R. MOFFAT, M.D.FRED. W. A. SKAE, M.D.I afterwards got the following brief particulars of his case:-A sister had been insane and recovered in MorningsideAsylum. For nearly a year he had been depressed in spirits,unable to settle down to his work, and suspicious of his wife'sfidelity and of her putting poison in his food. He had boughtthe pistol with which he shot himself, and kept it ready loadedabout six months before he used it. He had left his bed veryearly in the morning on the 28th, and gone out of the house.When his friends went in search of him, they found his discharged pistol and a pool of blood, together with some of hisclothes, on the bank of the river. They concluded that, having failed to take his life by shooting, he had afterwards drowned himself. But it turned out that he had gone homeand got quietly into his bed, where they found him. He wasafterwards visited and examined by three medical men, noneof whom were led to suspect any fracture of the skull or jaw;and it was agreed to send him to the Asylum. It must havebeen between three and four in the morning at latest on the28th when he shot himself-that is to say, at least 39 hoursbefore he was admitted, and about 48 before he died. The102 [April,Clinical Notes and Cases.most interesting feature in the case is, that the patient shouldhave survived such extensive injuries to the brain for so longa time; and that up to the time of his going to bed therewere really no symptoms of it. As to the fractures, especiallythat of the jaw, I am happy to have been in good company in failing to detect them. When a man insists that he hasfired a double- barrelled pistol, loaded with ball, at his head,and produced a frightful gash; and, when, at the same time,there is no wound to be seen, and no paralysis when he converses intelligently, though in a slow and dreary way, andputs out his tongue full length when asked-it is morenatural to conclude that his pistol had missed fire, than thathis skull and jaw-bone had been fractured.The report of the post-mortem examination was drawn upby my friend, Dr. Moffat, who kindly gave me his permission to make what use of it I liked .PART II.-REVIEWS.Arthur Schopenhauer. His Life and his Philosophy. ByHELEN ZIMMERN. London: Longmans, Green & Co.,1876.The object of this book is, as its preface states, to portrayfor general English readers a German philosopher whosename is comparatively new amongst us, and to serve as anavant-courier for the translation of his capital work, " DieWelt als Wille und Vorstellung." The memoir is by nomeans an exhaustive one, but well calculated to stimulatefurther curiosity concerning its subject; it has the merits ofsimplicity and clearness of style, and is throughout characterised by a moderate, judicial spirit. Schopenhauer stands before us as a representative of that school ofphilosophy " which finds rest in the conception of theuniverse as unity." As a metaphysician we may regard himas the direct descendant of Kant, but he is chiefly interestingas an exponent of the Indian intellect, -"a European Bud- dhist. "In England his name was first brought forward by an ablearticle in the "Westminster Review " for April, 1853,entitled " Iconoclasm in German Philosophy," and understood to have proceeded from Mr. John Oxenford: an articlewhich gave Schopenhauer himself unfeigned satisfaction and1876.]Reviews. 103pleasure. Since then allusions to his writings have not beenunfrequent in English periodical literature. He has a peculiar claim to our attention, because, unlike the majority ofGerman thinkers, he is a cosmopolitan, exempt from localand national trammels, and has thus deserved the dictum ofthe " Revue Contemporaine" - "Ce n'est pas un philosophecomme les autres, c'est un philosophe qui a vu le monde."Arthur Schopenhauer was born at Danzig, on the 22nd ofFebruary, 1788, his infant years being thus contemporaneouswith the French Revolution. His family was of Dutchextraction, and his ancestors, as far back as we may tracethem, seem to have been men of powerful and decisive character. In the days of Peter the Great, Arthur's great grandfather, Andreas Schopenhauer, was a rich and influentialcitizen, as is shown by the fact of the choice of his house forthe reception of the Czar and the Empress Catherine, duringtheir visit to Danzig. Arthur Schopenhauer's father,Heinrich Floris, was born in 1747; he was educated as amerchant, and spent a large portion of his youth in Franceand England. For the latter country he conceived an enthusiastic admiration, and we find him later in life imitatingthe English manner in the style of his country house andgarden at Oliva, near Danzig. He was also a constantreader of " the Times," from which, he said, " one couldlearn everything." His rectitude, candour, and uncompromising love of truth were remarkable, and won the esteemof his fellow citizens. When thirty-eight, Heinrich marriedJohanna Trosiener, the daughter of a member of the DanzigSenate. Her education appears to have been meagre and incomplete; but, possessed of good natural abilities, and aidedby an English clergyman, as well as by her husband, hermind was not slow to expand in the intellectual and æstheticatmosphere of her new home. In youth she had a pleasantthough not beautiful countenance, and a figure of mignonneproportions; through life she possessed a certain charm ofbearing and conversation, which courted attention in society.Shortly after their marriage, Heinrich took his young wifeon a distant journey, visiting some of the chief Germantowns, Belgium, Paris and England. He strongly desiredthat the son he hoped for might be born on English ground,and thus obtain the rights of our citizenship. It was foundnecessary, however, to return to Danzig, where, in 1788, thegreat thinker and pessimist was born. We know nothing ofthe events of his child-life until the year 1793, when Danzig104 Reviews [April,.was blockaded by the Prussians. As soon as their troopsentered the city, determining its subjugation, Heinrich,rather than submit to foreign rule, fled with his wife andfive-year-old son to Swedish Pomerania. Thence the selfexiled family migrated to Hamburg, where they formed a newhome. Here, Heinrich was seized with his former passionfor travel, and during a twelve years' residence at Hamburg,he and his wife accomplished several foreign journeys. Inthese Arthur always shared, his father wisely judging thatthe cosmopolitan culture thus gained would prove of invaluable service to him in mature life. He was thus broughtinto contact while yet a child with some of the most notedcelebrities of the period, amongst whom were the BaronessStaël, Klopstock, Reimarus, Madame Chevalier, Nelson, andLady Hamilton. In Arthur's ninth year his parents placedhim at Havre, under the care of a M. Gregoire, with whoseson he was educated. Here he remained two years, andgained so thorough a mastery of the French language thaton his return to Hamburg it was found he had forgottenGerman, and he was obliged to relearn it . He was then sentto school, and being destined by his father for a mercantilecareer, received a commercial education, in which the classicswere almost entirely neglected. Soon after his admission tothis school, he evinced a marked bent towards the study ofphilosophy, and begged to be allowed a collegiate education.Heinrich Schopenhauer, however, had set his heart on his sonbecoming a merchant, and at first gave a decisive refusal;then, finding the lad in earnest, placed before him thealternative of entering a high school, or of accompanyinghis parents on a tour of some years' length in France, England, and Switzerland. Should he choose the latter, Arthurmust renounce all thought of an academical career, and, onhis return to Hamburg, enter a mercantile business.It was not in the nature of a boy of fifteen to withstandthe bait of foreign travel; we find him therefore deciding forthe latter, and turning his back upon scholarship, finally, ashe then deemed. During a portion of the two years' tourArthur was placed at a school in Wimbledon, conducted bya clergyman. He appears to have been fretted by the strictness of his teacher's theology, and to have laid the foundationof a fierce hatred of English bigotry, apparent in his works.Here, however, he gained an accurate knowledge of theEnglish language and literature, and learnt to play the flute,as recreation. When the family visited Switzerland,1876.]Reviews. 105Arthur fell under the unique fascination excited by the Alps.Of Mount Blanc, his favourite, he never afterwards spokewithout that certain tone of sadness and yearning which theGermans call sehnsucht. Let us quote his reference to thisAlp in " Die Welt als Wille und Vorstellung."The sad disposition so often remarked in highly gifted men has itsemblem in this mountain with its cloud-capped summit. But whenat times, perchance at dawn, the veil of mist is torn asunder, and thepeak, glowing with the sun's reflection, looks down on Chamounixfrom its celestial height above the clouds, it is a spectacle which stirsevery soul to its inmost depths. Thus the most melancholy genius.will at times show signs of a peculiar cheerfulness of disposition,which springs from the complete objectiveness of his intellect, and ispossible only to him. It hovers like a halo about his noble forehead,in tristitia hilaris, in hilaritate tristis.In the autumn of this year ( 1804) , Arthur received confirmation at the Marienkirche, Danzig, and with the followingnew year entered a merchant's office. A few months afterwards his father lost his life through a fall, accidental orintentional, and thus left young Schopenhauer, at seventeen,to his own resources. Between Johanna Schopenhauerand her son there had always existed a degree of mentalestrangement, consequent upon intrinsic differences of temperament, and when, after Heinrich's death, they werenaturally thrown more together, the rift quickly widenedinto a chasm. Frau Schopenhauer courted pleasure andbrilliant society, -Arthur cherished morbid views of life ,liked solitude, and abhorred the current small talk calledconversation; it is no wonder then that the two grated uponeach other, and had little enjoyment in personal intercourse.Shortly after becoming a widow Johanna Schopenhauer established herself at Weimar, where she soon succeeded in surrounding herself with a constellation of genius, amongst whichshone Göethe, the brothers Schlegel and Grimm, PrincePückler, Fernow (whose biography she afterwards wrote),Wieland and Meyer. Meanwhile, Schopenhauer, much as hedetested office work, continued it from reverence to hisfather's memory, yet could not check all hankerings afterscholarship. His mother at last took alarm at the melancholy complaints of his " blighted fate" which pervaded hisletters, and, more sympathetic than her wont, consulted herWeimar friends concerning him. Through their influenceshe advised Arthur to retrace his steps; he immediatelythrew up business, and hastened to Gotha, where, by106 [April,Reviews.Fernow's advice, he began his academic career. Here hestudied ardently, paying especial attention to the acquisitionof ancient languages. His course at Gotha terminatedabruptly, after a period of six months, through a quarrelwith one of the professors. He left the Gymnasium in theautumn of 1807, and proceeded to Weimar, where he tooklodgings, and continued his preparatory studies."Helaboured day and night at Greek, Latin, Mathematics andHistory, allowing nothing to divert his attention . " In 1808he visited Erfurt, and was present at the famous congress ofkings and princes under the presidency of Napoleon, andalso at the theatre when Talma played before a "parterre ofkings. " In 1809, Schopenhauer, then twenty- one, matriculated in the medical faculty at the Göttingen University.During the first year of residence he attended lectures onConstitutional History, the Crusades, Natural History,Mineralogy, Physics and Botany, besides concomitant reading at home. He then passed in the philosophical faculty,devoting his attention first to Plato and Kant, and later toAristotle and Spinoza. He also found time to hear lectureson Astronomy, Meteorology, Physiology, Ethnography, andJurisprudence.It is interesting to note that one of Schopenhauer's constant companions at Göttingen was Bunsen, in whom, however, he afterwards failed to see more than a diplomatist,ignoring his friend's claims to literary distinction.In 1811 , Schopenhauer entered the University of Berlin,where he attended the lecture rooms of Fichte, Wolf, andSchleiermacher. Fichte's philosophical fame had drawn himto Berlin, but his reverence for this professor soon gave placeto disparaging criticism of his empty and misty metaphysics.Schleiermacher, as a lecturer, fares scarcely better thanFichte at Schopenhauer's hands; but to Wolf, the greatHomerist and classical critic, he seems to have accorded bothadmiration and regard. *In 1813, after the battle of Lützen, the tumult of warapproached Berlin, and Schopenhauer, who " hated interruptions " and cared little for politics, hastened to Saxony.After spending a few days at Weimar with his mother, hetook refuge in Rudolstadt, a little town in the Thuringian

• Schopenhauer also attended classes on Experimental Chemistry, Mag- netism and Electricity, Ornithology, Amphibiology, Ichthyology, Domestic Animals and Norse Poetry, and continued his Natural History studies, of

Physics, Astronomy, General Physiology, Zoology and Geology.1876.]Reviews. 107forest, where he evolved his " Inaugural Dissertation " whichobtained for him the title of Dr. of Philosophy from theUniversity of Jena. Let us give Miss Zimmern's criticismof this essay:-" This little tractate, on the Quadruple Rootof the Doctrine of Adequate Cause, "* is intended to show thatthe idea of causality is not grounded upon a single axiomor necessary truth, but upon four (truths), or rather perhapsupon one necessary truth contemplated in a four- fold aspect,according to its relation to any one in particular of the fourclasses comprising, in Schopenhauer's words, everythingcapable of being regarded by us as an object, i.e. , the entirecompass of our ideas. These are respectively: Phenomena,or the objects of sensuous perception; Reason, or theobjects of rational perception; Being, under the categories of space and time; and the Will. Hence it ensuesthat the necessity which accompanies a proposition conceivedas demonstrable à priori, is not one and invariable, but asmanifold as the sources of the proposition itself. " Thistractate won Göethe's attention, and led him to take a kindlyinterest in the young metaphysician. He proposed thatSchopenhauer should investigate his own theory of colours,and lent him, for the purpose, the greater part of his opticalapparatus. Schopenhauer undertook the task with theardour of a proselyte, but soon diverged into an independentpath which resulted in a pamphlet, entitled Ueber dasSehen und die Farben.' The interest thus awakened in thescience of colours continued with Schopenhauer, and yearsafterwards we find him sending the above- named treatise toSir Charles Eastlake, with a characteristic letter, too longfor quotation. Besides his friendship with Göethe, Schopenhauer became acquainted at Weimar with Frederick Mayer,to whom he was indebted for an introduction to Indian lore,the spirit of which infuses all his works. Schopenhauer, atthis period, also, came under the fascinating influence ofCaroline Jaegman, the Mrs. Siddons of the German stage,remarkable for beauty of form and voice, and histrionictalent. Being distracted by her charms, in combinationwith other sources of excitement, Schopenhauer wisely determined to quit Weimar, and continue his studies at Dresden,whither he removed in 1814. Now began the Sturm undDrang period of his life,' in which his mind graduallymellowed to ripeness, and he needed the world less becausehe had obtained un grand soi même.' He did not absent6

• Die Vierfache Wurzel des Satzes vom zureichenden Grunde.

108 [April,Reviews.himself from society, but frequented the art galleries, wherehe enjoyed above all the Sistine Madonna, and spent theevenings at the theatre, or with friends, amongst whom werethe novelists, Heun, Schulze, and Schilling, and the art-criticJohann Gottlieb von Quandt, who remained devoted to himtill death.' With Ludwig Tieck Schopenhauer was forsometime intimate, but their intercourse was ended throughsome disparaging remarks of Schopenhauer upon Schlegel,Tieck's close friend." Under such conditions," says our writer, " was Schopenhauer's opus maximum, Die Welt als Wille und Vorstellung,'* brought to an end. It contains his entire system;in it he reached the apex of his intellectual life; all hislater writings are mere brilliant commentaries and illustrations. In the spring of 1818 the work was published byMessrs. Brockhaus, at Leipzig, the author receiving a ducatper printed sheet (equivalent to 9s. 44d) . " No sooner had Schopenhauer finished his book than he hastened on ajourney in Italy. Miss Zimmern remarks with truth, thatthe fact of his retaining his pessimism in the sunny south,"is a convincing proof, were further needed, of its unaffectedsincerity." He visited the principal towns of north Italy,enjoyed the art galleries and the theatre, carried on thestudy of Italian, in which he was already proficient, and delighted in Rossini's operas. He always recalled these yearswith peculiar pleasure, as far as he would admit pleasure inanything. He thoughtfully studied the Italians, and writesof their religion:-"The Catholic religion is an order toobtain heaven by begging, because it would be too troublesome to earn it. The priests are the brokers for this trans- action."It is curious, as showing the complexity of Schopenhauer'smind, to find him writing at this period of Petrarch as hisfavourite Italian poet. We should have thought a pessimistwould naturally find something congenial in Dante's DivineComedy, dealing, as it does, with some of the most terribleenigmas of human guilt and suffering; but Schopenhauercomplains of Dante's " horrid distortions, " stigmatises " thewhole Inferno as an apotheosis of cruelty," and calls " thelast Canto but one a glorification of want of honour andconscience. " We are not surprised to find him speaking of"the phantastic follies of Ariosto. " He liked Tasso, but

• Literally " The World as Will and Idea.”

1876.]Reviews.109thoughthim unworthy of a fourth place amongst great Italianpoets.In December (1818) " Die Welt als Wille und Vorstellung " issued from the press. Schopenhauer sent a copy toGoethe, who appears to have been pleased with the book,although "the unwieldy size left him no peace," and hethought it would take a whole year to read. While Schopenhauer was at Rome, in 1819, he received tidings of theimpending bankruptcy of the Danzig mercantile firm inwhich a large portion of his own and the whole of hismother's fortune were invested. Dreading lest the loss offortune should compel him to abandon his intellectuallabours, he hastened to Germany. Happily, however, hearrived in time to withdraw the bulk of his own investment;while Frau Schopenhauer, characteristically sanguine andself-confident, disregarded all warnings, and, with herdaughter Adele, was rendered almost penniless by the finalcrash. * Schopenhauer now decided to seek some career,partly as a proviso against future pecuniary loss, partly to give play to his love of philosophic theorising. For thispurpose he removed to Berlin, in the spring of 1820, hopingere long to fill an academic chair. Schopenhauer's teaching,however, was not yet understood, and his lecture-room wasdeserted for those of Hegel and Schleiermacher. He speakswith caustic irony of their popularity, and goes so far as tosay " People like Fichte, Schelling, or Hegel should beshut out of the ranks of philosophers, as of yore the dealersand money-changers were cast out of the Temple." Again:"A fitting motto for Hegel's writings is Shakespeare's, Suchstuff as madmen tongue, and brain not' " (Cymbeline, Act v. ,Scene iv. ) . In 1822 Schopenhauer, thoroughly wearied ofBerlin, fled once more to Italy. Of this journey we have norecords; he probably returned in 1823, and in the followingyear established himself for some time at Dresden. Mortifiedby the continued popular indifference to " Die Welt als Willeund Vorstellung," from which he had hoped so much, heturned his thought towards translation. He proposedrendering David Hume's works into German, and wrote apreface for the purpose, which, however, was finally abandoned. In 1825 he returned to Berlin, and inscribed hisname for lectures; but, finding no ear for them, withdrewinto solitude, studying and reading for private gratification.6

• It is but just to Schopenhauer to add that he supported his impoverished mother and sister " for many years."

110 [April,Reviews.He learnt Spanish, and translated Gracian's " OraculoManual y Arte de Prudencia "-a translation which wasposthumously published. At Berlin, Schopenhauer becameacquainted with Alexander von Humboldt, of whom hewrites-" I only found great talent where I looked for genius;scientia where I expected sapientia. " An outbreak of cholera drove Schopenhauer from Berlin to Frankfort, where " hesunk into so sombre and saturnine a mood that for weeks hecould not be induced to speak a word." By his doctor'sadvice he removed to the neighbouring town of Mannheim,where he spent a year. In 1833 he returned to Frankfort, andfinally settled there for the remainder of life.Gloomy and dissatisfied with the non-recognition of thebook to which he had given so much earnest thought, Schopenhauer writes-"The entire neglect which my work hasexperienced proves that either I was unworthy my age, ormy age of me. In both cases one can only say, ' the rest issilence.' I have lifted the veil of truth higher than any mortal before me. But I should like to see the man whocould boast of a more miserable set of contemporaries thanmine." Again: " He who stands alone on a height to whichthe others cannot ascend, must descend to them, if he doesnot wish to be alone. "Schopenhauer's routine of life at Frankfort was simpleand methodical. He rose early, took a cold bath at thattime a phenomenon in Germany -and prepared his owncoffee, considering interruption at that hour to be " dangerous to the brain, which he compared to a freshly-tuned instrument. " He wrote for at least three hours in themorning, then received visitors, and on their departure unbent his mind over the flute. He dined at the mid-daytable-d'hôte of the Hôtel d'Angleterre, for which he always dressed with scrupulous care. " In the afternoon he indulged in an hour's siesta, and allowed some time for literature of the lighter kind. Towards evening he took a walk,on the score of health, his companion being a white poodle,with the philosophic name of Atma (i.e., Soul of the World) .Occasionally, however, he suffered his disciples to accompanyhim on these promenades. Subjects for philosophy werefurnished by any external incident; such as the gait of thepeople they met, which Schopenhauer would mimic to perfection . He hated an awkward carriage, and saw in ita connection with the functions of the brain . Schopenhauer, like his father, daily read the " Times," and some1876. ]Reviews.11166English and French reviews, at the reading- room, andusually attended the concert or theatre. He had a scientificknowledge of music, and took such pleasure in Beethoven'sSymphonies that if one of them were followed by a production of another master, he quitted the concert room ratherthan allow the impression to be disturbed. He did notappreciate Wagner's music; yet, curiously, this composer isone of his most ardent followers. Schopenhauer supped frugally at the Hôtel d'Angleterre, where, if he found congenialsociety, he would converse " far into the night." He enjoyedsmoking, and it was one of his eccentricities to use a pipe,five feet in length, on the ground that as the smoke becamecooled in this long transit, it was less noxious than in one of ordinary size. He was a diligent, though by no means anomnivorous reader," and agreed with the maxim of Carlylethat a book is not worth reading at all unless it be worthreading twice. He always marked " passages that struckhim, adding marginal annotations," and deprecated thereading of " ephemeral literature " to the neglect of theworks of the " rarest minds " of all ages. Schopenhauer wasfamiliar with the classic authors, especially Aristotle, Plato,and Seneca, besides the Septuagint version of the Old Testament and the Vedas. Of the Oupnekhat he read a portionevery night, calling it his Bible. He liked Machiavelli's " IlPrincipe," Goethe and Schiller, the French moralists, Shakespeare, Byron, Burns, Shenstone's works, and Calderon. Ofnovels he esteemed best " Don Quixote, " " Tristram Shandy,"the "Nouvelle Héloise," and Goethe's " Wilhelm Meister. "*Finding his principal work so little heeded, Schopenhauerpublished nothing for seventeen years, with the exception ofa Latin version of his optical treatise " Uber das Sehen unddie Farben " (published in the third vol. of " Scriptores Ophthalmologici Minores, " by Justus Radius, 1831) .In 1836 he broke this silence by a treatise on the " Will inNature;" and in 1839 competed for a prize offered by theRoyal Norwegian Academy of Drontheim for the best Essayon the Freedom of the Will and the Doctrine of PhilosophicalNecessity. Schopenhauer obtained the premium, and in1840 again competed for an analogous one, offered by theRoyal Danish Academy for the best inquiry into the grounds

• The prominent characteristic of his room was a gilt statue of Buddha, that stood on his writing- table next to a bust of Kant. Over his sofa hung an oil

portrait of Goethe, besides portraits of Kant, Shakespeare, Descartes, and Claudius, and innumerable engravings of dogs.112 [ April,Reviews.of Moral Obligation. Here he was unsuccessful, the DanishAcademicians hinting that he spoke too disrespectfully of hisphilosophic brethren to deserve recognition among them.Schopenhauer, however, published both essays in 1841 , underthe title of " Die Beiden Grundprobleme der Ethik,"* insisting that the words, " Not crowned by the Royal DanishAcademy" should be printed " in good fat letters " on thetitle-page. The first essay " is vigorous and perspicuous inthe highest degree," the argument apparently being “ thatall action is the necessary product of character, but that manis responsible for his character notwithstanding. ”second essay is more abstruse and original, though lessbrilliant. It endeavours to overthrow Kant's " categoricalimperative as the basis of moral obligation, " and to substitutethe Buddhistic theory, that no action can be meritoriousunless wholly disinterested .TheIn 1844, Schopenhauer published a second edition of " DieWelt als Wille und Vorstellung, " in two volumes. It attractedlittle general attention, but was the means of introducingSchopenhauer to Dr. Frauenstädt, who became one of hismost enthusiastic disciples. At their first interview Frauenstädt was charmed by Schopenhauer's " manner and appearance. The leonine head revealed the powerful intellect andthe mental work it had compassed; though only fifty- eight,hair and beard were already snow-white, and harmonisedwith the idea of the sage, but the eyes flashed youthful fire,and the play of features was as lively as a boy's. A sarcasticline round the mouth alone revealed the misanthrope. "+During part of the years 1847 and 1848, Schopenhauer'slabours were somewhat interrupted by the horrors of politicalrevolution. In 1850, however, he completed a book "thatshould at last open all eyes to him "—the " ‡Parerga et Paralipomena, " published at Berlin in 1851. "The style of thesetwo volumes of essays is in the highest degree attractive.They are neither so technical as to be abstruse, nor so long asto be wearisome; the subjects, moreover, are frequently ofgeneral interest. The first volume contains his most livelysallies, and some of his most virulent invectives against thesalaried professors of philosophy at the Universities; speculations on apparitions and somnambulism," and piquant

• The two main problems of Ethical Science.

+ Miss Zimmerns' Memoir has on its frontispiece a portrait of Schopenhauer,which well bears out this description.I.e., " Supplements and Omissions. "1876.]Reviews.113maxims on the general conduct of life. The second volume❝contains a large number of brief and animated disquisitionson a variety of subjects, including his favourite themes -theindestructibility of man's real being by death, suicide, study,authorship, criticism, and fame. " The "Parerga et Paralipomena" heralded the dawn of Schopenhauer's renown,and the last ten years of his life proved the brightest. The"Westminster Review " article ( April, 1853) was one ofthe first to draw general attention to his philosophy: it wastranslated by Dr. Lindner, one of Schopenhauer's disciples,into German. The press, the painter's brush, and thesculptor's chisel now combined to do him honour. " DieWelt als Wille und Vorstellung " went through a third edition, " Die Beiden Grundprobleme der Ethik " a second, foreach of which Schopenhauer received an honorarium. As hetouchingly said, fame " laid its wreath of roses upon his whitened hairs." He hoped to complete a hundred years;but in the spring of 1860 his vigorous health began to fail,and in September following he was attacked by inflammationof the lungs. Of this he died on the 21st of the samemonth, being alone at the final moment.-" Whoever hadbeen alone all through life must understand that solitarybusiness better than others," he had said. He was buried inthe Frankfort cemetery, where his grave now exists, halfhidden by evergreen shrubs, and bearing the simple inscription-"Arthur Schopenhauer. " This was his own wish;when his friend Dr. Gwinner asked where he desired to beburied, he said, " No matter where; posterity will find me;"-a prediction which now seems likely to be realised.Two chapters of the memoir before us are devoted to aconsideration of Schopenhauer's philosophical teaching; thefirst referring to the leading principles of " Die Welt alsWille und Vorstellung;" the second, to his " Ethics andEsthetics," as gathered from this and from his lesserwritings.Jean Paul Richter thus describes Schopenhauer's " opusmaximum, ”—“ a bold, philosophic, many-sided work, full ofgenius, profoundness, and penetration, but with a depthoften hopeless and bottomless, akin to the melancholy sunless lake in Norway, that is barred by a stern rampart ofbeetling crags, in whose depth only the starry day is reflected,whose surface no bird skims, no wave upheaves. Schopenhauer's system is fully contained in this remarkable book, onwhich indeed he based his philosophical reputation . "HisXXII. 8""114 Reviews [April,.own claim " was to be regarded as the immediate successorof Kant, and such, no doubt, considered merely as a metaphysician, he was. Philosophically, however, he is chieflyinteresting as a representative of Indian thought in thewest, and may be described as helping to indicate thattransition of the European mind from a monotheistic to apantheistic view of the universe which began with GiordanoBruno, and of which the end is not yet. " My age, " saysSchopenhauer, " after the teaching of Bruno, Spinoza, andSchelling, had perfectly understood that all things are butone; but the nature of this unity, and the rationale of itsappearance as plurality, were reserved for me to explain. "He endeavours to determine the substratum or essence ofexistence lying within the phenomenal manifestation of theUniverse, and defines it as a Will. "The world in itself," hedeclares, "is one enormous Will, constantly rushing intolife ." Will is , with Schopenhauer, "the condition of allexistence, sentient and insentient. " "Others," he says,"have asserted the Will's freedom, I prove its omnipotence.'"He is not original in this doctrine," says our Memoir, " buthas this peculiarity, that while other thinkers have usuallyassumed Intelligence as an attribute of Will, Intelligence isto him a mere phenomenon." We find, then, his philosophyto be a phase of Pantheism, a modification of the system represented in Europe by Bruno, Spinoza, and Schelling, thoughdifferentiated from their philosophies by a bisection of theSoul, Ego, or First Principle, into two factors described asWill and Intelligence-a separation capable, according tohimself, of resolving the contradictions charged againstpantheism in general.The genesis of this theory may be defined with equal propriety as an engrafting of Indian pantheism upon Kant, orvice versa. Kant, his first master, had taught him theillusiveness of space and time, and the unreality of theworld of phenomena. In his researches in Indian lore Schopenhauer found the same ideas reiterated in a mystical formcongenial to his imagination, and combined with that pessimistic view of life connate with his hypochondriacal temperament. The peculiar stress he was led to place upon the Willas the real cause of existence may be logically defensible, butwas, no doubt, in the first instance subjective, the reflection of his own individuality. ' An enormous Will, constantlyrushing into life, ' would be no bad description of his ownspiritual constitution. The Will, the blind instinctive im-1876.] Reviews. 115pulse, was with him continually getting the upper hand ofthe regulating faculty, the Reason. It was natural, therefore, that he should regard the former as the primary substance, the latter as the accident or phenomenon. "Warmly as the writer of our memoir appears to sympathisewith Schopenhauer's views, she is not slow to acknowledgethe practical disadvantages of his system, which she aptlycontrasts with that of Spinoza. "Schopenhauer," she remarks, " has no foundation for his universe, but a blindunintelligent force, which could not reasonably be an object of reverence, even were its operation as beneficial as,according to him, it is the reverse. No religion consequently remains, except that of simple philanthropy andself-denial. To Spinoza, on the contrary, Will and Intelligence alike, along with the entire material and spiritualuniverse, are but the manifestations of an infinite substance, which, as infinite, must necessarily be manifested inan infinity of ways utterly beyond our comprehension. ToSchopenhauer the universe has a centre, and that centre is amere blind impulse. To Spinoza, as has been finely said, thecentre is everywhere and the circumference nowhere. Theone, therefore, fully provides for the religious reverence theother abolishes." But, "as Schopenhauer himselfadmits, the appreciation of phenomena varies greatly as theinterpreter is by temperament *εύκολος οι δύσκολος.Very few of his followers have consistently adopted hispessimism."•"It need hardly be added that, although Schopenhauer'scardinal principle is the omnipotence of Will, the freedom ofthe individual Will is strenuously denied by him. All phenomena being but manifestations of the one primary force,are necessarily conditioned by it. No man can change hischaracter, for the character is the Will itself exhibited in aphenomenal form." . . . "He laid the greatest stressupon scientific research as bringing the student into immediate contact with concrete reality. He especially veneratedBichat, who had, he considered, already expressed his owngreat principle of the duality of the Will and the Intelligence under a philosophical form; the anatomist's ' organiclife ' being the physiological equivalent of Schopenhauer's' Will,' and his animal life ' of the latter's ' Intelligence.'' Schopenhauer's ethics are implied in the leading principles

• I.e., genial or morose.

116 [April,Reviews.66of his system. Everything hinges upon the affirmation or negation of the Will to live.' When this is affirmed, i.e.,when the individual's actions are directly or indirectly controlled by the wish to possess, enjoy, perpetuate, or embellishexistence, the imaginations of the heart are corrupt and evilcontinually.' In proportion ' (on the contrary) as individuality loses its value for the individual, as he recognisesthat it is in fact an illusion , and that he exists in others asmuch as in himself, he advances along the path of virtue..666Right moral action can spring only from the recognitionofthe essential evil of the phenomenal world, and the deliberate resolve to reduce it to a minimum. The secret of thislies in one word, abnegation. " The will to live " comprehends self assertion in every form and shape, and asevery charitable action involves the denial of self in somerespect, it follows that Schopenhauer's morality is in themain equivalent to the inculcation of universal philanthropy.Wisdom," to quote his own definition, " is not merelytheoretical, but also practical perfection; it is the ultimatetrue cognition of all things in mass and in detail, which hasso penetrated man's being, that it appears as the guide of allhis actions. The wisdom that imbues a man with meretheory not developed into practice, resembles the double rose,which pleases by its colour and fragrance, but drops, leavingno fruit. In its practical ethical aspect Schopenhauer'steaching differs in nothing from Buddhism. He maintainsthat the spirit of true religion is everywhere the same; hespeaks with the greatest respect of Christianity, apart fromwhat he deems its mythology, asserting that the spirit of theNew Testament is wholly on his side. "Christianity, " hesays, " is composed of two heterogenous ingredients," anethical view of life akin to Hindooism and a Jewish dogma.Its ethics are crippled by this latter foreign element, andcannot attain definite expression. Christian morality, butfor the defect of ignoring the animal world, would manifestthe utmost similarity to Brahminism and Buddhism, and isonly less emphatically expressed, and deficient in logicalconsistency. With Schopenhauer the intellectual conditionsof salvation are more strongly accentuated than the moral.

"Buddhism, the antithesis of Islam, holds to the absolute Freedom of man.The main article of Buddhism is , that neither in heaven nor on earth can aman escape from the consequences of his acts; that morals are, in theiressence, productive causes, without the aid or intervention of any higher authority; hence, forgiveness and atonement are ideas unknown in the dogma of Buddhism."-(Miss F. Cobbe's " Essay on Intuitive Morals," p. 163, notes . )1876.]Reviews. 117He shows a marked coincidence with Buddha in the preceptof kindness to animals, but the latter appears to build thisupon the compassionate instinct, while Schopenhauer gives ita philosophical basis. With him animals are imperfect men,incarnations of the universal Will in a more primitive form.In 1857, a living orang-outang was exhibited at Frankfort,and Schopenhauer went almost daily to see " the probableancestor of our race; " he considered the frontal bone andvertical arch better formed than those of the lowest humanraces, and thought that "the longing of the Will aftercognition was personified in this strange and melancholybeast, whose mien he likened to that of the prophet gazingover into the promised land. " He speaks emphatically inthe " Parerga " against the horrors of vivisection, " and heldit one of the glories of Englishmen to have organised aSociety for the Prevention of Cruelty to Animals." He alsogave practical expression to such views by leaving in his willa yearly income to his poodle, " to be made payable to whomsoever should take charge of him. ""We cannot feel," says the writer of our memoir, " thatSchopenhauer has in any way aided us to bridge over the gulfbetween theory and practice." His great originality consistsin his powerful assertion, contrary to the ordinary opinion, ofthe vast predominance of the instinctive element of humannature (the Will, in his vocabulary) over the reflective (theIntellect). " The passion of love and everything relating tothe perpetuation of the species " necessarily attracted Schopenhauer's attention. He regarded love as but a meanstowards an end, "the composition of the next generation,"saying, like Benedick, " the world must be peopled . Thisprosaic view of the ideal passion appears at first sight harshand inconsistent with Schopenhauer's fondness for Petrarch'samatory sonnets. But he presently redeems it, "this yearning, and this pain of love, cannot take their substance fromthe needs of an ephemeral individual, but they are the sighsof the spirit of species, which here sees a never-to-be-recovered means of gaining or losing its ends, and thereforeemits this groan. This, therefore, furnishes material for allthe finest erotic poetry, which rises accordingly intotranscendental metaphors surpassing everything earthly.This is the theme of Petrarch, the material for a *St. Preux,a Werther, and a Jacopo Ortis, which could otherwise beneither explained nor understood. "

• The hero of Rousseau's " Héloise."

118 Reviews [April, .To the artist, the man of genius, Schopenhauer attributesa perfection second only to that of the ascetic who hasattained entire negation of the will. The reason is that heaccomplishes, though only in moments of ecstasy, the sameend of self-annihilation which the other habitually achieves.Schopenhauer says, "Just because genius consists in the freeservice of the intellect, emancipated from the service of thewill, its productions can serve no useful purposes, whethermusic, philosophy, painting or poetry; a work of genius isnot a thing of utility. All other human works exist for themaintenance or convenience of existence, only not those in question. Thus we seldom see the beautiful and the usefulcombined; fine lofty trees bear no fruit; fruit trees are uglylittle cripples; the double garden rose is barren-only the little wild scentless one is fruitful. A man, who has aftermany bitter combats conquered his own nature, remains onlyas a purely intellectual being, an untarnished mirror of theuniverse. Nothing has power to disturb or agitate him, forhe has severed all the thousand threads of the will, whichbind us to the world, and draw us hither and thither inconstant pain, under the form of desire, fear, envy, anger.Life and its figures only pass before him like a fleeting ap- parition, a morning dream before one who is half awake;reality shimmers through, it can no longer deceive, and, likesuch a dream, without abrupt transition they disappear at last." Schopenhauer himself had no mean estimate of hisopus maximum. ” In a letter to Dr. Frauenstädt ( Sept.1850) he writes: "For where, in the range of Germanliterature, is there another book which, wherever it is opened,immediately reveals more thoughts than it is possible to grasp, like my second volume of ' Die Welt als Wille undVorstellung? " Schopenhauer certainly possessed self-esteem,if not egotism, in a considerable degree, but this was largelynecessary to prevent his being crushed in spirit by years of popular neglect. It seems not improbable that he was atheart amiable, but was forced to steel himself against theworld's rebuffs in an armour of misanthropic scorn, which atlength fitted so closely that it became as a part of the man.He once owned to having " felt terribly lonely " throughoutlife, but that he had met none worthy of regard, save Göethe and a few others, much older than himself, and had learnt atlast to love solitude, that heritage common to great minds.66We will leave Arthur Schopenhauer with Dr. Gwinner'swords, spoken above his grave. "This profound, thoughtful1876.]Reviews.119man, in whose breast a warm heart pulsated, ran through awhole lifetime like a child angered at play-solitary, misunderstood, but true to himself. His earthly goal was longveiled to him; the laurel that now crowns his brow was onlybestowed in the evening of life, but firm as a rock wasrooted in his soul belief in his mission. During long yearsof undeserved obscurity, he never swerved an inch from hissolitary lofty way; he waxed grey in the hard service of thecoy beloved he had chosen, mindful of the saying written inthe Book of Esdras: Great is truth, and mighty above allthings. ' " W.By CHARLES Macmillan and Co.,Vital Motion as a Mode of Physical Motion.BLAND RADCLIFFE, M.D., &c.London. 1876 .Dr. Radcliffe has for many years given his attention to theconsideration of vital action, and may therefore be presumedto be no mean authority on the subject. It is one, however,that is beset with difficulties on every hand, nor do we seethat he has made the path very much smoother. In reference to his former observations, he acknowledges that theywere, to a great extent, erroneous, and expresses the wishthat much that he has " written on this subject at differenttimes might be cancelled . " Still he affirms that his viewshave not been altered, and that the argument in support ofthem is in all essential particulars the same.Though the study of life must necessarily lie so far outsidethe reach of physical research as to render most of the observations as to it vague and uncertain, yet it is possible that,by a better understanding of the intangible forces operatingin nature as light, heat, and electricity, especially the latter,we shall have a clearer perception of the nature of that phe- nomenon which we call life . That vital action is attendedwith, or is dependent on electrical action has long beenacknowledged, but the subject is still involved in much obscurity, and certainly if Dr. Radcliffe's views be accepted, we shallhave to modify many of our ideas in respect to the nature of nervous and muscular action.Dr. Radcliffe endeavours to prove that contractility is nota vital process, but, on the contrary, is a state which is occasioned by the withdrawal of an inhibitory influence servingto keep up the state of muscular relaxation, therefore thatlife is not the occasion of motion, but is concerned in antago-120 [April,Reviews.nizing it, at least in so far as it depends on muscular contraction that this contraction is due to physical causes, andtherefore that vital motion is a mode of physical motion.This idea he endeavours to support by various experimentsand physiological and pathological observations, both by himself and others. Experimenting on living and dead amœbæ,fresh-water sponges, myxomycetes, and also pus, mucus, anddistilled water, he found that Thompson's electrometer failedto show any distinction between the living and dead state ofprotoplasmic substance, or between these substances, livingand dead indifferently, and sculptor's clay. From this heargues that there is no difference between the electrical condition of living protoplasmic substances and lifeless bodiesgenerally, but that any observed electric state in them is dueto the electric state of the earth. He is also led to believe"that amoeboid movements are the simple result of theaction in amoeboid bodies of the electricity belonging to thesein common with all terrestrial bodies ." He holds that theelectric state of the earth is one not of zero, but of charge,and that this charge is subject to remarkable tides and wavemovements; that things so charged must be in a state ofexpansion, and that this state of expansion must vary withevery variation in the charge; and that this expansion takesplace more readily in bodies, or in parts of these bodies, whichare less solid than in those which are more so. Hence, changesin expansion take place more readily in parts of amoeboidbodies which remain in a state of nascent protoplasm, andnot in the parts which have become granular; and thus thepeculiar amoeboid protrusions are produced in obedience tothe oscillations of the earth's electric state, at least as far asthe electrophysics of these organisms is concerned.The Electrophysics of Simple Muscular Movement and Simple Nervous Action. -The actual condition of each muscular fibreand nerve cell, when alive and at rest, is the same as an electromotive element in the state of open circuit. The coats.and contents are a voltaic pair, the former being positive andthe latter negative; the arterial blood, or fresh air, is the fluidby which the electromotive action is set up. These fibres andcells are in a constant state of charge, which causes an expansion of their contents, by mutual repulsion among the molecules . When action takes place, this charge disappears, and" induced currents and " extra currents are developed,but the contraction which results is due to the disappearanceof the charge, and not to the excitation produced by the991876.]Reviews. 121" induced " or 68 extra currents. When muscle or nervereturns to a state of rest, the electric charge reappears.He believes it is very probable, as Matteuci concluded, thatmuscular action is attended by a discharge of electricity analogous to that of a torpedo, and that, may be, it would be aspowerful, were it not lost in great measure by being shortcircuited within the body; and that nerve acts on muscle byinduction, or by a somewhat similar production of electricforce, which inhibits the natural charge of the muscle.The rhythmic action of the heart has been proved to dependupon the cardiac nerve-centres; the rhythm is occasioned,according to Dr. Radcliffe, on the electromotive action " running down" in the interval between any two fresh supplies ofarterial blood to their nerve centres. He bases this theory onthe fact that the heart of a frog will continue to beat if exposedto air or supplied with arterial blood, but will cease to do soif placed in a vacuum, or in an atmosphere of hydrogen, orcarbonic dioxide, or nitrogen, and will resume its beatingswhen air is readmitted into the vacuum, or substituted forthe gases.In the same manner may be explained the movements ofthe chest in mammals (respiration), mouth in cuttle-fish, etc.The respiratory movements in mammals are slower than thecardiac, because the former depend on the medulla oblongata,which is supplied with blood later than the cardiac nervecentres, and also uses it up slower. In other words, he believes that an electromotive action is rythmically set up inthe cardiac and respiratory centres respectively, from anintermitting supply of blood to these centres.From the way in which muscle and nerve are affected by Franklinic and Faradaic electricity, he argues that duringrest they are in a state of charge, and that the state of actionis attended by discharge. There is, however, more to belearnt from the effects of the constant current, that is,voltaic electricity. The action of the direct and inversecurrent is nearly the same: there is relaxation while thecircuit remains closed, and contraction upon opening andupon closing it. Contraction is connected with the production of instantaneous currents of high tension, the extra currents of Faraday.By experiments on galvanoscopic frogs he shows that theduration of the state of contraction in the limb is due, notto the direction of the current, inverse or direct, but to thecharges of free electricity, positive or negative, associated122 [April, Reviews,with the current. That it makes no difference, as far asmuscular action is concerned , whether the circuit is closedor open, the essential state being that of charge or discharge,the former counteracting, the latter causing action.The experiments of Lehut, Bellingheri, and Matteucci, goto show that sensation, like motion, has to do, not with theconstant current, but with the instantaneous extra currents;in fact, the action of electricity is the same on the sensory ason the motor nerves, and on the muscles.The sum of the whole matter amounts to this, that the differentforms of electricity, the voltaic, the Franklinic, the Faradaic, and thatwhich is natural to living substances, all agree in acting, not by polarization, or by any other working of the constant current, but by thecharge or discharge of free electricity, the charge (the negative as wellas the positive, but not to the same degree) causing the state of rest,and with it more or less expansion, by keeping the charged moleculesin a state of mutual repulsion, the discharge bringing about action,and with it the state opposed to expansion, by leaving the now chargeless molecules free to yield to simple molecular attraction.66Rigor Mortis is characterised by the disappearance of themuscle and nerve-current, and this disappearance is accomplished gradually as death gains mastery over life. Thefact, indeed, would seem to showthat muscle may have passedinto the state of cadaveric rigidity, because the attractiveforce which is inherent in the physical constitution of themuscular molecules is then no longer counteracted by theelectricity which belongs specially to living muscle and nerve.The Work of the Blood in Vital Motion. -Blood is not astimulant to vital motion; on the contrary, bleeding is attended by violent convulsion, as is also strangulation. Theexperiments of Sir Astley Cooper, and of Drs. Kussmaul andTenner, are quoted to show that the effect of tying or compressing the arteries supplying the head, is to produce convulsions, and the removal of the pressure or ligature is tosuddenly and completely relax the muscles.Dr. Harley has shewn that blood containing a smallquantity of strychnia is less capable of aëration, and therefore the change produced in the blood in fatal cases of poisoning is equivalent to copious loss of blood.Dr. Reid, of Aberdeen, and Professor Draper, of NewYork, have proved by experiments that in asphyxia blackblood gets through the smaller vessels less readily than redblood, " and from which, for this reason, it may be inferred1876.]Reviews.123that the state ofvascular contraction is more effectually counteracted by red blood than by black blood. "Muscles which are less vascular are more prone to enterinto, and remain in, the state of contraction than the muscleswhich are more vascular. Drs. Stannius and Brown- Séquard,by injecting blood into a criminal who had been decapitated,and into animals after rigor mortis had set in, found that itdoes away with this rigor mortis.Therefore, Dr. Radcliffe feels justified in supposing that, asrelaxation, not contraction, is associated with the presence,and contraction, not relaxation , with the absence ofred blood,the action of the blood tells in preventing muscular actionrather than in producing it . "That the action of the bloodin vital motion may be really resolvable into that of electricity-that the blood may antagonize the state of action innerve and muscle, because its oxygen has to do with the keeping up of that electro-motive condition in nerve and musclewhich antagonizes the state of action in nerve and muscle,and which in muscle keeps up in addition the state of relaxation. "The Work ofthe Nervous System in Vital Motion.-Havingbriefly explained some of the chief centres of nervous actionand their special function, and the effects of injury on them,Dr. Radcliffe passes on to the consideration of the causes ofthese phenomena.He believes that a frog's legs contract more readily on section of the spinal cord, because the inhibiting influence ofthe electricity imparted to the muscles from the great cerebrospinal nerve- centres has been removed.The destruction of the spinal cord causes a loss of musculartension, because the withdrawal of the electricity impartedto the muscles by the spinal cord must show itself not bycontraction, but by a loss of muscular tension.Spasm is due not to irritation, but to a lessening of theelectrical tension, which leaves the muscles free to yield totheattractive force inherent in the physical constitution of the muscular molecules.Trembling is substantially the same as spasm; some inhibitory influence is evidently withdrawn, which, while present,served to keep the muscles steady. There has been, as itwould seem, a lessening of cerebellar action in particular- achange, perhaps, by which the cerebellum is made to take thelower level, so to speak, of the rhythmic nerve-centres whichhave to do with cardiac and respiratory movement.124 Reviews. [April,Convulsion from injury to some parts of nervous system isthus explained:-A given supply of arterial blood to an ordinary non-rhythmic nervecentre is necessary to keep up electromotive action in that centre for agiven time. Ordinarily, this supply of arterial blood to the centre issufficient to keep up electromotive action in the centre all through theintervals which lie between the two moments when the centre receivesfresh supplies of arterial blood, and hence it is that the electro- motiveaction of this centre is practically constant, and, because constant,unattended by the development of the instantaneous currents whichgive rise to the convulsion. But not so when the supply of arterialblood to the centre is insufficient to keep up electromotive action inthe centre throughout the intervals between the moments when thecentre receives fresh supplies of arterial blood, for then it is evidentthat the electromotive action will be inconstant, and, because inconstant, attended by the development of the instantaneous currents ofhigh tension which may give rise to convulsion.In fact, they are reduced to the lower level of rhythmicnerve-centres as before mentioned.It does not seem that Dr. Radcliffe has quite appreciatedor understood Professor Ferrier's experiments, or he wouldhardly be led to say-" in all probability the recent investigations of Dr. Ferrier only bring out the old facts in anew light by showing, not that the convolutions of the brain.are mapped out into districts like certain underlying portionsof the automatic cranio- spinal axis; but that these latter portions may be reached from a distance through the brain. "He says very little else indeed about these important experiments, and this leads us to believe he has not studied them,or he might have adduced many as apparently confirmatoryof his views, though we are inclined to think that ProfessorFerrier would hardly agree with Dr. Radcliffe's ideas.Voluntary Nerve-action.-The will may simply make thenatural electricity and the natural molecular attractive forceof the muscle do its work in this matter in their own way,without calling upon any vital force to render any assistance.Hence, there is no such thing as " nerve force " or nervousinfluence " generated in the nerve-centres, in direct proportion to the functional activity of these centres.66Muscles act much in the same way as a piece of elasticdoes which is kept on the stretch. The fact that muscularaction is attended by waste, which waste is in proportion toits activity, is accounted for by supposing that "the wastemay have been incurred in restoring the state of relaxation."1876. ]Reviews.125A muscle may cease to contract after a time, " because theelectro-motive apparatus of the nerves and muscles has gotout of gear by being kept in action too long."The "stimulus" of a pin prick or a pinch is considered todepend on the pin or forceps accidentally closing electromotive circles which were previously open; but how about aprick or pinch from non- conducting bodies?Dr. Radcliffe does not wish to elevate the physical over thevital, but he believes that electricity is one modification of agreat central cosmical law which rules over everything, andtransfigures and spiritualizes matter, "a law which makesthe old belief of multicity in unity and unity in multicity asoberfact."Applying the theory he has enunciated to nervous diseases,Dr. Radcliffe endeavours to show that these depend not on anexcited or hyperæmic state of the central nervous organs, but,on the contrary, on a loss of excitability, and on a deficiency of arterial blood.Epilepsy. The precursor of an epileptic paroxysm is adeath-like pallor; this is often accompanied by sighing, andduring the fit there is suffocation, both showing that it is dueto some fault of respiration . The pulse is sometimes imperceptible, at others it rallies, and is hard and full, this is theapnæal pulse. Blood drawn from an artery during a fit isvenous; therefore, there is no sign of any vascular overaction in convulsion, but the reverse.In convulsion associated with chorea and hysteria, there isgenerally a sluggish circulation. In fevers, convulsions occurduring the cold not the hot stage. In Bright's disease, SirThos. Watson thinks the stupor has more connection with adeficiency of red corpuscles than with uræmia. Dr. Radcliffeconsiders the convulsions are also connected with the povertyof the blood."And thus," he sums up, " convulsion, in all its forms, isfound to be associated with a state in which the supply ofredblood to the system is either arrested altogether or greatlyinterfered with." We have yet to learn that leucocythæmiais associated with convulsion, as in these cases we have alwaysobserved a relaxed, rather than a contracted, muscular con- dition.The nervous state in convulsion is characterised by inactionin those parts which have to do the work of the mind, andare concerned in respiration. In hysteria and chorea the willis in abeyance, and there is a state of extreme nervous unrest.126 [April, Reviews.Convulsions are not caused by inflammation of the nervecentres; these are, in fact, starved for want of blood.99Convulsion is not a common symptom of inflammation ofthe brain or its membranes, nor ofacute mania. In apoplexyit is probably due to the pressure or other damage caused bythe extravasated blood. In " exalted or morbid irritability,'so called, it may be still due to certain nerve-centres beingstarved for want of blood, rather than to their being overfed with blood .In tetanus, though the pulse may be hard and quick, there isno inflammation, but this state of the pulse is due to partialsuffocation. The mind is depressed, the muscles have atendency to go into a state of rigor mortis. The cord is notinflamed, but disintegrated. There is a general waste of innervation.In catalepsy, cholera cramps, hydrophobia, and other formsof spasmodic disorder, there is no over-activity of the vascularsystem, but rather the reverse, and the mind is either in adeep sleep, fatuous, or prostrated .In dementia there is often cramp in the calf of the legs,and mental depression is frequently accompanied by pain inthe bowels. Shivering is evidently connected with a depressed state of the vascular system, caused by cold, and relieved by warmth. In delirium tremens, the tremor is also dueto vascular depression; when inflammation or fever sets in thetremors cease. Shivering mostly affects timid people, and indelirium tremens the mind is dejected, in subsultus there isapathetic drowsiness. The condition of the nervous systemis one of weakness.In neuralgia, whether as a special affection or an accompaniment of rheumatism, gout, fevers, etc., it is associatedwith vascular and mental inactivity; in fact, inflammationrelieves pain as in blistering, and lumbago is relieved byexercise.In conclusion, Dr. Radcliffe believes he has established thefollowing facts:-1. That the exaggeration of vital motionis not consequent on exalted vitality due to hyperæmia.2. That vital motion is merely a mode of physical motion, forwhich the only key needed is that which is supplied in thenatural workings of electricity and elasticity. 3. That amoeboid movements are the simple result of terrestrial electricity.4. That muscular fibres are analogous to amoeboid bodies, andare in a state of relaxation from the action of electric " charge.'5. That nerves resemble muscles electrically, and that""1876.]Reviews.127muscles and nerves interact on one another. 6. That the workof circulation and nervous action is carried out by electricity.7. That the due electromotive action of the nerve centres,and of all other parts of the nervous system, is dependentupon a due supply of arterial blood.Such, briefly, are the views Dr. Radcliffe holds in respectto vital motion. There is certainly something to be said infavour of them, but the probabilities are that he has not yet discovered the secret of vital motion. It is no doubt truethat contractility may, to some extent, result from a removalof an inhibiting influence, but it is hardly possible to assertthat irritation does not produce or induce contraction by direct stimulation.In cases of true hyperæmia, as in a healthy plethoric person, there is a greater tendency to contraction and a greaterpower; but passive hyperæmia has no resemblance to plethora, though Dr. Radcliffe seems to think it has; his viewstoo of inflammation are hardly consistent with modern obser- vations. Amoeboid movements and muscular contractionmust have a closer relation to nutritive changes than Dr.Radcliffe is inclined to believe; the electric disturbance, too,may be the result of these nutritive changes .The state of the muscles in rigor mortis is very differentfrom that of contraction in life, and, therefore, no analogycan be drawn between vital and post mortem muscular con- traction. In life the contraction is due to a change inthe shape of the sarcous elements, which become shortenedin the direction of the fibres and lengthened laterally,hence there is a bulging of the muscles during contrac- tion. After death, however, this bulging does not takeplace, or at least not to so great an extent as in life, and webelieve that instead ofthe contracted muscles being shortened,they will be found to be actually lengthened; post- mortemrigidity is due, not to contraction, but to coagulation ofthe fibrinous matter contained in the interfibrillar juice of muscles.It is no doubt a fact, and one that requires studying, thatthe secret of many of the changes both in the muscular andnervous system lies in the state of the red corpuscles; andthat poisons and other abnormal influences act through thesecorpuscles, and cause changes to take place in various organssupplied by the blood, the particular seat of lesion beingdetermined by other circ*mstances. Whether these areeffected by some disturbance of the nutritive or electric condition, or of both, we are of course unable to say.128 Reviews [April,.There is much in Dr. Radcliffe's book that will repay perusal, though it is written in a somewhat discursive manner,and pre-supposes rather more knowledge of electricity and itsphenomena than most readers possess.It is very possible that many of the experiments he quotesin support of his theory are fallacious, or, at any rate, do notwarrant the interpretation he puts on them. For instance,in reference to electrotonous, he says:-"There is an outflowof free electricity from the voltaic pole into the galvanometerin the case where electrotonic movements of the needle arepresent; there is no such outflow in the case where suchmovements are absent; and so I am at liberty to supposethat the electrotonic movements of the needle **** maybe nothing more than the natural consequence of the passageof free electricity into the coil from the voltaic pole whichhappens to be nearest to it." Now, this error is most carefully guarded against, and it has been demonstrated repeatedly that none of the battery current does escape toaffect the galvanometer. Moreover there will be no electrotonous perceptible if the nerve be tightly constricted by awet thread, which, of course, would not stop the batterycurrent.His theory, however, that muscular contraction is a signof want of nerve force, and that consequently the violentexertions of lunatics are not due to an excess of this power,but the reverse, may be worth considering in the treatmentof insanity, and may point to an application of galvanism even in acute mania.A. H. N.Leçons Cliniques sur les Maladies Mentales professées à la Sal- pêtrière. Par le Docteur AUGUSTE VOISIN. Paris:Baillière. 1876.Dr. Voisin, the accomplished physician of the Salpêtrière,has published some of his clinical lectures delivered at varioustimes since the year 1867. He commences by some remarkson classification, and condemns with a fervour which cannotfail to commend itself to some of his English readers the oldclassification by symptoms. Neither will he admit M. Morel'sclassification by ætiology. That which alone will satisfy himis one founded on ætiology, pathology, clinical examination,and pathological anatomy. Insanity he divides into six classes:-1876.]Reviews. 129I.-Acquired Insanity (folie acquise) which comes on in an individual hitherto sane.Of this there are four varieties:-(a) Folie primitive, orIdiopathic Insanity,which is dividedintoThat which is unaccompanied by anappreciable morbid lesion.That depending onmorbid lesions , viz.:1. Active congestion. Hyperæmia.2. Passive congestion.3. Simple anæmia.4. Secondary anæmia.5. Atheroma.6. Tumours.(b) Insanity following a nervous affection as epilepsy or hysteria.(c) Sensorial Insanity.(d) Sympathetic Insanity.II. Congenital Insanity (folie native) where the disorderhas appeared at a very early age.III.-Insanity from drink or poison.IV. -Cretinism, idiocy, and imbecility.V.-General Paralysis.VI.--Senile Dementia.Under the insanity which is unaccompanied by an appreciable morbid lesion, he places those cases where a moralcause has brought about the disorder. Such he believes toexist, but restricts them to a small number; he also thinksthat cases of instantaneous insanity are very rare, and that acertain period of incubation is generally found. Insanitydepending on active congestion is not to be confounded withthe congestive stage of general paralysis. In the former thespeech is perfect, the pupils are equal, the memory unimpaired . The patient's ideas may be exalted, but in a differentway, and without absurdity. There is a vivacity and dignity in his mien and carriage. His conversation is rapid andcurt. He may have hallucinations of general sensation andhearing, and the hallucinations often have reference to ideasof persecution. Microscopic examination reveals extravasation of blood both within and without the cerebrum. Themeninges are not always vascular, and are never adherent tothe grey matter. Both white and grey matter present capillary apoplexies , blood deposits, and crystals of various datesand in various stages; crystals of hematine are found inthe walls of the vessels, but there is no hypertrophy of connective tissue. M. Voisin treats this congestive insanityXXII. 9130 [April, Reviews.actively by antiphlogistic and derivative measures, blisters orcautery to the nape of the neck and small bleedings. As todrugs he gives digitalis and veratrum viride, and employs thewet sheet. He also advocates the use of the strait-waistcoat.Insanity depending on passive congestion occurs when thediminished tonicity of the arteries produces a stagnation ofthe blood in the capillaries. This he believes to be generallydue to atheroma. Simple anaemia may produce insanity,especially in young women. It is characterised by depression-melancholia, or melancholia cum stupore. Secondaryanæmia may also cause insanity, such as accompanies thetubercular or cancerous diathesis. Such patients are notviolent, though they may be restless and agitated. Theirmalady is characterised by illusions and hallucinations ofsight and hearing-such as are found in patients who havelost blood in other ways. The treatment should be tonic andsupporting, and is attended with very favourable results.Atheroma of the heart and large vessels is apt to produce aform of insanity marked by hallucinations, and proceedingthence to general mania. Our diagnosis may be assisted byauscultation of the heart, by the sphygmograph and opthalmoscope. There is a tendency to fatty degeneration of thebrain-substance: hence the malady frequently terminates indementia. In two cases M. Voisin found tumours in thebrain; in one there were two tumours, in the other sixhydatids. Such, he tells us, are rare in France.The next lecture he devotes to the consideration of a formof spinal meningitis localised in the posterior portion of thecord, which comes on in the course of general paralysis.This he believes to be an extension to the spinal membranesof the inflammation of the cerebral membranes in one of thecongestive attacks which are peculiar to this chronic meningoencephalitis. There is always to be found considerable localpain, a certain sign of spinal meningitis. There is also anataxic affection of the extremities due to a sclerosis of theposterior columns. This condition often precedes the epileptiform attacks which occur in this disorder. Another symptomoccasionally met with is sciatic pain. The patient complainsof a sudden pain extending throughout the length of thenerve, accompanied by considerable tenderness when thespinal apophyses of the lower dorsal vertebræ are pressed.Inone case these phenomena were preceded during four daysby nausea and vomiting. The sciatic pain was unilateral, not bilateral. On examination in an early stage the pia mater1876. ]Reviews. 131and arachnoid covering the surface of the cord are found tobe vascular, and there may be seen miliary granulations,thickened vessels, and a proliferation of connective tissue.Later we find the meninges thickened, the arachnoid opaqueand sometimes adherent, with calcareous incrustations andfibro-cartilaginous plaques analogous to those found in thepleura and peritoneum after inflammation of those membranes.M. Voisin commences his fifth lecture by insisting stronglyon the fact that insanity is a somatic disorder, and he is, hesays, more and more convinced that a purely moral treatmentis insufficient to effect the cure of it. He proceeds to enumerate the morbid lesions he has met with in those dyinginsane. These are congestions, apoplexies, extravasations ofhematine and hematodine, dilatations of the capillaries andnecrosis of the vessels. Atheroma is one of the mostfrequent, seldom to be discovered except with the aid of themicroscope, chiefly found at the bifurcation ofthe vessel, andrarely extending throughout its length. It produces ampullary dilatations, and these are followed by aneurism. M. Voisinhas never met with any patient whose malady was of twomonths' standing, in whose brain he did not find one or moreof the lesions above-mentioned. In the brain of those whodie after an acute attack of a few days he has found anintense hyperæmia of the cortical substance, and a marked injection of the smaller capillaries. He then describes thealterations in the brain-cells, which are of three degrees.First, the protoplasm undergoes a fatty and pigmentousdegeneration, the nucleus and nucleolus remaining intactas well as the axis-cylinder. Secondly, the protoplasm beginsto be absorbed, the cell becomes opaque, granular, and irregular, the nucleus and nucleolus are barely visible in thedarkened mass, and the cylinder is atrophied and filiform.Finally, the protoplasm disappears, the cell appears as anisolated body, varying in shape, the axis- cylinder beingdetached, granular, fatty or pigmentous, having the remains of the nucleus in the centre. These alterations are theconsequence of the obstacles to the normal flow of the blood,the lesions of the vessels and extravasations which precedethem. Another fact is of great interest. The alterations inthe brain-cells are not found to the same extent in thedifferent parts of the cerebrum. There is a localisationaccording to the form of the insanity. In partial insanity,with sensorial disturbance and hallucinations, and in partial132 [April,Reviews.sympathetic insanity, the lesions are seen in the optic thalamiand parietal convolutions, especially the first in the upperportion (lobule paracentral), while the frontal convolutions arehealthy. When the insanity is general and complicated byincoherence or dementia, the alterations are perceptible in allthe convolutions. The loss of consciousness of the disorderand the absolute belief in the reality of the delusions areevidence of the extension of the disease to the frontal convolutions. Certain observations of M. Schiff confirm theseviews. He found that excitation of the peripheral nerves.produced an increase of temperature in the nerve-centresapart from all changes of the circulation; and M. Voisintells us that excitation of the special nerves of hearing, smell,and sight increases the temperature in the parietal convolutions. He has often met with patients suffering from cataract who have had illusions and hallucinations ending ininsanity through excitations transmitted by means of theoptic nerve. And removal of the cataract cured the insanity.In the seventh lecture he pursues this subject further. He isof opinion, contrary to that of some writers, that hallucinations depend on excitation or lesion of the external organs of sense, at any rate in a certain proportion of cases. Withtheassistance of M. Galezowski he examined the eyes of twentyeight patients who suffered from primary hallucinations ofsight, and of the twenty-eight twenty were found to havelesions of the interior of the eye, two having glaucoma andeighteen cataract in various stages. All the eighteen hadhad, prior to the hallucinations, sensations of seeing blackflies, spiders, or specks with impaired eye sight. Hallucinations which have such an origin may be distinguished fromthose which are purely psychical by disappearing when theeyes are blindfolded , or when it is dark, or when total blindness supervenes. The mental state is affected by the objectsimperfectly seen , which create fear, doubt, or terror; or thelesions of the eye may create in the optic centres a state ofirritation which gives rise to false and exaggerated sensations. In the case of psychical, or psycho- sensorial hallucinations, memory and imagination are first disordered, andthe hallucinations are a secondary consequence. There arehallucinations of hearing of a similar kind depending onhyperæsthesia or irritation of the ear. These vanish if thereis complete silence, or if the ears are stopped, and are often unilateral.A certain class of insane patients, according to M. Voisin,1876.]Reviews. 133suffer from a sthenic pathological condition analogous to the"sthenie " of Brown. They may be known by their physiognomical characteristics. Their complexion is yellowish; theforehead, nose, and lips are drawn and pinched; the skinwrinkled; the whole countenance thin and miserable. Thebody and limbs are also emaciated. Amenorrhæa and constipation are present, together with anuria from spasm ofthe neck of the bladder. All the secretions are scanty, and theskin dry. The pulse is small and tense, as may be demonstrated by the sphygmograph, the trace being often nearly astraight line. The state of the heart is often the directlyopposite, the impulse being violent, so as to overcome the resistance of the spasmodic contraction of the peripheral vessels. The result of the latter is an anæmic condition ofthe nervous centres, and a disturbance of the relations ofthese parts. The patients chiefly suffer from melancholia ormelancholia cum stupore: they refuse their food, and declinerapidly. The treatment is by means of the chlorhydrateof morphia. The sthenic condition gradually disappears, andthe complexion improves as the arterial tension lessens . Thefact that during any febrile disorder the mind of an insanepatient frequently becomes clear, may be explained, accordingto the author, by the fever having produced in the brain aparalysis of the vasomotor nerves, and thus the sthenic condition of the vessels is diminished, or, for the time, removed.Besides morphia, baths and the constant current are of serviceto overcome the condition of spasm.M. Voisin tells us that neuralgic pains are common amongstthe insane, and may be felt in the body, limbs, or head, in thegenital organs both internal and external, and may be a pain,a sensation of heat or cold, pinching or dragging, lightness orheaviness, giving rise to various hallucinations or delusions.It may also be of the nature of an aura, and may rise fromthe limbs or genital organs to the head. Hyperæsthesia of theganglionic system may bring about a constant craving forfood, a constant desire to pass water, or sexual excitement.The treatment of such cases is by means of subcutaneous injections of the chlorhydrate of morphia. The next lecture ison sympathetic insanity, which takes its origin in some organ at a distance from the brain on which it reacts. The originis often difficult to discover; but it must be discovered , as thelesion must be cured in order to cure the insanity. Uterineaffections are often the starting point of the disorder, and acase is related where insanity of more than six years' stand-134 [April,Reviews.ing was cured by injections of nitrate of silver into theuterine cavity. In two autopsies of patients suffering fromsympathetic insanity, the abdominal ganglion of the sympathetic nerve was diseased, the nerve- cells being diminishedin number, atrophied, or filled with pigmentary and fattygranules. Insanity may also depend on maladies of the intestinal canal or liver, on worms, on cancer of the stomach,gastric disorders, and lung disorders . The next lecture is onthe insanity of early life, and in the following the authornarrates some interesting cases of insanity arising out of theevents ofthe siege and Commune, and then passes to the consideration of Tubercular Insanity. The cases to which hegives this name are characterised almost always by melancholia, by hallucinations of sight, and delusions which urgesthe patient to suicide; occasionally, though rarely, there maybe delusions of riches and grandeur. We may also sometimes observe symptoms akin to those of tubercular meningitis, such as partial paralysis of the face or limbs, togetherwith symptoms of tubercle of the lungs and bones and ofspinal meningitis. The morbid appearances may be compared with those of general paralysis, from which they are distinguished by the existence of tubercular granulations in thecapillaries of the cortical substance; or they may be thelesions of tubercular cerebro- spinal meningitis, or smallisolated tubercular masses visible in the cortical substancewith the naked eye. This form of insanity may be arrested,but the patients are always characterised by a mental weakness, which indicates that the brain has undergone somedefinite change. It bears no relation to the insanity whichsupervenes in persons who have reached an advanced stage oftubercular disease. In the next lecture M. Voisin considersthe mental symptoms observed in acute and chronic alcoholism. Alcoholism may, he tells us, give rise to everyvariety of insanity, being a general disorder. The acutesymptoms are chiefly melancholia, stupefaction, delusions ofpersecution leading to suicide, imaginary terrors, and sometimes delusions of pride and self- satisfaction. The chronicmental affections are amnesia with or without aphasia, difficulty of articulation, weakness of character and want ofenergy, a blunting of the intellect and imbecility. Drinkingpatients are liable to brain disturbance while suffering fromacute disorders, as acute rheumatism, pneumonia, pleurisy, orinjuries. He does not find that absinthism is characterised by symptoms differing from those of alcoholism . He is of11876.] Reviews. 135opinion that the legal responsibility of chronic drinkers isseldom complete, inasmuch as all their faculties, both moraland intellectual, may be affected; at the same time he thinksthat the doctrine of absolute irresponsibility is, as a rule, inadmissible. The concluding lecture is upon the affections ofspeech in general paralysis . The work is illustrated byplates of microscopical anatomy and by some photographs ofpatients. We commend these lectures to our readers; theyrepresent the results of investigations conducted in a truepathological spirit.The Superannuation of Officers in British Hospitals for theInsane: Its Principle, Policy, and Practice. By W.LAUDER LINDSAY, M.D., F.R.S.E., Physician to theMurray Royal Institution for the Insane, Perth. J.and A. Churchill.Dr. Lindsay has in this little book tabulated and explainedall the information available in regard to the very important subject of retiring allowances to the officers ofasylums. At much pains he has obtained the facts fromthe various institutions; with still greater labour he hasarranged them in the forms most suitable for reference, andhe has commented on them judiciously and enthusiastically.At the outset he very shrewdly remarks that the Governorsof Asylums are often guided less in regard to such aquestion by what is right in the abstract, "than simplyby the practice of their neighbours." By diffusing information, therefore, as to the practice of pensioning, whereverit has been adopted, Dr. Lindsay hopes to bring in a"fashion to grant superannuation allowances to all classesof officers and servants after fifteen years' service, at therate of about two thirds the total money value of officeat the date of retirement. "For his data the author went to the Irish LunacyAuthorities, to Dr. Kitchen's valuable pamphlet on thesubject, and to the officers of the English and ScotchAsylums and their Reports. Pensions have been grantedin twenty-eight English county Asylums, the criminalAsylum at Broadmoor, one borough, and one idiot asylum,and in five registered hospitals . In Ireland they have beengranted in fifteen district and one state Asylum; and inScotland in four Royal Asylums. There seems to be no136 [April,Reviews.provision in the statutes for granting pensions to the officersof the Scotch district asylums, an omission which reallylessens the value of salaries and wages in those institutionsby from ten to twenty per cent. , as compared with the RoyalAsylums. We do not think it creditable to the Scotch Boardof Lunacy, who have so much power in regard to the districtasylums, and who have taken such an interest in them, thata successful attempt to remedy this anomaly has not beenmade. That Board is not credited with any great reluctanceto go to Parliament to get amendments to the Scotch LunacyActs, in regard to matters which it considers important. Inthe long run it would do more for lunacy in Scotland to temptgood men to enter that branch of the profession, than manythings that are now more thought of. Our Scotch brethrenhave this grievance, and they ought not to be content; theyought to stir in the matter. The higher powers will be allthe more likely to help those who help themselves.The total yearly expenditure in England on pensions isover £10,000, in Ireland, £2,300, and in Scotland about£700. Dr. Lindsay points out the marked contrast in theexpenditure in different asylums on pensions, as illustratingthe very different views asylum committees take of their dutyin this respect. It seems to be at present a matter ofchance whether an officer gets a large or a small pension,or gets a pension at all. In Table 5 will be found in detailthe amounts paid to different classes of officers in thedifferent institutions. The Royal Asylum, Glasgow, headsthe list with £600 a year to Dr. Mackintosh, certainly a wellearned reward for long and good service. Kent rewardsits late asylum superintendent with £ 150 a year, fortunatelythe lowest sum in the table. It seems quite common inIreland to reward faithful service in the case of ordinaryattendants, with sums of four, five, six, and seven poundsa year. The author draws a very marked distinctionbetween officials who have, and those who have not, chargeof patients in the amount of pension he thinks they ought todraw. At p. 34 an interesting list of the amounts of salariesof the medical officers of asylums during active service isgiven. £1,000 a year is put down as the highest moneypayment. Dr. Lindsay thinks this small compared with thesums earned in practice by successful medical men, by whom£2,000 a year, he estimates, is commonly made. He thengoes on to the rather delicate question of the money valueof the official allowances of asylum officials , putting down in1876.]Reviews,137black and white what he considers to be their equivalents.We need scarcely recommend all medical superintendents ofasylums to study this table. It has the interest and valueof enabling them to see themselves as others see them, andit excites a not unnatural curiosity as to their neighbours'affairs, e.g., who the happy man was who made £900 a yearby consultation practice; or the equally fortunate individualwith the boarder who paid him £1,000 a year. It certainlydoes not impress one with the money to be made in ourspecialty, when we see that Dr. Lindsay only assigns a totalmoney value of £ 1,100 a year to the four best paid institutions in the United Kingdom, viz. , the Edinburgh, Essex,Glasgow, and Wakefield Asylums. We much doubt, however,whether the holders of those appointments would commute for that sum.The author then gives tables showing the duration ofservice and age of the various pensioners, and the period oftheir enjoyment of pensions up to this time. No Asylumpension has been enjoyed for twenty years. This fact shouldbe vigorously pressed on the notice of grudging committeesby expectant annuitants. The common belief that they neverdie is clearly not true in the case of those who have had thecharge of the insane. It is a most undoubted fact thatasylum work is wearing work, and that it tends to undermine the tone of the nervous system . Who ever heard ofan old asylum official who was not hypochondriacal at times?Dr. Lindsay also points out the risks to life and limb thatare inevitable to the service. He says that during twentyyears five serious attempts have been made on his own life.We have known many cases of attendants, whose nervehas been permanently broken after a struggle with a patient.The "morbidly irritable pugnacious condition that is sonaturally the result of the long-continued anxieties ofoffice, " is a real risk. "That they allowed their tempersto get the better of their judgment, is only a vulgar wayof putting a pathological fact," may be very true, but thereare obvious limits to its universal application, among asylumattendants for instance. In practice, we must assume thetruth of the doctrine of the freedom of the will in suchcases.The principle which ought to regulate Public Asylum authorities,is to regard the management of the insane as so much more exhausting and dangerous both to mind and body than any department ofH.M. Civil Service, or even H.M. Military or Naval Service, that in138 гReviews.[ April,addition to the benefits of the Civil Service Superannuation Act.aforesaid, Asylum officers should be entitled to certain special pensionprivileges represented by-(a.) Nominal additions to length of service or age, or by(b. ) Absolute additions to the maximum grants under the Act of 1859.The practice which ought to prevail should be-(a. ) To make a specific distinction between those officers andservants who have charge of patients, and those who have not; and(b.) To give a much higher rate of pension to the former-to wit,to Medical Superintendents, Matrons, and Attendants of both sexes,according to the degree and character of their responsibility, the exhausting and dangerous nature of their work, and the persistency of their worry.The task of writing this small book is a most publicspirited one on Dr. Lindsay's part. He deserves the thanksof all asylum officers. It will direct needed attention to thematter; and he will be a very incurious asylum official whodoes not master its contents, while he will not be a very wisesuperintendent who does not see that a copy is permanentlyplaced along with the Lunacy Acts in his Committee room.The Increase of Mental Disease.Dr. Jamieson, Physician to the Royal Asylum, Aberdeen,has delivered an address to the North of Scotland Association,in which, after describing the manner of treating the insanein the Old Asylum at Aberdeen, when he first became connected with it, he lays stress upon what he calls "thealarming increase of insanity in our time." The followingis Dr. Jamieson's interesting description of things as theywere in 1840:-At the beginning of the century, such of the insane as were poorand required medical treatment in Aberdeen were lodged in the backof the basem*nt of the Old Infirmary, in a part of the buildingpartaking in many respects of the character of a cellar, save that itwas not underground; and surely it was a great improvement on thismode of care when it was changed to the form of a separate hospital ,even although constructed under the asylum ideas of that day. Thehouse so built is not now in existence, but it was in partial use untilabout 1850, and was in full operation when I first became connectedwith the psychological department of medicine in 1840, forming,indeed, the larger part of the then working asylum. The floors wereof stone, the cubic space of the separate rooms was under half of1876.] Reviews. 139what would now be insisted upon as sanitary essential. Some of themwere entirely dark when the door was shut, and none of the rooms,though thought to be adapted for maniacal cases, had windows abovehalf a foot square, placed out of reach in a high corner, and guardedoutside by a strongly-bolted shutter. The cell -so was the roomnominated-may be said to have contained nothing in the way of furniture, often not even a bedstead; for the straw upon which thepatient lay was spread upon a built platform in the further corner,or behind the door, which was of plank, strongly fastened with a ponderous lock, and pierced with a slit, iron barred, for inspection. I am,of course, describing what were the worst points in our local Asylum,as a contrast to what exists now. The patients were neither medicallyneglected, ill fed , ill clothed, nor cruelly used, unless it might be inthe way of personal physical restraint, and all the surroundings werebut the reflection of the social and medical ideas of the time. Someof the customs and remedies in vogue would now make the inquirerstare-such as the bath of surprise, the rotatory chair, the applicationof jolting in cases of obstructed discharges, the idea of compulsion which ruled the moral treatment of the disorder, and the very generalapplication of bodily restraint in difficulties of management of theindividual. The suicidal were restrained; the destructive had theirhands fastened or covered; the violent were locked up or chained up,or both together; and runaways had their legs fastened or impeded .If you would not eat, you had to swallow per force; if you ate whatwas not food, you had to wear a mask; and if you would not lie inyour bed at night, a considerate kindness ingeniously tied you into it.The gradual amelioration and ultimate disappearance of all this haveoccurred in our own time. In no department of physic has the changebeen so progressive, so great, and so satisfactory.Dr. Jamieson entertains decided opinions concerning an increase in the production of insanity, which he has enunciatedvery positively. But we think that no one who has given.serious attention to the question will feel quite satisfied withthe grounds on which he has based his confident opinion.The " narrowness of view and latitude of assertion" whichhe discovers are plainly not all on one side.I believe that the most remarkable medical phenomenon in ourtime has been the alarming increase of insanity. Crime has beendiminishing; prisons, here and there, have been shut up; but whohears of an asylum being shut up anywhere, or even of its numerousinmates decreasing? Are we but changing lawlessness for incapacity,cunning for weakness, and are we better because fools accumulate andthieves decay? The fact has been denied, as most facts have, but Ihave heard of no proof of its contrary, beyond what has been basedeither on narrowness of view and latitude of assertion, or thatsociological optimism that insists that no evil can possibly increase inthis wonderfully enlightened age. But how stands the case as exhi-140 [April,Reviewsbited in the light of local experience? In 1844, or thirty-one yearsago, there was one asylum in Aberdeen, doing all for the district thatthe present existing Institution does, or more fully, and it contained 150 persons; now it contains 480. It has more than trebled the number of its inmates in thirty years. Has the population in thispart of Scotland trebled itself? Has it doubled itself, or even become a third more numerous in the same time? But this is not all; thereare in the neighbourhood three other asylums in the shape of poorhouses, none of which existed then, and a hundred additional lunaticsmay be credited to them. The last report of the Commissioners to Parliament shows that there has been a continuously growing ratio oflunatics in the population of Scotland since their appointment; that it increases faster than the population, and also faster than thepauperism of the nation, and that the increase is even yet greater in England. In 1840 ( I take this date because it is the date of my ownacquaintance with this special department of the profession) therewere just seven asylums in Scotland, now there are twenty-four,exclusive of eight private establishments and the lunatic wards ofmore than a dozen poorhouses. Last census made one patient inevery 430 of the population; whereas the census before, it was but530; and lately, I have heard the proportion surmised to be one in 300.Surely Dr. Jamieson must feel on reflection that these arefar from adequate data on which to base the unqualifiedassertion that " the disease increases in the population ,growing like a malignant fungus, living on the decayingvitality of the trunk from which it has parasitically sprung.At any rate, a remark which he makes in another part of hisaddress might have suggested to him that there are othercauses than an increase in the production of insanity whichwill account for much of the undoubted large increase in theregistered insane population. " Half-a-dozen Acts of Parliament," he says, " within less than twenty years, have assuredthe public of Scotland that their lunatics were not overlookedor forgotten-but overlooked in a less metaphorical senseby as many inspectors as there are Acts." Have these half-adozen Acts of Parliament had no effect in multiplying asylumsand swelling the number of registered insane persons, apartfrom any increase which there may have been in the production of insanity? Whether the disease be on the increase ornot in this generation, it admits of no doubt that Dr. Jamieson's picture must produce an erroneous impression upon theminds of those who have not investigated the subject.But Dr. Jamieson is by no means enamoured of the tendencies of the present age, and finds no difficulty in discovering the causes of the degeneration which he assumes.1876.]Reviews.141The causes which devitalise the nervous system of the individualultimately, have first injured the race generally, and become apparentin the advancing degeneration of the community. Is there such adegeneration? I am aware that to say so raises a clamour of dissent.Are we not bigger, braver, better, wiser, more long-lived, more everything that is admirable than our ancestors? Does not every authoritydeclare so, except your mere narrow-headed laudator temporis acti?Decay of vital force indeed! Do not censuses show increasing rates ofpopulation? Do not statisticians and insurance tables declare a longer average life? Are not old pests, plagues, and poxes less fatal? Arenot old armour and accoutrements found small for our better fed andmore powerful limbs? And, in short, instead of falling away, are wenot in a state of evolution and progression? But I for one do notsee it . I believe that there is a great increase in diseased and halfinvalided conditions; an increase in all diseases of the nervous system,or an increase of the nervous factor in all diseases; that there is ananæmic physiognomy prevalent in all town inhabitants; a readiness tobreak down under trial; a tendency to be unduly influenced by slightcauses; and a degeneration of physical character, as seems to be wellrecognised by those who enlist for military and naval services , or whor*quire to replace vacancies in the police, or amongst watchmen,warders, and such like. The physical deterioration is thought to be more observable in the male than in the female section of the community, and may be remarked on all occasions which lead to those ofsimilar station being brought together at kirk, market, or assembly.There is, one might say, a harmonious moral retrogression also , in theruling selfishness and loss of manliness that can find no pleasure inart, or effort, or sacrifice, but only strives , with any fervour, at suchaims as exacting more and more money for worse and worse work,with less hours of exertion, and shows less and less respect for all idea of duty. The very movement of women for what is called theirrights, so far as it means a wish to be independent of men, isbut a deflection of the balance showing loss of weight in the oppositescale.We cannot say that we share Dr. Jamieson's alarm. Theworld has been going wrong from the beginning-stoning ,burning, crucifying its prophets who were sent unto it, andyet, somehow, it has contrived to get on. When one nationdrops the torch, another nation takes it up and carries it forward, and we are not of those who think that Englishmen orScotchmen have touched the culminating point of progressand are destined to end the process of humanization on earth.But Rome decayed , and Athens strewed the plain,And Tyre's proud piers lie scattered in the main,Like these thy strength shall sink, in ruin hurl'd,And Britain fall, the empress of the world.142 [April,PART III.-PSYCHOLOGICAL RETROSPECT,1. American Psychological Literature.By T. W. McDOWALL, M.D., Northumberland County Asylum.American Journal of Insanity. Vol. xxx, January to April, 1874 .January, 1874. No. 3. Pathology of Insanity, by Dr. John P.Gray. On Expert Testimony in Judicial Proceedings, by Dr. John Ordronaux . On the Perivascular Spaces in the Nervous Centres, byTheodore Deecke. Two Cases of Paralysis, by Dr. Daniel H. Kitchen.Phosphorus in Insanity, by Dr. Willis E. Ford. Hæmatoma Auris.- Recovery, by Dr. E. H. Van Deusen. Clinical Observations on theDementia and Hemiplegia of Syphilis, by Dr. M. H. Henry.April, 1874. No. 4. Syphilitic Affections of the Nervous System,by Dr. W. H. Broadbent. Is Habitual Drunkenness a Disease? by Dr. John Ordronaux. On the Germ-Theory of Disease, by TheodoreDeecke.Vol. xxxi.July, 1874. No. 1. Pathological Insanity, by Dr. John P. Gray.Psychical or Physical, by Dr. Charles H. Hughes. Feigned Insanity,the Waltz Case. Clinical Cases, Syphilis, by Dr. Willis E. Ford.The New Lunacy Code.October, 1874. No. 2. Proceedings of the Association ofMedicalSuperintendents of American Institutions for the Insane. Homicide.-Suspected Simulation of Insanity, by Dr. I. Ray. State of Missouriv. Anton Holm, Murder in First Degree, by Dr. Charles H. Hughes.Psychological Medicine considered as a Speciality.January, 1875. No. 3. The Duncan Will Case, by Dr. I. Ray.Artificial Alimentation, by W. A. F. Browne. Case ofPerrine D.Matteson. Delirium Tremens, by Dr. Daniel H. Kitchen. Hospitalsfor Inebriates.April, 1875. No. 4. State of Missouri v. Benj. F. Cronenbold:Murder in the First Degree, by Dr. C. H. Hughes.Jenisch- Epileptic Insanity, by Dr. J. Ordronaux.Insanity, by Dr. John P. Gray.Vol. xxxii.Cuse of IsabellaGeneral View ofJuly, 1875. No. 1. Responsibility of the Insane, Homicide inInsanity, by Dr. John P. Gray. In the Matter of Richard Beckwith,a Lunatic.October, 1875. No. 2. Responsibility of the Insane, Homicide inInsanity, by Dr. John P. Gray. On the Vicarious Function of the1876.]143 Psychological Retrospect.Cerebral Hemispheres and Convolutions, considered in relation to Unilateral Wounds of the Head and Insanity, by Dr. C. H. Hughes. NewCerebro-Psychical Diseases, by Dr. W. A. F. Browne.Pathology of Insanity.-In this paper Dr. Gray states very shortly the results of extended observations he conducted at the New YorkState Lunatic Asylum. As all careful microscopic observations areof great value, the following paragraphs from the paper are given: -On comparing the various alterations displayed by the cases studied ,it seemed to be a phenomena of quite regular occurrence that themorbid process affects in the beginning and in a general manner thecentral elements, viz., the nerve cells and neuroglia undergo changesin their intimate composition and arrangement, before the integrityof the conducting elements of nerve fibre become notably impaired .The increase of interstitial amorphous matter between the fundamental nerve elements has been prominent in every case, and, whilethe connective fibres have been multiplied considerably beyond theirnatural degree, the scarcity or complete absence of connective nuclei has also been no less constant.In chronic mania and dementia the increase of interstitial, granular,amorphous matter and connective fibres, or, in other words, the hyperplasia of neuroglia, both in the grey and white substances, has beencharacteristic of the disease, reaching the highest limits ordinarily inthe grey matter and appearing more conspicuously in the anterior thanin the posterior regions of the brain. The alteration has displayeditself in some places in close connection with the capillaries; generally,however, the degeneration has originated in localized regions, distinctly parcelled out, as it were, from the rest of the cerebral tissue,circ*mscribed in a cystic cavity, formed by condensed minute connective fibres. These isolated masses are constituted of a granular andfriable matter becoming semi-transparent in its advanced stages, andin some cases converted into a serosity.The granulations which constitute these morbid products would notseem to be fatty, as they are neither dissolved by ether, chloroform oralkaline solutions, and become darker and more distinct when treatedby acetic acid, and while preserving their solid form they do not exhibit a hom*ogeneous mass. The study of these developments wouldlead to the conclusion that they take their origin in the interstitialelements of the nerve tissue, and that in their growth they determine,through a merely mechanical compression, the re-absorption of thenerve cells and fibres . The cavities in which they are contained varyin size from that of the nuclei of multipolar cells to that which can beseen by the naked eye, and constitute the pisiform cavities which giveto the brain sections in cases of chronic insanity the Gruyere cheeseappearance described by French alienists. That such pisiform cavitiesmay occasionally result from minute capillary hæmorrhages is a wellacknowledged fact. Then the surrounding tissue of the cavity displays a peculiar discoloration , changing from yellow to a dark rusty144 Psychological Retrospect. [April,brown or ochre colour, due to infiltration of the colouring matter ofthe blood. The cavities here described exhibit no such tint permeatingthe surrounding tissues, nor are they in direct connection with thecapillary vessels, as the cysts proceeding from old apoplexies alwaysIn the condition under consideration the brain elements disappear by re- absorption, in scattered points, under a circ*mscribednecrobiosis originating purely from local conditions of the morbid pro- cess developed in the brain.are.The trouble which brings about the alterations in the cerebral tissuein general paresis, it is acknowledged, originates mainly in the vascularsystem, as has been shown by the researches of Virchow, Westphal,Salomon, Lockhart Clark, Sankey, and others, and to this origin mustbe ascribed the epileptiform symptoms ordinarily attending generalparesis, and deriving their source in local disturbances of the cerebralcirculation . The change begins in the adventitious sheath of thearteries and veins, the arterioles and larger capillaries, first describedby Virchow and Robin, the so - called lymphatic space of His whichbecomes distended in a small portion of its traject, sometimes uniformly around the minute vessel within, at others bulging out laterally;the enlargement thus produced being filled with lymph, granular cells,and hæmatic crystals or granulations. More generally the vessel istwisted or elongated, and exhibits a fine fatty degeneration of its coatswhich are often torn asunder, allowing the blood to escape into thelymphatic surrounding sheath, where it coagulates and ultimatelyundergoes a fatty change. The nervous elements in the vicinity ofthe blood-vessels are also involved in their structure, and they equallyundergo an alteration characterized by a multiplication of the connective fibres and molecular granulations. To such a proliferation ofconnective elements are due the peculiar firmness and pellucid appearance with change of colour displayed in the grey substance, and whichBaillarger has described as one of the characteristic pathologicalchanges of the brain in general paresis .The condition of the brain in epileptic insanity, and especially thealterations in the medulla, agree in appearance and character withthose pointed out and described by Dr. Echeverria in his work onepilepsy.The instance of syphilitic insanity adds further proof to the fattydegeneration which constitutional syphilis brings about in every tissue.A fact which seems of the utmost importance is the similarity ofhistological changes attending the different forms of insanity. Ifsuch regularity is displayed in future investigations, as I am stronglyled to believe will be the case, this fact will practically confirm theprinciple, that in insanity we have to contend with only one disease,manifesting itself under different phases in its progress and results.The correspondence between the degenerations of the cortical substance and those in the central ganglia, pointed out in France by Luys,Laborde, and Charcot, and in this country by Echeverria, has found1876.]145 Psychological Retrospect.further confirmation in these researches; whereas, lesions in the structure of the third left convolution, as Bouchard and others have alreadyshown, have not necessarily involved the existence of aphasia or amnesia.The capillary system has participated in the morbid process in everyinstance, but it has seemed to be primarily affected, particularly ingeneral paresis and epilepsy. The nature of the alteration has been.ultimately atrophic in every case, that is, resulting in the disappearance of central nerve elements, to wit, nerve cells and fibres, with aremarkable hyperplasia of amorphous matter and connective fibres.In acute cases the involvement of the fundamental elements in themorbid process has appeared to have taken place rapidly and withoutany observable effusion of lymph throughout the tissue. Such amorbid process cannot be looked upon as of an inflammatory character,for no proliferation of capillary vessels, or the so- called inflammatorycorpuscles of Bennet, have occurred. The trouble here has ratherbetrayed itself in a condition of intense irritation, exhausting thepower of the cerebral cells, and ultimately bringing on their consecu- tive necrobiosis.On the Perivascular Spaces in the Nervous Centres. -Having brieflyreferred to the views of previous observers, Mr. Deecke proceeds todetail his own results, obtained from the examination of nineteenbrains of insane persons, and of one from a young man killed whilst ingood health. He invariably found a covering surrounding the vesselspenetrating the brain substance, and a sheath inclosing the vessels.The sheath-contents consisted principally of lymph, and by injectingthe lymph ducts of the pia mater a direct communication was proved toexist between the former and those surrounding the vessels of the piamater. As to the true nature of the ducts and membrane, Mr. Deeckeadheres to the opinion of the first discoverers, Virchow and Robin."Besides the hom*ogeneous tunics there are no other membranes visible,but the two in a close connection form the walls of the vessels them.selves. I have never observed , either in sections, or in carefully insulated specimens of larger vessels with numerous branches, afterremoving the sometimes very delicate tunics, any traces of anotherwhich could be regarded as an adventitious coat of the vessels . Butthe peculiarity that even ducts of a true capillary character also showthe presence of these membranes and in direct communication withthose of larger branches, renders it more than probable that they represent nothing more or less than the very adventitious coat itself."There may be deposits of fat globules, pigment, crystals, &c. , in the space between this membrane and the vessels, but such are notnecessarily morbid.Mr. Deecke thinks he has satisfactorily settled the question as tothe nature of the filaments crossing between the dilated tissue of thebrain and the enveloping sheath of the vessels. " In preparationstaken from hardened brain, as the hardening process depends upon aXXII.10146 Psychological Retrospect. [April,deprivation of water, the vessels will be found always in a more or lessshrivelled and contracted condition . The really existing physiologicalspace enclosed by the adventitious tunic will very rarely be visible evenin the thinnest sections. And the more the action of the hardeningagent advances, the less distended will these spaces appear; and inmost of the cases we may find the thin adventitious membrane soclosely adherent to the media that neither a separating space nor themembrane itself seems demonstrable by our optical instruments. It isfor this reason that in so many cases the natural condition has beenoverlooked. The space produced by the contraction of the adventitiawas accepted as a true canal around the vessels. The fact that it waspossible to fill these canals by an injection , especially by the use of thepuncturing methods, could only confirm this theory. In other cases inwhich the still expanded adventitious covering was seen containingthe organised lymph, this state was confounded with the former one,and Batty Tuke and others, in the belief that the one false interpretation had to fall with the other, created the new theory of this hyalinemembrane. Nevertheless, he is indebted to Virchow and Robin forthe explanation of what he himself calls the adventitious coat."Although in all specimens of hardened brain, as above-mentioned,the true adventitious membrane of the vessels is only with difficultydemonstrable, it is virtually always existing. In a closer examinationof the external surfaces, such vessels will never show the smoothappearance ofthe medium coat or the simple membrane of a capillary.They are uneven, shaggy, and trimmed with small bunches of twistedfibres, when insulated; and in sections there are in these artificial spacesthe same transversely crossing filaments observable as in the abovedescribed spaces of a morbid origin. The application of higher and well- defining powers will leave no doubt as to the determination oftheir nature. They represent the so-called Deiter's cells of the connective tissue of the brain substance, these peculiar brush- like orradiant-like cells which, adherent to the adventitious coat of thevessels, in consequence of its contraction, appear as drawn out fromthe molecular mass, which composes the parenchyma of the nervous centres. "American Association of Asylum Superintendents. -Various mattersof more or less importance were discussed at the meeting of this bodyin May, 1874.A paper by Dr. Ranney makes special reference to the employmentof restraint. Few in this country will agree with him when he says," In cases of suicidal patients, such restraint as is implied in the useof the covered bed, or crib, seems to me eminently appropriate atnight, and affords a full equivalent for watching, or other supervision,and it is less liable to abridge sleep than any other measures affording the needed security . . . And then how shall we treat that sofrequently fatal disease, acute delirious mania, if we do not applyrestraint to secure recumbency? Without such restraint as will1876.]147 Psychological Retrospect.secure it, and in the best possible way conserve the physical forces,there is no success. In many, or most other cases where restraint is applied, increased attendance will wholly, or in part, takeits place, but in this disorder such substitution is more likely to beattended with ill results than any needful application of mechanical restraint, for all experience goes to showthat the victims of this disordernever yield to any superior force; and, moreover, the simple presenceof persons tends to perpetuate the cerebral irritation and mental excitement. " This subject may, with great advantage, be shelved for anumber of years; certainly it will require a very able man to sayanything new concerning it. To expect uniformity in opinion andpractice is quite absurd and contrary to reason. It is, therefore,desirable that writing be discontinued and observation continued fora very considerable period; then let us have the results stated-notquotations from this one or that in support of the writer's opinions.In concluding the discussion, the President said " I was gratifiedwhen visiting the institutions in England, the few I did visit, to findthat almost universally-certainly in four- fifths of the cases-thesuperintendents expressed themselves in favour of mechanical restraint,and singularly enough, the superintendents lay the blame of non- restraint upon the Commissioners in Lunacy, and the Commissionersin Lunacy throw it back upon the superintendents . They say thesuperintendents are emulous, one of another, to report the smallest number of restraints during the year. Certainly in my presence, andthat of an American medical friend accompanying me, almost withoutexception, they expressed their preference for mechanical restraint,and hoped they would have it established there. From an experienceof over twenty years, and from a careful, and I hope by no meanssuperficial, study of this question, I firmly believe that, in the future, thepractice of our best American Asylums now will become the governingrule of Christ endom." In connection with the passage here printed initalics, it may be remarked that, if there be any truth in the sayingthat imitation is the sincerest form of flattery, then our Americanbrethren must surely feel satisfied when they are solemnly informed byDr. Ramsay that " professional and public opinion in England is receding from its extreme position, and conforming more to the opinionsand practices of alienists in this country!"Dr. Curwen made some remarks on the " peculiar manifestationsof insanity in families, and on the causes of the difference in mentaldevelopment in different members of the same family, and also on theprevention of insanity."Several members of the Association recounted their experience withvarious drugs, chiefly chloral hydrate. Many of the remarks are interesting and instructive, though it was necessary for the President toinform a doctor present that croton chloral hydrate had nothing to do with croton oil.Responsibility of the Insane. -Dr. Gray does not believe in impul-148 Psychological Retrospect. [April,sive insanity. He cannot conceive of a homicidal act, impulsive,without motive, delusion or passion, simply a so- called impulse to kill.The fifty-eight cases of homicide examined in this paper he dividesinto five classes:-1. Those in which the crime was the direct offspring of delusion. 2. Those in which the crime was committedduring a paroxysm of insanity. 3. Those in which the crime wascommitted by manifestly insane persons, from motives and conditionswhich might influence a sane mind, as anger, revenge, mistakenidentity, drunkenness. 4. Cases of epilepsy, in which the crime wascommitted while the persons were in the epileptic circle, or changed mental condition, following the fit. 5. Cases of mania à potu.6. Cases of delirium tremens. 7. Not insane.A large table gives valuable information on many points relatingto the cases; e.g., sex, age, habits, hereditary tendency, form of insanity, mode of homicide, motive or delusion, injuries to self andsuicidal attempts, particulars regarding the crime, &c.It is worthy of note that 27 of the 58 cases were known to be ofintemperate habits.Dr. Hammond on the Mental Functions of the Spinal Cord.The following extracts are taken from a paper by Dr. Hammondin the Journal of Nervous and Mental Diseases for January, 1876: —"All these and even more complicated motions are performed by thedecapitated alligator, and in fact may be witnessed to some extent inall animals. I have repeatedly seen the headless body of the rattlesnake coil itself into a threatening attitude, and, when irritated , strikeits bleeding trunk against the offending body. Upon one occasion, ateamster on the western plains had decapitated one of these reptileswith his whip, and while bending down to examine it more carefully,was struck by it full in the forehead; so powerful was the shock tohis nervous system that he fainted, and remained insensible for severalminutes. According to Maine de Biran, Perrault reports that a viperwhose head had been cut off moved determinedly towards its hole inthe wall. This subject has been well studied by Dr. Dowler, of NewOrleans, by Pfluger, * Paton, + Onimus, and several others. I haveperformed a great many experiments and made numerous observationsrelative to the matter, and have for a number of years taught in mycourses on diseases of the mind and nerve system the doctrine nowset forth, that wherever there is gray nervous tissue in action, thereis mind also. To the details of some of these experiments, I begto invite the attention of the Society, merely premising that I havequite recently gone over the ground with great care, verifying with

• Die Sensorischen Functionen der Ruckenmarks der Wirbelthiere, u. s. w.

Berlin, 1853.On the Perceptive Power of the Spinal Cord, as manifested by Experiments on Cold-blooded Animals.Journal d'Anatomie et de Physiologie, October, 1871.1876.] Psychological Retrospect 149 .as much exactness as possible the results obtained by others and bymyself, and extending the scope of the experiments in several important particulars."Experiment I.—I removed the brain of a large frog, and then waiting a few minutes for the animal to recover from the shock of theoperation, proceeded as follows: I pinched the left hind foot with apair of forceps , and the limb was at once withdrawn; I pinched a littleharder and the animal struggled vigorously to escape, and succeeding,made several leaps , each of two or three feet in length. I then touchedthe right side of the abdomen with a glass rod, on which was a dropof vinegar. The right hind foot was at once carried to the exact spotI had touched, and was rubbed energetically against the skin . Theleft side was treated similarly, and the rod being held in contact withthe skin, it was pushed away by the left hind foot. The skin overthe left shoulder was then seized with the forceps and tightly held;efforts were made to remove the instrument with the left hind foot,then with the left fore foot, and these not succeeding, the whole bodyof the animal was violently agitated, and through the struggling thehold of the forceps was broken and the frog gave two leaps. Laidupon its back, it immediately resumed the ordinary position on itsbelly with its hind legs drawn up. I then held the glass rod witha drop of vinegar against the right dorsal region. The frog tried topush the instrument away with its right hind foot. I cut off this foot,and it then made similar efforts with the left hind foot. These notbeing effectual, it made a leap of about a foot, and then scratched theirritated spot with the left hind foot.66 Experiment II.—I removed the brain from a frog, and after waiting as before for the immediate effects of the operation to disappear,placed the animal in a tub of water. It immediately began to swim.I held my hand so that the animal's head would come in contact withit, and prevent further progress . Continued efforts to swim weremade for a few seconds and then ceased. Removing my hand theanimal again swam."Of these movements Vulpian says, that when the frog is placed inwater an excitation is produced over the entire surface of the body incontact with the water; this excitation provokes the mechanism ofswimming, and this mechanism ceases to act as soon as the cause ofthe excitation has disappeared, by the removal of the frog from thewater. If this were a true explanation, the movements of swimmingwould certainly be continued, notwithstanding the interposition of anobstacle; but, as we have seen, they are arrested . Onimus shows veryconclusively, and I have verified his experiment, that Vulpian's explanation is not correct; for, as he declares, with frogs without brains.placed in water, and from which the skin has been entirely removed,the movements of swimming are continued when they are placed again in water, which proves that the excitation of the cutaneous surface isnot the true cause of these movements.150 Psychological Retrospect. [April," Now, what do such experiments show? If they do not prove thatthe spinal cord has the power of perception and of volition, what dothey prove? What more could the animal possibly do to escape theinconvenience to which it is subjected by having an irritation applied to its body? It must be remembered that it has but one sense--thatof touch- left, and that one-half or more of all the gray nerve tissueof its organism has been removed. It will not suffice to say, with Dr.Maudsley, that they are no more evidence of consciousness and willthan is the fact that in the double decomposition of a chemical saltone acid chooses voluntarily the other base; for in the first place theacid and the base are not organised and living substances, and in thenext place they always act in precisely the same way under similarcirc*mstances, which is not the case in the movements of the frogdeprived of its brain. It is true that there is a general similarity ofactions, but so there is when the brain has not been removed, and sothere is also in the higher animals, man included, when the circ*mstances determining certain actions are identical. And this is so wellknown a fact that we can predict with exactness what movements willbe performed under known conditions, not only as regards the loweranimals, but man himself. Dr. Maudsley admits that the actions inquestion are for a definite end , and have the semblance of pre-designingconsciousness and will, but he then says that they may be quite unconscious and automatic. But he forgets that in all our relations withour fellow creatures the only evidence we have of their consciousnessand volitional power is derived from our knowledge of their actions .No one can say with absolute certainty that any other person is performing a conscious and voluntary act. That is a matter which isonly known to the individual himself; and hence, however consciousthe frogs submitted to such experiments may be, we have no means ofascertaining the fact except by the careful study of the psychical andphysical phenomena manifested. We interrogate them, and theanswers are perfectly logical and definite; no less so, in fact, thanthey would have been had the brain not been removed." But there are many other facts which go to show that the spinalcord is something more than a nerve centre for reflex actions and aconductor of impressions to and from the brain. Paton, in a salamander, divided the vertebræ and spinal cord immediately below thebrachial plexus, so that the anterior extremities were still in nervouscommunication with the brain through the upper part of the cord, whilethe posterior extremities were cut off from it, and only received nervousinfluence from the lower part of the cord. After allowing a fewminutes to elapse, the following phenomena were observed:" The animal raised itself upon its fore legs and began to moveforward , but did not drag its hind feet like an animal that had sufferedparalysis, but supported its body on them as on its fore legs , andexerted them distinctly in the act of locomotion . I could observe no

• Body and Mind, second edition, London, 1873, p. 9.

1876.]151 Psychological Retrospect.difference between these movements and those which it performedbefore the division of the cord, except that it now walked with lesspower and energy. I allowed the animal to remain at rest for a shorttime, and then slightly touched with the point of a needle the integuments of the right dorsal region, and it raised up its right hind footand passed its toes across the part. On irritating the integuments ofthe left side of the abdomen, it raised up its left hind foot again andagain to the part. After a short interval, I touched with the point ofa needle the upper portion of the left dorsal region immediately belowthe division of the cord, and it raised up its left hind foot and passedits toes distinctly over the part. I continued the irritation, and theanimal repeated the movement, raising up its left hind foot and passedits toes over the part."We are, I think, justified in concluding:" 1st . That of the mental faculties, perception and volition areseated in the spinal cord, as well as in the cerebral ganglia."2nd. That the cord is not probably capable of originating mentalinfluence independently of sensorial impressions-a condition of thebrain also, till it has accumulated facts through the operation of the senses." 3rd. That as memory is not an attribute of the mental influenceevolved by the spinal cord, it requires, unlike the brain, a new impression, in order that mental force may be produced ."2. French Retrospect.(Concluded from Vol. xxi, p. 632.)M. LÉON DUMONT on Cerebral Reflex Action. *In this valuable paper M. L. Dumont gives a critical history ofcerebral reflex action , and of unconscious cerebration. Having givena short summary of the first definitions of reflex action, and taking theviews of Prochaska and Legallois as a starting-point of his history(Unzer was, however, the teacher of Prochaska, and the most philosophical inquirer of the last century) , he brings the subject to the timewhen Marshall Hall, founding on the experiments of Flourens, maintained that the brain is not an excito- motor organ , and cannot, therefore, be the seat of any reflex action.It was at this date ( 1837) that Layco*ck, in examining the pheno- mena of mesmerism, showed that both the mental and the motorphenomena caused by mesmeric processes are simply due to pathological conditions of the brain, thus artificially induced, and to be classedwith those of imitation, delirium, hallucination, somnambulism, & c . ,

• L'Action Reflexe Cerebrale. MM. Layco*ck, Carpenter, Luys. La Revue

Scientifique. Jan. 8th, 1876.152 Psychological Retrospect. [April,and that all these and other phenomena are dependent on a reflex function of the brain. Layco*ck further demonstrated, in investigatinghysterical phenomena, the influence of the ovaria in exciting automaticactivity of the brain in women, who are the chief subjects of mesmericas well as of hysterical disorders.M. Dumont then gives a summary and criticism of Layco*ck's chiefresearches, ending with his chapter on Memory, in the last volume ofthis Journal (July, 1875); fully asserting his priority as to reflexcerebration.M. Dumont next takes up Carpenter's researches, which date from1852, as then published in his " Outlines, " and more recently in his" Mental Physiology," and examines critically and at length the opinions which specially belong to Carpenter. He refers to his previousessay in the " Revue Scientifique, " as showing that the facts Carpenter quotes from Sir William Hamilton afford no support whateverto his doctrines of " Unconscious Cerebration . " And as to othermental phenomena brought forward by Carpenter, M. Dumont is equallydoubtful. Of this class are the recall into consciousness when we leastexpect it of an idea we have vainly sought to bring back, and theother like instances, such as the elaboration of judgments and theinvention of ideas. They are rather conjectures, to be explained by atheory of unconscious cerebration , than proofs of the doctrine. M.Dumont here introduces some interesting views of his own, which weshall shortly notice.Under a third head , M. Dumont notices the adoption of the doctrine of cerebral reflex action by English and French psychologists ofthe experimental school, and observes, that if contemporary Englishphilosophers, like Darwin, Spencer, and Bain (he might have alsonamed Huxley) , do not expressly extend the doctrine of reflex actionto the brain, it is only a question of terminology; while they speak ofspinal reflex action only, they do not fail to explain cerebral functionsas being reflex .M. Dumont thinks that the notion of extending the theory of reflexaction to cerebral phenomena, which has of late been largely developed in France, is probably due to the influence of English physiologists and psychologists. He specially names M. Taine, as havingapplied the doctrines to psychology, in his valuable work on the Intellect, and M. Onimus as having applied it to the elucidation of thephysiology of language, and of the morbid states known as aphasia. †M. Dumont devotes a fourth division of his history to the recenttreatise of M. Luys, observing that the labours of neither Layco*cknor Carpenter have any mention, as they ought to have had, in thatwork. So far as the general phenomena and doctrines are involved,"Conscience et Inconscience," Rev. Scient. , 28 Dec., 1872."Sur le Language considéré comme phénomène automatique."de l'Anat. et de la Physiol, 1873, p. 543.Journ.Etudes de Physiologie et de Pathologie Cerebrales. -Des actions reflexesdu cerveau dans les conditions normales et morbides de leur manifestations, 1874.1876.]153 Psychological Retrospect.M. Luys adds little to the views Layco*ck has taught and appliedto physiology, pathology, and practice. More especially Luys adoptsLayco*ck's theory that the hemispheres are in relation as " trophiccentres with the whole body, and have much more, therefore, than therestricted functions assigned to them by physiologists of ministeringto external relations and mental activity in the influence they exerciseover all internal relations. Concurrently with this view, Luys adoptsalso Layco*ck's doctrine of the diffusion of impressions through thebrain and nerve-centres, and thence through the body; but he fits to all these an anatomical theory of a "sensorium commune" whence the"irradiation of incitations takes place to all parts. " This he places incertain submeningeal zones of small cells to be found in the corticalsubstance of the convolutions . It is in this region that the operationsof the will , as due to cerebral reflex function, take place. M. Dumont,in criticising Carpenter's " suprasensible" hypothesis of the will , remarks that volition is, in truth, according to Carpenter's own ideomotor theory, a striking manifestation of reflex action , in accord withideas which are themselves due to excitation from without, and transformed in the depths of the cortical zones into corresponding ideations,M. Dumont, in objecting to Carpenter's anatomical theory of a sensorium commune, also observes that it is more reasonable to concludethat the seat of the consciousness of a given moment is that part ofthe brain or of the nervous system where the change takes place, uponwhich the consciousness of the moment depends. It is probable (hethinks) that with each act of attention or of will towards a determinateobject, there is a local cerebral hyperemia, within the limits of whichconsciousness becomes more vivid, to the detriment of consciousnessin all other parts of the brain , which, at the same time, also becomeproportionally anæmic. The play of the organ is super-excited by acertain amount of motion received from without, and hyperemia is the natural result of the acceleration of nutrition thus induced. Thishypothesis is not without solid support in other phenomena. Thus, ithas long been well known that the cutting off of the supply of bloodto a particular portion of the brain by plugging of the vessels , orotherwise, is followed by defective nutrient and functional activity ofthe portion of brain-tissue so supplied . Hughlings Jackson, in thiscountry, has largely illustrated this class of morbid phenomena, andmore recently M. Duret has given a very valuable exposition of thedistribution of the encephalic arteries, with special reference to thispoint. *These views have, however, rather a mechanical than a dynamicalbearing. It is desirable to know how, in attention, volition, thought,emotion and the like mental conditions, the activity of the circulationand of the nutrient processes is influenced in particular cerebral regions.To explain these phenomena, Layco*ck adopts the theory of cerebral

• "Archiv. de Physiolog. ," Dec., 1874.

154 Psychological Retrospect. [ April,vasomotor and trophic reflex action. Accordingly the various encephalic centres, which are vasomotor centres, have respectively theircorresponding cerebral areas or regions of arterial distribution andtrophic activity. This is seen, e.g. , in the relation of the pons to theparts supplied from the vertebrals and basilar artery, and of the areasof the internal carotid -the hemispheres. Thus, there is an anatomical relation between the development of the cerebral nerve- centresand the trophic areas on the one hand, and between these latter andthe source of excitation , whether they be external , or internal on the other. Layco*ck has applied these views to both physiology andpathology. *This is but a brief notice of M. Dumont's important critical history.Other interesting views as to consciousness are stated by M. Dumonthimself, but there are difficulties in the way of clearly comprehendingthem, more especially as to the relations of consciousness to organization, which are due, apparently, to ambiguities in the use of the term.It would be of essential service to future inquiries and discussions , ifan exact physiological meaning of this and other terms could be agreedIt might be settled , for example, whether the word " consciousness " should be used strictly to denote a cause or a condition, and, thatbeing determined, to take another word to denote the cause, if consciousness be held to be a state or condition, and due to a cause—as,for example, when the state of hotness is said to be due to heat. Inthis case, mind might be used to denote the energy or cause on whichconsciousness as a considered condition depends.on.Some Observations on Mental Disease. By Dr. LEntz. †The first of these observations treats of the use of hot water as arevulsive. It is well-known that congestion, especially in its morerapid and severe forms, is often frequent in both the cerebro- spinaland respiratory systems of the insane, and often proves rapidly fatal .The general debility of the insane appears to be daily increasing, and their condition to demand rather the infusion than the abstraction ofblood.It is in asylums that these congestive attacks are most frequentlyseen, often following convulsive attacks of various forms, and producing an embarrassment of respiration which must soon lead to afatal result, unless assistance be afforded . Bleeding, in all its forms,must be discarded, its employment only tending to hasten death,+ See "Mind and Brain," 2nd edit. , 1869, Vol. ii , p. 471 , et seq. , whereganglionic and segmental areas of nutrition in the brain and spinal cord are defined. See also for practical applications to clinical observation, " A Clinical Trophic and Vasomotor Anatomy of theBrain and Spinal Cord, from a new point of view," " Med. Times and Gazette," 19 Aug. and 2nd Sept., 1871.+ Bulletin de la Société de Medecine Mentale de Belgique, 1873.1876.] Psychological 155 Retrospect.especially after the convulsions of general paralysis. In these casestreatment must be prompt and decisive, and these indications appearto be responded to by the use of hot water as a revulsive in the following manner. A large sheet, folded in four, is to be soaked inhot water, and to be immediately applied to the whole anterior andposterior surfaces of the trunk alternately; in some cases to both atonce, as well as to the soles of the feet and the calves of the legs.The applications may be renewed every minute, the temperature ofthe water varying with the gravity of the case, and even boilingwater may be used. These applications are of special value whenapplied to the whole extent of the spine. This procedure is not new,and though of no avail in the cure of paralysis or epilepsy, has savedlife, and possesses the advantage of easy and rapid application . Itacts rapidly on sensibility, and, applied to the spine, it restorespatients from the prolonged stupidity which follows epilepsy. Theresult in these cases is as much attributable to the action on sensibilityas to that on the vascular system. Further, this treatment is perfectly harmless; the most serious result being a slight scald, which,however, is rarely seen , the action of the hot water being less severewhen applied by means of linen than when directly applied.The second observation is on a case of pachymeningitis, in a youngman of 21 , the result of a fall on the head. On admission thepatient, while exhibiting the symptoms of acute delirious mania, wasemaciated and pale, showing that bleeding had been freely resortedto. He was incoherent and restless; possessed varying delusions;slept little; and was very dirty in his habits. Nothing striking wasobserved in the state of the motor functions, or inthe sensibility. Thehistory was imperfect, but some months previously a piece of coal hadfallen on his head while in the pit. The disease had begun by anaccess of fever, returning each afternoon, and characterised by rednessof the face, injection of the eyes, pain in the head, an expression ofstupor, and, finally, a restlessness increasing until evening. In themorning he would be better, but after admission this intermittencedisappeared.After four months he was discharged convalescent, but in five months was readmitted. On this occasion he was in a state ofabsolute dementia, silent, dirty, and requiring his food to be placed inhis mouth. Sensibility remained, but was obtuse. He remained inthis condition for three months, after which he began to brighten,talking incoherently, and taking notice of what was going on abouthim. An attack of excitement seemed to be imminent, when suddenly in October he sustained an attack of epileptiform convulsions,which left him in a condition very similar to that in which he waswhen readmitted. This attack was soon followed by others, his condition varying from stupor to restless excitement, and in one of greaterseverity than usual he died.156 Psychological Retrospect. [April,On post-mortem examination the calvarium was found normal; thedura mater much injected, especially on the right side , which exhibitedcomplete fluctuation; the left side was normally resistent. The openingof the arachnoid cavity displayed a true sac, occupying the wholeextent of the right half of that cavity. The sac, completely closed,was perfectly organized, and composed of a soft, velvety membrane,with a smooth and glossy surface, free where opposed to the brain,but slightly attached where opposed to the dura mater. It containeda considerable quantity of blood, which had collected at the base of thebrain, especially in the infra-spinous fossa. Save a slight injection,the brain and its membranes were healthy, though in the right hemisphere there existed a well-marked depression, corresponding to thecollection of blood in the infra- spinous fossa. The other organs presented nothing unusual.This condition, viewed in connection with the progress of the caseand the nature of its symptoms, appears to support the theory lastmaintained by Virchow, on the formation of neo-membranes of the dura mater. Whilst Baillarger admitted that the cyst was formedfrom the effused blood itself, others held that that only acted as anirritant on the arachnoid, provoking an exudation, which, becomingorganised, formed the cyst, in both theories the hæmorrhage being looked upon as primary.Virchow holds that the cyst is a result of inflammation of the duramater, and that the blood is afterwards effused into it.In this case, the first symptoms were suggestive of the irritation ofinflammation; as the membrane became organized these graduallydisappeared, then hæmorrhage taking place, the appearances of dementia were produced, these again in their turn to fade away as the clot became absorbed.Another point of interest in this case is the fact of the occurrenceof traumatic pachymeningitis in a patient lacking a well- marked predisposition.As regards diagnosis, this case appears to be one of well- definedsymptomatic mania, the disease being pachymeningitis, the mania onlya symptom. In two cases, with similar delusions, one may be diagnosedas symptomatic; the other as due to organic disease, by the absencefrom, or presence in, at their outset, of those evidences of loss ofintellectual power, often seen in old standing cases , or early in thecourse of general paralysis .1876.]157PART IV. -NOTES AND NEWS.THE MEDICO- PSYCHOLOGICAL ASSOCIATION.A quarterly meeting of the Medico- Psychological Association was held in the Royal College of Physicians, Edinburgh, on Tuesday, the 14th of December.Among those present were Drs. Jamieson, Clouston, Fraser, Batty Tuke,Ireland, Frd. Skae, Anderson, Thomas Howden, J. A. Campbell, Layco*ck,McDowall, Brodie, Grierson, Maclaren, Denholm, Stewart, and Professor Cal- derwood.On the motion of Dr. IRELAND, Dr. LAYco*ck was called to the chair.The minutes of last meeting were held as read.EXHIBITION OF PATHOLOGICAL SPECIMENS.Dr. CLOUSTON showed the brain of the epileptic patient, whose case was described in the " Clinical Notes and Cases" of the Journal for October, 1875(p. 427) . Dr. Clouston then showed two microscopic specimens, being sections made by Dr. J. J. Brown, of Morningside. The one showed innumerable smallapoplexies in the spinal cord of a kind not previously described, and the other miliary sclerosis affecting the medulla in a case of general paralysis, where the sclerosis followed the peripheral nerve- fibres inwards, and also followed the course of the small arteries.REFLEX AUTOMATIC AND UNCONSCIOUS CEREBRATION.The CHAIRMAN then said, an interesting paper on " The Unilateral Phenomenaof Mental and Nervous Disorders," by Dr. Archibald Robertson, indicates afield of observation which Asylum Superintendents might very usefully occupyon a systematic plan. Many years ago I worked at these unilateral phenomena,and have a chapter on the subject in my " Treatise on the Nervous Diseases ofWomen" (p. 199) . I venture to suggest a few points of not difficult observation.The physiognomical diagnosis of unilateral diseases might be helped by observ- ing the unilateral development, atrophy, or other conditions of soft parts like the ears and nostrils, or the development and colour of the hair on head andface. It is seldom that the two ears are alike in size or form or development of lobe or helix. Thus there may be a soldered lobe on one side and a 66 wattle"or unsoldered lobe on the other. When this is so, it is most usual for the cerebralor encephalic disease to be on the same side as the soldered lobe. In the "Medical Times and Gazette" for 22nd March, 1862, I have given illustrations of various kinds of ears. Hæmatoma may also be unilateral. I have observedin cases of encephalic diseases hæmatoma of the ear on the same side as thesymptoms. The experiments of Brown Sequard tend to show that there is aspot in the restiform tract which regulates the circulation in the ears of rabbits.The distribution of the hair on the face corresponds obviously to nerve- centres.It is usually thinner on the left than on the right side. So also as to colour and greyness . One whisker may be greyer than the other. A medical friend informs me that he had a neuralgia on both sides of his face, and that hiswhiskers turned so grey that he shaved them off; his moustache and chin beardbeing unaffected. Lately attention has been directed in " Nature" to the proportions of the hand and fingers, but more especially of the index to the ring finger. The varying proportions observed have been thought to be due to race,but it is more probable that the special uses of the hands determine these.Here, again, the two sides differ in proportion, size, &c. The easiest and surest plan of observing the proportions of the hands would be to place each hand flaton a piece of stout paper with the palms downwards, and the thumbs placed158 Notes and News [April,.close to the index finger, and then to mark the outlines in pencil; or thethumb may be placed at a fixed distance from the index, say an inch, measured at the tip of the thumb. Ears might be either photographed or casts taken.In either case it would be well to notice the line of direction of the long axis of the ears to the cranium, which from much observation I have concluded isethnic, and in relation to the form and set of the nose. Other points might be named, but these are enough for illustration.Professor LAYco*ck then read a paper on " Reflex, Automatic, and Unconscious Cerebration. " (See Originals, Pt. I, and January No., p. 477.)Dr. IRELAND, in the course of a few remarks upon Dr. Layco*ck's paper, said that his own position had been well enough defined by the title of his essay- " Can Unconscious Cerebration be proved?" Many processes might take placewithin the cerebrum of which we knew nothing; but when anyone asserted that such a process took place, the onus of proving it rested upon that person. Hewould not enter into the question of priority between Dr. Layco*ck and Dr. Carpenter; and one of the reasons why he had paid more attention to the ex- positions of the theory made by Dr. Carpenter, was that Dr, Layco*ck had mixedup his views on unconscious cerebration with his theory of reflex cerebral func- tion. Nevertheless there was no necessary connection between the two.Reflex cerebral action, as described by Dr. Layco*ck, might take place, and beattended with consciousness . Dr. Layco*ck had demurred to his remark that unconscious cerebration derived no support from physiology, but was based upon self- examination or inferences derived from it. But in those portions of his paper which Dr. Layco*ck had read to the meeting, there was nothing to show that this was erroneous. Dr. Layco*ck had asserted that the examinationof certain mental processes resembled those which the chemist made upon visible matter. In the case of the chemist certain re-actions could be seen totake place within the test tube; but in the brain certain molecular changes were known as ideas. If any one could study these molecular changes, andtell their order, nature, and succession, that would be physiology; but to study them as ideas, and then to tell us that these ideas were the result of molecularchanges, was a mixture of psychology and physiology which he held in little esteem. He was apt to get impatient at explanations which still left everything to be explained. His own mind instinctively recoiled from any causal connec- tion between changes in the composition or arrangement of molecules and ourideas. He thought the learned professor's remarks on the teleological nature of organisms were well put. He had read one of Dr. Layco*ck's philosophicalpapers, in which he referred certain instincts in animals to a principle of un- conscious mind in the universe, which, like the force of gravity, is a property of matter, and like it probably dependent upon an immediate volition of the Deity.We were thus led back by the learned doctor to a purely immaterial conscious force as the real origin and final cause of what had been called reflex action and instinct. He could not clearly distinguish this from the old axiom-Deusanima brutorum. Dr. Layco*ck had a great talent for detecting analogies; but these analogies appeared to himto be often too loose. He often reminded himof the speculations of ancient Greek philosophers. The Greeks, in their dearth of observations, explained the phenomena of the physical world by generalisa- tions taken from mental processes, such as the relations of form and number.Dr. Layco*ck seeks to explain mental processes by analogies drawn from physicalscience. Dr. Layco*ck said that mental association was a process similar or identical to spinal reflex action. Well, he could see a certain loose resemblance;but the comparison looked better in the mouth of a poet than in that of ametaphysician. Dr. Ireland then went on to remark upon the great difficulty of proving that we have been unconscious of any past mental process. The state of double consciousness would always be in the way of any attempt like those made by Dr. Carpenter to infer the existence of unconscious cerebration from realised intellectual results, for it never could be proved that such results1876.]Notes and News.159were not worked out in states of dreaming or somnambulism, in which con- sciousness existed, though separated from memory. Dr. Ireland did not,as Dr. Layco*ck seemed to believe, entirely agree with Sir Wm. Hamilton's view that consciousness was retained even during sleep; but he thought it probable that a feeble condition of consciousness might remain at some times,getting weaker or stronger, or again lapsing into unconsciousness . He thought that the subject could not be studied without very searching self-examination.He had noted several instances in which people might hastily say that theiractions were not accompanied by consciousness, and yet, where, on reflection,it was found that they were so. A man had a heavy body in his pocket, andyet had no distinct consciousness of the weight; but ifthe weight were suddenly pulled out of his pocket by someone unknown to him he often noted the differ- ence, that is between the weight he formerly supported and the weight he now supported; but in order to make the comparison he must have known both the first weight and the second weight which he supported. He referred to a wellknown instance where a woman, who had lost sensation on one side, was apt to drop her infant when her eye did not rest upon it, showing that consciousness was necessary to a simple operation, which could easily be combined with otheractions. Dr. Ireland mentioned a case which had happened to him the otherday. He wrote a letter, promising to send an enclosure, and sealed it up.Almost immediately after he could not recollect whether he had put in the en- closure or not, and opened the letter; but on seeing the enclosure something in the manner it was folded immediately brought back to his memory that he hadbeen quite conscious when he put it in. There were generally several parallelobjects of consciousness, but the memory did not always follow all these parallel objects . In general those objects which were most attended to were best remembered.Dr. CLOUSTON said he was sure they had all listened with great pleasureto Dr. Layco*ck's paper, and that he thought they would all agree he hadmade out a remarkably good case in proof of his discovery of reflex functionas applied to certain parts of the brain; and thought there was no doubtthat in future the credit of making this discovery would be given to Dr.Layco*ck, and not to Dr. Carpenter; and that, in regard to the discovery of this and other similar functions of the brain which Dr. Layco*ck had made, they wereso much in accordance with the law of evolution as they now understood it, somuch in accordance with what Herbert Spencer had called the developmentfrom the hom*ogeneous to the heterogeneous, that they must be true. They coincided entirely with the whole lawof evolution as it was applied to biology. Dr.Layco*ck's discovery of reflex action, as applied to the higher functions of thebrain, followed its discovery as applied to the cord, his discovery of trophiccentres followed that, and, last of all, his generalization as to the thermal centres,all these generalizations formed a part not only of physiological discovery, but apart of the law of evolution, as it was understood . It struck him that there was one weak point in Dr. Layco*ck's paper. As he understood it, the Dr.claimed for himself to have distinctly stated the law of evolution in 1839. Hequoted the words of the passage, " chain of phenomena." Now he thought thatthe pointing out of a " chain of phenomena" and the statement of a law ofevolution, as now stated by Mr. Herbert Spencer, were two different things-asMr. Spencer would say the one is a being, the other is a becoming; the one isthe pointing out of a mere gradation; the other of a development; the one is aseries of phenomena, the other is a real law or generalization. In regard to theautomatic function of the brain it seemed to him that Dr. Layco*ck and Dr.Carpenter were using the same phrase in totally different meanings, and,therefore, they occupied different grounds. This applied also to the unconsciouscerebration, and when they jumped from the automatic to the unconsciouscerebration, they jumped from the region of physiology to the region ofmetaphysics. Dr. Ireland had sufficiently dwelt on this aspect of the question.160 [April,Notes and News.SirThe CHAIRMAN said Dr. Ireland seemed to have a difficulty in regard to thedifferences between physiology and metaphysics. There can be no doubt that these terms are often used in a vague way, whether they refer to method or subject of inquiry. Sir W. Hamilton dwelt fully upon that in his lectures. Thescience of phusis or nature-natura in Latin-has both a general and a limited scope. Primarily it was general, and was the science of the laws which govern thematerial universe. Hence, physiology and physics-ta phusica-what belonged to phusis or nature corresponded formerly to what are now known as the philosophy of nature-natural philosophy-the natural sciences. The wordmetaphysics, merely denoted ta meta phusica-what came after the phusica in Aristotle's works, and thus another subject and method was differentiated.Now the mental physiology of the present day, so far as it includes memory and other cerebral phenomena, are termed in Aristotle the less phusica, or" Parva naturalia." But phusis and natura are words which denote laws in the sense of order of development or genesis, and, therefore, mean also evolu- tion, and more especially the things that are about to be evolved -naturabeing the plural of the obsolete naturus. The word metaphysics, as now com- monly used, means, in regard to method, the acquisition of knowledge of mental phenomena by speculation or thinking about them; more especially in a widersense by thinking ahout those phenomena of nature which are beyond observa- tion or experience. From this point of view Mr. G. H. Lewes has proposed tosubstitute the term metemperics-that is to say, beyond experience -for theword metaphysics. Dr. Ireland has observed that it was utterly absurd to speak of any connection between atoms and consciousness. But not so absurdas it may appear, when it is remembered that atoms are metaphysical and metempirical things. No one has ever seen or felt an atom, nor even amolecule, which is a congeries of atoms united according to definite laws.Wm. Thompson has attempted to calculate from mathematical data the size ofthe molecules of water, but even that process is metempirical. There are, how- ever, two kinds of philosophical or metaphysical speculation, which are wholly different. The one starts with a fact of experience, i.e. , of something done-the other with a something thought, the common method. A knowledge of atoms isreached bythe first mentioned method. The thinker divides a piece of matter intotwo parts (here the Chairman divided a piece of paper). Then each half is thus further divided, and each sub-half is again divided, and so on, until the act or fact of division is mechanically impossible. But he can go on dividing inthought or imagination, and can thus repeat the process ad infinitum, conclud- ing necessarily that matter is thus infinitely divisible. This, then, is bothmetaphysical and metempirical. But, for the purposes of deduction and practical work, the mental process of subdivision must stop somewhere, and so at the point where it is stopped we say the particle of matter is indivisible further. Now this is simply the meaning of the word atom. All this whilethe atoms exist to us only in thought, and, as such, are inseparably connected with that state of consciousness upon which the thought depends. But allthought, however profound, requires brains -made up theoretically of thesemetaphysical or metempirical atoms-indeed, the more profound the thought,the more necessary are brains for the thinking. It was simply an impossibility that the " mongol" idiot woman (pointing to a cast of whose skull was on thetable) could have any reasonable notions of philosophy or of atoms. The Chair- man then proceeded to show that another source of the difficulties Dr. Ireland had found was in the vague and contradictory meanings attached to the words unconsciousness, mind, and the like, and thus confounding the states or con- ditions of the living man, named consciousness, with the cause of these conditions. What he had all along attempted to show was, that consciousness asusually and practically understood, is not a cause, but that causation must be put further back, and traced to a point of origin common to both the pheno- mena of life and of consciousness. This, in fact, was done long since in Greek1876.]Notes and News. 161philosophy, and by St. Paul, one of the greatest of both Jewish and Christian philosophers of his time. The Chairman also reverted to the philosophy of evolu- tion as a philosophy of the causes of the phenomena of life, and which, taken in connection with the correlation of physical forces, first shown by Faraday in modern times, will give a new view to many questions of the day, as has been already shown by the philosophical works of Herbert Spencer. He thought itonly right to observe, however, that the same method was followed by him forty years ago, and that he had acquired much information from the writings of philosophers of the 17th century, when the discoveries of Newton led to changes in philosophy, and to discussions like those of the present day. The doctrine that motion or energy is indestructible, and is never lost, but only transferred, wasexplicitly stated by Grew in his Cosmologia Sacra. What he (the Chairman) had developed most especially in regard to mental science and the practice of medicine, both in mental and general diseases, was the doctrine of the law of reversion as correlative with that of evolution, and of both as correlative withthe laws of development and nutrition, not only of all living things, and of granules and cells, but of the molecular evolution and reversion of their chemicalconstituents. Here was a field for working at what comes before us in daily life, which is " the prime wisdom." There are insuperable difficulties , doubt.less, in the way of ascertaining the relations between conciousness and organi- sation, some of which the Chairman named, but it was a serious fallacy in method to conclude, from our ignorance of things, that they are non- existent.He did not say, therefore, that plants are unconscions, because that which in us corresponds to vegetative life is so. He could not, in fact, solve the question,except metempirically, or by speculation, but if he were obliged to come to aconclusion on the question, the answer would be a modified acquiescence in theaffirmative, assuming also that there may be very different states of conscious- ness from those of mankind.CASE AND AUTOPSY OF A KALMUC IDIOT.At this stage Dr. JAMIESON, of Aberdeen, took the chair.Dr. FRASER read a paper on a " Case and Autopsy of a Kalmuc Idiot. " (This will appear with illustrations in a future number.)Dr. IRELAND said, that in the absence of Dr. Brodie, he wished to make afew remarks. The paper had interested him extremely, and he hoped it would open the field for a new type of idiocy. He believed this co- relation of structure sometimes gave a clue to a line of research. It was difficult to see theconnection between the different peculiarities which Dr. Fraser had so carefully studied. But it was possible that by comparing them with healthy individuals they might be able to get at a specific generalisation. He could not say that he ever met such a type or felt in his own mind the necessity of classifying it .But the subject was almost entirely new to him, and he would certainly look and see whether he could find any members of the class which Dr. Mitchell andDr. Fraser had described. He did not think that there were any Kalmucs inthe East, and he thought they should exclude this kind of patronymic from the kingdom of Fife (laughter). He did not quite understand that all the featuresthat constituted a type had been observed by Dr. Mitchell. He certainly had good hopes that Drs. Mitchell and Fraser would yet work out something in regard to the matter worthy of notice. In regard to an allied type of idiocy he must say that he did not think he had seen cases of Cretins in this country.Some asserted that Cretins were a very distinct form of idiot. If they tried to describe the Cretin they would find that the exceptions were as great as the rule. He could not make out that they could prove the existence of Cretins in Scotland. He said if he were classifying the Kalmuc idiot he would put him under his own Congenital" class. He had stated his belief that the class ofcongenital idiots, when it was fairly worked out, would be resolved into twoor three classes. He would be very well pleased to see a sub-class of idiocy erected.XXII. 1166162 [April,Notes and News.The CHAIRMAN said it struck him that the term Kalmuc was a very objec- tionable term. He thought there was nothing marked adout the Kalmuc, and there was no reason for nicknaming an idiot by calling him a Kalmuc. He thought this uncalled- forterm should be departed from. Why did they call such an one a Kalmuc? The idiot is no more a Kalmuc than any other human being.Dr. FRASER-It is so called on account of the form of the eyes and the size of the head.IMPULSIVE INSANITY.Dr. MACLAREN read a paper on Impulsive Insanity."*The CHAIRMAN said he thought this was a very interesting paper, andhe would be glad to hear observations upon it . His own idea was that it was acase of epilepsy-a variety of epilepsy-and was one of those to which criminalinsanity belonged, and he asked whether the lady had been under any treatment at all."6Dr. MACLAREN replied that she seemed to have been greatly over-drugged.Dr. CLOUSTON said his idea was that it was most closely allied to epilepsy, butnot quite that disease. There were many of the features of the case that madeit very analogous to what was called automatism. Looked at from a physio- logical point of view the case was one of automatic and unconscious cerebration.On the previous day he had met the lady walking with two attendants. They had each hold of one hand, and seemed to be somewhat afraid of her. He toldthem to let go her hand and she would walk with him. She walked round theasylum grounds perfectly well except on passing a heap of manure, when she ran towards it and tried to take hold of the spade that was in it. He afterwardsasked her why she went tothe manure. " Well," she replied, " I never can passa heap of manure without an impulse to go to it, because when I was a girl I denied Christ." He asked " How?" She said, Because when I was oncetold some good thing had to be done, I made an excuse and would not do it. Iwent out after I had said so, and I thought that as I had denied Christ I wouldtake to very low work to make up for it, and the first thing that I saw was some dung, which I at once began to spread." It appeared that her pastor had quoted a particular passage of Scripture with reference to the meaning ofdenying Christ, and she had never passed a heap of dung ever since without having an impulse to go and spread it, thinking at the same time of that passage, and repeating it aloud. This was certainly an automatic action of the brain, or, as some physiologists would call it , a reflex action, and illustrated themorbid brain- working which resulted in those impulsive acts, described by Dr.Maclaren. I believe she had been heavily drugged by bromide of potassium ,chloral, and other drugs. Since she came to Morningside she had got scarcely anything of that kind; nothing but fresh air and food , and in some respects,she was better in regard to her mental state, but these impulsive attacks cameon, and during each of her conditions the very same association of ideas and reflex acts occurred. In the one case she was conscious, and in the otherunconscious, which was very interesting as regards the mode of action of the higher centres of the brain, that being entirely independent of what is called consciousness. He thought the paper was very interesting and well written.Dr. CAMPBELL said that there were many people who believed that hæmatoma was caused by injury. Now he would like to know Dr. Maclaren's experienceon that subject in regard to what he had seen at Morningside. He directed attention to the occurrence of impulsive acts the result of masturbation.Dr. MACLAREN said his opinion was that it might occur independently ofinjury.LUNACY ACTS.Dr. SKAE then read " Remarks on Lunacy Acts (Scotland) ," by Dr. Rorie.The CHAIRMAN said it was a great practical inconvenience to certify every.See " Medical Times and Gazette, " Jan., 1876.1876.]Notes and News. 163body to be insane after they had been three years in an asylum, and he thoughtit was a piece of unnecessary legislation.Dr. SKAE thought the tendency was more and more now-a-days to find out that the insane, instead of being put into an asylum, might, to a great extent,be properly treated at home, and that perhaps would increase as a knowledge of insanity spread among the people. He would look with apprehension to the probability of everybody whois insane being put into an asylum, as they would not know where to stop (laughter) .Dr. CLOUSTON said, with reference to paralytics and other broken downspecimens of humanity of that kind, that it might be a subject of con- sideration whether it was a philanthropic and merciful thing to havethem sent to asylums. He said that on coming to Scotland he was struck with the extreme licence given in regard to the release of patients. He could not realise, when he came here, that while the placing of a pauperlunatic in an asylum required the sanction of the sheriff and two medical men, the discharge of that lunatic was scarcely provided for at all. Therewere no legal documents and no formal procedings by whichthey should regulate the matter. That struck him as being a very anomalous thing in law. Hethought the annual certificate was a useless form, whatever was the intention.He did not think that many Superintendents of asylums gave much considera- tion in going over the cases, but certified them as a matter of course. The only benefit the regulation had, was that it gave them a handle in regard to inspectors of the poor, so that they could say that they were unable conscientiously to certify certain cases .A YEAR'S EXPERIENCE OF THE DISUSE OF AIRING COURTS.Dr. SKAE then read a paper by Dr. FRASER, on " A Year's Experience of the Disuse of Airing Courts.'The CHAIRMAN said he had never found any inconvenience from the use of airing courts. His asylum was very near a large town, and his grounds wereonly 40 acres at the outside. He never experienced any difficulties in connec- tion with the use of the airing courts; the deaths were very few, and he ad- hered to his present arrangement. He had no " airing court diseases."Dr. IRELAND said, with reference to Dr. Fraser's experiences, that the question might arise whether there were no patients for whom airing courts werenecessary. There might be patients who would do better out of the courts, butwere there none who would do better in them? If so, he did not see whysuperintendents should pull down the walls of their airing courts.Dr. HOWDEN, Haddington, said he had never seen a case in which the airing courts were really required, and the walls of his airing court would be taken down in the course of a day or two. He had no cases of general paralysis.Dr. CAMPBELL said he thought that those in a state of paralysis and acute excitement were safer in the courts than they would be otherwise.Dr. ANDERSON said he had abolished airing courts to a considerable extent,and made them rather to resemble gardens. He would like if the courts werealtered so as to be as much like gardens as possible, and be open from the Asylum, on the principle of there being greater freedom to the patients in that way.Dr. CLOUSTON had not quite abolished the airing courts, but he thought the less they could use these courts the better, except as gardens, and for certain exceptional, acute, and excited cases. He thought that if the airing courtswere of such a kind that the inmates could sit and enjoy themselves in themon a warm day they would be pleasant and good things; but he thought the old system of airing courts in some asylums was very objectionable, and led to many of the results which Dr. Fraser had mentioned. Since he came toMorningside he had greatly diminished the use of airing courts, and abolished them altogether for the higher class of patients. During the months of164 Notes and News [April, .November, December, and January they did not allow the patients to sit out- side; but as much as possible during the year they allowed them to go out into the garden, and his experience tended to bear out Dr. Fraser to a great extent in his principle, although that gentleman had perhaps contrasted in too vivid colours the former and the present state of the patients in the Fife Asylum (alaugh).Dr. SKAE then read the note of " A Case of Death from Undetected Injuries," which had occurred in his asylum (see Clinical Notes and Cases, p. 99);and a paper by Dr. FINLAY MURCHISON, entitled " What is our present position in reference to the Use of Mechanical Restraint in the Management and Treat- ment of the Insane?"THE MEETINGS OF THE ASSOCIATION.Some discussion took place as to the time at which the quarterly meetings of the Association in Scotland should be held; and it was agreed that the next one should be held in the first week in March, and the following one in the firstweek in October; and that after that they should be held in the first week ofFebruary, and first week of September; the hour of meeting to be one o'clock.Votes of thanks were then given to Dr. LAYco*ck and Dr. JAMIESON for presiding, and to the Royal College of Physicians for the use of the hall.The proceedings then terminated.THE IRISH LUNATIC ASYLUM SERVICE.It will be within the recollection of the readers of the " Journal of MentalScience," that at the Annual Meeting of the Medico- Psychological Association,whichwas held last year in Dublin, a paper was read by Dr. Stewart, of Bristol,on the subject of the Irish Lunatic Asylum Service. Dr. Stewart's paper, which was listened to with great interest, contrasted the position of English and IrishMedical Superintendents of Public Asylums, and pointed out that Irish Super- intendents were required to perform so many and such various duties that little time was left to them for the cultivation of the scientific branches of psycho- logy, that they are, for instance, held responsible for the discharge of duties that in England fall to the share of the Clerk to the Committee of Visitors,and to the Steward of the Asylum. English Medical Superintendents were somewhat surprised to find their Irish colleagues charged with the duty of making out voluminous returns, conducting the whole correspondence of their es- tablishments, paying the salaries and wages of the staff, managing the asylum farms; and that in the majority of Irish institutions for the insane, these duties had to be performed without even the assistance of a second resident medicalofficer. The fact of the meeting being held in Dublin, and the large number of Irish members of the asociation who were present, led to a long discussion uponthe subject- matter of Dr. Stewart's paper, and the Irish Superintendents were gratified to observe the warm interest manifested in their behalf by the English and Scotch members of the Association present. For the information of thosewho were not able to attend the Annual Meeting, we may observe that the position of Medical Superintendent of Irish District Asylums, until the discussion of lastyear, had been little known or understood by their English brethren. In England the appointment of Superintendent rests in the hands of the Committee of therespective Asylums-he is their officer, entirely under their control, and is paid by them. Whether this is in accordance with the most advanced ideas of asylum management or is the best possible relative position, either for the medical menthemselves, or the patients under their care, may perhaps be a matter of doubt.In Ireland the case is very different; there the appointment of Superintendent is made by the Lord Lieutenant; the Superintendent holds his office fromGovernment, is dismissed only by order of the Lord Lieutenant, is responsible1876.]Notes and News. 165to him, but receives his pay from the county cess levied for the general support of the Asylum-an anomalous position, and one which, in these days of change,can hardly be expected to last.The Irish Superintendents, alive to the necessity of speedy action, and with the view of improving their position, in the event of approaching legislation,determined to lay their case before the Chief Secretary.A meeting having been convened on the last day of November, and Dr. Lalor having heen called to the chair, the following, amongst other, resolutions were unanimously passed:--- -Cory of Resolutions passed at a Meeting of Medical Superintendents of Irish Lunatic Asylums held in the Hall of the King's and Queen's College of Physicians, on Tuesday, Nov. 30th , 1875.RESOLUTION No. I. -That a Committee be appointed to further the interests of the Irish Superintendents.RESOLUTION NO. II. -That Dr. Courtenay be appointed Secretary and Treasurer.RESOLUTION No. IV. -That we, the Resident Medical Superintendents of District Asylums in Ireland, being Government Officer , appointed under warrant of the Lord Lieutenant,respectfully request that our Salaries may be paid by the Government out of the Capitation Grant now paid to the several Asylums.RESOLUTION No. V.-That we think it advisable that Assistants to Resident Medical Super- intendents should be appointed to all the Asylums, in order that Privy Council Rules 47 and 50 may be carried out in their integrity; and that in Asylums containing more than five hundred patients there should be two, and, when more than a thousand, three Medical Officers, in addition to the Superintendent.RESOLUTION No. VI. That we call the attention of the Government to the omission of any provision for the Salaries of Medical Superintendents of Irish District Lunatic Asy- fums containing over eight hundred patients, and that we consider our pay should increase in proportion with the number of our patients, no matter how large the Institution.RESOLUTION No. VII. -Weconsider that No XXXV. of the Privy Council Rules and Regulations for the management of District Lunatic Asylums in Ireland is most objectionable,placing us on the same footing as the Matron with regard to leaving the Asylum.And we further think, that the words in Rule XIII. " She shall not absent herself from the Asylum at the same time as the Resident Medical Superintendent, " should read " She shall not absent herself from the Asylum without the leave of the Resident Medical Superintendent."The meeting, convinced of the necessity of the co-operation of their wholebody, so as to make their case as strong as possible in the eyes of the public,directed their Secretary to forward the following letter to each Irish Superin- tendent:-9th December, 1875.SIR, -I am directed to forward you a Copy of certain Resolutions, passed at a Meeting of Irish Resident Medical Superintendents, held at the College of Physicians, on Tuesday, No- vember 30th, 1875, and to inform you that a Deputation, consisting of Drs. LALOR, TYNER,EAMES, ROBERTSON, and COURTENAY, waited afterwards upon the Inspectors of District Lunatic Asylums, when these Resolutions were submitted for their consideration and advice thereon, and I amhappy to have to state that the deputation was favourably received by them;on consultation, it was deemed advisable to turn all our efforts to obtaining the end pointed out in No. IV. Resolution, as, that being granted, the question of Superannuation would of necessity follow.Having decided to wait upon the Chief Secretary at the earliest opportunity and urge our claims, I will communicate to you, when SIR MICHAEL HICKS BEACH will be willing to receive that deputation, when it is earnestly requested you will attend, as our success, to a very great degree, will depend on the unanimity and co- operation we evince in pressing our claims.With reference to Resolution No. VII. , it was, of course, only intended for the consideration of the Inspectors.I am, Sir, your obedient servant,E. MAZIERE COURTENAY, M.B.,Hon. Sec. and Treasurer.At a meeting subsequently held at the King and Queen's College of Physiciansin Ireland, it was resolved to press upon the attention of the Chief Secretary for Ireland the desire of the Irish Medical Superintendents that their salariesshould form a first charge upon the capitation grant of four shillings per head,which Parliament had voted on the suggestion of the Chancellor of the Ex- chequer, in relief of the local burthen falling upon county cesspayers. It wasfelt by the Irish Superintendents that, if they could carry this point, their claim to be placed upon a more favourable footing as to superannuation would followas a matter of course, inasmuch as their being paid their salaries out of the166 [April,Notes and News.Consolidated Fund would, at one step, constitute them civil servants, and bringthe scale on which they could retire within the terms of the Act 22 Vict. , ch. 26.Resolving, therefore, to concentrate their efforts, so far as the Chief Secretarywas concerned, upon this important point, the following memorial was drawnup and signed, we understand, by 22 out of 24 Irish Superintendents ofAsylums:To Sir MICHAEL HICKS BEACH, Bart. , Chief Secretary for Ireland.The Memorial of the Resident Medical Superintendents of District Lunatic Asylums in Ireland,RESPECTFULLY SHEWETH ,That our position at present is an anomalous one, different from any other Branch of the Service, as we are appointed by the Lord Lieutenant and responsible to the Government, but are paid by the Rate- payers.That by reason thereof we are deprived of the benefit of the Superannuation Act of 1859,not being recognised as Civil Servants, as our Salaries are not paid through the Treasury, and we can therefore only obtain a Pension under the Act of 30 & 31 Vict. , cap. 118, sec. 8, under which Act we must hold office for Forty Years in the same Asylum before we can obtain two- thirds of our salary as Superannuation, whilst our Brethren in England are entitled to the same pension after Fifteen Years Service ( 25 & 26 Vic. , cap. 3, sec. 12) .That the Public Service suffers from the present state of the law, as senior men of many years' experience refuse the charge of larger Asylums, knowing that by removing from one Asylum to another they would forfeit their right to a pension should the length of their ser- vice not extend to forty years in the latter.That the Government now contribute so large a share through the Capitation Grant to the support of District Asylums (about two-thirds of the whole amount) , the payment of the Medical Superintendents out of that Grant would cause no increase of expenditure.That the Poor Law Medical Officers of Unions in Ireland, who are not appointed by Govern- ment, and over whom the Executive have no control, receive half their salaries from the Consolidated Fund.Memorialists therefore respectfully request that you will take this matter into your favour- able consideration, so that steps may be taken if it be deemed right that our salaries be in future paid bythe Government out of the Capitation Grant, now paid to the several Asylums.AND MEMORIALISTS WILL EVER PRAY.It will be observed that another most important object would be attained bythe success of the effort thus made to have the salaries of the Irish Superintendents paid out of the rate-in- aid. Such salaries would cease to be a local charge,and, in the event of an Irish Superintendent being transferred from one asylumto another of greater magnitude, or of greater difficulty of management, thenumber of years that he had served in one county would not be lost to him onhis transfer. He might be moved as often as the executive thought fit, andfinally superannuated upon the whole term of his service. At present, a Superintendent serving for 20 years in one county, and afterwards transferred to amore difficult and responsible post, where he might serve say for 10 years longer,would, upon superannuation, lose the whole of the 20 years ' service. This hasall along been felt to constitute a very real grievance, inasmuch as it imposeda penalty upon promotion, and induced very able Superintendents to remain insmall asylums, where their length of service had given them a claim to somesuperannuation in the event of their being unable to continue the active discharge of their duties.Early in February the Chief Secretary signified his readiness to receive the deputation, which accordingly waited upon him. Dr. Lalor ably represented the views and wishes of the Irish Lunatic Asylum Service; but, in the shortaccount of the interview that has reached us, we remark that the Inspectors of Irish Asylums are conspicuous by their absence. We may be permitted to observe that, upon such an occasion, we should have expected to find one or both of the Inspectors present, and prepared to support the very reasonable and respectfully urged request of our Irish brethren. The Chief Secretary forIreland, while receiving the deputation with marked courtesy, said that he didnot at present feel prepared to legislate further on the subject of Irish Lunacy,and that when the opportunity for so doing might arise, the wishes of the depu- tation should be borne in mind; and, at the same time, he remarked upon the absence of any representations from the Boards of Governors of Irish Asylums on the subject of the memorial. We counsel our Irish friends to take the hint,1876. ]Notes and News. 167and to secure the support of their respective Boards. In a matter which does not directly increase local burdens, we should imagine that the various Boards would be found willing to assist their officers. It is not improbable that further legislation may be in contemplation with regard to the Irish Asylum Service,and we venture to think that the suggestion thrown out by the Chief Secretary will, if generally adopted, strengthen his hands in carrying out the wishes of our Irish confrères .EFFECTS OF COLOURS ON THE INSANE.The "Gazette des Hôpitaux " contains a curious article on this subject. Dr.Ponza, director of the lunatic asylum at Alessandria, Piedmont, having con- ceived the idea that the solar rays might have some curative power in diseases of the brain, communicated his views to Father Secchi, of Rome, who replied inthe following terms: -" The idea of studying the disturbed state of lunatics inconnection with magnetic perturbations, and with the coloured, especially violet, light of the sun, is of remarkable importance, and I consider it well worth being cultivated. " Such light is easily obtained by filtering the solarrays through a glass of that colour. " Violet," adds Father Secchi, " has something melancholy and depressive about it, which, physiologically, causes low spirits; hence, no doubt, poets have draped melancholy in violet garments.Perhaps violet light may calm the nervous excitement of unfortunate maniacs. "He then, in his letter, advises Dr. Ponza to perform his experiments in rooms the walls of which are painted of the same colour as the glass panes of the windows, which should be as numerous as possible, in order to favour the actionof solar light, so that it may be admissible at any hour of the day. The patients should pass the night in rooms oriented to the east and south, andpainted and glazed as above. Dr. Ponza, following the instructions of the learned Jesuit, prepared several rooms in the manner described, and kept several patients there under observation. One of them, affected with morbidtaciturnity, became gay and affable after three hours' stay in a red chamber;another, a maniac who refused all food , asked for some breakfast after having stayed twenty-four hours in the same red chamber. In a blue one, a highlyexcited madman with a straight waistcoat on was kept all day; an hour after he appeared much calmer. The action of blue light is very intense on the opticnerve, and seems to cause a sort of oppression. A patient was made to passthe night in a violet chamber; on the following day he begged Dr. Ponza to send him home, because he felt himself cured, and indeed he has been well ever since. Dr. Ponza's conclusions from his experiments are these:-"The violetrays are, of all others, those that possess the most intense electro- chemicalpower; the red light is also very rich in calorific rays; blue light, on the contrary, is quite devoid of them, as well as of chemical and electric ones. Its beneficent influence is hard to explain; as it is the absolute negation of allexcitement, it succeeds admirably in calming the furious excitement of maniacs,"-English Mechanic, March 3rd, 1876."The curious oriental reds, yellows, blues, and greens in glasse- painting,especially when the sun shines, doe much refresh the spirits. After thismanner did Dr. R. revive the spirits of a poor distracted gentleman, for whereas his former physician shutt up his windows, and kept him in utter dark- ness, he did open his window lids and let in the light, and filled his windowswith glasses of curious tinctures, which the distempered person would always be looking on, and it did conduce to the quieting of his disturbed spirits."-Aubrey, in Anecdotes and Traditions; Camden Society Edition, p. 96.Dr. Symes Saunders of the Devon County Asylum has made ingenious use ofthis quotation from Aubrey; having placed it at the head of a subscription list for stained glass windows to be placed in the new Chapel.168 Notes and News.Appointments.DAVIES, F. P., M.B., C.M. , M.R.C.S.E., has been appointed Medical Super- intendent of the Kent County Asylum, Barming-heath, near Maidstone, vice W. P. Kirkman, M.D., resigned.MAJOR, H. C. , M.D., has been appointed Medical Superintendent of the West Riding of Yorkshire Lunatic Asylum, Wakefield, vice Dr. Crichton Browne, ap- pointed a Chancery Visitor of Lunatics.MILES, G. E., M.R.C.S.E. , has been appointed Assistant Medical Officer to the North Wales Counties' Lunatic Asylum, Denbigh, vice Ellis, resigned.WOOD, T. O., M.R.C.P.Ed., F.R.C.S.Ed., M.R.C.S.E. (Assistant Medical Officerof the Kent Asylum, Maidstone), has been appointed Resident Medical Superintendent of the Isle of Man Lunatic Asylum, Douglas, vice Harrison,deceased.YOUNG, A., B.A., L.S.A.L., has been appointed Second Assistant Medical Officer to the Kent County Lunatic Asylum, Barming Heath, vice Wood,resigned, on being appointed Medical Superintendent of the Isle of Man Lunatic Asylum, Douglas.THE W. AND S. TUKE PRIZE ESSAY.EXTENSION OF TIME.Some of the descendants of WILLIAM and SAMUEL TUKE (the former of whomproposed the establishment of the York Retreat in 1792, and the latter wrote the "Description " of the humane system of treatment commenced there) having placed at the disposal of the Medico- Psychological Association the sum of One Hundred Guineas, the Association offers a prize of this amount for "The best series of original Cases and Commentary, illustrative of theSomatic Etiology of various Forms of Insanity, accompanied, when possible,in fatal cases, by reports of post- mortem examinations and microscopical pre- parations-their bearing on the symptoms being pointed out. "Cases not seen by the writer may be cited, but must be distinguished from those actually witnessed by himself.The W. and S. TUKE PRIZE is open to all without restriction as to country,profession, &c., but the right is reserved to withhold it, should there be no essay of sufficient merit. Essays, to be written in English, and not in the author'shandwriting, to be sent in a sealed envelope, bearing the motto of the essay,containing the name of the writer, to the undersigned, not later than June 30th, 1877. The microscopical preparations, but not the essay, to belong to the Association.Bethlem Royal Hospital, London,Dec., 1874.W. RHYS WILLIAMS, M.D.,Hon. Sec.It will be observed that the time at which Essays are to be sent in has beenextended from June 30th, 1876, to June 30th, 1877.THE MEDICO- PSYCHOLOGICAL ASSOCIATION.On Wednesday, May 10th, there will be a quarterly meeting of the Medico- Psychological Association at Bethlem Royal Hospital, London, S.E., when Dr. T. C. Shaw will read a paper on " The Measurement of the Palate; " and Dr.Hack Tuke a paper on " A Short History of Bethlem Royal Hospital." Notices of further papers to be sent to the Hon. Sec. , Dr. W. Rhys Williams.ERRATUM. -The name of JOHN M. DIARMID, at the head of the second OriginalArticle, should be JOHN MCDIARMID.ERRATA.DR.LAYco*ck'S PAPER, JANUARY, 1876.Page 483, line 7, from top-For arguments like these, read arguments like those39 ,, 13, from bottom-For 1851 , read 1852.99» 484,» 487,29 489,,, 491,29"939""1, from top-For by the preface, read in the preface.18, from top-For wholly excluding , read wholly excludes.17, from top-For must fully admit, read most fully admit.17, from bottom-For αὶτοματος read αὐτοματος.,, 492, lowest line-For 14 and 16, read 14-16.

Journal of Mental Science NoXCVIII.KALMUC IDIOT.Farlane & Erskine Lith Edin?THE JOURNAL OF MENTAL SCIENCE.[ Published by Authority ofthe Medico- Psychological Association. ]No. 98. NEW SERIES, No 62. JULY, 1876. VOL. XXII.PART 1. -ORIGINAL ARTICLES.Kalmuc Idiocy: Report of a Case with Autopsy. By JOHNFRASER, M.B. With Notes on Sixty-two Cases. By Dr.ARTHUR MITCHELL, Commissioner in Lunacy.My attention was directed to this case by Dr. ArthurMitchell, Commissioner in Lunacy, in the course of hisofficial visit last spring. He informed me that it was one ofso-called Kalmuc idiocy, a form of idiocy rarely met within asylums, but nevertheless not really uncommon. Dr.Mitchell pointed out in this case the distinguishing physicalcharacters of this class of idiots. Some of the more prominent of these are obliquity of the eyes and palpebral slits ,shortness and flatness of the nose, depression at its root,broadness or squatness of the hands, transverse fissuringof the tongue, shortness of stature, disproportion betweendifferent parts of the limbs, smallness of the head, andshortness of its antero-posterior measurements. Certainmental characteristics are said to be very constantlypresent, and these will be referred to in the details of thecase. The peculiarity of the eyes and nose give the facea Kalmuc look, and hence the name.After having my attention thus drawn to this case, Iendeavoured to obtain the literature relating to this form ofidiocy, but without success. Dr. Mitchell, however, hasnotes, casts, photographs, sketches, &c. , of a considerablenumber of cases . He has given me in a letter a digest ofthese notes which he has permitted me to append to thisreport. The lithograph is from a photograph kindly lent meby Dr. Mitchell.Report of Case.Elizabeth Meldrum, aged 40; admitted 18th Feby., 1875; fromFerryport-on-Craig, Fife; died, 29th March, 1875 .History. The following is all I have been able to gather regardingXXII. 12170 Kalmuc Idiocy, with Notes, [Julythe patient. She was an illegitimate child, and parturition at her birth is said to have been normal. Her mother, who died some timebefore the patient's admission into the asylum, is said to have sufferedremorse and mental pain during her pregnancy, and to have expiatedher sin by constant and affectionate care of her unfortunate offspring.Physical Condition.-Patient was a short slenderly made womanin fair condition, weight 6st. 12lbs. , height 4ft. 8 inches. Thetrunk was symmetrical but flattish; breasts small and firm, resemblingthose common in a girl in 12 or 14; upper limbs were short; arm very short in comparison with forearm; hands broad and short;fingers short, and when hand was placed on any flat surface, the fingersinclined to spread widely out; joints of fingers lax, and admitted ofabnormal extension, nails almond- shaped, short and curved inwards atpoints. Lower limbs were short in proportion to the trunk; thighshort in proportion to the leg. The foot presented the followingpeculiarities: the big toe was large in proportion to the foot; secondtoe was unusually long, third toe was half the length of the second;the fourth, half the length of the third, and the fifth or small toe wasof normal size (see sketch) . The fourth toe was curved downwards,and but a small triangular portion was left uncovered by the thirdand small toes. This peculiar deformity was symmetrical, and fromthe drawings of the feet of other Kalmuc idiots , it seems a deformitynot altogether uncommon among them.Her head was small and round. The asymmetrical condition ofthe head, which will be particularly referred to in the description ofthe skull, was not observed during life. The hair was fine, thin inquantity, and of a light brown colour. The ears were small andsimple in conformation.The following are the dimensions of the head:-1. Circumference in line of eyebrows, inside.upper part of ear and occipital protu- berance2. From root of nose to occipital protuberance3. From ear to ear over vault .4. Longitudinal diameter5. Transverse6. Diagonal diametersFrom right anteriorly to left posteriorlyleft anteriorly to right posteriorlyInches.191140112101615615급654478Dr. Mitchell pointed out to me that the plane of the face and theplane of the back of the head tended to form two parallel lines. Thespace between these lines measured 63 inches.The face was almost square, the length to the breadth being 63inches to 43. Cheek bones prominent, and chin sharp and projecting.Forehead was rounded in outline and surface, and rose in a moderatelyJournal of Mental Science. N°XCVIII.SKULL, CAS , & FOOT OF E.M. A KAIMUS HIGM:Farine & Erskine Lith Edin!

1876.] by J. FRASER, M.B. and DR. MITCHELL .171straight manner. It was by no means a retreating or low forehead.Two peculiarities were at once noticeable, viz . , the obliquity of the palpebral slits and the broadness of the base of the nose. Thepalpebral slits ran outwards and upwards in a very marked manner.The inner canthus seemed drawn down. The eyebrows shared in thisobliquity. The eyes were small in comparison with the size ofthe orbits, colour of iris grey, and eye-lashes were absent. The bridgeof the nose was narrow, but inferiorly the base became broadened out.Mouth was small, and always pursed, lips thin and angles generally curved downwards.Interior of mouth presented the following peculiarities: the tonguewas long, thin, and much pointed. On the dorsum were numeroustransverse fissures, and on the left side about the beginning of theposterior half was a strip of smooth surface about an inch long, andthree-eighths of an inch broad. Only the incisor teeth were present,two in upper and four in lower jaw. Palate was not particularly arched.Physical examination as to the position, size, and condition of internal organs revealed nothing abnormal until her illness set in.Mental Phenomena. -Her intellect may be said to have been thatof a child from a year to eighteen months old. She could not speak,but she uttered sounds with volubility as if she were busily speaking,and when in anger she did this with emphasis and vehemence. Her sight and hearing were good. She remembered the faces of thosewho were kind to her, and of those who annoyed her, and soughtnotice from the former and avoided the latter. Her chief characteristic was an affectionate disposition . This was evidenced by herkind, contented, and happy expression, and by her grasping the handof any one who took notice of her, patting it, and putting it to her cheek. At times she had the peculiar habit of putting one's hand onthe back of her head, and indicating that she wanted it smoothed .Another characteristic was her love of decoration. Any brightarticle of dress she wore with jealous care, and drew every one'sattention to it. If any other patient had anything gay on, she alwayspointed to it.She is reported as being very fond of music.She continually sat in the corner of a bench next the fire, with herfeet under her. She had no sense of modesty, and her habits weredirty. She had a great hatred of water, and her struggles againstbeing bathed were strong and persistent. On admission she was extremely dirty, and I attribute the cause of death, acute pleurisy, tothe constant bathing which was rendered necessary by her habits.The description of the mental state would have been fuller, had thepatient been longer under observation. She died after about sixweeks' residence in the asylum.Post- mortem Examination. -After the full details given under thehead of " physical condition, " I need here only describe the skull andbrain, and incidentally refer to the viscera within the trunk.172 Kalmuc Idiocy, with Notes, [July,Head. -Scalp very thin. ( Sketch of cast of head as taken 14hours after death is to be seen in Plate 2. )Skull as a whole is very light, weighing, inferior maxilla included,only 1lb. Many parts are extremely thin, especially the roofs of theorbits, the wings of the sphenoid, and the fossa for the lobes of thecerebellum .The configuration is asymmetrical . The cranium seems as if it hadbeen grasped diagonally from left anteriorly to right posteriorly, andsqueezed. There is a flattening over the outer edge of the left orbitand right parietal eminence, and a slight bulging out at right frontal region and left parietal eminence. The internal fossa are unequal,the left occipital fossa is of an inch broader in the transversedirection than the right, and the right middle fossa is evidently broader than the left.The sutures of the vault are very open; slight force would separateeach bone. The frontal is open throughout its entire length, thoughthe age of the patient was forty. As many as five wormian bones are to be counted in each lambdoidal and squamous suture. At thebase, a wide interval exists between the petrous bones and the basilarportions of the occipitals. In these spaces, wormian bones of apparently poor cancellous tissue are to be found. The spheno-basilarsynchondrosis is not visible, nor is there any elevation or ridge tomark its site. The basilar bone seems normal in every particular.The suture between the lesser wings of the sphenoid and the frontal bone is open. From the state of all the sutures, it will be evidentthat the skull could have expanded in every direction. This case istherefore one not due to early ossification of any suture.Foramina of the base are large, especially the median and posterioron either side. Arterial foramina are normal.As regards individual bones, the most important peculiarity is the absence of the nasal bones. A small projection from the frontal boneseems to be their representation. (Well illustrated in sketch ofskull. ) The processus auditorius on each side is whiter than thesurrounding parts of the temporal bone, and these processes seem tohave maintained their individuality. The horizontal plate of thepalate bone is not arched, and the suture between the two maxillarybones at this part is complete. The inferior maxilla has the obtuseangle consequent upon an edentulous condition.The orbital cavities are normal, but the anterior nasal aperture is,comparatively speaking, large.The following are the measurements of skull: -Measurements of Skull.Inches.17111""115급External cranial circumference99 "" longitudinal curve transverseLongitudinal diameter

Journal of Mental Science NXCVIII.BRAIN OF EM. A KALMUC IDIOT.McFarlane & Erskme Lith's Edin .1876. ] by J. FRASER, M.B. and DR. MITCHELL. 173Transverse diameterBimastoid 29Bizygomatic ""Frontal 99Length of Hard PalateBreadth "Breadth of OrbitVertical width of OrbitDepth of Orbit.at widest part.Width of Anterior Nares at widest partVertical width of Anterior NaresWidth between orbitsInternal BaseDistance from Foramen Cocum to InternalOccipital ProtuberanceDistance from Foramen Cocum to Anterioredge of Foramen MagnumInches.5141814418 4341- LT141161161167g1165131841· 1111%11%5Distance from junction of Sup. Petrosal Sinus to Lateral Sinus on either sideAnterior-posterior length of Basilar Process29 "" diameter of Foramen Magnum ·Transverse diameter of Foramen MagnumBrain.The membranes were normal. Veins running into Sup. Longitudinal Sinus were engorged in consequence of the obstructive pulmonary disease of which the patient died.The organ is small, the whole encephalon only weighing 401 ozs.Consistence was normal, but configuration was asymmetrical , corresponding, of course, to want of symmetry described as appertaining tothe skull. There was bulging in right frontal and left parietal regions, and slight flattening in left frontal and right parietal lobes.Convolutions were slightly flattened when brain was removed. Thegeneral course of the gyri is comparatively simple. ( See drawing ofbrain. ) The sulci vary in depth; anteriorly many are very deep.The principal fissures are well marked, the external parieto- occipitalfissure on the left side runs outwardly for nearly two inches. Posteriorpart of both third frontal convolutions is very narrow; this taken inconnection with the patient's want of articulate speech is interesting.The island of Reil on both sides is small and undivided; no convolutions spring from its external margin. The superior gyrus ofboth temporo- sphenoidal lobes is very narrow.The base was carefully examined at time of removal, but the cranialnerves, pons, medulla, crura, and arteries presented no noticeableabnormality.174 Kalmuc Idiocy, with Notes, [July,On Section, the grey matter had a breadth of four to five millimetresanteriorly, and of three to four posteriorly. Being desirous of preserving the brain in its entirety, only few measurements with thetephrylometer have been taken, and only the tip of the right frontallobe was hardened for sections.Ventricles normal.Microscopic Examination of grey matter shows an average numberof tripolar and multipolar cells of apparently normal size, distinctness,and contents. Some have the usual yellow pigment. Nuclei ofneuroglia are not increased, nor is there any abnormal fibrillation .The perivascular canals are dilated, and the hyaline membrane is inmany preparations puckered and kinked .Cerebellum.-The left lobe is slightly longer in transverse diameterthan the right, otherwise this organ is normal.Sympathetic ganglia of the neck were removed. These were small,and the right superior one was half the size of the one on the left side .Thorax was symmetrical.Trunk.On opening cavity, 75 ounces of bloody serum was found in leftpleural cavity. Both costal and visceral pleura were coated with vascular flocculent lymph; organ collapsed. On section , substance wasfound to contain miliary tubercles in first or cartilaginous stage.Right lung was emphysematous anteriorly, and hyperæmic posteriorly. Miliary tubercles also present, but in lesser quantity.Heart was small, aortic valves fenestrated, otherwise normal.Abdomen.Though every organ was carefully examined, it is unnecessary todetail the state of each. I may mention, however, that the uteruswas small, or round, cervix uteri constricted , and that the ovarieswere small, and full of cicatrices of ovulation, but none apparentlyrecent.Notes by Dr. MITCHELL.1. I have a record of visits paid to sixty-two so- calledKalmuc idiots; and I have notes, more or less full, regardingthe physical and mental condition of fifty-four of the sixty- two. What follows is taken from these notes, and refers ofcourse to the class rather than to individuals.2. I think it almost beyond question that they are morecommon on the east side of Scotland than on the west.3. I have never seen a Kalmuc idiot in any Scotch asylum,except in that of the Fife and Kinross District, in whichthere have been two-Kinloch and Meldrum. In our insti-1876.] by J. FRASER, M.B. and DR. MITCHELL. 175tutions for imbeciles, so far as I can remember, I have onlyseen two.4. Of the fifty-four, thirty were males and twenty-four females.5. I think it nearly certain that they are short-lived. The oldest I ever saw was 43. The ages of the fifty-four areshown in the statement which follows:-AGES. M. F.0-10 ... ... ... 7 010-15 ... ... 5 615-20 ... 5 420-25 6 425-30 0 430-35 ... 5 435-4040-45... 1 1... 1

1530 246. Many of the fifty-four are now dead.Phthisis causeda large majority of these deaths. In not a few instances,however, death was attributed to nothing more definite thangeneral decay-a sort of precipitated senility.7. I have recorded the height of seven adult males andfifteen adult females. The males give an average of nearly4 feet 8 inches-the range being from 4 feet 2 inches to 5feet 3 inches. The females give an average of nearly 4 feet5 inches -the range being from 4 feet 1 inch to 5 feet 1 inch.8. I have various head measurements in the cases of elevenadult males and fourteen adult females. The average circumference of the male heads was 203 inches, and the rangewas from 19 to 21. The average circumference of thefemale heads was 19 , and the range from 18 to 20. Theantero-posterior relatively to the lateral diameters wereshort-that is, the heads were brachycephalic, as well assmall. I think this was almost invariably the case.9. In a large proportion of the cases, these idiots wererecognised as notably small and weak at birth. I convinced myself that this was almost certainly true of nineteenof the males and thirteen of the females. In other words,the condition appears to date from the intra-uterine life.10. Heredity as a cause does not appear with any specialfrequency in their history. My notes rather indicate the reverse.176 Kalmuc Idiocy, with Notes, [July,11. Kinship of parentage is certainly infrequent. No caseof the relation of full cousinship between the parents is recorded in my notes. In four cases, however, the parentswere related to each other as second cousins, and in othertwo cases a still more distant relationship existed. On thispoint I obtained information regarding fifty- one of the idiots.12. Of a considerable number I have noted that themothers were in a marked state of bad health duringpregnancy; in a state of bad health, however, which receivedno name, but of which it was always told to me that emaciation was a result.13. It not unfrequently happens that in the male adultKalmuc idiot only one testicl* descends. I have recorded thisof five cases. In one boy, ten years old, neither testicl* hadcome down. The hair on the pubes, in the axillæ, and onthe chin and cheeks, is generally scanty.14. Puberty is reached late and the menstrual dischargesoon ceases in the females, who never show active eroticism .My observations point clearly to this conclusion as correct. Ihave not known any case of a Kalmuc idiot woman having aa child. As in the males, so in the females also, the hair onthe pubes and in the axillæ is scanty. At the time of theestablishment of the menstrual discharge, however, plumpness appears, and the mammæ are fairly developed.15. The shape of the head-the position of the eyes-theweak sight-the condition of the tongue, teeth, and palatethe burr in articulation and the defective speech-the shapeof the hand snd feet- &c. , &c . , occur in the class generallyvery much as they occurred in Meldrum, but they are betterseen in idiots of the class who are somewhat younger thanshe was, and who have not begun to show signs of decay.16. The large, rough, red, hacked tongue is very constant.At one time I thought there was a uniformity of pattern inthe hackings, but the drawings I made show that this is not the case.17. In no instance did I find that the hand or foot differedin character from what was seen in the case of Meldrum. AsI made numerous casts and drawings I was led to lookminutely into this point. I refer here only to the shortnessand broadness of the hand and foot.18. Many of the fifty-four were photographed for me, andof others I had large chalk drawings made. Both the photographs and drawings were the work of country artists, andwith the exception, perhaps, of the little photograph I1876. ] by J. FRASER, M.B. and DR. MITCHELL. 177gave you (the name of patient I have omitted to preserve)not one of them can be called successful.19. The concurrent constancy of a characteristic conditionof mind with a characteristic condition of the body is whatgives interest to this form of idiocy. The mental state is asdistinct, as peculiar, and as steady as the physical. If thefifty-four were brought together they would be found to resemble each other strikingly in personal appearance. Butmore than this , they would also be found to resemble eachother in character, in capacity, in likings and dislikings , inhabits, in defects, in aptitudes, &c.there are,20. They are not cretins, but I can quite understand thatthey might be held to be cretinoid idiots . Of full cretinsI think, only from 12 to 20 in Scotland, appearing preferentially in no particular district. Not one of the fullcretins seen by me in Scotland was goitrous. The same was true of the Kalmuc idiots. But both full cretins and cretinoididiots occur, even in strongly goitrous districts, without exhibiting in themselves any trace of goître. Cretinism is aform of idiocy which affects goitrous districts, but whichmay present itself anywhere. When goître is associatedwith cretinism, it is as an accident of the idiocy . That accident, of course, will present itself with frequency wheregoître prevails, which it usually does where cretinism pre- vails. Goitrous persons are not necessarily cretins or cretinoid; and cretins or the cretinoid are not necessarilygoitrous. It is even a question whether in a goitrousdistrict, the proportion of the cretins who are goitrous isvery much greater than the proportion of the goitrous in thegeneral community. It is quite possible, therefore, to regardthe Kalmuc idiots as cretinoid, though they show no tendencyto goître. I do not say that they should be so regarded;but at the same time I recognise certain points of alliancebetween the mental and physical states of so- called Kalmuc and of cretinoid idiots.21. Only two of the fifty-four are recorded as illegitimates,but I scarcely think that this can represent the case truly.Of idiots and imbeciles of all sorts in Scotland, one in everysix is born out of wedlock. There can, however, be no specialconnection between illegitimacy and Kalmuc idiocy, for(putting aside the fact that I have not recorded anythingto show such a connection, which might be an omission,and is at best negative evidence) , I find that I have in a largen umber of cases recorded the idiot's position in the family178 Kalmuc Idiocy, with Notes, [July,of which he was a member-that is, whether he was firstborn, last born, or neither first nor last. The facts so recordeddo not point to the frequent occurrence of illegitimacy.22. Some of these facts are grouped in what follows:-(a) Six of the idiots are given as first born.(b) Twenty as the absolutely last born in families consisting of more than one and often of many more than onechild.(c) Eight as not the absolutely last born, but as appearingfar down among numerous births. Thus:-1 is said to be the sixth child1 seventh child.4 are "said to be ninth children.1 is said to be the tenth child.1 "" ""fourteenth child.My notes indicate that in these eight families other birthsfollowed the birth of the idiot, -even in the last, where theidiot was a fourteenth child.I have not noted anywhere that the idiot was a solitarychild. Still in some cases that must have been so, as happened indeed in the case of Meldrum, who is one of the twoillegitimates referred to.The inference from these facts appears to be that Kalmucidiots show even a less tendency to be first born childrenthan do the idiotic taken all together. Illegitimates arefrequently first born.23. In thirteen instances I have noted that at the birth ofthe idiot labour was normal and easy. In no case have I notedthat instrumental assistance was needed . This I think conclusively shows that Kalmuc idiocy is not referable to injuries sustained at birth, because, when I made these notes, Itook a special interest in the whole child-bearing history ofthe mothers of idiots, including in a special manner thebirth-history of the idiots themselves. On these points, Isubjoin all the facts which I have recorded, and which seemof any value:—1. In one case there were long and irregular intervals between the births of the different members of the family.2. In another case the idiot was born prematurely.3. In another, the idiot lost blood largely from the navelsoon after birth.1876.] by J. FRASER, M.B. and DR. MITCHELL.1794. In another, the idiot presented by the breech, and the labour was long.5. In another, the mother was seriously injured by a fallwhen pregnant with the idiot.6. In another, the idiot was born eleven months after itsmother had had a miscarriage in the third month ofpregnancy-the miscarriage being followed by illnessand great debility.7. In another, the idiot was born two years after its motherhad had two miscarriages close after each other.8. In another, frequent miscarriages appear in the childbearing history of the mother.9. In another, the mother, after bearing six healthychildren, was injured by a fall-had several miscarriages -then ceased to become pregnant for eightyears, when she gave birth to an idiot, and after another short interval to the Kalmuc idiot.10. In another, labour was long, and the placenta adherent.11. In another, after having several healthy bastards, awoman married, and bore the Kalmuc idiot-the onlychild she had in marriage.12. In another, the parents of the idiots were five yearsmarried before the birth of their first child. Afteranother interval of five years, their second and lastchild, the idiot, was born.13. In many cases the mothers told me that the motion ofthe idiot in utero was little felt.14. In one case, the mother of the idiot ceased to be prolificat 31 .15. In another, at 35.16. In nine cases the mothers' ages at the time of the idiots'birth were respectively 50, 46, 44, 43, 43, 42, 42, 42, 40.17. In one case the father's age was said to be 70.18. In another, the mother of the idiot had twins, and sohad its father's mother.19. In another, the idiot was one of twins.20. In another, the father's mother had twins.21. In another the mother of the idiot had twins, and thematernal aunt of the idiot had twins four timesrunning.22. In another, the mother of the idiot had twins.180 [July,John Howard. An Essay.*The name of John Howard stands alone in history as thepre-eminent type of disinterested benevolence, and the tendency of his work has been universally accepted as having less admixture of evil than perhaps that of any other man. Respect and admiration have been lavished upon him withoutmeasure; whether by those whose sympathies were naturallywith the objects of his commiseration, or by those who simplydesired to emulate his singlemindedness and active humanity.There is this peculiarity in his wide reputation, namely, thatthe criminal as well as the unfortunate have a direct interestin applauding his beneficence; while the good cannot butadmire his devotion to the cause of the helpless, and hisstraightforward simple method. It would be too much to saythat he preceded as well as excelled all other labourers in hisspecial field, or that without him prison reform would neverhave been achieved, or would have been even indefinitely postponed; for a Parliamentary Committee had reported fully onthe subject 70 years before, and Mr. Popham was Howard'simmediate predecessor in introducing some important practical legislative improvements. But it is indisputable thatHowardawakened an enthusiasm on the subject without whichit is impossible to say how far those improvements could havebeen carried; and further-that he was the principal meansof the complete exposure of the frightful abuses and defectsof prison management which were then so prevalent. Theexpansion of his indomitable labours to nearly every cornerof Europe, while it established England's pre- eminence inthe stupidity as well as cruelty of its maladministration,furnished him not only with ample proofs that these evilswere almost equalled in some foreign countries, but withmany examples and patterns (for instance, in Holland andSwitzerland), which he copied and laboured to introducegenerally; and added such weight and volume to the publicopinion, which he created or converted to his views, thatthere is no similar movement which has been more widely,energetically, and persistently sustained .

• As it is often very profitable to have the routine of thought disturbed by the presentation of a subject in an entirely new view, we publish this original essay, which has come to us from Australia, without endorsing the author's views or his estimate of Howard; in justice to whose memory we have thought

it right to append, as notes, the brief comments of one who is singularly qualified by study of Howard's life and character to give a just opinion con- cerning both.1876.]John Howard. An Essay. 181One stain only has been attempted to be cast upon hismemory-namely, his asserted severity to his son. Eventhis, however, has been confidently and triumphantly denied.Possibly, few believed it; and of those, probably a majority-judging by the fact that his son's ultimate insanity ensuedupon a brief career of unbridled dissipation-believe thatHoward really erred, if at all, on the side of leniency. Inany case, the purity of his motives cannot be impugned;and if a difference in his conduct towards his son might haveproduced different results, society at large-whose advantageengrossed his care to the prejudice of his parental characterwould have felt itself ungrateful had it questioned the propriety of his devoted service; as it would certainly have beenunwise to repress any exhibition of that social feeling whichit is really so important to cultivate and so difficult to arouse.But his son was born in 1765, and Howard from thattime was rarely at home. He resumed his travels abroadat once, partly to fill the void in his mind caused by hiswife's loss, and partly-for the same reason which had madehim a traveller from his youth-to improve his health, andhis knowledge of men and things. His special career commenced in 1773 only, when he was forty-seven years of age, upon his appointment as Sheriff of Bedford.Thenceforward he appears to have suffered nothing to interfere with the prosecution of his peculiar mission. Anyseverity which he may have practised towards his son canscarcely be supposed to have been sufficiently continuous to affect the lad's mental constitution permanently. Even thecharge of neglect seems scarcely consistent with the factsrecorded, that no expense was spared in his son's education,and that considerable care appears to have been manifestedin the selection of those persons to whom it was confided .So far, indeed, as the causes of young Howard's excessesand insanity are traceable to the conduct of his father, itwould seem quite as probable that they arose from theexcess of care with which it was attempted to guard himfrom contamination . It is not unusual for only sons to bebrought up in a singular manner, nor is it at all uncommonfor persons of like rigidly ascetical principles to imagine thatvirtue is tarnished by the mere knowledge of vice. Thousands of young persons have in this manner been kept insuch utter ignorance of the ordinary temptations of the worldthat they have never had opportunities of exercising theirjudgment and discrimination as to the consequences of good182 John Howard [July, . An Essay.or evil conduct. The only theoretical motives to virtue and deterrents from vice with which they have ever been acquaintedare of so eminently unpractical a kind, that they are instinctively prevented from even endeavouring to apply them whenoccasions proper for testing them arise. Not being even forewarned, they are anything but forearmed. It is quite overlooked that, in the moral struggles of a rational being, knowledge is power; and that moral education is far more amatter of exercise than of inculcation.Whether young Howard's moral collapse ensued more orless from causes herein indicated, must remain now a matterrather of speculation; though the general circ*mstances ofhis youth seem to favour the supposition of their applicability. Many features in the singular, though eminentlypractical, character of his father, suggest that it might havehad a deeper origin in inherited temperament and mentalconstitution, His father notoriously suffered much from badhealth, and most in youth. He had an apparently morbidlove of travelling. That he was remarkably impulsive; thatis, that he was very susceptible to certain impulses, whichwere liable to engross his nature, and so to affect his historyto a startling degree-is abundantly proved . His first marriage, from a sentiment of gratitude; his attempted journeyto Lisbon after the desolating earthquake of 1755; his curious compact with his second wife to the effect that in all casesof difference of opinion his voice should rule; the curiousfact that though his sympathies must doubtless have beenstrongly engaged in favour of prisoners, while he himselfwas suffering as a prisoner in France, yet his concentratedenergy was not actively aroused in their behalf until he wasactually 47 years old, 18 years after;* the manner in whichhe thenceforward devoted his whole time and strength unrestingly to objects in which his interest was awakened solate in life; and still more, perhaps, the subsequent diversionof his attention from prison discipline, which for years whollyengrossed him, to the investigation ofthe plague and quarantine systems; all these things indicate a mental constitutionliable to be overwhelmingly affected by casual circ*mstances,and yet capable of responding with its entire energy to anThe fact that Howard, after obtaining exact information respecting hisfellow prisoners in France, procured their release, is overlooked.+ The obvious explanation that quite early in his prison inquiries Howard became profoundly interested in the Gaol Fever and Confluent Small-pox, and curiously unwholesome state of our prisons, is ignored.1876.]183 John Howard. An Essay.impulse thus casually awakened, to a complete disregard ofevery other. He apparently inherited a strongly asceticalinstinct, itself indicative of great enthusiastic capabilities,and of a tendency to run to extremes in action as well as inspeculation. It does not appear further than as a generalimpression derived from a perusal of his life, that wealth hadbeen long the condition of his family. It has been advancedby psychologists of repute that the acquisition of unwontedwealth in a family has a tendency to produce mental aberration; and though this as a concomitant cause can now-indefect of more precise information-be no more than a matterof indirect inference, it corresponds so far with fact and probability, that it should not be lightly excluded from consideration. Very high authorities can be quoted to the effect thatsingularity and extraordinary energetic action are in themselves abnormal, and indicate a condition liable to, if notindeed involving, actual aberration more or less. It has alsobeen said by an expert that by means of such the great advances in civilisation are achieved.My object, however, is to point out the most importantlessons which it strikes me are to be learnt from the historyof Howard, and without which it would scarcely be worthwhile to discuss points which must nowbe too obscure to serveas matters of very profitable speculation .No one could be further than I am from impugning theperfect purity of John Howard's motives. But I demur altogether to the propriety of judging any man by his motives,and for two ample reasons. In the first place his motivescannot be known with any degree of certainty; and in thesecond place, the most evil acts might be excused by real oralleged purity of intention; and though no one consistentlyjudges his neighbours by their intentions or alleged motives,still the principle is so far assumed as valid, that the utmostconfusion obtains in ordinary judgments of right and wrong.Hence my desire to place the matter in a rational and properlight.It is very generally recognised that it is both rash and uncharitable to impute evil motives, and very properly so; onthe ground ofthe utter uncertainty as to the motives assumed.But this being the case it should be obvious that the uncerHoward was always the object of a most liberal expenditure at the hands of his father, and was accustomed from childhood to the display of wealth. Thefather's wealth was the result of industry in trade, so that he was not the vic- tim of wealth unexpectedly obtained.184 John Howard [July,. An Essay.tainty, and therefore the rashness, must be as great with respect to good motives; and that judgment of good actions bymotives, on whatever grounds assumed, should be exactly asopen to suspicion, or rather must be as little reliable, as thatof any evil actions. The uncertainty in the imputation ofmotives-the imminent risk of falsity of conclusion, from thelack of reliable data, when judging men by their supposedmotives can be the only rational ground of objection; forthere can surely be no impropriety whatever in imputing truemotives, could they only be certainly known to be there alone.It may be contended that a man is certainly aware of hisown motives, if he can be trusted to state them accurately.There is nothing I should have more confidence in contesting.Not only will men in general unhesitatingly refuse to admitas reliable any one man's account of his own motives for anyparticular act, but I believe they will on consideration admitthat though the opinions of others of his act are necessarilyliable to be utterly mistaken (which is proved in most casesby the fact that they will differ about themto any conceivableextent) , yet that those opinions are in general far more probably correct not only than the man's account to others ofhis own motives, but even than his account to himself. Thereis, in fact, nothing about which men are so likely to be deceived as the motives which really cause their own actions.For instance, most men will at once adduce rational or socialmotives for their own acts, and also rational or what are termedself-regarding ones for those of others; whereas no positionis more impregnable than that in which it is affirmed that mendo not, as a rule, act in obedience to deliberate reason, butrather to habit or instinct. The two motives doubtless ordinarily coincide, and the conflict does not then appear; butwhere they do conflict, habit carries the day with but littleassistance from circ*mstance . A person habituated to virtuewill not do a vicious act, unless the pressure of circ*mstancesbe overwhelming. When rational conviction adds its weightto that of habit, the pressure of circ*mstances may be reducedto a minimum. So criminal habits, which are nearly alwaysboth inherited and confirmed and supported by circ*mstancesof strong temptation, can never be eradicated; though whilecirc*mstances are modified, so as to reduce temptation to aminimum, the criminal tendency will remain latent; and ifevil temptations and associations can be permanently prevented it is weakened, and there may be room to hope thatmoral habits may be not only generated but confirmed. When,1876.]John Howard. An Essay. 185however, habit is confirmed and assisted by organic degeneration, as in the case of victims of drunkenness, it is notoriousthat the strongest rational conviction of certain evil resultsnay, even experience ofthem-is insufficient, as a rule, to stayit. There is something analogous in physics. Sir W. Thomson and Helmholtz are said to have found that, under certainconditions, "if motion of the kind called rotational is onceset up in a fluid, the portion of the fluid to which this motionis communicated, retains for ever, during all its wanderingsthrough the fluid mass the character of the motion thus impressed upon it. " (See "Nature," 23 Jan., 1873, page 220.)This appears to me a perfect illustration, not only of the persistence of force, but also an explanation of the force of habit.Habit-hereditary or acquired is thus the general spring ofhuman action. In fact, virtue that is not habitual, is notvirtue, nor does an isolated evil act constitute vice. To beeither virtuous or vicious, a man's acts must be not only habitual but characteristic. Character is a word of ambiguousinterpretation; but either meaning is significant of the driftof my argument. It implies either that inherent constitutionof a man, in virtue of which his acts are of a certain forecalculable quality, and in accordance with which therefore hecannot but act; or, otherwise, his reputation in society, whichis determined necessarily solely by results, and not by hismotives or intentions . The word character has really nomeaning on any other theory, and is diametrically inconsistentwith that of free volitions as an element of moral action;habits being, as a rule, formed and consolidated before thematurity or the application of the rational judgment. It isbecause I feel that most of man's errors-personal and social-arise from his being habitually ruled by feeling instead ofhis rational judgment, that I undertake to write this paper.Not that I hope thereby to effect a reform. But I know thatevery little helps, and I think it right to contribute my mitetowards a result which will surely come. And not that I meanto assert that my real motive in writing is that I think it rightto do so. I am aware that my writing is the product of mycirc*mstances and temperament. If I say-woe is me if Ipreach not this gospel; I mean that it would be essentially woeto me were I to do otherwise. But I also know that anyaction produces effects, however small, and that I am now butone of a numerous class which is working towards the sameend. Every-ever so-little really helps.Howard's motives could not have been purer. But howXXII. 13186 [July,John Howard. An Essay.know I that?* Admitting that his conscious motives mayhave been concealed, and that his real motives-the causesof his conduct-may have been, and probably were, vastlydifferent from those of which he was conscious? Simplybecause I know and am persuaded that no man is impure orunclean by reason of the motives that determine andproduce his conduct. If one be pure, wise, and useful, andanother impure, foolish, and mischievous, each is so by reasonof a chain of causes of which a few links only can be discovered by the careful exercise of the highest faculty of man-Reason upon his experience. And this can be consistentlydenied only by denying also the existence of a chain ofcausation of the relations, in fact, of cause and effect. Itshould be clear that all desire good by whatever means they propose to attain to it. That is their one universal motive.Ignorance and prejudice distort and disguise it, and frequently cruel circ*mstance reduces the prospect of it to ahard choice between closely balanced evils. And when insuch conditions the wise shall scarcely be saved, where shallthe inheritor of folly and vice appear? There is no fact moreevident than the infinite variety and disparities of humancapacities of every kind. It would be as rational to denythe diversity of their conditions . Yet the assertion of thefreedom of the will is equivalent to a denial of any differencewhatever in their physical and mental constitution, in theirknowledge, and in their circ*mstances.There is no man-no criminal in Newgate-who wouldnot, if he could, be perfectly wise and virtuous. But hecannot. There is no virtue which I would not possess andpractice, if I could, and I am certain that my reader-be hewhom he may-can say, and truly say, the same of himself.Yet we fall far short of our desires-of our will. There isproof extant that Howard himself was as far behind hisstandard and aspirations as either of us fall short of ours.†What ground then can we have for judging differently of ourneighbours, or of Howard's son? None. And if it thusappears the depth of uncharitableness to judge themdifferently, I know that that uncharitableness arises solelyfrom prejudice and error almost universally inherited, and

• In all this discourse about motive, no notice is taken of Howard's repeated statements in his letters to private friends, and in his diaries, that his motive

was a sense of duty, and love of Christ. Whatever the real bearing of this fact on the author's argument, he should have noticed it.+ Only inasmuch as he took for his standard the ideal of Christ and religious obligation.1876. ]John Howard. An Essay.187originally a necessary product of superficial observation andimpulsive action; and that to blame those who exhibit itwould be an error equally wild. Let us not therefore judgeone another any more; but judge this rather, that no manput a stumbling block or an occasion to fall in his brother'sway.We know that heredity does not necessarily affect everysuccessive generation observably; that atavism may exemptat least one occasionally in the series from what will in- evitably reappear. It is therefore not certain that thedefects of young Howard were derived direct from either ofhis immediate parents. Still his father exhibited characteristics which, with slight modification by circ*mstances,might be expected to produce such aberration in his offspring, if not in himself. There can be little doubt that tomany persons Howard himself appeared scarcely sane. Itmay be that apparently slight differences in their experiencesmight have reversed the characters of Howard and his son.They were of one stock, with the addition in the son's caseof the cross of the blood of Henrietta Leeds, whose idiosyncrasy there is no known reason to suppose was essentiallycalculated to change it. * The son's capabilities for evil aswell as good were certainly inherited, whether from hisfather or not; for it may be even more confidently asserted that what comes out in the flesh was bred in the bone-thanthe converse, which is almost a truism, and is certainly trite.And his desires, there is no reason to suppose, were worse,though his associations, habits, and perhaps tendencies weredifferent. His attitude was doubtless accurately describedby Paul; the good that he would-he did not; and the evil that he would not-that he did. The same language wasprecisely as applicable to his father, judging by the recordsof his private diary.Now it will be readily conceded that so far as a man doesinherit irrepressible impulses to act in this or that manner,he deserves no praise for obeying them, any more than hedeserves praise for being six feet high or red-haired. Hecannot help himself if he would; for whether he would ornot, must depend upon his impulses, inherited or otherwisecaused. It is also obvious that Howard's actions were notperformed against his inclination or will, and that for him toThe early death of Henrietta Leeds, Howard's second wife, from what wasmost probably consumption, is a fact which no writer on the Psychology of Howard ought to overlook.188 John Howard. An Essay. [July,have acted otherwise would have been disagreeable andpainful to him. He was very wealthy and his own master;and he obeyed his instinct, whencesoever derived, and indulged his peculiar hobby to the top of his bent. Thoughhe spent tens of thousands in travelling about Europe fulfilling his inclination , which coincided with what he thoughthis duty, he was far from impoverishing himself; * and hedoes not appear to have denied himself anything which wasreally a pleasure to him, or to have subjected himself to anything which was not capable of being made subservient tohis favourite objects, and therefore to him a source of enjoyment. Yet the main ground of the praise lavished upon himis his self- sacrifice and disinterestedness! He certainlylacked as much as Zaccheus. Nay, he sacrificed everything-even his son-to his particular hobby, and devoted himselfto that alone which his peculiar nature made him feelpleasure in doing. † Was not his son actually more entitledto credit for self- sacrifice? For HE did sacrifice his health,his reason, his life, and of course his wealth. He literallyand unequivocally sacrificed himself, and for a most inadequateobject. The elder Howard achieved a reputation which thewhole world envies . Empresses solicited his company in vain.Emperors he kept standing for hours in deference to hisunbending humour. He died in old age, wealthy, respected,mourned, and almost adored by all Europe, the good and thebad, from the sovereign on his throne to the felon in thedungeon. Contrast with this his son's miserable end. Ihold that, accurately speaking, young Howard far more thanhis father practised self- sacrifice; and that to say that thefather was disinterested in devoting himself to the objects inwhich he felt most interest, is a simple contradiction in terms.I say this advisedly, and am quite prepared to accept thelogical consequence, that self-sacrifice, so far as real, isessentially what it was in young Howard's case-VICE; andthat virtue-including such as Howard's-is none the lessvirtue, because it is, like his son's vice, though voluntary(that is, done with consent, pleasure, and will, and the

• A letter to Samuel Whitbread, in which Howard speaks of selling Carding- ton, shows that this statement is inexact.

Inconsistent with a previous statement, and not true. Howard's treatment of his son can be blamed only by those (if any exist) who deem it the duty of a widowed father to live under the same roof with an only son, and keep him in perpetual tutelage.This is new to me.SA most imperfect and misleading account of Howard's death.1876.]John Howard. An Essay. 189prospect of good as motive), performed with as little realoption or choice, as are the dictates of the blindest instinct.Thus they personally are worthy of neither blame nor praise.But I think it even more incumbent on us to estimate carefully the value of their work by the results, and to markstrongly our approbation or disapprobation of their conduct.We are enabled to do this with the greater freedom andforce, while attributing their conduct not to them but tocirc*mstances; we can condemn or approve their acts without blaming or even praising them. Men are attempted tobe judged by their motives, which in my view are all equallygood, and in the popular view cannot possibly be known;their work, by the results, which are generally very differentfrom those which they have in contemplation. But thuswisdom can be really charitable, and freely forgive them,for they know not what they do!I hold that with motives-supposed good or bad-we havenothing to do. They cannot possibly be distinguished witheven approximate certainty; and if they could they would befound so inextricably interwoven with ancient heredity anddistantly converging circ*mstances that nothing could be moresenseless than to praise or blame the active or passive instrument of their fruition; or to imagine that he could possiblyhave acted otherwise without reversing the past history ofthe universe, and substituting a fresh chain of causation fromall eternity. Men are but the seeds of time; and if onebears ample fruit, and like Newton interprets nature, and another like Napoleon sends thousands to destruction, while athird, like Howard, abolishes cruel abuses, each does his partat the expense of his neighbours; as the one acorn whichfructifies absorbs nutriment from thousands of others equallypotential in themselves, but, for lack of opportunity, serve onlyas manure for his particular growth. It is not unworthy ofremark that the above-named three historical charactersappear to have formed the culmination of their stock, and tohave exhausted its capabilities of variation in themselves;while in ordinary cases, though matrimonial connectionsappear to secure variation by instinctively forming antithetical conjunctions, the result is almost invariably a stereotyped mediocrity.I think we have now arrived at a stage in the developmentof intellect whence we should discern the fallacy of judgingof the worth or utility of conduct by its proximate ratherthan its ulterior results, and the uselessness of expecting to190 [July,John Howard. An Essay.modify the course of events to any great extent by operating upon proximate rather than distant links in the chain ofcausation. This improvement could only ensue upon the expansion of knowledge and the multiplication of recordedobservations. And in proportion to the enlargement of ourapprehension of the importance of studying wider causes andeffects, will mere human individuality sink into its properrelative insignificance in the production of sociological improvement; and steps in civilisation, and even the achievements of the least puny of men as much as the movementsof the masses which they appear to direct, will be recognisedas being evolved in cosmical history of which they form but infinitesimal parts . While the attention of men was restricted to immediate causes and effects , it was scarcelywonderful that they should entirely fail to modify thesequence of events to any large extent. The theory of freewill-which arose in a feeling of personal power with anignorance of its source-was the very narrowest possibleconception of causation, in which all but the single last connected link in the chain of causation escaped observationaltogether; and it was scarcely wonderful that the influenceof human wisdom upon the course of events should havebeen proportionately slight. As we gain a more accurateconception of causes and effects we shall learn also how muchmore powerfully intelligent and consistent efforts arecapable of modifying the distant future; and hence also theultimate importance of all our actions. The further back inthe precession of events that human wisdom recognises theefficience of causes, so much further may it hope eventuallyto influence effects . Could Howard have discerned theremote effects of his course of action he would certainlyhave modified it so as to prevent the evil in them. But theycould not be discerned then by Howard, nor even perhaps byJudge Heath himself.By declining to judge men by their motives, and to allotpraise and blame to them for what is the product less of their intervention than of antecedent and concomitant circ*mstances, we shall entirely avoid injustice and uncharitableness to those who would certainly have done better if theycould; and by estimating the value of their actions by theresults alone, we shall with due caution derive much moreadvantage in guiding our own conduct than if we proceededon the theory of motives. Judging Howard's work by hismotives, which were good, we should be bound to accept the1876.]John Howard. An Essay. 191results as good. But, if so, we should recognise the results of any other man's work, however evil, as good also, becausegood is the motive of all.* And it seems to me that the truevalue of his work has yet to be estimated; in fact, it hasscarcely yet been fully developed. What are now theresults?The most obvious immediate result which Howard discerned was the lessening the actual physical cruelty practisedupon prisoners. This was a good. But what has been thelater effect upon the world? Prisoners, as a rule, may fairlybe taken to represent the bad-the evil portion of humansociety. To say that Howard did good solely or mainly tothe evil would be to give an entirely new aspect to the question of the value of his work. If that were the case, andthe whole of it, surely the results would be wholly evil. Butit is not the whole of the case, though a material feature init. Howard's sympathy was with misfortune rather thanwith crime. He was one of the first builders of modelcottages, and was careful that those who inhabited themshould be good citizens so far as he could judge. This waseven better, for thus he marked the distinction between goodand evil. He founded schools, too, which was better still .For that was calculated to spread knowledge, which is thebest preservative against evil. But alas! he sadly qualifiedthe good thus done; for in his schools girls were not taughtto write, and that accomplishment was withheld from allboys, except a few that he selected as fittest to be trustedwith so much power. This evident want of confidence inknowledge as the best preventative of crime strongly suggeststhat Howard acted in blindness to consequences, though notin disregard of those which he discerned . We should learnbetter. I am not forgetful that his later labours were partlydirected to the improvement of hospitals and the alleviationof the sufferings of others beside criminals. I shall showthateven this has also produced evil effects . But his principalwork was directed to the improvement of the condition ofprisoners in gaols, and upon that is mainly based his reputation. † In the right hand of his statue in St. Paul's Cathedral is a KEY.This assumption that good is the motive of all men is scarcely fit to be used in any serious essay.This statement is imperfect. The improvement of the condition of pri- soners was but one of a series of labours to which he was successively calledby duty and opportunity.192 [July, John Howard. An Essay.Before Howard's time, although the Report of the Committee of 1701-2 proves that the abuses in prison management had received attention and condemnation, no effectivemeasures appear to have been taken to remedy them until1773, when Mr. Popham brought a bill into Parliament toremedy the greatest general abuse, which Howard soon afterwards assisted to abolish, namely, the payment of gaolers byfees instead of by wages. Howard's enthusiasm doubtlessaccomplished in a few years what might otherwise have takenmuch longer to do. * But his enthusiasm overshot the mark,as feeling not strictly regulated by reason always does.I must now endeavour to distinguish the results to whichhis enthusiasm was blind, but which the disregarded reasonof his time was not incompetent to discern. The logic ofJudge Heath was almost impregnable (" Dixon's Life ofHoward," p. 219) . Speaking of transportation, he said, “ Ifyou imprison at home, the criminal is soon thrown back uponyou hardened in guilt. If you transport, you corruptinfant societies, and sow the seeds of atrocious crimes overthe habitable globe. There is no regenerating a felon in thislife. And for his own sake, as well as for the sake of society,I think it better to hang." The only defect of this reasoringis, that in it the alternative of perpetual imprisonment wasoverlooked, and short imprisonments only were contemplated.Whereas, if convicted criminals were never released , thegreatest mischiefs that they do would be entirely prevented.First, they would not contaminate the honest and innocent;and, secondly, they would not propagate their evil stock. Itis altogether a narrow, imperfect view that regards only theparticular case or individual. The improvement of society,or rather its preservation from evil, is the pre- eminent duty of social rational men. Good citizens should always be preferred to bad ones by moral beings. This principle dictatedanother wise saying, which has been preserved, though notadequately appreciated . It was spoken by an English judge,but I regret that I know not if it was Heath. " Prisoner atthe bar," said he, " you will be hanged-not because youhave stolen a horse, but in order that horses may not bestolen." In this admirable pithy saying is embodied thewhole duty of man as legislator and administrator. Societyat large, and particularly those of its members otherwiseThis is a very inexact statement. The work that Popham did not succeedin doing, Howard accomplished in about five months of the winter of 1773-74.Nor was any work ever less deserving of the epithet " enthusiasm ."1876.]John Howard. An Essay.193most exposed to contamination and temptation, are in it regarded as entitled to security from those evils, and to consideration in preference to one individual who has forfeited his title to any. Were this principle consistently practised,crime would be greatly lessened, if not nearly exterminated,in a few generations.Howard, however, like other people, and more particularly like criminals, acted from feeling and not from reason. Hisinstinct was to do good, to alleviate and relieve suffering;and he devoted himself to what seemed to his superficialview the cases in which amendment was most required. Hedisregarded the reason of his age, which I have quoted. StillI amfar from saying that he should be blamed or held res- ponsible for the evil which has followed. He did his best;but though his motives were as pure as Judge Heath's, the present result of his labours I hold to be mischievous andimmoral in the highest degree. I do not say that he in anyinstance sympathised with a criminal as such. But from histime certainly dates the unreasoning sympathy with crimi- nals which has spread and grown to the present time, havingsprung originally from his enthusiasm as cause. It may be that we should ascend to even more distant causes, and traceHoward's own enthusiasm as well as that to which it gavebirth, to that system of which he was such a devoted adherent, and which states that there is more joy in heaven overone sinner that repenteth than over ninety and nine just persons who need no repentance. In worldly practice no principle could offer a more direct premium to crime, or could bemore mischievous or immoral in its general tendency.I hold that all men are alike blameless; their motives beingwithout and not within them; and good-not evil-beingtheir universal desire. The results of their acts are aloneworth estimating, as furnishing data for future rational action,and those results I now desire to expose as accurately as possible. I maintain that the sympathy and enthusiasm in favourof criminals, which Howard's work was mainly instrumentalin producing, tends to confound the judgment of good andevil more or less throughout society. It tends directly toameliorate the physical condition of the felon to such anextent, as to make him an object of rational envy to the thousands of struggling poor who are far worse housed, fed, andclothed than he. It has tended inevitably to provide for thefelon and criminal a life of ease and comfort in gaol, whilehundreds starve-and see their children starve and grow194 John Howard [July, . An Essay.criminal-simply because they will not thieve and swindle. *It has affected popular feeling, and legislation, and administration to such an extent, that sleek convicts are constantlyreleased to contaminate the previously honest, and demonstrate to them that the simplest and legal way to exchange acondition of cruel anxiety as well as privation for one of easeand idleness is to violate the laws of society. It has rewardedthe guilty and taught immorality to the innocent, and it hasso blinded men to these results, that the human race is nowundergoing a process of deterioration in other ways. TheNON " survival of the fittest" is now the rule. Irrespectiveof the moral contamination which the perpetual release ofinvigorated and skilled criminals ensures, the morbid sentimentality which blindly causes this evil, produced othersscarcely less gigantic and pernicious. The hopelessly diseased and the lunatic are the objects of far more care andexpenditure than the honest distressed poor; and it is notorious that the imprudent, the diseased, the weakly, the immoral, and the criminal, propagate in an enormously greaterratio than the prudent, the healthy, the strong, the moral andthe honest. I say notorious; and to show that the imprudent and the immoral, which include the criminal, do sorequires no corroborative remark. That the diseased andweakly do so is easily shown. For a larger proportion ofthem lead sedentary or home lives, and receive attentionswhich lead to matrimonial connections, while the healthy andstrong run risks, and are often actively engaged, so as to preclude settling down to a home life; and the chances are infavour of the most enterprising among them being cut offby accident or privation . The multiplication of the evil proportion would not be much the greatest, were it not that amuch larger number than formerly are, at great cost andwith most pernicious results, saved from the exterminationfor which nature would select them. What logical reasonto counterbalance the obvious evil results-can be given forpreserving any person with hereditary disease? Yet this isdone at enormous expense. Or in defence of the heavy expenditure incurred for the support of gibbering idiots andtwo-legged animals who possess no distinguishing characteristic of humanity but the form and the capacity for mischief?Formerly they were exterminated by neglect and barbarity.Why should the healthy and the sane be sacrificed, as theyObviously untrue.Some proof of this ought to have been given.1876.]John Howard. An Essay.195now are, for the sake of the sickly and the mindless? Wouldit not be better for the sake of our posterity, and to preventthe certain deterioration and possible destruction of the humanrace, that they should be exterminated with tenderness andhumanity?* Particularly while it is merely barbarity andworse than neglect to keep them alive in conditions of disadvantage, and frequently of positive pain? Reason unmistakably pronounces their doom. Only feeling exclaims againstit. Why? Is it not because, listening to feeling and beingdeaf to reason, causes crime, lunacy, disease, and even weakness? Is not the very sympathy felt with those whom naturewould unhesitatingly condemn to rapid extermination symptomatic of the general spread of the disease itself?+ Wouldit be exhibited by perfectly sane and healthy persons? Isnot the whole head sick and the whole heart faint? Whywill ye be stricken any more?I think it certain that, from the above causes, the averageof morality and intelligence in the human family is loweringsurely and perhaps not slowly. The first and most feasibleremedy is the perpetual imprisonment of criminals. Thenext is the painless destruction of all those whose intellectualexistence has already ceased, and of those by whom diseasewould be propagated. Thirdly I would recommend athorough knowledge of physiology to be taught to all ofboth sexes, with a view to guard against evil matrimonial connections. These measures alone would suffice to work amoral revolution in the world.-Nothing was farther from Howard's intentions than toassist in the production of such a state of things as now exists .And I honour him personally exactly as much (and as little)as any one else for his intentions. I think it, however, theduty or function of a rational being to endeavour to discernthe truth, and, having found it, to proclaim it for the benefitof the world; and if Howard did good to the diseased andthe criminal, I confess that I would rather save the healthyand the moral from degenerating to the conditions whichawakened his sympathy; the present NON-SURVIVAL OF THE

• If this be seriously meant, it is not very consistent. Such practice would

be the most effectual way of exterminating that social and moral feeling of man- kind which is the essential condition of the evolution of the social organism.Is not human sympathy then nature; and human art, whether it be supposed to mend or mar nature, itself nature? The author is practically declaring that nature was more enlightened at its lower than at its higher stages of evolution.He clearly should give reasons for this assumption, and not merely declare it.196 John Howard. An Essay. [July,FITTEST being a great and increasing fact. * To all who believe in heredity (and who does not, more or less?) it shouldbe a striking fact that one Howard should really do muchmischief, while nominally sacrificing himself for the benefitof the most evil of mankind, † and that the next Howardshould have actually sacrificed himself to vice; and for whoseadvantage, if not theirs who have the wit to reason out thesalvation of humanity from the history of both?I am strongly of opinion that Howard did most good by farby the uncompromising way in which he did and said what heimagined to be right, without heeding the prejudices and conventionalities of society. True, he could well afford to do it,and for his mere constitutional energy he deserves no praise.But he seems to have done it consistently without fear orfavour; and if that were generally done, I believe that farmore would be done than Howard did by all his labours .On the Measurement of the Palate in Idiots and Imbeciles. ByT. CLAYE SHAW, M.D., Medical Superintendent of the Leavesden Asylum.(Read before the Medico-Psychological Society at Bethlem Hospital, on May 10,1876.)There is a general idea expressed in text-books, and moreor less freely asserted in practice, but which I shall prove tobe a fallacy, that a high-arched palate is so frequently metwith in idiocy and imbecility that it may be taken as a signof their existence. Indeed, when a case of this kind isbrought forward the patient is made to open his mouth, underthe conviction that a high palate will be found as certainly asa superficial alteration of the tongue in gastric disturbance.We shall see that the connection is an accidental one; andthere is, in reality, no relationship between the developmentof the intellect and the height and width of the palate. Ifwe consider that the bones of the cranium are developed in adifferent manner from those of the face, and that ossificationat the base is complete long before that of the bones formingthe palate, it is clear that there can be no primâ facie reason

• Howard did largely save the healthy and the moral from disease and degeneracy.

Not so -not for the prisoner only, but quite as much for those whom thestate of prisons in his own day destroyed-inside and out.1876.] On the Measurement 197 of the Palate.for thinking that because a person has an imperfect brain heshould therefore have an imperfect palate; yet such an interdependence is held. It is quite true that a constitutionaltaint, such as rickets or syphilis, which affects the ossificationof the bones generally and the cranial sutures, would probablyaffect the palatine bones, and hence it is that many idiots andimbeciles are found to have high or imperfect palates: but onthe other hand some modifying taint may dwarf the heightof the body, may affect the shape of the head to such anextent as to make an idiot of the microcephalic type, and yetleave the palate untouched, perfect in all conditions ofwidth,height, number, quality, and regularity of teeth.With a view to settling the question, I have measured thepalates of the patients of this Asylum, and have drawnsome conclusions which, though mostly negative in character, may be, I hope, of positive value in proving thatthere is no necessary connection between idiocy and ahigh palate, but that persons with acute intellects may have most highly arched and contracted ones. To avoiderror I have taken adults, but not old people, since atrophyof the alveolar process would cause lessening of the vertical height, or at any rate the appearance of it. Myfriend and colleague, Dr. Chas. Cobbold, has assisted me incarrying out the measurements, and in kindly tabulating thefigures, of which, however, I can in this paper give a few only.We have, also, in addition to the palate measurements,taken those of the skull, in most instances, as to contour,greatest length, height, and width and degree of contractionof base, Between some of these measurements and those ofthe palate there is a general connection, but not by anymeans the one that has been accepted. The instrument Ihave designed (made for me by Elliott, of St. Martin's Lane)can be applied to the measurement at any point of the palate,to its length, width, and vertical height. It consists of twopieces of German silver, sliding one within the other, an inchlong when closed, but capable of extension to more than twoinches, graduated on the margin into English lines. Theseslides are worked by two levers, moved outside the mouth andturning on pivots for use in any direction. The horizontalslides are traversed by a groove in the same axis in whichworks a lever acting at right angles moved from outside themouth by a handle of flexible metal; this second steel levergives the vertical height of the palate taken from the alveolarprocess. By this arrangement we can at the same moment198 On the [July,Measurement of the Palate,take the transverse and vertical measurements at any pointwished, from the pterygoid processes behind to the intermaxillary bone in front. The scale is made out in Englishinches and lines, and if the palate is very narrow in front, thepalatometer can be supplemented by a pair of hinged compasses blunted at the points.On taking up a well-formed skull we see that a plane withnearly equal sides can be formed by a series of lines drawn infront from the nose-frontal articulation to the anterior nasalspine, below from this anterior nasal spine to the posterioredge of the hard palate, above from the naso-frontal articulation to the anterior border of the sella turcica, and behindby a line connecting the sphenoid with the posterior edge ofthe hard palate. The intermaxillary bones may thus be putout of count as affecting the arch of the palate, being inde .pendent of this quadrilateral, and not entering materiallyinto the formation of the palatine arch, which is composed, forall practical purposes, of processes from the maxillary andpalate bones. In measuring the palate I always try to hitthe position of the anterior palatine foramen, the distancebetween this foramen and the posterior nasal spine beingnearly equal, in a symmetrical skull, to a length which I propose to designate the "nasal length," that, namely, from thenaso-frontal articulation to the anterior nasal spine. This" nasal length" being easily measured may be taken as aconvenient standard for getting the dimensions of the anteriorpart of the skull, for by it we can approximately guess thelength from the root of the nose to the body of the sphenoidbone, the development of the pterygoid processes ofthe palatebones, and the length of the hard palate.On what does the height of the palate depend? Chiefly onthe degree of development of the alveolar processes and theperiod of ossification of the palatine and maxillary sutures.There is to be noticed a curious coincidence, viz. , that a longor wide palate is, as a rule, found with, I do not say is determined by, a long or wide cranium. Virchow's theory ofirregular ossification best explains this: thus as premature ossification of the sagittal suture causes the dolicho- cephalicor elongated type of cranium, so here we find a palate longerthan usual, presumably dependent on premature ossification of the inter-maxillary suture. Again, in the brachy-cephalictype where date of ossification in the coronal and lambdoidalsutures is anticipated, and the cranium consequently bulgesfrom side to side, we have a broad palate and a low arch. It1876.]199 by T. CLAYE SHAW, M.D.is not uncommon to see a non-symmetrical palate longer andhigher on one side than on the other; this corresponds withwhat is often seen in the cranium, where from irregular ossification of one side the other developes so as to produce anon-symmetrical skull. The sutures we have to deal with inconsidering the palate are four-the inter-maxillary, the interpalatine, and two palato-maxillary. We may thus have1st. Long palate, from premature inter-maxillary andinter-palatine ossification.2nd. Broad palate, from premature palato-maxillary ossi- fication.3rd. Non-symmetrical palate, from irregular ossification on one side.What causes a high palate is not very easy to determine.Certain it is, however, that a contracted pterygoid width isassociated with it, and as this occurs mostly, if not always (asproved by measurement), in long palates, it is presumablyowing to a premature inter-palatine and inter-maxillarycontraction which mould the growth of the palate bones totake the direction of least resistance, i.e., upwards. Anarrowpterygoid width is usually associated with an approximationof the molars of opposite sides. In measuring these mouthsI have taken the length between of the hard palate from theposterior nasal spine to the anterior palatine foramen, thewidth between the pterygoid processes, the width and heightat the first molars and those at the first bicuspids. It is a factworth keeping in memory that the posterior edge of the hardpalate is midway between the anterior palatine foramen andthe anterior edge of the foramen magnum, so that in generalterms, given the " nasal length," we have, approximately, thelength of the palate, the position of the foramen magnum,and that of the vomer. It is difficult to say with accuracywhat part the vomer takes in the development of the palate.It probable serves merely to transmit any shocks that maybe sustained by the palate to the firm basis of the body of thesphenoid. Its true function is to support the triangular cartilage and the mucous membrane of the nose, and is reallymore a sufferer than a causative agent in palatal deformities,as may be seen in cases where it is decidedly curved, bulginginto one nostril or the other, because instead of being symmetrically developed with the palate and maxillary bones thelatter have preceded it, leaving it between two fixed points,above and below, to follow the line of least resistance, i.e., towards one or other of the nasal cavities. After taking many200 On the Measurement of the Palate, [July,measurements I have formulated these as fair averages, premising that there is little difference between male and female skulls.Length of Nasal Palate. Length.Pterygoid Width.Width at Height at 1st Molars. 1st Molars.Width at 1st Bicusp.Height at 1st Bicusp.in. lines . in . lines.2 0 2 0in. lines.1 6in. lines.1 5in. lines.07 in. lines.1 4in. lines.0 7The greatest variations I have found are2 3 2 6 1 9 1 9The smallest variations are-| 20 |1 6 0 101 7 1 5 1 1 0 10 0 4 0 7 0 4E. F.(Idiot) 1 11 J. F.(Idiot) 1 91 10 1 7 1 3 0 4 0 7 0 41 9 1 3 1 3 08 0 11 0 7The measurements of these idiots (sisters) who have microcephalic skulls give, as a matter of fact, the lowest verticalheights of any that I have taken, including persons of highintellect.Moreover, their small palatal height shows that no connection can be drawn between a high palate and basal synostosis,for in their case the lengths of bone were very small, viz. ,5-1lin. and 5-4in. respectively.I hand round a diagram containing the measurementsof many palates, taken from persons sound and of goodintellects, of idiots and imbeciles, and of patients in variousstates of insanity to prove that1.-There is no necessary connection between a high palateand the degree of mental capacity of the individual. Someidiots have the flattest and most symmetrical palates, whilstmany with strong individuality of character have highlyarched palates.2.-There is a general relation between the shape of thepalate and that of the skull as to length and breadth.3.-A narrow pterygoid width is invariably associated witha high palate, as is also a narrow skull.4.-The width at the first molars is almost invariably less1876. ] by T. CLAYE SHAW, M.D. 201than or equal to the inter-pterygoid width, and is only veryrarely greater.5. The arching of the palate has nothing to do, as regardsheight, with premature synostosis of the skull-base.6. The differences in the palatal measurements of variousmouths are so slight and so various that it is difficult to seeof what service a palatal investigation can be in affording aclue to the mental faculties.Bethlem Royal Hospital. By DANIEL HACK Tuke, M.D.,F.R.C.P.(Read at the Quarterly Meeting of the Medico- Psychological Association at Bethlem Royal Hospital, May 10th, 1876.)The chief point of interest in the subject to which thispaper has reference, centres in the questions where and whatwas the provision made for the insane in England in theearliest period in which we can discover traces of their custody? As this enquiry at once leads us to Bethlem Hospital,I thought when Dr. Williams, some weeks ago, asked me tocontribute a paper to the next Quarterly Meeting of theAssociation, that it might fittingly occupy a portion of ourtime this evening.Many, I suppose, are familiar with the fact of the originalfoundation in 1247 of a Priory in Bishopsgate- street, for theOrder of St. Mary of Bethlem, but few are aware at whatperiod it was used for the care or confinement oflunatics, andstill fewer have any knowledge of the form of the buildingwhich I shall invariably designate, to avoid confusion, as thefirst Bethlem Hospital -the word " Bethlem" soon degenerating into Bedlam.Before entering upon the less known facts, I will remindyou,that an alderman and sheriff of London , Simon Fitzmary,gave in the 31st year of the reign of Henry III. , 1247, to theBishop and Church of Bethlem, in Holyland, all his housesand grounds in the parish of St. Botolph without Bishopsgate,that there might be thereupon built a Priory for a prior,canons, brethren, and sisters of the Order of Bethlem or theStar, wherein the Bishop of Bethlem was to be entertainedwhen he came to England, and to whose visitation and correction all the members of the house were subjected. *XXII.

• Dugdale's " Monasticon, " Vol. vi. , pt. iii . , p. 621.

14202 Bethlem Royal Hospital, [July,The following is the wording of the original grant, slightlyabridged:-

To all the children of our Mother holy Church, to whom this presentwriting shall come, Simon, the Son of Mary, sendeth greeting in ourLord, * having special and singular devotion to the Church ofthe glorious Virgin at Bethelem, when the same Virgin brought forthour Saviour incarnate, and lying in the Cratch, and with her own milknourished; and where the same child to us there born, the Chivalryof the Heavenly Company, sange the new hymne, Gloria in excelsisDeo. * a new Starre going before them, as the Honour andReverence of the same child, and his most meek mother, and to theexaltation of my most noble Lord, Henry King of England, **and to the manifold increase of this City of London, in which I wasborn and also for the health of my soul, and the souls of my predecessors and successors, my father, mother and my friends, I havegiven, and by this my present Charter, here, have confirmed to God,and to the Church of St. Mary of Bethelem, all my Lands which Ihave in the Parish of St. Buttolph, without Bishopsgate of London,

• • in houses, gardens, pools, ponds, ditches, and pits, and all their

appurtenances as they be closed in by their bounds, which now extend inlength from the King's high street, East, to the great Ditch, in theWest, the which is called Deep Ditch; and in breadth to the lands ofRalph Downing, in the North; and to the land of the Church of St.Buttolph in the South; *** to make there a Priory, and to ordaina Prior and Canons, brothers and also sisters , and in the sameplace, the Rule and Order of the said Church of Bethelem solemnlyprofessing which shall bear the Token of a Starre openly in their Coapesand Mantles of profession, and for to say Divine Service there, for thesouls aforesaid, and all Christian souls, and specially to receive there, theBishop of Bethelem, Canons, brothers, and messengers of the churchof Bethelem for ever more, as often as they shall come thither. Andthat a Church or Oratory there shall be builded, as soon as our Lordshall enlarge his grace, under such form, that the Order, institutionof Priors, & c . to the Bishop of Bethelem and his successors shallpertain for evermore. *** And Lord Godfrey, bishop of Bethelem,into bodily possession, I have indented and given to his possession all the foresaid Lands; which possession he hath received, andentered in form aforesaid.And in token of subjection and reverence, the said place in Londonshall payyearly a mark sterling at Easter to the Bishop of Bethelem .This gift and confirmation of my Deed, & the putting to of my Sealfor me and mine heirs, I have steadfastly made strong, the year of ourLord God, 1247, the Wednesday after the Feast of St. Luke theEvangelist.From this it appears that Simon Fitzmary's land extendedfrom the King's Highway on the east (Bishopsgate- street1876.] by DANIEL HACK TUKE, M.D. 203without) to the fosse called Depeditch on the west. The landof Saint Botolph Church bounded it on the south, and theproperty of a Ralph Downing on the north.A considerable portion of this site is occupied at the presentday by Liverpool- street, and the Railway Stations which have sprung up there.The topographer in search of the old site, finds to-daystriking proofs of the changes which 600 years have broughtwith them. He is surrounded by the Metropolitan, NorthLondon, and the Great Eastern Railways, while BethlemGate, the entrance to the Hospital from Bishopsgate- street,is superseded now-a-days by boardings covered with the inevitable advertisem*nt of the paper which enjoys the largestcirculation in the world. Deep Ditch is now Bloomfieldstreet. The name of Ralph Downing, whose property ismentioned in the charter as bounding Bethlem on the north,is, I suspect, represented after the lapse of six centuries, byDunning's Alley and Place.There was a churchyard on the property, which was enclosed for the use of adjoining parishes by Sir Thos. Rowe,Lord Mayor of London, at a much later period ( 1569) . Probably the inmates were buried there also. The Broad-streetRailway Station booking-office is situated upon part of itssite. In connection with this, I may refer to a statement inMr. Buckland's " Curiosities of Natural History," to the effectthat a skeleton, on which fetters were riveted, was found in1863, in St. Mary Axe, by some workmen engaged in excavations. Mr. Buckland states, on the authority of Mr. Hanco*ck,that Sir Thos. Rowe gave ground in St. Mary Axe, for theuse of Old Bethlem Hospital, and certain adjoining parishes.Mr Buckland, therefore, concluded that the skeleton was thatof a man who had been a patient in Bedlam, and buried inhis chains. He was good enough to place them at my disposal this evening, but as I can find no evidence that Sir T.Rowe did more than what I have above stated, I think thereis no connection proved between the skeleton in irons andBedlam, and have therefore not availed myself of Mr. Buckland's kindness. Bethlem has sufficient sins to answer for,without our adding to the catalogue any which cannot beclearly established.In this churchyard was buried Ludwig Muggleton-anappropriate resting- place, considering its proximity to a madhouse. Also John Lilburne; four thousand persons, it is said,attending his funeral.204 [July, Bethlem Royal Hospital,66Mr. Roach Smith, who formerly lived in Liverpool- street,informs me that on one occasion an incident proved theformer existence of a burial ground on this spot. He writes,Opposite my house (No. 5) on the other side of the street,was a long dead wall, which separated the street from a longpiece of garden-ground which faced some high houses standing, probably, on the site of Bedlam. This garden may havestood on the burial ground. When my man buried in it adeceased favourite cat, he said he came upon the remains ofhuman skeletons. But revolution brought about the disturbance of the cat which had disturbed some of old London'speople. A few years since the cat's coffin and her epitaphwere brought before the Directors of a Railway as a verypuzzling discovery. " The engineers of the North London andGreat Eastern Railways inform me that many bones weredug up in excavating for the Broad-street and Liverpoolstreet Stations .The locality of the first Bethlem Hospital is, I hope, nowclearly before you. I will describe the form of the buildingsshortly, but will first trace the history of the convent to thetime of Henry VIII.In the year 1330, eighty- three years after its foundation , itis mentioned as a " Hospital, " in a license granted by KingEd. III., to collect alms in England, Ireland and Wales,but it must not be inferred from this that it was necessarily used for the sick, as the word Hospital was then,and long after, employed as " a place for shelter or entertainment. " (Johnson) . It is so employed by Spencer inthe " Faerie Queene:"-They spy'd a goodly castle, plac'd Foreby a river in a pleasant dale,Which chusing for that evening's Hospital They thither march'd.Very shortly after this, namely, in 1346, the monastery orHospital was so miserably poor that the master applied to themayor, aldermen, and citizens of London to be received undertheir protection. This was agreed to, and they were governedafterwards by two aldermen, one chosen by the mayor andthe other by the monastery.Then we come to an important event--the seizure of Bethlem by the Crown. This was in 1375, the 48th year of Edw.III. It was done on the pretext that it was an alien or foreignpriory. There was not therefore any seizing of the monastery by Henry VIII. as is usually stated . That had been done1876.] by DANIEL HACK TUKE, M.D. 205already. The master ofBethlem stated at this time that theannual value of the House was 6 marcs; and that he paid13s. 4d. a-year to the Bishop of Bethlem, and 40s. rent tothe Guildhall for the benefit of the city. Disputes afterwardsarose between the Crown and the City as to their right toappoint the Master of the House, but the former triumphed,and Richard II. , Henry IV. , Henry VI. , and Henry VIII.insisted upon and exercised their right of presentation.It appears that the City had let some house to the Hospitalfor which they received rent. And further, that afterwardswhen disputes arose, they actually pretended that the Hospitalitself was originally theirs.I now call your attention to the year 1403, the 4th year ofHen. IV. It appears that Peter, the porter of the House, hadmisbehaved himself in some way, and it was deemed sufficiently important to necessitate an " Inquisition, " to ascertain the condition and management of the monastery.And it is here that we meet with the earliest indication ofBethlem being a receptacle for the insane. I have examinedthe report of the Royal Commission, and find they state thatsix men were confined there who were lunatics (sex hominesmente capti) . The number, therefore, was very small at thattime. As might be expected, the glimpse we get of theirmode of treatment reveals the customary restraints of formerdays. The inventory records " Six chains of iron, with sixlocks; four pairs of manacles of iron, and two pairs ofstocks." I do not here, or elsewhere, find any reference tothe use of the whip. I may remark, by the way, that theCommissioners observe that whereas originally the Master ofthe house wore the Star of the Order of Bethlem, the Masterat that time did not. The original star contained 16 points,which we may consider to indicate, appropriately, the wordsEstoile de Bethlem.On the arms of Bethlem, was also a basket of bread, inreference to the Hebrew etymology, " House of Bread. " Thebread is described as wastell cake, a word first met with in astatute 51 Hen. III. , where it is described as white breadwell baked.Chaucer says of the " Prioress ".Of small houndes hadde she, that she fedde With roasted flesh, and milk and wastel brede.The derivation of the word, according to Douce's " Illustrations of Shakespeare, " is from gasteau, now gâteau, anciently206 Bethlem Royal Hospital, [July,written gastel, and, in the Picard dialect, ouastel or watel,a cake; and not from wassail, as has been stated by somewriters .I would here draw your attention to the site of St. Martin's Lane, and the adjoining district. At the south-west cornerof St. Martin's Lane, in the angle formed by it and CharingCross, was situated a religious house, of the foundation ofwhich I can discover nothing. The point of interest to usin connection with it is this: that at a very early periodlunatics were confined there. Stow, in his " Survey of theCity of Westminster," says "On the north side (that is,after proceeding westward from Temple Bar) , to a lane thaturneth to the parish church of St. Martin's-in-the- Fields,and stretcheth to St. Giles- in-the- Fields, then had ye anhouse, wherein some time were distraught and lunatickpeople; of what antiquity founded, or by whom, I have notread, neither of the suppression; but it was said that sometime a king of England, not liking such a kind of people toremain so near his Palace, caused them to be removedfurther off to Bethlem-without- Bishopsgate, of London, andto that hospital the said house by Charing Cross doth yetbelong " (Strype's Stow, 1720, p. 2) .I have spent considerable time in endeavouring to discover who this king was, but without success. If we assumethat this was the first time that Bethlem received lunaticswithin its walls, we must refer the event to a date prior to1403, because we know, as I have pointed out, that therewere mad people in Bethlem at that date. Whoever theking was, he appears to have been rather fastidious, considering the proximity is not very close between CharingCross and the Royal Palace of Westminster. Possibly, asthe Royal Mews was at Charing Cross, his Majesty mayhave sometimes visited his falcons, which were " mewed,or confined there-long before the same place was used forstables-and been disturbed by the sounds he heard.* Itis interesting in this connection to learn that Chaucer wasclerk of the Charing Cross Mews. On the site of the Mewsstands now the National Gallery, and the religious house forlunatics must have been situated in Trafalgar Square, aboutwhere Havelock's equestrian statue stands.You will have observed that in the passage cited fromStow, the house at Charing Cross is described as belonging to

• Some derive the term from the moulting of falcons.

1876.] by DANIEL HACK TUKE, M.D. 207Bethlem Hospital. It did not belong to Bethlem when thelatter was founded in 1247, and when it acquired it I do notknow; but it is certain that it possessed it as early as 1399,and in all probability at the time of the transfer of lunaticsto Bishopsgate Street by order of the unknown king. Certain,also, it is that the Charing Cross property belonged to Bethlem Hospital until 1830, when it was sold or exchanged inorder to allow of the improvements which were shortly afterwards made there in laying out Trafalgar Square and buildingthe National Gallery.We know, then, that from about 1400, if not earlier, Bethlem received lunatics, on however small a scale; and we havehere an explanation of the fact which has surprised some, thatbefore the time of the charter of Henry VIII. , whose name isinscribed over the pediment of the building in which wemeet, the word " Bedlam " is used for a madman or madhouse. Thus Tyndale makes use of the word some twentyyears before the Royal Grant in his " Prologue to the Testament," a unique fragment of which exists in the BritishMuseum, where he says it is " bedlam madde to affirme thatgood is the natural cause of yvell."Speaking of Wolsey, Skelton, who died in 1529, says inhis "Why come ye not to Court? ".-He grinnes and he gapes,As it were Jacke Napes,Such a mad Bedlam.Our familiar expression " Jackanapes " is evidently a corruption of the above.6666And Sir Thomas More, in his Treatise " De QuatuorNovissimis," says, "Think not that everything is pleasant that men for madness laugh at. For thou shalt in Bedleem seeone laugh at the knocking of his own hed against a post, andyet there is little pleasure therein. " And, again, in theApology " made by him in 1533 (thirteen years before theGrant), in which he gives a most curious account of the treatment of a poor lunatic: He was one which after that hehad fallen into that frantick heresies, fell soon after intoplaine open franzye beside. And all beit that he had therefore bene put up in Bedelem, and afterward by beating andcorreccion gathered his remembraance to him and beganne tocome again to himselfe, being thereupon set at liberty, andwalkinge aboute abrode, his olde fansies beganne to fallagaine in his heade. " Although the next paragraph has208 Bethlem Royal Hospital, [July,nothing to do with Bethlem, I cannot avoid quoting it, as itillustrates so graphically the whipping-post treatment of that day. " I caused him," he says, " as he came wanderinge by my doore, to be taken by the connstables and boundento a tree in the streete before the whole towne, and ther theystripped [ striped] him with roddes therefore till he waxedweary and somewhat lenger. And it appeared well that hysremembrance was goode ineoughe save that it went aboutin grazing [ wool gathering! ] til it was beaten home. Forhe coulde then verye wel reherse his fautes himselfe, andspeake and treate very well, and promise to doe afterward aswell." Sir Thomas More ends with this delicious sentence:-" And verylye God be thanked I heare nowe harme of himnow."*To return to Bethlem Hospital. I can discover nothing ofinterest in regard to it between 1403 and 1523; except,indeed, that I observe in the " Memorials of London, " 1276-1419, a man was punished by the pillory for pretending to bea Collector for the Hospital of " Bedlem, " in 1412. He wasto remain for one hour of the day there, the money box hehad used being " in the meantime placed and tied to his neck. " At the date just mentioned, according to Stow,Stephen Jennings, previously Lord Mayor of London, gave asum of money in his will towards the purchase of thepatronage of Bethlem Hospital. Three and twenty years later(1546) the citizens of London are said to have purchased" the patronage thereof, with all the lands and tenementsthereunto belonging." But there is no evidence that theydid give any money for this patronage. Sir John Gresham,the Lord Mayor, petitioned the King in this year to grantBethlem Hospital to the City; and the King did grant italong with St. Bartholomew's Hospital, on condition that theCity should expend a certain amount of money on newbuildings in connection with the latter. It is only in thissense, I believe, that they " purchased" Bethlem Hospital;and further, it must be understood that the City obtained thepatronage or government only, and not the freehold of thepremises, although in process of time the Crown ceased toclaim or possess any property in the Hospital .In the Indenture of the Covenant made 27th December,1546, between the King and the City of London granting St.Bartholomew's Hospital and Bethlem, there is no mention of"The Workes of Sir Thomas More," vol. vii. , p. 901. Edit. London, 1557.1876.]209 by DANIEL HACK TUKE, M.D.appropriating the latter to the use of lunatics (for this, as wehave seen, had been done already) , but it is simply said"the King granted to the said citizens that they and their successors should thenceforth be masters, rulers , andgovernors of the hospital or house called Bethlem, andshould have the governance of the same and of the peoplethere, with power to see and to cause the rents and profits ofthe lands and possessions of the same hospital to beemployed for the relief of the poor people there, according tothe meaning of the foundation of the same, or otherwise as itshould please the King for better order to devise. " Thecharter was granted in the 13th of January, 1547. TheKing died on the 29th. The value of the estate at thisperiod is said to have been £501 12s. 11d. *I wish to reproduce before you the form of the buildingsof Bethlem (or, as we ought now to designate it, Bethlemor Bethlehem Royal Hospital) at the time of Henry theEighth, and for long before and after that time. I have, Ibelieve, consulted every important map of old London, andhave found it no easy task to obtain a clear notion of the appearance of the building at that period . No print of the firsthospital is in existence; at least, I have never been able tofind it, or met with anyone who has seen it . I believe, however, that a good idea of the premises can be formed from acomparison of the map of Ralf Aggas, made not very longafter the death of Henry VIII. ( 1560) , and that of Braun andHogenberg in their " Civitates Orbis Terrarum," made a littlelater still (1572) . I have reconstructed an elevation of thehospital, which will, I believe, convey to you a fairlycorrect notion of the extent and character of the premises.I am gratified to know that you will see, I believe, for thefirst time, so distinct a representation on a fair sized scale ofthe first Bethlem-the real old Bedlam of Sir Thomas More,of Tyndale, and Shakespeare-within the walls of BethlehemRoyal Hospital itself. Shakespeare, I may here say, uses theword Bedlam six times. You observe a rectangular areasurrounded by buildings. In the centre is the church withits chapel. This was taken down in the reign of QueenElizabeth, and other buildings erected in its place.The oldest written description of any portion of the building which is extant mentions " below stairs a parlour, akitchen, two larders, a long entry [ corridor] throughout the

• Malcolm's " Londinum Redivivum," 1803, vol. i. , p. 351.

210 Bethlem Royal Hospital, [July,house, and twenty-one rooms wherein the poor distractedpeople lie; and above the stairs eight rooms more forservants and the poor to lie in ."*You will observe that there was a gate on the west side,and another on the east side.Eight years after the death of Henry the Eighth ( 1555) -the second year of Philip and Mary-it was ordered thatthe Governors of Christ's Hospital should be charged withthe oversight and government of Bethlem, and receive theaccount ofrents, &c. , instead of the City Chamberlain; but thisarrangement lasted only a short time, for in Sept., 1557 (thefourth year of Queen Mary) the management was transferredto the Governors of Bridewell (which had been given to theCity by Edward VI. in 1553) , subject, of course, to the juris- diction of the citizens. The same treasurer was appointedfor both. This union of the hospitals was confirmed by theAct 22 Geo. III. , c. 77, and continues, as is well known, tothe present day. It was not until this Act that the paramount authority of the City passed away, and the governmentnow in force was established, by which it was distinctlyvested in a President, Treasurer, the Court of Aldermen, andthe Common Council, and an unlimited number of governors,elected by ballot. So that now the only sense in whichBethlem continues to belong to the City is that the Aldermenand Common Councilmen are ex-officio governors. As thereare at the present time upwards of two hundred governors,they are in a decided minority.Time was when Bethlem Hospital did not possess themagnificent income which she now enjoys. She knew, as wehave seen, what poverty meant; and even if we make dueallowance for the increased value of money, we can hardlyread without surprise that in 1555 the income from all thepossessions of the hospital only amounted to £40 8s. 4d.Of course, considerable sums were collected as alms. Nearlya century after, the valuation of real estates showed anannual value of £470. Several annuities had also beenbequeathed, as that of Sir Thomas Gresham in 1575, for " thepoor diseased in their minds in Bethlem ."The revenues, however, fell far short of the requirementsof the hospital-namely, about two-thirds of the yearlycharge-and at a court held in 1642 preachers were directedto preach at the Spital of St. Mary, in Bishopsgate Street,

• Charity Commissioners' Report, 1837, from which much valuable informa- tion has been derived.

1876.]211 by DANIEL HACK TUKE, M.D.informing the public of the need of pecuniary help, and exciting them to the exercise of charity.Again, in 1669 a deputation waited on the Lord Mayor toacquaint him with the great cost of Bethlem, and to requestthat no patient should be sent until the president wasinformed, in order that he might fix on the weekly allowance,and obtain some security of payment.I need not say that since the period to which I refer, theincome of Bethlem Hospital has, in consequence of gifts, andthe enormously greater value of house property in London,been immensely increased, and that what with its annuities,its stocks of various kinds, and its extensive estates, it is today in the position of doing, and without doubt actually doesan immense amount of good.Half a century after Henry the Eighth's death, BethlemHospital was reported to be so loathsome as to be unfit forany man to enter. There were then twenty patients. I donot know, however, that any action was taken in consequence.Thirty-four years afterwards (1632) , I observe that the buildings were enlarged, and mention is made of " one messuage,newly builded of brick at the charge of the said hospital,containing a cellar, a kitchen, a hall, four chambers, and agarret, being newly added unto the old rooms. Also,"a long waste room now being contrived and in work, tomake eight rooms more for poor people to lodge where there lacked room before. "*99In 1624, and I daresay at many other periods, the patientswere so refractory that it was necessary to call in the flaxdressers, whose Tenter boards may be seen in the adjoiningfield in the maps of London of this period, in order to assistthe keepers in their duties!Just about the same date ( 1632) I notice that an Inquisition mentions various sums being expended on fetters andstraw. The governor at that time, I should add, was amedical man. This is the first mention of such being thecase. His name was Helkins Crooke.Ten years later ( 1642) there was a still further addition toBethlem. Twelve rooms were built on the ground floor,over which there were eight for lunatics. The hospital, however, only accommodated some fifty or sixty patients, and itis observed in " Stow's Survey of London," that besidesbeing too small to receive a sufficient number of distracted

• Charity Commissioners' Report, p. 390.

212 Bethlem Royal Hospital, [July,persons of both sexes, it stood on an obscure and close placenear to many common sewers.Smith, in his " Ancient Topography of London, " says-andthe authority for most of his statements was Mr. Haslam-" The men and women in old Bethlem were huddled togetherin the same ward." It was only when the second Bethlemwas built that they had separate wards.In Hollar's Map of London, engraved 1667, which givesthe most distinct representation of Bethlem Hospital at thatperiod, there are no additional buildings given, although we know they had been made. Nor are those inserted whichwere built on the site of the church in the centre of theQuadrangle.I will now pass on to the close of the chapter of this the firstBethlem Hospital, with the remark in passing that Charles theFirst confirmed the Charter of Henry the Eighth in 1638,* andwill direct attention to the year 1674, when the old premiseshaving become totally unfit for the care-to say nothing ofthe treatment-of the inmates, it was decided to build another hospital. The City granted a piece of land on thenorth side of London wall, extending fromMoor Gate, 740 feet,to a postern opposite Winchester street, and in breadth 80feet-the whole length of what is now the south side of Finsbury Circus. At the present time Albion Hall, at the cornerof London Wall and Pavement, with the houses to the east,marks this spot, the grounds in front of the Hospital being,of course, situated in what is now Finsbury Circus.Smith's plates, in his " Ancient London," show the backand west wing of the asylum very well; and an elevationshowing its front which looked north towards what is nowthe London Institution, is represented in an engraving frequently met with in the print shops. Circus Place now runsthrough what was the centre of the building. The building,intended for 120 patients (but capable of holding 150) , wascommenced in April, 1675, and finished in July of the following year, at a cost of £ 17,000. It was 540 feet long by 40feet broad.Of this building, Gay wroteThrough fam'd Moorfields, extends a spacious seat,Where mortals of exalted wit retreat;Where, wrapp'd in contemplation and in straw,The wiser few from the mad world withdraw.

• This charter appears to grant more than the mere patronage of the Hospital.

1876.]213 by DANIEL HACK TUKE, M.D.As the Hospital was opened in 1676, it is noteworthy thatit is now just two centuries since the first asylum was builtfor the sole and express object of providing for the insane inEngland. This is the building in Moorfields so familiar to ourforefathers for nearly a century and a half, and known as OldBethlem by print dealers, and, indeed, by almost everyoneelse; for the memories and traditions of the genuine OldBethlem, which I have endeavoured to resuscitate to-day,have almost faded away.Let me bring before you for a moment the condition ofMoorfields in those days. Finsbury was so called fromthe finny district in which it lay. Skating was largely practised here. In the old maps Finsbury fields lie on the north- east side of Moorfields. Now Finsbury Circus and Squarecorrespond to the site of a part of Moorfields . FormerlyMoorfields extended up to Hoxton, " but being one continuedmarsh, they were in 1511 made passable by proper bridgesand causeways. Since that time the ground has been gradually drained and raised. "*It was a favourite resort for archers. An association calledthe Archers of Finsbury was formed in King Edward theFirst's time. There is an old book on Archery, entitled"Ayme for Finsbury Archers, " 1628. An anonymous poemin blank verse, published in 1717, entitled " Bethlem Hospital," but attributed to John Rutter, M.A., contains thefollowing lines, referring to the appropriation of the groundfor drying clothes:-Where for the City dames to blaunch their cloaths,Some sober matron (so tradition says)On families affairs intent, concern'd,At the dark hue of the then decent RuffFrom marshy or from moorish barren grounds,Caused to be taken in, what now Moorfields,Shaded by trees and pleasant walks laid out,Is called, the name retaining to denote,From what they were, how Time can alter things.Here close adjoining, mournful to behold The dismal habitation stands alone.The following is the description of the building given bySmith in his " Ancient Topography of London: "-The principal entrance is from the north, of brick and free-stone,adorned with four pilasters, a circular pediment, and entablature of the Corinthian Order. The King's arms are in the pediment, and

• Noorthouck's " London," 1773.

214 [July, Bethlem Royal Hospital,those of Sir Wm. Turner above the front centre window. * Itcertainly conveys ideas of grandeur. Indeed it was for many years the only building which looked like a palace in London. Before the front there is a spacious paved court, bounded by a pair of massy irongates, surmounted with the arms of the Hospital. These gates hang on two stone piers, composed of columns of the Ionic Order, on either side of which there is a small gate for common use. On the top ofeach pier was a recumbent figure, one of raving, the other of melancholy madness, carved by Caius Gabriel Cibber. The feeling of thissculptor was so acute, that it is said he would begin immediately tocarve the subject from the block, without any previous model, or even fixing any points to guide him. I have often heard my father say thathis master, Roubiliac, whenever city business called him thither,would always return by Bethlem, purposely to view these figures.— Smith, p. 32.Under an engraving of them by Stothard, are the lines:-Bethlemi ad portas se tollit dupla columna;Εικόνα τῶν ἐντός χώ λίθος ἐκτος ἔχει Hic calvum ad dextram tristi caput ore reclinat,Vix illum ad lævam ferrea vincla tenent.Dissimilis furor est statuis; sed utrumq. laboremEt genium artificis laudat uterq. furor.Pope, in the " Dunciad," thus spitefully refers to thesefigures in connection with the sculptor's son, the comedian -Close to those walls where Folly holds her throne,And laughs to think Monro would take her down,Where o'er the gates by his famed father's handGreat Cibber's brazen, brainless brothers stand.Nettled at being made the brother of two madmen, Cibberretaliated in a lampoon upon Pope, which it is said (withwhat truth I know not) hastened his death. *These figures, now banished to South Kensington Museum,and there incarcerated at the very top of the building, andonly seen by special permission, are, of course, quite unsuitable for the entrance of the Hospital, but I should plead fortheir being placed somewhere in these premises, their naturalhabitat. As works of art, the Governors and Officers cannotbut be proud of them. I suppose, however, their banishmentis intended as a public protest against the old system oftreatment which one of them exhibits, and from this point ofviewis no doubt creditable. I would here observe that the figureof the maniac is superior to that of the melancholiac, whose

• Pennant's " London," p. 267.

1876.] by DANIEL HACK TUKE, M.D. 215expression is rather that of dementia than melancholia. Ithink that when Bacon, in 1820, repaired this statue, he musthave altered the mouth, because, in the engraving by Stothard, this feature, and perhaps others, are more expressive.66At Bethlem Hospital there were also certain gates calledthe penny gates, and on each side of them was a figureof a maniac-one a male, the other a female. They areexcellently carved in wood, nearly the size of life, have frequently been painted in proper colours, and bear other evidence of age. It is reported they were brought from OldBethlem. In tablets over the niches in which they stand, isthe following supplication:- Pray remember the poor Lunaticks, and putyour Charity into the Box with your own hand.""*There was a portrait of Henry VIII. in the Hospital, whichwas said to have been brought from the first Bethlem. Theportrait is now in the Committee-room of the Hospital, in which we meet to-day.The "penny gates " refer, I suppose, to the custom ofallowing Bethlem to be one of the sights of the metropolis,the admission of any one being allowed for a penny, by whichan annual income of at least £400 was realized. The practicewas discontinued in 1770. This amount is, however, probablyexaggerated, as it is difficult to believe that 96,000 personsvisited the Hospital in the course of the year. Ned Wright,however, from whom I shall shortly quote, says the fee was2d. in his time. If so, 48,000 may be about correct,In the Rake's Progress, Hogarth represents two fashionable ladies visiting this Hospital as a show- place, while thepoor Rake is being fettered by a keeper. The doctor, I suppose, is standing by. The deserted woman who has followedhim in his downward course is by his side in the Hospital.The expression of the Rake has been said to be a perfectrepresentation ofMoody madness laughing wild, amid severest woe.The maniac in the straw in one of the cells was taken byHogarth from one of Cibber's figures. The chain is clearly visible.In another cell, is a man who believes himself a king, and wears a crown of straw.An astronomer has made himself a roll of paper for a telescope, and imagines that he is looking at the heavens. TheSmith op. cit. p. 35.216 Bethlem Royal [July,Hospital,patient by him has drawn on the wall the firing off a bomb,and a ship moored in the distance. Ireland, in his " Noteson Hogarth," says it was to ridicule Whiston's project forthe discovery of the longitude, which then attracted attention,and had sent some people crazy. Then there is a mad musician with his music- book on his head; a sham Pope; and a poorman on the stairs " crazed by care, and crossed by hopelesslove," who has chalked "Charming Betty Careless" uponthe rail. One figure looks like a woman, holding a tape inher hands, but is intended for a tailor. *In a poem, bearing the title of " Bedlam," and the date1776, the writer, after bestowing praise on the building,adds:-Far other views than these within appear,And Woe and Horror dwell for ever here;For ever from the echoing roofs rebounds A dreadful Din of heterogenous sounds:From this, from that, from every quarter riseLoud shouts, and sullen groans, and doleful cries;

Within the chambers which this Dome contains,In all

her "frantic" forms, Distraction reigns:

• *

Rattling his chains, the wretch all raving lies,And roars and foams, and Earth and Heaven defies .Ned Ward, in his " London Spy, " 1703, gives a graphicaccount of his visit with a friend to Bedlam:—Thus, he says, we prattled away our time, till we came in sight of anoble pile of buildings, which diverted us from our former discourse,and gave my friend the occasion of asking me my thoughts of thismagnificent edifice . I told him I conceived it to be my Lord Mayor'sPalace, for I could not imagine so stately a structure to be designedfor any quality inferior; he smiled at my innocent conjecture, and informed me this was Bedlam, an Hospital for mad folks. In truth,said I , I think they were mad that built so costly a college for such acrack-brained society; adding, it was a pity so fine a buildingshould not be possessed by such who had a sense of their happiness sure, said I , it was a mad age when this was raised , and thechief of the city were in great danger of losing their senses, so contrived it the more noble for their own reception, or they would neverhave flung away so much money to so foolish a purpose . You mustconsider, says my friend, this stands upon the same foundation as theMonument, and the fortunes of a great many poor wretches lies buriedin this ostentatious piece of vanity; and this, like the other, is but amonument of the City's shame and dishonour, instead of its glory;

• Cf. Ireland's " Hogarth," for description of this plate.

1876.] 217 by DANIEL HACK TUKE, M.D.come, let us take a walk in, and view its inside. Accordingly we wereadmitted in thro' an iron gate, within which sat a brawny Cerberus, ofanIndico-colour, leaning upon a money-box; we turned in throughanother Iron-Barricado, where we heard such a rattling of chains,drumming of doors, ranting, hollowing, singing, and running, that Icould think of nothing but Don Quevedo's Vision, where the lostsouls broke loose and put Hell in an uproar. The first whimse- headed wretch of this lunatic family that we observed , was a merryfellow in a straw cap who was talking to himself, "that he had anarmy of Eagles at his command," then clapping his hand upon hishead, swore by his crown of moonshine, he would battle all the Starsin the Skies but he would have some claret. We thenmoved on till we found another remarkable figure worth our observing,who was peeping through his wicket, eating of bread and cheese,talking all the while like a carrier at his supper, chewing his wordswith his victuals, all that he spoke being in praise of bread and cheese:"bread was good with cheese, and cheese was good with bread, andbread and cheese was good together; " and abundance of such stuff;to which my friend and I, with others stood listening; at last hecounterfeits a sneeze, and shot such a mouthful of bread and cheeseamongst us, that every spectator had some share of his kindness,which made us retreat. P. 61 .•Many other dialogues with the inmates of Bedlam are given,but they are evidently embellished, or altogether fictitious;true as I believe the description of the building and the uproar within to be.Mr. Harvey, from his recollections of the Hospital in Moorfields, in the early part of this century, thus writes in 1863:"When I remember Moorfields first, it was a large, openquadrangular space, shut in by the Pavement to the west,the Hospital and its outbuildings to the south, and lines ofshops with fronts, occupied chiefly by dealers in old furniture, to the east and north. Most of these shops were coveredin by screens of canvas or rough boards, so as to form anapology for a piazza; and if you were bold enough, in wetweather you might take refuge under them, but it was at theimminent risk of your purse or your handkerchief. It wasinteresting to inspect the articles exposed for sale here acracked mirror in a dingy frame, a set of hair-seated chairs,the horse-hair protruding; a table, stiff, upright easy chairs,without a bottom, &c. These miscellaneous treasures wereguarded by swarthy men and women of Israel, who paradedin front of their narrow dominions all the working day, andif you did but pause for an instant, you must expect to bedragged into some hideous Babel of frowsy chattels, and madeXXII.15218 [July,Bethlem Royal Hospital,a purchaser in spite of yourself. Escaping from this uncomfortable mart to the Hospital footway, a strange scene ofutter desertion came over you; long, gloomy lines of cells,strongly barred, and obscured with the accumulated dust,silent as the grave, unless fancy brought sounds of woe to your ears, rose before you; and there, on each side of theprincipal entrance, were the wonderful effigies of raving andmoping madness, chiselled by the elder Cibber. How thosestone faces and eyes glared! How sternly the razor must have swept over those bare heads. How listless and deadwere those limbs, bound with inexorable fetters , while theiron of despair had pierced the hearts of the prisoned maniacs . "*It was in 1733 that two wings were added for incurablepatients, but this proved insufficient in the course of time;and in 1793 an adjoining plot of ground was obtained, andmore accommodation provided. Only six years later, however, surveyors appointed to inspect the premises reportedthat the Hospital was dreary, low, melancholy, and not wellaired; and in 1804 the condition of the building was so dangerous that it was resolved to admit no more patients exceptthose already petitioned for. As the Asylum had been builtupon the ancient ditch of the city, a large portion of thefoundation was insecure. Serious settlements had taken place,and rendered it necessary to underpin the walls. When onelooks at the palatial building represented in the plate, onefeels some surprise to find it described as so low and dreary;but doubtless it was quite time to erect another asylum, andseek a better and more open site.I do not propose to enter upon the revelations made of theinternal condition of Bethlem Hospital by the investigationsof the Committee of the House of Commons in 1815; § someof you are familiar with the prints exhibited at this Committee, of poor Norris who was secured by chains as thererepresented, consisting of ( 1 ) a collar, encircling the neck,and confined by a chain to a pole fixed at the head of the

• Malcolm, in his " Londinum Redivivum," 1803 (Vol. i. , 351 ) , says, "The back part of the hospital, next London Wall, is too near the street. I have been

much shocked at the screams and extravagances of the sufferers when passing there. This circ*mstance is to be deplored, but cannot now be remedied. "+ Proceedings of the Committee and Reports from Surveyors respecting the state of Bethlem Hospital in 1800 and 1804. London, 1805.Charity Commissioners' Report, 1837.§ Bethlem expended £606 in 1814 and 1816 in opposing the Madhouse Regulation Bill.1876. ] by DANIEL HACK TUKE, M.D. 219patient's bed; (2) an iron frame, the lower part of whichencircled the body, and the upper part of which passed overthe shoulders , having on either side apertures for the arms,which encircled them above the elbow; (3) a chain passingfrom the ankle of the patient to the foot of the bed.Time will not allow of my detailing the medical treatmentpursued at this time at Bethlem, but I may just give the pithof it, as expressed in one sentence by Dr. Monro in his evidence before the Committee. He had been Visiting Physiciansince 1783. " Patients," he says, " are ordered to be bledabout the latter end of May, according to the weather; andafter they have been bled, they take vomits, once a week fora certain number of weeks; after that we purge the patients.That has been the practice invariably for years long beforemy time; it was handed down to me by my father, and I donot know any better practice." If in all this we are disposed to blame Bethlem, let us still more condemn thelamentable ignorance and miserable medical red-tapismwhich marked the practice of lunacy in former times.I may here remark that, prior to the Monros, Dr. ThomasAllen was, in 1679, Visiting Physician to Bethlem, and that,as I have observed already, Helkins Crooke ( 1632) was the firstmedical man who is known to have been at the head of thishospital. Dr. Tyson was physician from 1684 to 1703. Mr.Haslam was appointed resident apothecary in 1795, and in1815 gave evidence before the Committee of the House ofCommons. At that time he said there were 122 patients;"not half the number, " he stated, " which we used to have."For these there were three male and two female keepers: theformer assisting the latter when the female patients were refractory. Ten patients he said were at that moment inchains, and we may be sure that the number was much largerbefore public feeling had been aroused to demand investigation. The ultimatum of our restraint, " said Mr. Haslam,"is manacles, and a chain round the leg, or being chained byone arm; the strait waistcoat for the best of reasons is neveremployed by us." Mr. Haslam, when asked whether a violentpatient could be safely trusted when his fist and wrists werechained, replied , " Then he would be an innoxious animal."Patients, however, were frequently chained to the wall inaddition to being manacled.We now arrive at the close of the second act in the dramaof the Royal Hospital of Bethlehem. The scene of Act theThird is laid in St. George's Fields, after a site at Islington220 Bethlem Royal [July,Hospital,was fixed upon, but soon relinquished. The area of land covered about twelve acres. Provision was to be made fortwo hundred patients. In 1810 an Act of Parliament wasobtained (50 Geo. III. , c. 198) , by which the City wasauthorised to grant the property to trustees for the governorsof the hospital, for the purpose of erecting a new one on anenlarged scale-on lease for 865 years, at a yearly rent of 1s.The Corporation entered upon the spot occupied by the oldhospital in Moorfields. The first stone was laid in April,1812, and it was opened August, 1815, consisting of a centreand two wings, the frontage extending 594 feet." Theformer has a portico, raised on a flight of steps, and composed of six columns of the Ionic order, surmounted by theirentablature, and a pediment in the tympanum on which is arelief of the Royal arms. The height to apex is 60 feet."The funds were derived from the following sources:-Grant from Parliament...Benefactions from Public BodiesPrivate IndividualsAmount of Interest upon Balancesin handContributed from funds ofHospital1600£ s. d.72,819 05,405 05,709 014,873 4 823,766 2 3£122,572 7 5Additional buildings were erected in 1838, the new stonebeing laid July 26th of that year, when a public breakfast wasgiven at a cost of £464; and a narrative of the event at acost of £140; a generous outlay of charitable funds.Of the site of the third Bethlem Hospital a few words will suffice. The notorious tavern called " The Dog and Duck "was here, and there is still to be seen in the wall to the rightof the entrance to the hospital a representation in stone ofthe dog, with the neck of a duck in its mouth. It bears thedate of 1716. In Mr. Timbs' " London " it is mis- stated1617. Doubtless in olden time there was a pond here, and aduck hunt was a common sport, and brought in much customto the inn. After the " Dog and Duck," this site was occupied by a blind school, pulled down in 1811 .Shakespeare makes the Duke of York say in Hen. VI.: —Soldiers, I thank you all; disperse yourselves;Meet me to-morrow in St. George's Fields.2 Hen. VI., Act. v. , Sc. 11876.]221 by DANIEL HACK TUKE, M.D.The only other reference in Shakespeare to this locality indicates that in his time there was a Windmill Inn in St.George's Fields, for he makes Shallow say to Falstaff: -O, Sir John, do you remember since we lay all night in the Windmill, in Saint George's Fields?2 Hen. IV. , Act iii. , Sc. 2.The subsequent history of Bethlem Royal Hospital; theconsiderable improvements which succeeded the investigation; the enquiry and admirable Report of the Charity Commissioners in 1837, from which it appears that at that timesome ofthe patients were still chained, and that the funds ofBethlem had been to no slight extent appropriated to personaluses; its exemption from the official visitation of asylums required by the Act of Parliament passed in 1845 ( 8 and 9Vict. , c. 100); the unsatisfactory condition of the institutionas revealed by the investigations made in 1851 (June 28 toDecember 4); the placing of the hospital in 1853 in the sameposition as regards inspection as other institutions for theinsane ( 16 and 17 Vict . c. 96); the sweeping away of the oldrégime, and the introduction of a new order of things; thegreat lesson to be learned from this history being, as I think,the necessity of having lunatic asylums open to periodicalvisitation; and last, but not least, the establishment of aConvalescent Hospital at Witley within the last few years;-these important events I must content myself with merelyenumerating, but I cannot close without expressing the satisfaction with which we must regard the present management of the hospital, all the more striking when we recallsome of the past pages of its history; nor can I avoid congratulating the Resident Physician and the other officers ofthe institution upon this result.I am much indebted to Mr. Gardiner, of St. John's Wood, and to Mr. Crase,of Dulwich, for permission to examine their splendid collections of prints and maps of London. My best thanks are also due to Mr. Coote, of the Map Department of the British Museum, and to Mr. Overall, of the Guildhall Library, for their valuable assistance.222 [July,Notes on the Reparative Power in Insanity. By J. A.CAMPBELL, M.D., Garlands, Carlisle.(Read at a Quarterly Meeting of the Medico-Psychological Society held in the Hall of the Faculty of Physicians, Glasgow, March 3rd, 1876.)The short notes which I am going to bring before you refermore directly to the power of repair of bony structures andsoft tissues in fractures and wounds, occurring in cases of insanity; and I have the less hesitation in calling your attention to the subject, because I see by the last " Commissioners'Report" that during 1874 twenty- six fractures occurred in theScotch Royal and District Asylums. I hope, therefore, to hearsome useful remarks on the subject from the members pre- sent.CASE 1.-August 3rd, 1868. R. C. , male, æt . 44 years. Ageneralparalytic. At an early stage of the disease, while walking in theairing-court, was kicked in the chest by a fellow-patient (a clergymanof the Church of England, of great energy and agility), who fanciedR. C. was the devil, and gave as his reason that he intended to kickhim back to hell. R. C. was immediately taken in, examined,and found to have fracture of more than one rib on the right sidethe sixth and seventh, at least, between their sternal attachments andangle. A strip of Emplastrum Roborans was put round the chest anda flannel roller above this. During the first week after the fracturehis evening temperature rose once to 100°, but never above it. Therewas no apparent discomfort-he took his food well and lay quietly.The bandages were removed at the end of a month; his ribs seemedfirmly united.The patient died in May, 1872. At the post-mortem the sixth andseventh ribs of the right side bore evidence of old fracture, and had amass of bony matter between them, though not quite uniting them bybony union. The fifth rib was rough and thickened, with somenodules of bone at its edges; but on sawing it along, it showed noappearance of having been fractured.CASE 2.-T. B., male, æt. 33 years.Admitted October 10th, 1871;labouring under acute mania. On June 6th, while amusing himself byplaying at leap-frog over a fellow patient, came down on his righthand, fracturing his radius close to its articular end above wrist. Thearm was put up in pasteboard splints, but as he was constantlywetting his arm, and making water on it if he could not wet it otherwise, wooden splints were substituted. He was most restless, and thougha canvas sleeve was sewed over the splints, he managed on severaloccasions to take the splints off; but they were replaced each time,1876.]223 Notes on Reparative Power in Insanity.and when finally removed at the end of six weeks, a good union, asregards position and firmness, had taken place.CASE 3.-G. S. , male, æt. 66 years; labouring under melancholia;for many years an inmate of the asylum. On September 22nd, 1872 , ageneral paralytic fellow patient stumbled against him and threw himdown; he fell on his right arm, causing a comminuted fracture ofhumerus at its middle third. The fracture was put up in short woodensplints. The day after, as the hand was oedematous, the splints weretaken off and reapplied. The splints were kept on for seven weeks,whenthe humerus was found quite united by bony union .CASE 4.-H. T., male, æt. 57 years. Ageneral paralytic, admittedDecember, 1869. On May 28th, 1873, he had for some time been soparalysed in the lower extremities as to be unable to stand, and wasconfined to bed, without a bedstead, in a single room with a halfshutter up. He was found lying opposite the window with his left femur fractured at its lower third. It was put up in a starchbandage, and he was restrained by sheets; but as he was continuallywet, the starch bandage was found useless, and the next day thefracture was put up in poroplastic splints, and a little extensionapplied to leg. The patient was restrained by sheets for six weeksand five days, except for two hours daily, when his bedding was changed, his back washed and rubbed with carbolic oil. When thesplints were removed the femur was found firmly united, with muchnew bone about the union, with shortening of leg to about one and ahalf inch. This patient is now alive-a general paralytic, with hisdisease of more than six years' duration.CASE 5.-C. D., female, æt. 65 years. Chronic mania. Noisy andrestless. October 21st, 1874. Was to-day pushed over by a fellowpatient, fell on left shoulder, fractured left clavicle. Her left arm wasfixed across breast and supported at elbows. Patient was kept in bed.Fracture united firmly, and in good position, within a month,CASE 6.-N. T., male, æt. 80 years. Chronic mania. Whileworking, fell off the edge of a dung- heap and fractured his right clavicle. He would not allow any treatment, so he was let alone. Hewas continually moving his arm about. Clavicle united, and he was at work within six weeks.CASE 7. -July 1st, 1874. J. F., male, æt. 58 years . Chronic mania.Had necrosis of proximal phalanx of index finger of right hand. Iremoved the finger at the metacarpal joint, and dressed the woundantiseptically. In spite of very bad treatment from the patient, whotore the dressings off and used the hand as if it was well, the woundwas perfectly healed within three weeks.CASE 8.-M. M., female, æt. 39 years. Chronic mania. June 16th ,1875.-Had been in the asylum for four years; two months ago hadcomplained of pain in right knee, for which various modes of treatment had been resorted to -rest, blisters , and lastly the actualcautery. She had been getting nourishing diet, stimulants, and iron and224 Notes on Reparative Power in Insanity, [July,quinine; but the knee had gradually become swollen and more painful,and the patient had fallen off in condition. Acting on the advice ofour consulting surgeon, I removed the leg by Carden's operation abovethe knee joint. Antiseptic dressings were used, and in this case thepatient was most careful of the stump.July 1st (fourteen days after the operation). The patient has donewell; the stump is almost completely healed, and, except along theligature-where, till they came away, there was daily a drop or two ofpus-the flaps simply stuck together at first, and united without anysuppuration. Bodily health improved; is much fatter.CASE 9.-J. R. P., male, æt . 31 years. Epileptic mania.This patient took numerous fits in succession, and then for some timeremained in an exhausted state, with vitality lowered and circulationfeeble. During his comparatively lively stage he had in some way hurt the fourth toe of his left foot. He had been in bed for sometime on account of this when the ungual phalanx necrosed and cameaway, but the toe got no better, and the foot was blue and swollen. OnMay 18th it looked worse, so I removed it. The patient got tonics and stimulants, but was in a low state of vitality. The line ofsection was almost healed, when an abscess formed in the sole of thefoot, which was opened. The wound at last healed, all except one point, when an abscess formed over the ball of the great toe. Thiswas opened, carefully washed out with solution of boracic acid, anddressed daily, but the foot got worse.On June 20th, after making some exploratory incisions, andconsulting with Mr. Page, Carlisle, I removed the foot by Syme'soperation. The patient lay still for several hours, but then got muchexcited, became restless, and before the medical officer reached him hadcaused considerable hæmorrhage by the rough way he used his stump.He was at once restrained by sheets, and the restraint retained forthirty - four hours. Considerable oozing took place the first night andday after the operation, but after that healing went on rapidly, and onthe 1st of August (a period of five weeks after the operation ) thestump was healed.CASE 10.-T. J., male, æt. 51 years. Epileptic mania; always infeeble health. November 3rd, 1875. Had disease of right anklejoint for some time; after consultation with Mr. Page and Dr.Maclaren of Carlisle, it was decided to remove the foot by Syme'soperation. I did so, but found caries in the centre of the tibia. Aftersawing off its articular surfaces , I turned up the periosteum for aboutan inch, and sawed off another slice, but found the bone still diseased.I then gouged the centre of the bone, but found it diseased for at leastan inch in the centre of the shaft; so I amputated through the lowerpart of the middle of the leg, making a long anterior flap, and put upthe stump in carbolic dressings. The patient was very restless , gotout of bed, and had to be kept under the influence of chloral at night;during the day sitting with his leg bent, and would not lay it down.1876.] by J. A. CAMPBELL, M.D. 225The flap united well; at the end of six weeks the line of section healed,and the stump was firm and serviceable; but an abscess formed above theedge of the tibia, and remained discharging small quantities of waterypus. It seems now quite healed ( February 28th ). The patient isstill in weakly health .Cut Throat Wounds. -In six cases of this nature treated atGarlands healing took place rapidly. In two cases thetrachea was opened into. In one, reported by Dr. Macleod,in the "Journal of Mental Science, " July, 1875, thepharynx was opened into, and the epiglottis divided, andin one case the tongue was cut away from the hyoid-bone.In 1870 I reported in the " British Medical Journal "acase of fæcal abscess connected with the caput cocum,which discharged at a point in the upper part of right groin.The patient recovered and is still in Garlands Asylum .Scalp Wounds.-Though I have seen a large number ofvery serious scalp wounds caused by epileptics falling in fits ,or by attacks of fellow patients, I have never, except in onecase, and that an elderly man in an advanced stage ofgeneral paralysis, seen any erysipelatous drawbacks to healing; usually shaving a small portion of the scalp, drawing theedges of the wound together with adhesive plaster, andputting some dry lint over it, being all that is needed, thewound healing by first intention or scabbing.Excluding general paralysis and epileptic insanity, inthe other forms of insanity, while the digestive powers aregood and the patient taking a fair amount of nutriment,repair, as regards fractured bones, or divided soft tissues,takes place quite as well as in sane patients; in cases offracture where there is considerable restlessness, there ismore swelling round the fracture, and union seems speedier.Considering the difficulty of treating fractures in insanepatients, I have been more than once surprised by theexcellence of union as regards position and freedom fromshortening that I have noticed in such cases.In epileptics and general paralytics healing power of skinwounds is at times greater, according to my experience, thaneven in perfect health, during the period that epileptics arefree from taking fits, and while general paralytics are at thestage that they eat ravenously and are getting fat.In epileptics, after a succession of fits, and in generalparalytics, in an advanced stage, or in an early stage afterepileptiform fits, vitality is so much lowered that bedsores226 Notes on Reparative Power in Insanity. [July,may appear after lying in bed one night, and remain withoutany healing going on till the nervous system rallies.In general paralysis the inequality and uncertainty of thepower of repair are marvellous, while the digestive apparatusremains nearly always efficient to the last; death of structurewithout outward cause may take place in one part of the bodywhile fat is being laid on in another. The peculiarities inregard to healing and death of structure in epileptics andgeneral paralytics are, of course, due to the diseased trophicnervous action affecting the blood supply and nutrition of thetissues.The Plea of Insanity in Cases of Murder-Cases of Macklinand Barr. By D. YELLOWLEES, M.D. Edin. , F.F.P.S.G.Physician Superintendent, Glasgow Royal Asylum.The two following cases, which were tried at the GlasgowCircuit Court, in May, 1876, seem of sufficient importance todeserve record and comment in the " Journal of MentalScience." In both the facts were undisputed, and theinterest centred in the mental condition of the prisoner.James Macklin, aged 29, single, a labourer and fireman,deliberately shot his mother in their own house near Airdrie,on 17th December, 1875, killing her on the spot. He immediately ran away, and spent the night in the fields to avoidthe police; next morning he borrowed an old table-knife at aroadside cottage three miles from his home, and havingsharpened it on a piece of slate cut off his scrotum andtesticl*s, returned the knife, and was subsequently found bythe police lying at the foot of a coal heap almost dead fromhæmorrhage.The wound healed very quickly, and without a bad symptom. He told me that he intended to have killed himselfrather than be hanged, and he thought this was a better waythan cutting his throat.The prisoner's mental condition is succinctly described inmy evidence, which I quote from the " Glasgow Herald " ofMay 10th, 1876: -Dr. Yellowlees , Superintendent of Gartnavel Asylum, deponed- I saw the prisoner on two occasions. I came to the conclusion thathe was naturally somewhat silly or imbecile, and that he was labouring under various delusions. These delusions were chiefly with1876.] The Plea of Insanity in Cases of Murder. 227reference to one subject, namely, that about three years ago he hadgone to a certain doctor to be treated for a particular disease; thatthe doctor had subjected him to very extreme and unnecessary tortureunder the guise of treatment; that the object of that torture was tochange his religion and compel him to become a Roman Catholic;that the torture was instigated by his mother, who was in collusionwith the doctor, and had for a long time had improper intimacy withhim; moreover, that his mother was in the habit of having improperintimacy with other men as well, who came to the house while theprisoner and his brother were at work. He thought, further, that theill -usage to which he had been subjected had ruined his health, and hesaid that the cruelty he had endured and the misconduct of hismother weighed constantly on his mind, and it was bound to be seento somehow. The delusion was such that it would probably have ledto violence I think the deed of which he is accused was the directresult of the insanity under which he laboured.By the Advocate- Depute- In addition to the suspicions about hismother, the prisoner had delusions about the doctor.By the Court-The opinions about the medical man were insane delusions. They were the interpretation put by a weak mind on what I have no doubt had been done to him.The Lord Justice-Clerk-From your experience and examinationsof insane persons you can easily discriminate between real and feignedinsanity?Witness-Not easily at all times, but in this case I have nosuspicion of feigning. It is not an unusual phase of insanity thatideas of the kind described should be taken up about particular individuals; and the weakened mind that could not correct false impressions at one time may allow them to be formed equally at anothertime, so that similar delusions may be taken up with regard to otherpeople.The natural imbecility was quite obvious. As his motherdescribed it to one of the witnesses, he had always been"thick-witted;" but he possessed the shrewdness andhumour often associated with this condition, and as thedeficiency did not lead to misconduct nor unfit him for work,many of his neighbours had never observed it.The origin and gradual growth of his delusions were veryinteresting. He said that while treating him for gonorrhoea,the doctor had one day asked him why he was a Protestant,and why he did not come to the Roman Catholic Chapelwith his mother. This led to some conversation on theopposing faiths, a subject on which the prisoner's mind hadbeen previously awakened, as his mother was a RomanCatholic, while his father, whose creed he followed, had been228 The Plea of Insanity in Cases of Murder, [July,a Protestant. While this matter was uppermost in histhoughts, he was subjected by the doctor to great pain, apparently from a urethral injection; and it occurred to him, notat the moment but subsequently, that surely so much suffering could not have been inflicted to promote his recovery, butmust have been connected with the previous discussion, anddesigned to make him become a Roman Catholic, like hismother and the doctor. Then he became convinced that thedoctor would not persist in so torturing him unless instigated by his mother, and that her visits to the doctor abouther own ailments were merely a blind to conceal this collusion. A casual remark by the doctor concerning anotherwoman next led him to suspect not only collusion but improper intimacy-notwithstanding that his mother was about70 years of age; and this suspicion, once entertained, soonextended to other men, so that he gradually grew into thebelief that his mother was at once cruel and depraved, andhad occasioned him both torture and disgrace. These feelings found expression eventually in threats and abusivelanguage, and in occasionally ordering his mother out of thehouse, as he could not bear to see her after what she haddone. At last, after three years' gradual growth, they overpowered all other considerations, and culminated in hermurder. The doctor must have narrowly escaped the samefate, for he said he would have killed his mother and thedoctor, " and a dozen of them," rather than have enduredsuch things.The result of the trial was never doubtful. The prisonerwas found to be insane, and ordered to be confined duringher Majesty's pleasure.The Lord Justice Clerk (Lord Moncrieff), in summing upthe evidence, very carefully expounded the legal tests ofcriminal responsibility. The following extract is from thereport in the "Glasgow News " of May 10th, 1876:-If Macklin was responsible for his actions, then the duty of thejury, however painful, was clear enough. But it was said on his behalf that he was not of sound mind when he committed thisoffence, and that really was the plea that, apart from its importanceto the prisoner and the public, gave this case a very peculiar aspect.He would say a few words on what he thought necessary, so far as the legal or scientific aspect of the case was concerned. It was one hehad had occasion frequently to consider, and he would state what werethe views which he thought had the greatest weight among jurists ofthe present day. A man is not responsible for his actions if he be of1876.] by D. YELLOWLEES, M.D. 229unsound mind, but if he be not of unsound mind, or if it be notproved that his mind is unsound, then, although he be of feeble or excitable mind, or of variable temperament, driven about by jealousy, orpride, or self- conceit, or anger, or temper, none of these infer in- sanity-unsound by reason of disease. What were the indicationsfrom which unsoundness of mind may be inferred? He could laydown no general test which could be applied to solve such a question .At one time lawyers were apt to avoid all difficulty by inquiringwhether the prisoner knew right from wrong; and as, in point of fact,except in acute mania or idiocy, there are very few lunatics who donot know right from wrong, in the sense of being capable of formingand even acting on the distinction, much unreasoning inhumanity had been the result of this unscientific maxim. If it were said that hecould form a sound judgment on the subject of moral duty, that was only stating in another form the problem, and not solving it. Hewould suggest to them what he thought a far safer, and a more constitutional and a more reasonable ground. Soundness or unsoundnessof mind was a fact which had to be judged of not as a question oflaw or of science, but on the ordinary rules which one applied in dailylife. One took the assistance of legal and scientific views, but thejury were as good judges as any lawyer or doctor of whether a man whom they met in daily life was sound or not. If it turned out thathe was able to conduct himself with propriety in the ordinary relationsof life , not excluded from the confidence of his fellow-men by reasonof distrust of his sanity, they had advanced not the whole of thejourney, but nine- tenths of it, towards their conclusions. In this caseit did not appear that anybody ever doubted the soundness of mind somuch as to withhold from him any employment. The prisoner was agood workman, and seemed to have been an intelligent companion.Of the general evidence the jury were quite as able to judge as he himself was. He had said that they had advanced nine-tenths on thejourney towards a solution, but there was a further step, on which thedifficulty and the importance of the case rested. The chief question remained-if this man laboured under an insane delusion. That helaboured under a delusion about this matter was perfectly clear, butthe question was whether he laboured under any insane delusion . Ifhe laboured under any insane delusion , then without doubt his mindwas not sane or sound, even although the insane delusion mightexhibit itself against only one particular person.These views show a wonderful advance on the " unscientific maxims " and " unreasoning inhumanity " of otherdays; but they also show that the insanity of the physicianand the insanity of the jurist are very different, andshould never have been confounded. The physician is concerned with the brain and its function, the jurist with thepublic and its safety. The physician asks if the brain is230 The Plea of Insanity in Cases of Murder, [July,healthy in its nutrition, its repose and its working; while thejurist cares chiefly to enquire if the man be " able to conducthimself with propriety in the ordinary relations of life, " andbe credited by his neighbours with such ability.When this enquiry of the jurist is answered in the negative, perhaps insanity may be safely inferred; but the converseis by no means true, as this very case sufficiently proves.Macklin was a sober, well- conducted man, and the mainsupport of his widowed mother; as a fireman, he was carefuland attentive; and, notwithstanding his natural silliness ,many of his neighbours and fellow workmen had never seen anything peculiar about him. Yet this man had for yearsbeen brooding over imaginary wrongs, and dangerous delusions had been secretly and gradually acquiring such strengthin his mind that they at length broke out in fatal violence.This " habit and repute " test, therefore, utterly fails, andwhen a test which is said to guide us nine-tenths of the wayis thus found wanting, it is obviously unsafe; it not only does not guide but it misleads. Even when the presence of"delusion " is added to the " habit and repute test, thecriterion remains defective and unsafe. The most dangerouslunatics often have no delusions, and it is in emotionalinsanity, which these tests ignore, that terrible crimes mostfrequently occur.All such special tests must disappear like the "unscientificmaxims " formerly accepted, and in every case the broadissue must be raised-Was this deed the result of disease,and did the disease so dominate in the prisoner's mind as tocontrol and determine his conduct?The next case which was tried before the same Judge onthe following day, was a very different one.Thomas Barr, aged 36, picture dealer and book- hawker, awidower with four children, was married for the second timein October, 1874, to a woman who was 14 years his junior.The couple led a most miserable life, the wife complaining ofconstant harshness and frequent violence, the husband of con- stant negligence, and frequent unfaithfulness . The wife lefther husband's house 17 times during the 17 months of theirmarried life, and usually sought refuge with her mother. On the last of these occasions Barr went on the afternoon ofMarch 1st, 1876, to his mother-in- law's house, forced anentrance in spite of resistance, and fatally stabbed both1876.] by D. YELLOWLEES, M.D. 231his wife and mother- in-law with a pocket-knife. The motherwas killed on the spot; the wife died seven weeks afterwardsfrom the effects of the wounds . The murderer hastilyescaped by train, and eluded pursuit by assuming a false nameand keeping in out-of-the-way places, but was eventually captured a fortnight afterwards in Aberdeenshire.The apparent motive for the crime was jealousy. Barrmade the foulest accusations against his wife, and assertedthat her misdeeds were countenanced, or at least winked atby her mother, who harboured her against his will.None of these accusations against Mrs. Barr were provedto be well-founded, and all the evidence at the trial was tothe contrary effect. Barr could not at first name any individual with whom she had been guilty, although he spokeof several whose names he did not know; eventually henamed one person, by whom the allegation was positivelydenied at the trial. His wife, in her dying deposition, alsosolemnly denied that she had been unfaithful.It is said, I believe with truth, that Barr imputed unfaithfulness to his first wife also. He was evidently a man of anaturally jealous disposition, and of a hasty, impulsive,excitable temperament. None can know what cause, orwhether any cause, gave rise to his jealousy of the secondwife, but it seems to have grown until it filled his whole mind,until every trivial occurrence was construed into a fresh wrongand aggravated the morbid mood by which it had been misapprehended. One thoughtless remark seems to have hastenedthe catastrophe. Barr and his wife frequently took theirmeals at a certain eating-house, and a few days before themurder he went to ask if she had been there. One of thewaiters foolishly answered that they were wondering whosewife she was as she had been there with two different men.Here at last, he thought, was the proof of her wrong doing,and his jealousy became fiercer than ever.The following extracts from a letter written by Barr to hiswife's brother on the day before the murder shew his stateof mind, and how completely the demon of jealousy possessed him.I suppose you are silent because you have no defence on behalfof your sister? Would any man or woman stand such calumny ifthey could disprove it? I charge your sister with being in impropercompany, under degrading circ*mstances. So much so that partiesran to the windows to see how they went down the street. Would youlike two swells with tall hats to be taking day about with your wife.232 The Plea of Insanity in Cases of Murder, [July,Come now be a man. Would you like I would take as good care ofyour wife as you have of mine?from under my control.I can prove you helped to keep herWhen I went to tell your mother facts she raged and raved and said it was not true. It is true. Ican prove it, and will. I will bring to light the worst caseof persecution ever a poor soul had to suffer, cold- blooded murder,disgraced for all time by a dd scheming villain . I told her shewas not cheating me. I knew all, though I could not prove it tillnow.The following extract from the declaration emitted by theprisoner further shews his feeling towards his wife, and giveshis version of the murder:-I found that when she left me she pretended to go to her mother'shouse, and I found that under her mother's care, and that of herbrother, she was keeping improper company with drunken men. Herconduct made me mad. I lost my reason . On the 1st of this monthI went into her mother's house with a forgiving spirit. Both mywife and her mother attacked me. They seized hold of my collar andof my watch and chain, and tore the necktie off my neck My wifeacknowledged her adultery, and she said the child she was then carrying was not mine, and she would not allow me to be the father of it,on account of my delicate health . She said she would not have strong children from me. She said that often . After they attacked me,and after my wife had said that, I do not know what occurred, exceptfrom what I have seen in the newspapers. I fled from the house, and ran I know not whither.While in prison he wrote to his dying wife a letter full offoul accusations and curses , from which a very short extractmay be tolerated for the sake of the revelation it gives of the writer's mental condition.How dare you come back and lie with me after publicly prostituting? Are you aware your body is not your own, but mine? If Icould draw down all the curses of Heaven at once upon your whorishhead I would do it. But you can sit and laugh because you are awoman. So was Eve. Curses upon you! I will curse you with mydying breath. Before Heaven you are heart-lazy, a glutton, adrunkard, a whor*, a murderer, a deceiver, a brute, a villain, a very Hell.The only facts elicited at the trial which bore on theprisoner's mental history were that his father had been veryexcitable and impulsive, and that his paternal grandfatherhad been insane for five years before his death. This evidencewas permitted by the Court, though not formally allowed as a matter of law.1876.] by D. YELLOWLEES, M.D. 233Dr. Robertson, who was the other medical witness for theCrown, gave the following evidence. This and the subsequentquotations are from the " Glasgow Herald," of May 11th,1876:-Dr. Alexander Robertson, Superintendent of the City ParochialAsylum, interrogated -You have had great experience in cases ofinsanity?-A. I have had 20 years' experience, and made it a specialstudy. I was asked to see the prisoner. I saw him for the first timeon 16th March, and I saw him again yesterday. I was with himabout an hour and a quarter on the 16th March, and yesterday abouthalf-an-hour alone, and about a quarter of an hour with Dr. Yellowlees.Q. What opinion did you form in regard to the state of his mind?-A. I thought he was an irritable, excitable, very jealous minded man,but I did not see any symptoms of insanity either past or present. Ihave heard the evidence led to -day. Q. Does what you have heardconfirm your opinion?-A. Yes it corroborates my opinion entirelyas to the character of the prisoner's mind.-I was unable to speak so absolutely, especially after hearingthese letters, which were not shewn to us until they were readat the trial. Having intimated my belief that the lettersshowed " some degree of mental disturbance," I was notcalled by the Crown but by the prisoner's counsel, and gavethe following evidence:-Dr. Yellowlees-I am superintendent of Gartnavel Asylum. I havepaid considerable attention to the subject of insanity. I examinedthe prisoner Barr on the 15th March, and again yesterday. On thefirst occasion he was somewhat agitated in manner, but there wasnothing about him to indicate mental disturbance. His intelligenceseemed above the average. He told me a great deal about his wife,about her misconduct and unfaithfulness. I had at that time nomeans of checking what he said as to its truth. Q. Fromthe evidenceyou have heard to-day, what is your opinion as to these jealous statements he made?-A. That these suspicions seem to be unfounded.Q. Would you say that he was suffering under delusions on thispoint?-A. I would call them unfounded suspicions which graduallygrew in strength by being brooded over so long. I also heard theletter read by the Advocate Depute, addressed by the prisoner toWilliam Sloan, the brother of the deceased. It expressed very muchthe same suspicions which Barr expressed to me. Q. Did you thinkthe statements in the letter without foundation? -A. They had nofoundation, if I am to judge from the evidence I have heard.The Lord Justice-Clerk-That is a question for the jury.Mr. Wallace- Have you noticed nervousness and excitability inhim on the occasions on which you attended him?—I think he is anexcitable, irritable man, but I did not see any-at least, not much ofXXII.16234 The Plea of Insanity in Cases of Murder, [July,it. Q. When a man is suffering from these unfounded delusions, hashe full control of his actions?-A. It depends altogether upon thedegree to which he believes these delusions, and whether they be mereunfounded suspicions .The Lord Justice -Clerk-You have not said they were delusions.-A. I have not, my lord.Mr. Wallace-Assuming that the ideas were utterly unfounded,does that not put them in the category of delusions?-A. They are unfounded beliefs. Q. Are such unfounded beliefs not likely to lessenthe control which a man has over his actions?-A. It depends uponthe extent to which they are believed. A man may have an unfoundedbelief which does not influence his conduct, but he may brood over ituntil it becomes overpowering and dominates all that he does. Q.These beliefs, unfounded as they are, may so influence him as todeprive him of control of his actions? -A. More or less .The Lord Justice- Clerk-May a sane man's belief not influence hisconduct? Does it not do it every day?-A. I say it may more orless affect his control over his conduct. Q. Acting on an unfoundedbelief is surely the normal state of humanity. We are all liable to bemistaken in our opinions. Does what you say go beyond this, thatthis man believed what he really had no sufficient ground for believing?-A. I think it does. Q. To what extent? -A. I do not thinkhe merely had an unfounded belief, but that he had brooded over thatbelief until it influenced his conduct very greatly. Q. It becamemorbid?-A. Yes.Mr. Wallace Has the fact which was spoken to by last witness asto the state of the prisoner's grandfather not a bearing upon thisquestion?-A. It renders it more likely that this man has an excitable brain and a temperament more readily excited .The Lord Justice- Clerk-Is that not the question that was dis- allowed?Mr. Wallace-Did you find the prisoner suffering under any formof disease when you examined him?-A. He has the appearance ofa man labouring under consumption . I do not know whether he isor not, but he has that appearance. Q. Is there such a thing aspht hisical insanity?-A. There is a form of mental disturbance oftenassociated with lung disease in the form of phthisis, called phthisicalinsanity . Q. Does this form of mental disturbance exhibit itselfin the earlier stages of consumption?-A. Usually in the earlier more markedly than in the latter stages. Q. I suppose if this manis in consumption he is in the earlier stages? A. In the earlierstages.The Lord Justice Clerk-I presume the mere fact that this manhad suspicions in regard to his wife's conduct, although these suspicions were not well founded , is not of itself an indication that he isaninsane man? -A. No; but if these suspicions are long brooded over,the whole tone of the man's mind becomes altered thereby, and then1876.] by D. YELLOWLEES, M.D. 235it becomes a morbid condition. Q. Is there anything unusual in asuspicion of that kind being entertained by a man although his mindis not unsound?—Ithink it is very unusual that they should go to suchan extent. -Q. To what extent?-A. To the extent, for example, ofinvolving his mother-in-law in the suspicion-to the extent of supposing that she aided and abetted her daughter's misconduct to theextent of supposing himself the most persecuted man who ever livedin the world. Q. You are assuming that there was no foundation forall that he felt. But assuming that the mother-in-law had persuadedthe wife to live separate from him over and over again, is it an indication of insanity that he should be irritable on that subject?—A.No; supposing that the mother- in-law could have done what heimagined. Q. But if she had done what I have suggested, would youthink the person insane who resented that?-A. That would not beinsanity. Q. Supposing the fact was that they did not live happily,that he did not treat her well, that the mother-in - law interfered andtook her daughter away, if the husband resented that, is there anything in all that?-A. Nothing.The defective mode in which scientific evidence is oftentaken was curiously shown in the fact that I was never askedthe crucial question whether, in my opinion, this morbid condition was such as to destroy the prisoner's self-control andimpel him irresistibly to such a deed. Crown counselfeared I would go too far in the prisoner's favour, while theprisoner's counsel knew I would not go far enough for hispurpose, so my full opinion was never elicited. Scientificevidence must always be hampered when given by way ofquestion and answer.It was argued for the prosecution that the deed was theresult of reckless passion, and that laws were made in orderto repress such crimes; while for the defence the plea ofinsanity was strongly urged, founded on the deep and causeless jealousy, the sudden and ill - contrived way in which thedeed was done, the hereditary tendency to mental disturbance, and the likelihood of phthisical insanity.Lord Moncrieff's charge to the jury contained the following clear and admirable comment on the prisoner's mentalcondition.I shall now state what I think are the only propositions necessaryfor me to state in order to guide your judgment in this matter; andit might almost be said of them, as I laid down in the case yesterday,that the question of sanity or insanity, soundness or unsoundness ofmind, is simply a question of fact, to be judged of by you upon ordinary rules and the intercourse between men and men in daily life.It is not a question of law, as I said, or a question of science . It236 The Plea of Insanity in Cases of Murder, [July,would be most unfortunate were it either the one or the other. Thetendency of the lawyer would be to find all men sane, and the tendency of the medical man might be to find all men insane. But the realquestion you have to consider is whether, as regards the prisoner atthe bar, he was or was not of unsound mind. Now, unsound mind ina man means that his mind is diseased , and that he is not capable ofconducting himself in the ordinary relations, or, at least, in some ofthe relations, of life. I said yesterday, and I say again, that thepower ofjudging between right and wrong is not an accurate or philosophical test of the soundness or unsoundness of a man's mind,because there are many men in lunatic asylums that can judge perfectly well of right and wrong-that is to say, can judge of moralobligation and duty, and they do it every day; but the question iswhether they can form a sane idea of right and wrong. And, indeed,I do not feel it desirable to put it in that way at all, because what is right and what is wrong would be a question to solve. The truequestion to consider is whether this man's mind was diseased; whetherhe was the victim of unsound thought-by which I mean thought of a mind that is not sane. Now, it is for you, with the assistance youhave from the evidence, to say whether-whatever may have been theimpulses working on this man, whatever his power of moral restraintmight be, whatever the strength or weakness of his will , whatever thepower of his passions-it is for you to say whether that man was orwas not responsible for his actions . The crime which we are trying isthe crime of murder, and you must know perfectly well that thoseimpulses and passions that have generally given rise to that crime areimpulses and passions that overcome a man's better nature for thetime. The more deliberate cases of murder arise almost uniformlyfrom these impulses, either from the hope of gain, or from the desireof revenge. And in either the one or the other, if you were tobalance the advantages to be gained against the risks to be run, or themoral enormity of the offence, of course no man of sane or sound mind,in one sense, would commit the crime. That is not what is meant bythe absence of legal responsibility; and indeed the world would notgoon if it were, because, as I have said, the more atrocious the crimetheless the man has to resist those impulses that ought to have deterredhim from committing it, and the more does he give way to the impulses that he ought to have suppressed. It is quite true, as Dr.Yellowlees stated, that a man, by brooding over an unfounded conclusion, may lose his moral restraint, and, forming a wrong conclusion ,act upon it. But, alas! gentlemen, it is vain to say that a man shallnot be responsible for his actions because he has formed a wrong conclusion, and has allowed it to weigh upon his mind. I cannot saythat because his conclusion rests upon things that are supposed to beindicative of other things done in secret and without witnesses and incapable of proof, and because he allows himself to be possessed withthat feeling, therefore he should not be held responsible for his actions .1876.] by D. YELLOWLEES, M.D. 237If, however, you should be of opinion that the man was acting undera conclusion that was not only unsound in the way of not being wellfounded, but that it was a conclusion he had formed because his mindwas insane, that, no doubt, if you find ground for it, might amount toinsanity; but if is proved that he suspected his wife without a cause,and that, being a man of violent and irritable temper, he would brookthe interference of his mother-in- law no longer, and chose to vent hispassions in this way, there is not only here no case of freedom fromresponsibility, but I can see no approach to it. Now, gentlemen, Ihave stated these views to you, because, while you cannot help commiserating the unfortunate prisoner at the bar, you will see at oncehow it would go to break the bonds of society, and how it wouldadmit principles destructive of the proper power and regulating effectof law altogether, were such a theory as I have indicated to be sustained without the real ground and foundation on which alone it must rest. In bringing these observations to bear on the facts, I have tosay that it has been too much assumed that this notion of jealousy by the man of his wife was the main cause which he had for the state ofirritated passion in which he undoubtedly was. But you will remember that from the date of their marriage they lived unhappily, andnot solely on the ground of Mrs. Barr's suspected infidelity . Therewas another ground, and that appears from one of the letters. Therewas a former family, and there were disputes on that ground. It was said that Mrs. Barr was unkind to the children. Whether she was soor not I cannot tell, but I do find in one of her letters some expressions regarding the antecedent history of the family.[The letter was here read. ]Gentlemen, I think that shows that there was in this unfortunatehousehold an element of unhappiness apart from jealousy-namely,the children—and also that one of the causes that stirred him up tothis act was the determination of his wife to leave him. She went toher mother's, and the mother harboured her, and beyond question itwas on the mother's advice that this was done. Therefore, gentlemen, I fear that the evidence in this matter, as far as it was gone into,has supplied a motive. It was not a sudden ebullition of passion, buta long-working and sustained jealousy-a fever of imagination-arising on the one hand from a desire to live happily with his wife, andon the other hand from an inability to control his temper—a state ofmind not at all unlikely to lead to such a lamentable result . But,gentlemen, that is not enough. If you should be of opinion that thereis nothing more in the case than that, I am very much afraid youcannot say the prisoner at the bar is not responsible for his actions.Gentlemen, I don't wish to press this too strongly. You have heardthe evidence, and everything I have said is entirely subject to youropinion in the matter, for, as I have said, the question is, whetherjudging him by the ordinary rules applicable to ordinary life you do or238 The Plea of Insanity in Cases of Murder, [July,do not think he is responsible. On the other hand, I must say, for Iam bound to say so, placed as I am in reference to the law and thosewho are under the law, that although you have no proof here to meetthe grounds of this jealous feeling, it is a stretch upon the fact toassume that the man had no foundation for his opinion-I meanin his own mind. I think myself that when the poor woman on herdeath-bed declared that she had been faithful to him she spoke thetruth; but it does not follow that there may not have been thingsoccurring which, without the presumption of insanity, might have had an effect upon the jealous temperament of this man. As to the insanity of the grandfather, I have doubts as to how far that can tell onthe case before us. I really think that although the grandfather'smind was unhinged by the loss of money which his son had causedhim, that is not an element which you could possibly apply in thiscase. Now, gentlemen, I think I have said all that is necessary inorder to enable you to come to a verdict. Do not leave out of sightthe fact, which in a case of this kind none of us can afford to leaveout of view, that you are trying a man for his life. Every reasonabledoubt that you can entertain must be thrown into the scale in favourcfthe prisoner; and if, upon this view of his legal and moral responsibility, you are of opinion that he is insane, or if there is reasonableground for hoping that he was insane , you will give him the benefit ofsuch a conclusion. But if you hold that although the man was ofviolent temper, and brooded over his fancied calamities until he lostcontrol of himself, yet that he was just as sane as far as soundness ofmind is concerned as any other criminal who commits acts of thatkind , I am quite sure that however painful your duty may be you willbravely and conscientiously discharge it.After half-an-hour's deliberation, the jury unanimouslyfound the prisoner guilty of the double murder, and that hewas of sound mind when he committed the deed.Barr made a short speech after sentence was pronounced,asserting that he had no intention of murder or violence whenhe went to his mother-in-law's house, and that he was notresponsible for what he had done there.He was executed on 31st May. It is said that before hisdeath he became very penitent, and was greatly changed;but he did not withdraw the accusations of unchastity againsthis wife, nor admit that he deserved to die, but maintainedthat he never intended murder, and had lost all power of selfcontrol when he did it, so that he was not responsible.Barr did not labour under phthisis, as was at first assumed.Even if he had been phthisical, the mental disturbance sometimes connected with the development of tubercle is very1876. ]by D. YELLOWLEES, M.D. 239rarely of such a type as to constitute a successful defence ina case of murder.A few days before his trial he had, or said he had, strangevisions. He told the warder that he had seen a child with ahugh head in a cradle, and he told Dr. Robertson and myselfthat he had seen a skeleton in his cell. We could not regardthese as genuine hallucinations of insanity; they were eitherwholly feigned, or were the memories of troubled dreams, suchas his anxious position might well occasion.The chief question raised by this case is a very important one. Can any emotion, or passion, or desire becomeso intense and so extreme as, in itself, and without anyfurther morbid symptom, to constitute insanity? A physician will answer Yes, a lawyer will answer emphaticallyNo. The physician has seen terror, pride, depression,suspicion and jealousy so extreme, that he must call themmorbid, and it is a mere question of verbal definition whethersuch morbid conditions are to be called " Insanity" or not.The lawyer scouts the idea that such a morbid condition ofmind can constitute insanity; to him insanity is co-extensivewith irresponsibility; he asserts that such extreme emotionalconditions are but signs of an ill-regulated mind, and expressions, or, at most, exaggerations, of natural character; andhe declares that no one would be safe if the mere intensityof an emotion were a sufficient excuse for the violence towhich it led.With his limited definition of insanity, and as a guardianof the public safety, the lawyer is right. Yet what is homicidal mania but a morbid desire to destroy? and what issuicidal mania but a morbid desire to die? It is the very intensity of these morbid desires which compels their recognitionas insanity; and they cannot be explained away as signs ofan ill-regulated mind, or exaggerations of natural character,for they occur in persons who are neither habitually cruel norhabitually desponding.An emotion then may become so intense as to be morbid,and so morbid as to constitute insanity, even in the legal senseof the word.At what point a natural emotion becomes morbid in intensity, or insane in character, only Omniscience can perfectly determine. There are, however, several considerationswhich may help us, though not infallibly, to a decision insuch cases. A mind in which one emotion has acquired insane intensity will probably have a prior history of nervous240 The Plea of Insanity in Cases of Murder. [July,instability, or of inherited predisposition to insanity; therewill probably be no reasonable cause for the intense feeling,or no sufficient motive to inspire it; above all, the insanefeeling is not likely to concentrate itself wholly upon onesubject or one individual, but will, in most cases, find variousoutlets, and will be the habitual attitude of the mind towardsevery thing or every person around it.Let us apply these considerations to Barr's case. Therecan be no doubt that he had, both from habit and by inheritance, an excitable nervous temperament. As to the cause ofhis jealousy, although none was found, and although thedying wife asserted her innocence, it is of course quite possible that there may have been circ*mstances which seemedto his mind a sufficient cause, and which, if known, mightdeprive the jealousy of much of its morbid character. Itis, however, chiefly in the last respect, that Barr's suspicions came short of the insane type; they had but onedirection, and one object; there was no poison in his food;no whispered conversation about him; no malign influenceexerted upon him; no secret conspiracy to ruin him; it wassimply that he suspected his wife of unfaithfulness, and heblamed her mother for protecting her.However intense this feeling might be, there was certainlyno good reason to think that it had destroyed his self-control,and impelled him irresistibly to the fatal deed. There wasno sufficient ground for deeming him legally insane, and itwould assuredly be most perilous to society if a man mightmurder his wife and mother-in-law with impunity, providedonly that his jealous suspicions were sufficiently deep andstrong.Cases may occur where such morbid emotional conditionsshould modify responsibility, and therefore mitigate punishment, but this principle cannot be accepted as a generalrule. Evil passions uncontrolled are the most fruitful sourceof all crimes, and too often without the excuse which insanityaffords.1876. ]241An Arab Physician on Insanity.The following account of the symptoms and treatment ofinsanity, as known to Arab Physicians, is taken from thePersian Medical Work " Tibb i Akbari, " written by Muhammad Akbar, about the middle of the 17th century. The"Tibb i Akbari" is a translation from the Arabic of theSharh ul Asbab wa Ullamut, a commentary written by Nafisbin Awaz, in the year 1450, on the Asbab wa Ullamut, amedical treatise by Năjăb ud din Unhammad of Samarcand,an Arab Physician, who wrote about the middle of the 8thcentury.The subjoined arrangement gives the names of the differenttypes of insanity and the order of their description in the "Tibb i Akbari:"-I.-Souda à Tabee.1. Souda.2. Janoon.II.-Murrāē Soudā .III.-Malikhōlia ā Marāki.IV.-Diwangi.1. Kutrib.2. Mania.3. Daul Kulb.4. Sadar.V.-Haziyān.1. Mibdā ā illut dimāgh {2. Mibda a illut Marak.3. Būkhārāt Had.VI. -Raoonut.VII.-Himak.VIII.-Ishk.IX.-Nisyān.1. Harām.2. Pak.1. Zikr.with six subdivisions.2. Fikr.3. Takhil.Muhammad Ukbar defines insanity as " a state of agitationand distraction, with alteration or loss of reason, caused byweakness or disease affecting the brain."242 An Arab Physician on Insanity. [July,1.- Souda à Tabee originates in constitutional disease,causing fevers to ascend from the body to the brain, and ter- minates in unconsciousness.' (Dementia?)""The symptoms met with in this form of insanity are of three kinds.1st. When the patient shows great carelessness, as regards clothing, cleanliness, attention to the bodily requirements and the calls ofnature, the pulse being astonishingly irregular, the skin coarse, andpresenting a black colour, and the urine thick.2nd. When the memory is impaired, with a childish merriness ofheart, and unprovoked laughter, a rapid pulse, and congestion of theeyes.3rd. (Met with mostly in the young. ) When the patient manifestsintense anxiety, and suffers from a constant dread of something unknown, these symptoms being associated with extraordinary movements of the hands and feet, leaping, beating the ground, &c.When there is a combination of the preceding three classes of symptoms the disease is named Souda.Souda becoming chronic ends in Janoon.In Janoon the patient is extremely restless , sleepless , taciturn ,shows great antipathy to mankind, is violent, and at times roars like awild beast. His skin is dry, the heat of his blood is generally diminished, there being at the same time occasional loss of speech.Janoon is a most unfavourable form of insanity. The word originally signifies to beat the earth with the hands and feet and to fight.Treatment in Souda à Tabee.In the early stage of the disease bleed and purge, nourish andpurify the blood, regulate the system, and endeavour in every way toestablish a good condition by giving nutritious foods, the use of baths,and liniments, and milk rubbed on skin of head and body. As articlesof diet, meat of the first quality, wheat, and good butter are advan- tageous. The patient's taste as to what he would like to eat shouldbe consulted, and every care taken to make things savoury, and to havethem thoroughly well cooked in butter. Sweets and dry fruits, withalmonds, are recommended. Cooling drinks , such as are made frommilk of almonds , sweetened with sugar candy, are extremely useful ,as are also sweet grapes, apples, and water melons, which, in additionto their cooling and nutritious properties, have the effect of strengthening the brain and powers of speech. Whey, which contains much.nourishment, should be given freely.Change of climate is highly necessary, and in the selection of asuitable place, care is to be taken to avoid in every possible way thingslikely to cause irritation, so that the mind may have complete rest .The mental powers are to be strengthened by surrounding the patients1876.] An Arab Physician on Insanity. 243with all things likely to give pleasure; e.g. , soft music, gardens having planted in them trees and fragrant shrubs, with shady places hereand there in which refuge can be taken from the heat, &c.By the use of measures such as these, sleep may be brought on.Sound sleep is the best known remedy for this disease, and far pre- ferable to all medical treatment.The general health having been regulated, the patient is tohave no restrictions placed on him, except only such as areabsolutely necessary for his protection .Previous to the patient's going out for exercise, a glass of wheyshould be given him, and a place for his exercise is to be selectedwhere the air is fresh and pure, where there is no noise or brawling,he at the same time being surrounded with all obtainable beautifulthings, which by giving him pleasure may strengthen his mind. Togive pleasure to these unfortunate men, although the ancients andmoderns affect to despise it, is the only remedy for their cure.Shaik lá Ajab (an Arabic writer) says regarding insanity, " Beit known that of all remedies, to strengthen the heart and brain isthe safest and most sure, guiding the mind and actions; do nothingto frighten a patient, and let him select his own employment. Makethe senses a special subject of treatment, and occasionally give partialintoxicants. Rest and fresh air are required for the miserable menafflicted with insanity. They should be shown every possible kindness; in fact, they are to be treated by those under whose care they areplaced as if they were their own offspring, so as to encourage them tobestow their confidence , and to communicate their feelings and sufferings. This will at least be a relief to those unfortunates, and a charityin the eyes of God."Having done all that is possible to strengthen the brain and mindby avoiding anything likely to cause vexation, pain, sorrow, or disturbthe rest, and the patient still continuing hot-tempered, intoxicating(i.e., mirth-producing, soothing and desirable) drugs may be tried along with a soft bed to rest on (luxuries) .Drink, composed as follows, may be given:--Rose flowers, 3vi.; Sad Kofi; Karan Mustaki; Sumbol, tib .;Asaroon aa 3iij .; Kusfah; Zurnab; Saffron aa 3iij; Kaklah; Basbasa; Jozboa aa 3j .; Amlah 9 (in number). Preparation Amlahilb. boiled in water 7lbs. , till reduced to 3lbs. , strained and mixed withlb. honey, the mixture to be boiled, and the above-mentioned drugspowdered, added, and dissolved. Keep the solution for two months and then use. It will give pleasure to the mind, assist digestion, inducehealthy sleep . Caution: only pure drugs are to be used in the preparation of the above, as the constitution of those who will take themixture is extremely sensitive. (Several other prescriptions aregiven. )244 An Arab Physician on Insanity. [July,II.-Murrãē Soudā.A form of insanity, having its principal seat in the head, but generally connected with disease existing in some other part of the body.It is generally found in men who devote nights and days to study ofLaw precepts, and is a very unfavourable form of disease. Rufus, anArab Physician, associates this form of mental disease with Philosophy, and in this he agrees with the writings of Plato. Tibri, anArab Physician (? ) , states that this disease attacks men who devotetheir lives to science and art. Tibb i Akbari does not limit the disease ,but regards it as a common form of insanity.Symptoms. -The person suffering from Murrāē Souda is loadedwith cares, and constantly full of doubts. When he walks he alwayslooks on the ground; his head and face are thin , whilst the rest of thebody is of medium size; his eyes appear sunken; his pulse is varied,sometimes weak, fast or slow; his urine is thin and clear. Previousto these symptoms appearing, the patient is anxious and sleepless,and should he be exposed to the sun or have suffered from sunstroke,the disease is rapidly developed . Indigestion, and over-spiced foods,by sending heat to the brain, as also eating too many onions, are regarded as producers of this disease.Treatment. Where there is plethora, bleed from temporal artery orcephalic vein (note whether the blood when it settles be black, red , ormixed), and if the drawn blood be black, continue the bleeding tillsuch a time as the blood comes of a pure colour. The bleedingshould, however, be moderate, as excessive blood- letting causes debility. If the blood drawn be of a mixed colour, bleed but seldom ,and when it is red and pure stop the bleeding, as its continuance willonly weaken the brain, for, with blood of a healthy character, it may be assumed that no bodily disease exists. When the patient is veryrestless, before resorting to blood letting, try the effect of some ofthe prescriptions given as beneficial in Souda à Tabee. Do nothingto agitate the brain, avoid violent purgatives, give nourishing drinks,also flesh, fish, &c. As a cooling drink, a milk made from the expressed juice of wheat, poppy seeds and almonds, mixed with sugarcandy, may be used, and the same milk may be used as a liniment tobe rubbed on the head. The non- stimulating oils recommended inthe chapter on Epilepsy, may also be used as liniments . They will cause the eyes to water. Water composed of Shaser, Mukushar,Nelofar, and Burg- Kah, is also to be dashed on the head, &c.The patient should bathe frequently in fresh water, live in atemperate place, surrounded with many trees and shrubs, plants and roses. Whatever is injurious to the general health, such asfasting, cares, excessive cohabitation, and such things, should be avoided.Medicines that are strengthening, combined with nutritious food,are to be employed.1876. ] An Arab Physician on Insanity.245III.-Malikhōlia ā Marāki.This form of insanity is caused by the humours, or by Stomach?or by Nasirak of Tahal. *The humours are collected , and the heat of the body passes from the limbs to the brain.Another name for this form of Insanity is Nafkhae Mālīkhōliā,and sometimes Nafkhae Marāki. Nafkha is the name of that particular form of air or vapour which the angel Gabriel is said to haveblown or caused to pass from his coat sleeve into the windpipe of Marythe Mother of Jesus, for the purpose of impregnation (!!! ) . Marākis the name given to a special kind of heat resident in the body imperceptible to the touch, but of great intensity. When this Marakslowly ascends from the body to the brain it destroys the soul of thebody and darkens the intellect.Symptoms of Mālīkhōlia a Marāki.Sour taste in mouth, great thirst, voracious appetite, thefood does not nourish the body, much spitting, pain in thechest, indigestion, the stomach being sometimes hard, and atother times tender and sensitive.The genitals are hot, there is frequent priapism, and greatdesire for sexual intercourse, with incapacity for its properperformance.The general health is bad, and if not early attended to,there is great increase of the mental symptoms, the suffereris always present with evil, loses all sense of shame, allpower of reasoning, imagination and action, and ends bybecoming completely demented. If the bile be the humouraffected, the patient will be quarrelsome and dangerous toothers; if the saliva, he will be quiet, and have the appearance of being drunk.Treatment. When the signs of inflammation are present,purge, bleed, and let the patient have a diet composed ofmilk. The bleeding is to be regulated by the patient'sstrength, and violent purging is to be avoided, as vomitingand purging in this form of insanity are adverse, and shouldbe at once stopped if they occur.When there is no tendency to inflammation, the strengthening treatment already given is to be used.Should the stomach be swollen, it is to be fomented withoil of roses, Sumbul and Mastaki.

• An exact translation, but meaning unknown to translator.

246 An Arab Physician on Insanity. [July,II.-Diwangi or various forms of Insanity.1. Kutrib.Theterm Kutrib has no exact signification, being the nameof a small animal that is constantly on the move, here, there,backwards, forwards, sideways, &c. , and it has been made useof to represent a form of insanity in which great restlessnessis associated with the mental symptoms. The name is alsogiven to a jackal, and as the patients sometimes howl likejackals, the term has been employed to designate their disease.Symptoms. The patient is always morose, continually onthe move, never resting for a minute in one place; his judgment is defective, his speech absurd, has suspicions that menare about to kill him. These suspicions lead to his hidingduring the day in woods and amongst tombs, only appearingat night. These suspicions are not always present. Thecountenances of patients suffering from this form of insanityhave a melancholy appearance, as if they were constantlylamenting. They also attack men in the desert places whichthey frequent; they move on all fours, like quadrupeds, orstand on their heads. Sometimes they lacerate their bodieswith thorns and stones. (See Mark's Gospel, chap. v. ) Thereis in this disease dryness of the tongue and heat of body.Treatment consists in bloodletting at the outset, the administration of cooling drinks, regulation of general healthby such medicines as are suitable to the patient's temperament, and by attention to diet. Removal from all sources ofirritation or anxiety, fear or discomfort. Promote healthysleep. Compel the patient to be constantly employed, it beingof the utmost importance to get the patient to work.Failing this treatment, " Shaik "? ( ) advisesthat water should be constantly dashed on the head, and thepatient prevented from sitting in the dark, i.e., secludinghimself, at the same time giving all sorts of medicines to coolthe brain. If this treatment be persevered with, recoverymay be confidently expected.2. Mania, a Greek term, equivalent to the Arabic " JanoonTabee, " or to what is termed by Razu, an Arab writer on thesubject, " Janoon Haeeg."Symptoms. -Persons suffering from this disease break andtear whatever they come near. They rush into places wheremen are congregated, not for the sake of society, but simplyto gratify their desire for mischief and destructiveness.1876.] An Arab Physician 247 on Insanity.The treatment for this form ofinsanity is some one ofthosepreviously given as suitable for insanity.3. Daul-Kulb is a form of insanity in which the destructiveness and mischief manifested in mania is associated withirregular manifestations of gentleness and fawning, after the manner of dogs; hence the name. It is also to be noted thatif a healthy man is bitten by a person suffering from DaulKulb, the healthy man will speedily die with symptomsexactly similar to those which manifest themselves in a person that has been bitten by a mad dog. The cause of thisform of insanity is said to be the bile.When the disease is caused by the bile affecting the brain,the patient is at first thoughtful and silent. When he doesspeak it is difficult to understand him, and he may continuespeaking for a long time. When in a fit of rage he becomesunmanageable. He is emaciated, and his colour is changedinto black. Later on there is great mental anguish; oneminute he is violent and unmanageable, and the next quietand sorrowful. A swelling of the brain exists in this disease.The treatment consists in regulating the patient's health,giving nourishing food and medicines that will strengthenthe brain and heart, combined with perfect rest, and removalto a cold climate,4. Sadar. (A Sooryam word, signifying Janoon- mufrit)said to be mania associated with swelling of brain.Symptoms.Sleeplessness . Melancholy and distractionof mind, heaviness of head, terrifying dreams arouse fromsleep. The patients frequently beat themselves, theyanswer questions in a curious way, i.e. , give unmeaningreplies; they forget everything; their eyes are red, heavy,and have an appearance as if something had been putinto them. The urine is white and thin; there is frequentshivering.Treatment. -Give in this disease the medicines recommended in Sarsam. The hands and feet should be tied.The advantages of restraint are, 1st, that the patientmay not show restlessness; 2nd, that his brain may haverest; 3rd, that he may be prevented from killing himself orothers.Tibree (?) states that he saw two men in Tibristan who, afterkilling many men and women, committed suicide by hangingthemselves from trees.248 An Arab Physician on Insanity. [July,V.-Haziyān, a disorder of judgment, resulting in the lossof the power of thought. It has three subdivisions.1. Mibdā à illut dimāgh.Manifesting itself by the mind magnifying whatever ispresented to it, and leading to actions that are outrages onsociety; to habits that are animal; to displays of opposition;to absurd conduct, laughing, dancing, &c. , without reason,and caused by Soudaê damwee; to acts of violence, restlessness; to abstinences from society, concealment of face; tosleeplessness. Sometimes these mental symptoms are associated with inflammation of brain, eruptions on head, andfever.2. Mibdā ā illut Marak,Said to be due to the loss of Spermatic fluid.3. Būkhārāt Hād,Said to be due to heat from the bones ascending tothe brain. The symptoms are? and the treatment is that of?VI. -Raoonut and VII. Himak.Are forms of insanity in which the thoughts are disordered,and the power of making use of the mental powers entirelylost. The patients who suffer from these forms of mentaldisease do all sorts of silly things, useless work, or will notwork, their whole conduct being childish. It has been noticedthat, along with the above symptoms, there is restlessness,sleeplessness , and a dryness of the eyes.Treatment the same as regards food , rest, &c. , given as ofuse in the other forms of insanity, as regards medicines give,those recommended as of use in Nisyan.VIII.- Ishk.The term Ishk is taken from Ishka, a creeper that twinesround a tree, gradually causing its death.The mental symptoms are, grief and weeping, avoidance ofsociety and seclusion, with constant concentration of mind onan object loved; anxiety, fear, silence. Associated with themental symptoms are dryness of blood, with a varying pulse.Treatment. After an examination of the patient's constitution and temperament, prescribe the diet recommended inMalikhōlia, also such of the drugs of use in that form ofinsanity, as may appear suitable. In addition to the above,1876.] An Arab Physician on Insanity.249the patients must be amused and kept merry. Sometimes " itmay be advantageous to decry the objects loved, or, again, toconfine the patient along with his mistress, or some otherwoman, so that he may, by association, be led to form correctjudgment, and conquer his condition.Marriage, where it can be accomplished, is the best of allhuman treatment. It is particularly necessary in this formof insanity that the patients be not allowed to be idle, so as to furnish them with leisure to brood over their own thoughts,but that they should be compelled to work.It is not known to man how love causes insanity, and whatever is written on the subject is vain. Physicians have failedto trace the origin of the disease.Allah ' hōōma Urzukna. God keep it far from us.Ishk is subdivided into1. Harām, or Insanity produced by impure love.2. Pak pure love carriedto excess. The symptoms and treatment are thosealready given.IX.-Nisyan, or Loss of Memory, has three subdivisions, viz.1. Zikr.2. Fikr.3. Takhil.Symptoms and treatment unknown. J. G. Balfour.CLINICAL NOTES AND CASES .Two Cases having certain points of resemblance to GeneralParalysis of the Insane, but without Insanity; andOccasional Memoranda of a Third Case. By W. T.GAIRDNER, M.D. , Professor of Medicine in the Universityof Glasgow.The cases hereafter detailed from the journals of theWestern Infirmary, Glasgow, are those of two patients submitted personally to the observation of the members of theScottish Branch of the Medico- Psychological Association, onMay 5th, 1876; and the discussion thence arising will befound reported in this Number of the " Journal of Mental Science." I have added some particulars of a third case, referred to by Dr. Clouston during the discussion, from loosememoranda made at the time; but I have not endeavoured togive this last case in anything like a complete form, asXXII. 17 2250 Clinical Notes and Cases. [July,materials are wanting, or, at least, could not be easilyobtained under the circ*mstances. It is very difficult, ofcourse, to convey in words the impression given to the mindof the observer, in the first two cases, as to the absolute integrity, to all appearance, of the strictly mental functions;but in the case of S. D., I can most truly state that after morethan two months' watching of him in hospital, not a singleparticular was observed tending to indicate the slightestdeviation from a normal condition, whether of the intellect,or of the emotions. S. D. is, moreover, a man very muchabove the average of hospital patients, and responds readilyand naturally to all the tests which can be applied, in conversation and otherwise, to elicit the qualities of a welleducated, intelligent, and well-balanced mind. T. H. is aman of inferior social position , and of a much less cultivated,as well as, I think, lower organisation than S. D.; nevertheless he is not deficient in shrewdness, and in a certainhumorous faculty which, in his case, is perfectly undercontrol, and serves to display to some advantage what mightbe called a rude and coarse, but certainly not an insane mind. Both patients have seemed to me entirely free fromthe kind of exaltation or extravagance so characteristic ofthe delusions of general paralysis, and equally removed fromthe other extreme of melancholia or morbid depression.They are both keenly alive to their own bodily complaints,and able to take an intelligent and rational view of everything bearing upon them. With these preliminary remarks,I shall leave the notes taken in hospital of these two casesto speak for themselves.CASE I.-Defects of articulation and gait for two and a-halfyears, followed by imperfection in the minuter combined movementsof the fingers (occupation, watchmaker) . Sensibility intact. Doubtful trace of right portio dura paralysis. Startings, but no considerable pains, preceding the impaired movements. A temperate man,with no morbid tendencies to excess, either sexual or alcoholic.Physical conformation robust. No fever.S. D., æt. 50, watchmaker, admitted on 2nd February, 1876 , complaining of weakness in the limbs, difficulty of walking, and defect inthe power of articulating words. A stout, muscular man, of healthyappearance, with well-marked arcus senilis. Has always enjoyed goodhealth till the present illness. Difficulty in walking commenced twoyears and a-half ago; startings had been present for a long time previously, but no serious pains. About a month later some of the moredelicate manipulations proper to his handicraft became difficult to him,and he had at last to abandon them altogether. It is eighteen1876.]Clinical Notes and Cases. 251months since the defective articulation began to be observed; and eversince it has made very gradual progress. At times he feels as if hewould choke in swallowing his saliva; but there is no persistent orconsiderable dysphagia. No irregularity in the axial movements ofthe two eyes; no diplopia at any time. Vision, as well as hearing,taste, and smell, appear to ordinary testing to be perfect. No inequality of the pupils. Slight difficulty in attempting to whistle isapparent to patient himself, and questionable signs of paralysis ofportio dura on right side were discovered soon after admission inpresence of Dr. Yellowlees. * Tactile sensibility is unaffectedthroughout the body. [ This statement, made in the first instance ingeneral terms, was afterwards tested in every possible way with thesame result . The sense of weight was so delicate that he could withperfect ease and certainty distinguish half-a-sovereign from a sixpenny piece; and he distinguished weights placed upon either footwith ease down to half an ounce. There was no loss either ofcutaneous or of muscular sensibility in the lower limbs. ] Patient iseasily fatigued in walking, but there is no real paraplegia, and themuscular activity and power of the lower limbs are apparently quite unaffected, except as regards progression . The bladder is not paralysed,though perhaps a little irritable in the earlier part of the night,before he falls asleep. The sexual functions are normal; or, at least,if morbidly affected at all, it is in the direction of slightly impaired,but not lost, energy . There does not appear to have been any kind ofabuse of the generative organs, and patient never had syphilis. He ismarried, and his wife had a miscarriage soon after marriage. Hebelieves that she suffered some injury to the uterine organs interfering with procreation, as she has never had any children since.The organs of the chest and abdomen give normal results tophysical examination . The bowels are regular. Pulse rather feeble,88 per minute. No fever. The family history gives nothing remarkable, and nothing can be elicited as to prevalence of nervous diseasein the family, unless it be that a half-brother (son of his mother, whoherself died at the age of 84) is at present hemiplegic, by a recentstroke, at 74 years of age. The state of the intelligence, and of the mental functions generally, has been sufficiently indicated above.The defect of articulation is not easily reduced to any precise formof expression. There is no single word, or ordinary combination ofvowels or consonants, which fails to be produced with tolerable precision when his attention is carefully given to it; but yet there is amanifest thickness of utterance, and a constant disposition to slur overconsonants when he is speaking unguardedly. He himself givessixpence " as a word which he feels to be as awkward to pronounceas any; while, on the other hand, such words as Constantinople,hippopotamus, perpendicular, are, on the whole, well pronounced; the66

• See the discussion in the Report of the Quarterly Meeting.

252 Clinical Notes and Cases [July,.tendency to slur being greater in the lingual than in the labial consomants. All the rougher movements of the tongue are perfectlyaccomplished, and there is no deviation.The defect in progression is described in considerable detail in theJournal, but the following may suffice to convey its general character.On a level surface, and when free from agitation, patient can walk,when left to himself, without any very obvious disorder of movement,but perhaps with more appearance of deliberation than is strictlynormal. His difficulties are increased by turning, by walking on anarrow base, or with closed eyes; under such circ*mstances, and particularly in attempting to walk straight on the breadth of one or twoplanks, he often lurches over, and almost always towards the left side.He says that this has been so all along. There is none of the stamping peculiarity, or extreme non-coördination proper to locomotor ataxy;and the inability to walk with the eyes closed is much diminished aftera little practice. He experiences greater difficulty in descent than inascent.Although, as stated, the more delicate manipulations proper to hisoccupation have become impossible to him, he can handle money, andpay it from one hand into another, without any apparent want of pre- cision of movement. In using the dynamograph he can employ agreat amount of pressure with the hand, and the resulting penciltracing on the instrument is not appreciably different from the normal. When, however, he spreads out his fingers and maintainsthem in this position for some time, there are obviously abnormal,though slight, tremors and lateral movements of an involuntarykind in the individual fingers , especially in the left hand, and in thering finger. His handwriting, which we have had a good opportunityof comparing with a MS. written before his illness, betrays a dis- tinctly tremulous character, but nowhere so great as to causeobscurity in reading it.An ophthalmoscopic examination by Dr. Thomas Reid reveals onlycongestive changes in the retina, more or less on both sides, but theyare such that Dr. Reid is disposed to regard them as having relationwith the morbid alterations in the nervous system rather than with overwork or other local disease of the eyes themselves.The treatment was partly by a mixture of strychnine and gentian(which appeared to him to do a little good) , partly by galvanic continuous currents applied to the sympathetic (on the advice of Dr. Finlayson), and afterwards by Kirby's phosphorus pills. It cannotbe said, however, that any permanent benefit resulted from the treat- ment. He left the hospital after more than two months' residence, onthe 14th April.CASE II.-Headaches for seven or eight years (occasional). Asingle slight quasi- epileptic seizure in the midst of otherwise good health,five years ago. A more decidedly epileptiform attack five months ago,1876. ]Clinical Notes and Cases. 253succeeded by very gradually progressive lesion of motility, manifestedchiefly in the gait and the articulation . No distinct paralysis, and nofurther epileptiform or other spasm. Tremulous movement offingers,and unsteady handwriting, but firm grasp. Slight tremors offibrilla oftongue. No anaesthesia, nor abnormal sensibility. History of sexualexcesses in married life, but no syphilis, and no impotence. Habits temperate as regards alcoholic drinks.T. H., æt. 45, miner, sent by a practitioner from the country forexamination, but not admitted to hospital; the suspicion entertainedwas that it might be a case of " locomotor ataxy. " Subject to headaches for seven or eight years, regarded as ordinary " bilious" headaches, and concurring with costiveness. Otherwise health good upto about five months ago, with exception of something like an attackof sudden unconsciousness five years ago, and a more positive suddenseizure of some kind five months ago, during which he bit his tongueconsiderably on the right side, but seems quite confident that he feltand knew everything that happened. Nothing more can be elicitedabout this fit except that it seems to patient to be the starting - pointof his present disease, while neither the headaches, nor the formerattack referred to appear to him to have in any way affected hishealth; and the headaches indeed have been almost absent since thepresent symptoms began, nor has there been any new sudden nervouscomplication. For five months he has had a very gradually increasinginstability in gait, and a disorder in the articulation , together withsuch an amount of want of control over the right arm as to incapacitate him for work; all which disorders are dated pretty accuratelyfrom the seizure above referred to, though not, like it, of suddenonset, but of gradual and almost imperceptible increase. He hasnever been so much disabled as at present.The disorder of motility, in so far as it affects the lower limbs, consists of a general instability of gait, with an occasional tendency tolurch over to one side, exactly as in the case of a drunken man, butwithout the slightest apparent disorder of the consciousness, or of theintelligence . He has been able to walk from the Queen-street Stationto the Infirmary, a distance of nearly two miles, with some difficulty,but still with a sense of increased , rather than diminished freedom inthe use of his limbs as a consequence of the exertion . He experiencesincreased difficulty and uncertainty in walking upon a narrow base,but still without the slightest tendency to stamping, or any of themore erratic movements of locomotor ataxy. In standing, he prefersa broad base, but is not wholly unsteady even when the two feet areclose together. The equilibration is considerably less perfect with theeyes shut, and is accompanied, after a time, by a swaying movement,which ends in his tendency to fall over; but he can walk several stepseven with the eyes shut, proceeding cautiously, and with full knowledgeof the surroundings. There is no marked increase of unsteadiness afterstanding a considerable time with the eyes open; and there are no254 Clinical Notes and Cases. [July,tremors in the muscles of the lower limbs . In the right hand, on theother hand, there are distinct tremors of the fingers , specially observedwhen the thumb is closed upon the two first fingers; but when this ismost considerable, it is never more than the movement of a few muscular fibres at a time; and, as far as it can be observed, not predominating in any particular set of muscles. The handwriting is verydecidedly affected, not so as to be illegible, but shaky and tremulousto a marked degree, and on comparison with MS. written before hisillness, it is in a larger character, more apparently elaborated, and atthe same time much more unsteady. Notwithstanding this tremoras regards the minuter movements of the fingers, the grasp of theright hand is quite steady and firm, and the register with the dynamograph is equally good as with the left hand, the tracing beingnormally straight in both cases.The cutaneous sensibility, both of the upper and lower extremities,seems perfectly preserved; there is no sensation of cushioning betweenhis feet and the floor, no numbness; he can distinguish easily byweight, and with the eyes shut, between a half- sovereign and a sixpenny piece.The defect of articulation may be described generally as a thicknessof speech, affecting both the labial and the lingual consonants. Thereare no marked tremors of the lips, and the tongue is protruded normally in all directions, but slight abnormal tremulousness is observedon several occasions in the muscular fibrillæ of the tongue, as examined on the dorsum.He says, in answer to a question, that his memory has been bad fortwenty years, and that " it was novel-reading that spoiled it" -arather strange confession for a miner; but there has not been theslightest appearance of any lapse in his narrative as tested in presenceof his wife, nor has there been the slightest manifestation of undueemotional tendency or exaggeration; but, on the contrary, a clear,sharp, and in a certain sense, accurately logical view of his own position.There has been nothing resembling, in any degree, the sharp, or" lightning" pains of locomotor ataxy, nor, indeed, any well-knownpains, with the exception of some stiffness of the knee, and pain inbending it, apparently rheumatic; a little also of pain and stiffness inthe back on rising in the morning. There has been complete controlover the sphincters throughout, and no important disorder of micturition or defecation. Urine normal.He had a gonorrhoea at 19 years of age; married at 20 , and had alarge family of healthy children by his first wife. No history of syphilis at any time. His present wife is childless . His habit allalong has been to have frequent sexual intercourse with his wife, andin the first years of his married life there seems to be no doubt that heindulged in this to great excess, but without at any time being sensible of directly bad effects. Of late he has been more moderate, but1876.] Clinical Notes and Cases. 255the generative power and desire are obviously unimpaired, or evenmore active than in the average of healthy men at his age. As regards alcoholic liquors, his wife's testimony and his own concur in representing him as a very temperate man. He never cared forwhisky, and for many years he has been nearly an abstainer.Dr. Reid examined the eyes, and found them hypermetropic, all theother lesions discovered being apparently related to this condition.His vision has been long rather indistinct, for ten years, at least; hethinks it has been rather more so of late; but diplopia, strabismus,&c., have been absent throughout.The treatment adopted was, in the first instance, by iodide of potassium, 20-40 gr. doses, under the idea partly of reducing the almostabnormally developed sexual desire. Afterwards Kirby's pills weregiven, but they seemed to disagree, and produce diarrhoea; thepatient spontaneously reverting to the iodide, which he believed haddone him some good. Strychnine and gentian in combination werealso employed, partly with, and partly apart from the iodide. It isdifficult to say whether any good effect resulted, Galvanism was notemployed, as the patient lived at too great a distance to allow of itsregular systematic use.Remarks.-The resemblance of these two cases, in manyrespects, to the general paralysis of the insane, was fullyadmitted by the members of the Medico- Psychological Association, to whose observation they were directly submitted.A group of cases of the latter affection in various stages,selected for me by Dr. Yellowlees from the large field at hisdisposal, enabled the students of the clinical class in theWestern Infirmary to recognise this resemblance, especiallyas regards the articulation. As the cases do not, in theirpresent stage, illustrate clearly any definite question connected with cerebro-spinal pathology, I shall content myselfwith recording the symptoms and history here. Any one whohas studied personally, or in duch*enne's elaborate description, the type now so well characterised under the name oflocomotor ataxy, will have no difficulty in placing these two cases quite apart from those so designated. The entireabsence of the peculiar jerking and stamping movements,and of anesthesia in the lower limbs; the absence also of the"douleurs fulgurantes " in the early stage, and of all thespecial ocular symptoms of duch*enne's disease; the presence,on the other hand, of defects of articulation, which are almost never observed in locomotor ataxy, form a group of distinctive characters, amply sufficient to establish the diagnosis.The epileptiform antecedents, in the case of T. H., may,perhaps, be considered to point to cerebellar paralysis as a256 Clinical Notes and Cases [July, .possible diagnosis, but there is little else to recommend thisview of either case; no local pain, little, if any, well- markedvertigo, no sickness which can be viewed as characteristic,the headaches in the case of T. H. purely occasional, chieflyfrontal, and ceasing with the invasion of the more serioussymptoms. Lastly, notwithstanding the presence of musculartremors over a limited area, the cases do not present definitelythe features of the types of " sclerose en plaques disséminés,"as described by Charcot and Bourneville. I have, therefore,thought them worthy of record in this Journal.The following very imperfect, but still, I think, more orless valuable memorandum relating to a case which excited inno ordinary degree the sympathy, as well as the medical interest, of a wide circle of friends, may be added here, inasmuch as the remarks of Dr. Clouston have already indicatedthe resemblance, in many respects, of this case to the twopreceding. The subject of it was a medical practitioner ofsingularly clear judgment and profound insight, who, duringa career of twenty years as a surgeon, had acquired a local reputation of the highest order, and whose devotion to hisprofession and to his patients secured him the personalaffection, as well as respect in a high degree, of all whoknew him. Without encroaching on the domain of privatefriendship, I may be permitted to say that few things in myprofessional experience have been more painfully and sadlyinstructive than to watch the approaches of insidious nervousdisease in one who confided to me his inmost thoughts andfeelings, and who up to a late stage, at least, of the disorder,could not but be regarded as eminently qualified, by his enthusiasm in pathological studies, to appreciate the character,and foresee the end, of his own case. One other remark Iwill venture to make, for the sake of those who may readthese notes with a knowledge of the personal history in- volved in them. Cherishing my friend's memory as I do, Ibelieve that certain misunderstandings which occurred towardsthe close of his useful and honoured life were brought about by external causes acting on a diseased brain. But in noother respect, perhaps not even in this respect, could thesubject of the following notes have been pronounced technically insane, even up to the latest period at which I had anycognizance of his symptoms.CASE III.-X., a practitioner of surgery, was known to me fromthe time of his early manhood as a remarkably active, modest, soundminded, and in every way most estimable and loveable man. The only1876.]Clinical Notes and Cases. 257considerable bodily infirmity to which he was liable was a tendency todiarrhoea, which, however, did not at all interfere with his generalhealth or good condition, and even at times seemed to act as a safetyvalve, especially when, as often happened, he was engaged in pathological researches involving the risk of septic poisoning. He consultedme about this on one occasion when he entertained an idea of goingto India; but about the same time, a good opening for practice occurringat home, he abandoned the idea, and with it all serious questions connected with the diarrhoea. He continued in very active practice,without any appearance of impaired health, till about the year 1871 ,when he himself grew more or less anxious, on account of certainsensations in his head, accompanied, as he thought, by a somewhatdisabling amount of deafness in the left ear, and by a consciousness asif of something impending which might tend to arrest his career ofusefulness and work. It was very difficult, even for a confidentialfriend, at this time, to get from him any clear idea of what the actualsymptoms were. He believed that his memory was becoming impaired-but all that could really be perceived by any one else wasthat his own confidence in it was shaken. He complained, if I remember aright, of noises in his left ear, and was acutely sensible ofthe diminished distinctness of his hearing, which was originally, likeall his other senses and faculties, extremely perfect. He was exposedat this time to some domestic calamities, which seriously weighedupon his mind, and afforded a presumption that he might, under theinfluence of these mental causes, be taking too serious a view of hisown symptoms. A year afterwards, the presumptions of fatal diseasewere much stronger; he was evidently the subject of some progressive form of slow paralysis. His articulation was affected; there wasslowness and hesitancy, with manifest thickness of utterance both ofthe labial and of the lingual consonants. Still, this symptom variedso much from day to day that I was told that on the occasion of hisconsulting one of the most distinguished London physicians the flawin the articulation was imperceptible, and the whole of the symptomsappeared to that eminent authority to admit of a favourable prognosis. To myself, on the other hand, and subsequently to Dr. Warburton Begbie, as well as to all of those medical friends who weremost constantly associated with him, the facts of his case seemedmost ominous and the ultimate prognosis very gloomy. I have roughand brief notes taken at this time of the following symptoms; and Iparticularly remember being strongly impressed with the clear and unexaggerated account he gave of them, and the apparently just andwell-balanced estimate which, notwithstanding much suppressed emotion, he obviously formed of his own case."Articulation like that of general paralysis; labials first, then linguals, perhaps palate. No affection of voice; no aphasia. Slight tremorsof tongue fibres; no deviation or loss of power; uvula straight." Deafness-originally in left ear -with great noise, which afterwards ceased. Then deafness in right ear, without noise. Hinton,258 [July,Clinical Notes and Cases.who examined the ears , pronounced no local disease, unless, perhaps,of labyrinth-recommended a holiday in Switzerland, with residenceat not less than 4,000 feet above the sea level. [ X. had returnedfrom his Swiss tour at this time, decidedly worse. ]"Vision perfect throughout. [ As he had been a considerablesmoker, though in no other way intemperate, I questioned him as tothe effect of tobacco. He said he was not conscious of its havingdone him any harm, but that he had become aware of a comparativeinability to smoke much as his disease advanced . The disposition,too, to smoke had almost ceased. ]"Giddiness like that from too much wine-a temporary, but not amomentary sensation, often quite absent, and varying in amount, likethe fault in articulation , from day to day. Feeling of weakness in themuscles of the legs and thighs, with uncertainty of gait, but notmuch liability to fall, except when giddiness comes on suddenly. Nomarked peculiarity of gait to an observer, and no trace of locomotorataxy. He fancies that at times he does not quite know where heputs his feet; there may, therefore, be muscular anæsthesia, but thereis no want of sensibility of sole of foot. These phenomena in thelimbs are only of three weeks ' standing. There is no twitching, or sudden starting, and no pain; he has had, however, at times what hedescribes as ' thrills ' in the muscles both of arms and legs, like thefeeblest possible Faradic currents-these often when he awakes in themorning."Writing is difficult to him-MS. alters from day to day, and sometimes in the course of a single letter. [ I could not get him to giveme a specimen of his MS. without exciting undue susceptibility. ]"Memory impaired; according to his own impression decidedly so.[ He never varied in his statements on this point, but, according tomost of his friends at this time, little or nothing wrong was manifestto them in ordinary intercourse. My impression is, that having anoriginally powerful and exact memory for details beyond most people,he had got into the habit of trusting to it unduly, and had begun tofind himself at a loss as to circ*mstances which most people would have committed to paper. But in regard to this, as to other mentalphenomena, it would be very difficult to fix absolutely the beginningsof what could be fairly called morbid changes. There was certainlyno loss of memory such as to lead to inconsecutive thought, or uncertainty as to the details of his own case. ]"Intellect otherwise quite sound. Emotional manifestions (?)[ Once or twice, during a long conversation, he manifested considerable emotion; but not, as I thought, in excess of what was natural under the circ*mstances. Considered in relation to the theory ofgeneral paralysis what was most striking was the exact apprehensionmanifested of the bearing of all these medical details, and the evidentlycomplete self-mastery which enabled him to look facts in the facewithout disguise, and without flinching. ]" No pain throughout, unless on one occasion in the evening (pro-1876.]Clinical Notes and Cases. 259bably accidental); pain referred to occiput. He also speaks of afeeling of anxiety or uneasiness about the diaphragm after much con- versation. "It only remains to be stated at this stage of the case that my friendassured me positively that there never had been any syphilitic infection . He had tried arsenic, iodide of potassium, and other remedies,and at one period appeared to derive a certain amount of relief fromthe use of port wine as regards the noise in his head. He used this,however, as a medical prescription, and was never addicted to excess.In his Swiss journey he employed various narcotics, viz. , hydrate ofchloral, opium, and bromide of potassium to procure sleep; but heafterwards abandoned all of these, and did not complain of sleeplessness at the time of my visit. He said he always felt better after ameal, but could not take wine without a certain sense of increasedgiddiness and instability.Such was the state of X. in the autumn of 1872. In November hewas seen by Dr. Warburton Begbie, who wrote to me as follows: -" I have seen poor X. He has been rather improving since yourvisit-speaking and walking better. His case is, however, a very anxious one. General paralysis is the disease which is threatened;the defective articulation is distinctly of the kind met with in thatdisease. I do not think his memory is materially affected; he is, however, emotional, and much depressed. I agree with you in the recommendation of a trial being given to electricity. Further-and Iagree to order cod liver oil, with dilute phosphoric acid. " The gentleman referred to here was the one of all X.'s professional friends whohad been most intimately associated with him in business; and who,with many others, took exactly the same view of the case that we did.Indeed, I do not know any one who saw him, being accustomed to observe cases of general paralysis , who was not similarly struck by theresemblance of the motor lesion to what is observed in asylums; butit was necessary, of course, for obvious reasons, to be very guarded inthe expression of this view. ]Although X. was at this time living many miles away from hispractice, and professedly in seclusion; although, I believe, he wasdeeply depressed about himself, and, from the medical point of view,clearly foresaw his end, he was by no means unable for, or finallysevered from, medical work. He saw many patients after this atvarious times, and prescribed for them intelligently; he co- operatedwith others, and gave every indication of sound medical judgment andgood diagnostic discrimination, but he could not do the smallestsurgical operation, even the attempt to do one causing intense prostration. This fact will explain the following letter, describing in some measure the first of a series of cerebral attacks of a dangerous kind, well known in connection with general paralysis of the insane. It was written by the professional friend and associate abovereferred to, and bears date 6th December, 1872.260 [July,Clinical Notes and Cases.head?'-he nodded.6your" I am truly sorry to have to send you a very much worse account ofpoor X. T (another attached medical friend, in practice where X. wasstaying at the time) wrote to me last night asking me to go over today to see him, and I have just returned. On Wednesday he visited some patients with T., and entered into their cases with his usualacuteness; afterwards dined with T, then went to , and there tobed. Yesterday morning his brother took him his letters, and foundhim asleep. His sister went in two hours afterwards, and could notawake him, although he had evidently read his letters. T was sentfor. Throughout the day he remained in a stupid state, and could scarcely be got to speak a word. When I went into the room helooked hard at me, then put out his hand, took mine affectionately,and his eyes filled with tears. I asked him a few simple questions,but failed to get a reply. I then said, ' You cannot, ''Have you pain?' -a shake of the head. Perhaps you can write better than speak?' He said, ' Yes.' I thengave him a pencil, and in answer to questions he wrote most distinctly ' No' singing in my head. ' How do you feel?' I asked. ' Well.'1 asked him to examine his brother's hand , which has boils upon it;he did so, skilfully. Then I asked whether he thought they shouldbe opened, and he said distinctly, ' No.' I replied, I know youwould not if they were yours, ' and he smiled. All the functions wereright-pulse over 100 , head rather hot, looks much changed-- possiblya little drooping of one lid. The end is evidently nearer than we anticipated ." After this he was even worse-"so ill," as his friendT. wrote on the 9th December, " that scarcely expected to seehim again alive when he left him last night. The bad symptoms were stupor, gradually increasing (not coma, however) , difficulty of swallowing, and very shallow respiration. He did not speak a word fortwenty four hours, although he seemed conscious of what was passing around him. There has been no approach to delusion. "6From this state he gradually emerged, but there was an interveningperiod of " delirium, very much like that of typhoid fever, or acutetuberculosis ." He was closely watched by many attached medicalfriends, and on the 23rd December it was reported to me that " X. con- tinues well. His mind is perfectly clear, except that he remembersnothing that occurred during his severe illness . But he remembersthings that happened on the day preceding it-even small things thatany one might have forgotten. His speech seems considerably betterthan before, and he hears more distinctly. He is very thin , and haslittle muscular power, but is improving in both these respects . Heseems much more hopeful about himself."During 1874 X. failed gradually both in body and mind. He hadan extreme disinclination to exert himself, and any unusual exercisewas followed by an altogether disproportionate weariness and senseof exhaustion. In this, his case was very like a certain stage ofgeneral paralysis, when the motor energy is very small, and soon ex-1876.]Clinical Notes and Cases. 261hausted. The only thing in which it differed from those typical casesof the disease was his consciousness of the exhaustion. He hadseveral " congestive attacks," like the one described, and in 1875became so weak and helpless that he was entirely confined to bed,and had to use a water mattress to avoid bed sores, thus showing thatthe trophic system was deeply involved in the advancing nervous degeneration. During the last months of his life all his mentalpower was quite gone, and there was almost complete paralysis of thelimbs, as well as of the pharynx. He died in the end of 1875.Notes of a Case of Sporadic Cretinism, with an Account ofthe Autopsy. By FLETCHER BEACH, M.B. Lond. ,Medical Superintendent of the Clapton Idiot Asylum.(Read before the Medico-Psychological Association, at Bethlem Hospital,May, 1876.)The notes of the following case of " Sporadic Cretinism "-the name given to this class by Dr. Hilton fa*gge, in contradistinction to endemic cretinism-will, I hope, from the comparative rarity of the disease, be interesting to members ofthis Association. My experience in connection with thisdisease has been exceptionally fortunate, for it has fallen tomy lot not only to see, I think, altogether eight cases, but tomake four post-mortem examinations. Autopsies on cases ofsporadic cretinism are apparently very rare-only five are onrecord. Of these two have been made by Mr. Curling, oneby Dr. Hilton fa*gge, and two by myself. Accounts of themwill be found in the " Pathological Transactions of London."The fatty tumours-the special characteristic of the disease-are, in this case, larger than I have before seen.photographs exhibited were taken shortly before death.The following is an account of the case:-TheM. H., a girl, aged 15 years, was transferred to the ClaptonIdiot Asylum from Hampstead Asylum on the 8th of May,1875, and died March 26th, 1876, of bronchitis.The history of the case is unfortunately very meagre. Onthe form which accompanied her admission into the ClaptonAsylum the only fact of importance was that she had been"idiotic from childhood. " As her address was unknown, ithas been impossible to gain any other particulars. This is unfortunate, as information as to the causation of the diseaseis much wanted, especially with respect to the part which in-262 Clinical Notes and Cases [July, .temperance may play in producing it. Of the eight caseswhich I have had the opportunity of seeing, six were born oftemperate parents, while the remaining two not only had intemperate fathers, but these had been intoxicated at thetime of coition. At present my experience, as far as itgoes, does not point to intemperance as the sole cause ofthe disease. Of seven cases related by Dr. Hilton fa*gge, infour the parents are stated to have been temperate, while inthe remaining three no statement is made on the point. Dr.Langdon Down, however, holds that the disease is due to intoxication of one or both parents at the time of the procreative act. Further information must be obtained to settle thequestion.The following was the child's condition:-"She was 38 inches in height and weighed 3 stone 3lbs.(without clothes). She was exceedingly well nourished,having a considerable amount of fat in the abdominal walls.During the time she was resident in the asylum she got muchfatter, and there was marked obesity at the time of herdeath, the abdomen measuring 26 inches in circumferenceat the umbilicus. The head was large, flattened at the top,and spreading out at the sides, measuring 11 inches longitudinally, 10 inches transversely, and 19 inches in circumference. The anterior fontanelle was not yet closed, there being a small depression evident in that position. Thesutures, however, were well united. The hair was black andcoarse, and fairly abundant. The face was broad. Theforehead was 2 inches in height and 4 inches in breadth.The distance between the forehead and the chin was 6 inches,and between the chin and auditory meatus 5 inches. Thechild was a brunette, and her countenance, which was not atall vacant, was often lighted up by a bright smile. Eyeshazel, with long black eyelashes. Nose pug-shaped. Lipsexceedingly thick and generally slightly apart. Gumshealthy, and the teeth regular and in good condition.Arch of palate not flattened . Ears and tongue of normalsize. Cheeks full and flabby, at times flushed. No goitre,and apparently no thyroid gland, but well developed swellings on either side of the neck above the clavicles . Thearms and legs were short and curved; the former measuring10 inches from the tips of the shoulders to the wrists, thelatter 16 inches from the anterior inferior spinous processesof the ileum to the external malleoli. The hands and feet1876. ] Clinical Notes and Cases. 263were short and broad-the former measuring 4 inches, thelatter 5 inches . The skin of the body was thick, and overthe arms and legs easily separable from the subjacent muscles.The labia were well developed. "She was of a very cheerful disposition, and though shedid not say much, she would shew by her manner her appre- ciation of any amusem*nt that was going on. She went toschool in the asylum, and could say her alphabet, spell a fewwords of three letters, and write from dictation two letters.She could add to 5, count to 50, multiply 2 to 12, and coulddistinguish three colours. She could hem a little. Fromthis it will be seen that she had a certain amount of intelligence. She was cleanly in her habits; her appetite was good,and she slept well. She had menstruated two or three times.At the autopsy the scalp was found to be thicker thannormal, and easily separable from the cranium, to which itwas attached by loose connective tissue. On inspecting thecranium, the anterior fontanelle was found to be not yet closed,there being a piece of membraneof the accompanying size andshape in that position. The sutures were well united, their linesof union, however, being evidentby congestion. The calvaria wasremoved with some difficulty, in consequence of the firm adhesionof the dura mater to the anterior fontanelle and sagittal suture, as well as a little to each side of it. On examiningthe bone, there was seen to be slight bulging inwards of thefrontal, and bulging outwards of the parietal bones. It wassymmetrical. It was thicker anteriorly and posteriorly thanlaterally, being inch in width in the former positions. Onremoving the brain and looking at the base of the cranium,the foramen magnum was found to be smaller than normal,and on each side near its margin was an elevated rim, the space inclosed being triangular in shape. The cerebellar fossæwere flattened and the middle fossæ deep. The anterior fossæ were normal. The sella turcica was narrowed frombefore backwards, and the clivus, or inclined plane formed bythe union of the basilar process of the occipital with thesphenoid, was very steep. The suture between the sphenoidand occipital bone was soft and cut with the knife. Theanterior and posterior clinoid processes were on the same264 [July, Clinical Notes and Cases.level. The base of the skull measured internally 63 inchesantero-posteriorly, and 4 inches transversely.The brain weighed 34oz. The convolutions were exceedingly coarse, measuring half an inch in width. They, as wella the sulci, were well marked. The posterior lobes of thebrain entirely overlapped the cerebellum. There was nocongestion of vessels, and little fluid in the ventricles .pons and medulla were small, the latter corresponding withthe small size of the foramen magnum.TheA portion of the brain was submitted to my friend, Dr.Savage, for microscopical examination, and the following ishis report:-Cerebral Convolution of Cretin.Pia mater thickened and adherent.Vessels tortuous.Cortical layer thicker than usual.Pyramidal cortical corpuscles normal, with rather large nuclei.The corpuscles in the more superficial layers are surrounded by larger spaces than usual.No general wasting and no signs of inflammatory change.GEO. H. SAVAGE.The trachea showed no sign of a thyroid gland, but ineach posterior triangle of the neck was a large fatty tumour(exhibited). The tumours were not encapsuled, so that therewas some difficulty in defining their limits. They sent processes beneath the sterno-mastoids and downwards beneaththe clavicles. In colour they were slightly pinker than thesurrounding fat.The heart, liver, spleen, and kidneys were normal. Thelungs showed the usual signs due to bronchitis. The omentum contained a quantity of fat. The ovaries were larger than normal.The specimen shows the trachea and attached muscles,and the fatty tumours.The appearances found in the base of the skull in thiscase correspond in great measure with those found in a caseof endemic cretinism, in which the inspection was made byProfessor Virchow, especially in the fact that the clivus wassteep; but differ from those present in two cases broughtbefore the Pathological Society by Dr. Hilton fa*gge andmyself, in which the clivus was nearly horizontal, -this condition also being present in autopsies made by Niépce,

Bankr1876.]Clinical Notes and Cases. 265Iphofen, and other continental observers . The elevated rimround the foramen magnum noticed in this case, and in thetwo cases just alluded to, and which at the time of bringing my case before the above Society I considered unusual, Ihave since found to be not at all uncommon in the skulls ofidiots.Though atrophy of the thyroid body usually takes place insporadic cretinism, yet there are exceptions to this rule.Two cases are on record in which bronchocele was presentone mentioned in the third edition of " The Manual ofPsychological Medicine, " by Drs. Bucknill and Tuke; theother, in " The Pathological Transactions for 1874, " by Dr.Hilton fa*gge. The fatty tumours, however, are alwayspresent, and they may therefore be considered the specialcharacteristic of sporadic cretinism . So far as I know, theydo not occur in endemic cretinism .The accompanying Plate exhibits a photograph of M. H., and adrawing of the trachea, showing the absence of the thyroid gland, andthe fatty tumour on each side.OCCASIONAL NOTES OF THE QUARTER.The Relations of Drink and Insanity.At a recent meeting of the Rugby Temperance Association,the following speech was made by Dr. Bucknill; in referenceto which the succeeding correspondence took place betweenDr. Bucknill and Dr. Clouston:-“ Dr. Bucknill, in seconding the resolution, said the questionof temperance was one in which he took great interest; infact, no one could fail to do so who had any regard for thewelfare of his race or the progress of his country. He hadsomething specially to say upon one point of the resolution ,and should therefore pass over the results of drink in brutality,female degradation, and reckless prodigality, and apply himself to it as a cause of disease both in body and mind.would be difficult, within any reasonable time, for him to givean outline even of his experience as a physician of the insane,with regard to the production of insanity by intoxicatingliquors. It not only produced insanity directly, but by itseffects upon other organs which react upon the brain, and byXXII. 18It266 [July,Occasional Notes of the Quarter.a variety of causes-by domestic brawls and discomfort towhich it gave rise and it also produced insanity to a frightful extent by leaving it as a fearful inheritance to the childrenof drunkards. In the production of diseases of the body, hefeared the common notions of the disease-producing powersof alcohol were too much confined to what was seen inthorough drunkards, in people who abuse drink to such anextent that they frequently became drunk. But physiciansknow that that was scarcely the greatest evil. A man whonever got drunk, who was never perhaps drunk in his life,might yet drink too much every day, and so shorten his lifeand weaken his health, thereby stealing away that which wasthe labouring man's best possession, and which too often thewealthy man could not enjoy-the blessing of healthy existence. He had heard the Revd. Mr. Venables speak withemphasis and enthusiasm of the part which members of hisprofession were taking in the crusade against intemperance,and he wished he could supplement it by saying that themembers of his (Dr. Bucknill's) profession were taking awise, patriotic, and useful part in the attack upon thegreat vice of our age and country. But he was afraidthat just now members of his profession were taking holdof the stick by the wrong end, and were considering drunkenness not as a cause of disease, but as a disease in itself,which to his mind was a very great mistake. If drunkenness was a disease, it was not a vice, and could not bedealt with by education, and repression, and attempts toreform, but must be dealt with-as indeed many of his profession proposed to deal with it-by establishing hospitalsfor what they called the unfortunate drunkard. Theysaid, " Poor fellow, he can't help it; he must be placedunder medical treatment, and have all the comforts and luxuries he wants, until he is cured. " That was not his view ofthe case. He believed drunkenness to be a fruitful cause ofdisease, but not in itself a disease; and he looked upon inebriate asylums as an unfortunate attempt to coddle drunkenness, and patch up a wide and fruitful social mischief. Lastyear he was in America, and took a great interest in visitingthe institutions for the promotion of sobriety. He mightmention that at the great Centennary he wasin Boston, whena crowd of perhaps 150,000 persons went to Concord andLexington, very fairly to congratulate themselves on the victories their grandfathers won over ours. He mixed with thecrowd, and must say they were very disorderly-the police1876.]Occasional Notes of the Quarter.267had to make themselves scarce-but he did not see, the wholeof the day, in that vast crowd, one man the worse for liquor.He visited many of the American inebriate asylums, and hecame to the conclusion that the gentlemen confined in themwere generally rather proud of their position, and felt themselves interesting subjects of enquiry. As far as he couldobserve, they were there under a very lazy and shameful pretence of curing a disease which did not exist, by remedieswhich were not applied. They had only to walk outside thewalls of the institution to the nearest liquor-shop, and get asmuch liquor as they chose to buy, and they could take liquor into the asylum with them. A friend told him that he wentinto the inebriate asylum on Ward Island, for New York,and visited the rooms of four of these unfortunate inebriates,every one of whom was enabled to offer him a choice ofspirits.He was not surprised to hear that there was not a veryfriendly feeling in America between the teetotallers and thesupporters of these inebriate asylums. On the previous dayhe received a report of the American Association for the Cureof Inebriates, and in that he found a letter from Mr. CarstenHolthouse, a physician to a private institution for inebriatesin London, who said with reference to the relations whichexist in this country between teetotallers and the promotersof these asylums: —"As regards the bearing of the temperance world generally towardsthe undertaking-it is not unfriendly; the more moderate abstainersare decidedly favourable; while the prohibitionists only say, ' Youare beginning at the wrong end- providing for the manufacturedarticle, instead of putting a stop to the manufacture. ' This sectionof the temperance people forms, however, but a small portion of thecommunity in this country, and I feel confident that Sir WilfridLawson will never get his Permissive Bill carried in the present generation, and I am still more sure that if he succeeded, it would fail inits object and be evaded in every possible way."Dr. Bucknill continued, that if the teetotallers were friendlytowards Mr. Holthouse, their friendship did not seem to bewarmly reciprocated. These gentlemen were urging veryconstantly and persistently on the Legislature a change in the law which would enable doctors to treat drunkards as poordiseased people-not as he would deal with them, as viciouspeople, to be repressed and reformed; or to deal with thequestion as a great social one, upon which the lines of theireducational system should be very much directed . He very268 Occasional Notes of the Quarter. [July,earnestly hoped that the Rugby association, and the greatone to which it was allied, would set their faces against theview of drunkenness as a disease. Habitual drunkenness isnot a disease, though it causes all manner of diseases; but initself it is a vice, and ought to be treated as a vice. Thehabitual drunkard is a man who likes to drink whenever hecan, and who can drink whenever he likes."Royal Asylum, Morningside, Edinburgh,20th April, 1876 .MY DEAR DR. BUCKNILL,-Many thanks for your kindness in sending me the newspaper containing your speech on Intemperance. Iconfess I was startled at the heresies you express on the question .It seemed as if you were pulling down one of the pillars of ourtemple.So far as our case- books here reveal the facts, the following arethe answers to the enquiries contained in your note: -1. Intemperance is the " assigned cause" in 13 per cent. of ouradmissions here. ( 112 in 878 of all classes during 1873, 1874, and1875. ) But of these 878 cases, 310 were put down " unknown,"under the head of " causation. " If that number is taken off, it leaves568 with assigned causes for their malady, 112, or 20 per cent. of whom were caused by intemperate habits. But these " unknown"may mean, either that nothing was known of the history of the case,or that his history being known, the cause of the insanity was unknown,in fact, there was no cause to be assigned. In the latter class of casesit was known that intemperance was not the cause, and therefore theyought not to be taken off the whole number, and the percentage ofcases caused by intemperance would not be as great as 20 per cent .We are as careful as possible about getting the histories of our caseshere, but as you well know there are, from various reasons, among such a crowd of admissions as we have here (over 300 a-year) manycases where our information is false, or imperfect, or wanting altogether.2. I have gone over the last cases admitted here, until I got 100said to be caused by intemperance. The following are the heads Iput them under, and the numbers under each head: -a. Heredity to insanity .b. Heredity to intemperancec. Previous attacks of insanityd. Other bodily causes also present e. Mental dittof. Cases purely alcoholicditto•

-

• 2162319• · 540*

• The total of 114 results from the fact that in some of the cases more than

one " cause" was assigned, e.g. , previous attacks and heredity.1876.] Occasional Notes of the Quarter.269The numbers under b are not reliable, questions not having beenput on this point in regard to many of the cases. I may say that Iknew all these cases myself, so that there is otherwise a fair approach to accuracy in the numbers.It seems to me, however, that the existence of heredity, or previousattacks, &c. , does not much affect the question of intemperance causing mental disease. But for an original instability of brain functionof some sort, it would take powerful causes of any kind to produceinsanity, and I fancy few asylums would be needed -or few prisonseither, for that matter.If I might be pardoned for presuming to criticise your views, Iwould say that in the first place you did not fairly represent theopinions of the medical profession when you told your Rugby audiencethat we all were considering drunkenness not as a cause of disease,but as a disease itself. I don't know any medical man who considersall drunkenness to be a disease, or the result of disease. Most of usdo consider that there is a certain kind of drunkenness which is adisease, and not merely a vice. I think you imply that this vice ishereditary, and that it is disease-producing. I confess I cannot myselfin all cases distinguish what is vice and what is disease in my drunkardpatients, any more than in many of my other insane patients. Thereseems to be much truth in the idea that disease, its seeds and potentiality, is the vice and sin ofthe body in many cases, and that the realmoral vice and sin are, in those cases, its result and expression. I cannot see that our considering drunkenness as a disease in certain cases,should in any way tend to the disuse of attempts to stop and cure itby " education, repression, and attempts to reform. " No one saysthat it is a disease which was always an actuality. It was in all casesat one time of life a mere potentiality, requiring many circ*mstancesto bring it into being . Your measures tend to prevent this, and no sensible man would say that they are the least important. But whenthe evil germs have grown, is there not room, is there not necessitythen, for the disease-theory and the disease-treatment? Can any onedeny that all the " repression and attempts to reform" in the worldwill fail to prevent the neurotic drunkard, whose drunken father wasinsane, from drinking himself to death, so long as he passes gin - shopsevery day with money in his pocket? Can any medico-psychologistsay that the inhibitory power of such a man over his desires andcravings is as great as that of the average sane man? or that thesedesires and cravings are not morbid and abnormal both in their strength and direction? Is not the utter and blind disregard of consequencesitself a sign of disease, and strictly analogous to the madman's conduct?Is not the loss of inhibitory power over the appetites as great inthose cases as over the muscles in chronic alcoholism, and from thesame cause, viz . , weakening of the controlling powers of the higherbrain centres by alcoholic poisoning?I so far agree with your views in the practical treatment of all such270 Occasional Notes of the Quarter. [July,cases, that along with removing temptations to drinking, I always tellthe patient (the sinner-I beg your pardon) , that except he wishes to becured, and tries his best to be cured, no power on earth will cure him.The fact is your " vice" is always present along with my "disease. "I yield that point; but I object to your ousting my disease-theory fromthe case altogether! I don't see that the practice of American inebriate institutions should make us ignore the facts of nature. It isbut natural that the first attempt to deal with this most intractablevice-disease should be uncertain in its result. My notion is muchmore in the direction of setting up Botany Bays for them, where achange of climate and life would combine with the absence of temptation and with hard work in the open air to alter their morbid constitutions. Then you can't deny that half of them are fools from thebeginning, and the other half become fools by their indulgences. Theyare usually ( I mean my diseased drunkards) facile, sensual, irresoluteliars, devoid of the rudiments of conscience, self- control, or true affection.I am, my dear Dr. Bucknill,Yours very faithfully,Dr. Bucknill, F.R.S.T. S. CLOUSTON.Hillmorton Hall, Rugby,April 27th, 1876 .MY DEAR DR. CLOUSTON,-Your welcome letter has been food formuch thought, but if I do not sit down to answer it until I have founddefinite answers to some of the questions in it, it will be a long timebefore you get an answer.First let me thank you for so kindly taking so much trouble to answer my questions about the Statistics of Insanity. I think I willsave all I have to say on that subject for the present, and begin withanswering, as well as I may, your very fair and weighty criticism onthe opinions I expressed at Rugby about habitual drunkenness.And, first, let me say that those opinions were expressed in an unprepared speech made to a popular audience, upon which I desired toimpress a broad conviction . On a different occasion I might havetaken greater care to define my position . I do not wish to excusemyself for anything that I did say, but to give a reason why I did not enter into nice distinctions.Really I think our opinions differ very little, as we might expect,looking, as we do, at the same class of phenomena from the samephysiological point of view. I use the word physiological in preference to the word materialistic, which conveys a false impression, ifnot an imputation.Thereis one, and only one, point offact upon which perhaps we differnamely, the opinions which have been put forward by medical men onthe nature of drunkenness. If you will read Peddies and Bodington's papers on the subject (read last August, before the British1876.] Occasional Notes of the Quarter.271Medical Association, at Edinburgh), you will, I think, see that I wasjustified in my statement. Dr. Bodington especially is very precisein his declaration that all habitual drunkenness is a disease, and thatthere are not two kinds of habitual drunkenness, but that " the casesare, one and all, cases of dipsomania, of irresistible, uncontrollable,morbid impulse to drink stimulants. " The American Association forthe Cure of Inebriates, composed of the Superintendents of InebriateAsylums, at their first meeting issued a Declaration of principle, inwhich the prime article of faith announced was that " Intemperance isa Disease;" and at all their subsequent meetings, the papers readappear to have been mainly directed to the support of this dogma.And all I have said and written on the subject has been aimed at themischief which I thought likely to arise from this unqualifiedopinion. I never supposed that you, or indeed any man able to bringa practised habit of thoughtful consideration upon a large observationof vice and mental disease , could adopt such an opinion without widereserves and exceptions; but such a man with his appreciation ofquantitative and qualitative truth is not likely to appear as an agitatorfor a great change of law of doubtful wisdom upon a platform of dis- puted fact.99I think there is very little difference of opinion between us, if any.I fully recognize the cases you mention the men who are " facile,sensual, irresolute liars , devoid of the rudiments of conscience, selfcontrol, or true affection, " and habitual drunkards withal, as " diseaseddrunkards." I see that our dear old friend Skae, in the short, butpregnant evidence which he gave before Dalrymple's Committee,maintained the same view Question 610 ] . He said, " In speakingof dipsomaniacs there are other symptoms of insanity besides themere drinking. They are entirely given to lying; you cannot believea word they say when under the influence of drink, and they will veryoften entertain a dislike to their friends , which makes them dangerous."I should like to add to this, that, according to my experience, if youare able to watch these cases for some time, you will see short outbreaks of mania not due to drink; and I regard them as a true classof lunatics whose cure is extremely difficult. Perhaps, if there area sufficient number of them in the country, it would be well that theyshould be placed under care and treatment in a separate asylum, themanagement of which might be especially adapted to their peculiarities, and in which they might be detained during a longer periodof convalescence than other lunatics, in accordance with a recommendation which I think has been made by the Scotch Commissioners.But these are not by any means the kind of men I have met within Inebriate Asylums, nor the kind of men on behalf of whomDr. Peddie and Dr. Bodington advocate an important change in thelaw of the land . The Inebriates [ what an abominable euphemismthis is! ] whom I have seen in these asylums have been as devoid of272 Occasional Notes of the Quarter. [July,any real signs of mental infirmity as any set of men I ever saw livingtogether in common. And when Dr. Mitchell visited QueensberryLodge to ascertain whether " any lunatics in the ordinary sense of theword, were there," persons of such a description were not found.But still more convincing evidence that Inebriates do not corres -pond with our " diseased drunkards," is to be found in the vauntedresults of treatment. Dr. Willard Parker, at the last meeting of theAssociation for the Cure of Inebriates in the United States, read apaper, the title of which was " Why Inebriate Asylums should beSustained; " in which he compared the results of treatment in theBinghampton Inebriate Asylum with those obtained in some of thebest lunatic asylums in the United States. At Binghampton thereare one hundred beds, with an average number of patients of abouteighty, and during the year one hundred and thirty- seven patientswere discharged cured; while at the New York State Lunatic Asylumthere were five hundred and eighty beds, and only one hundred andeighty-two recoveries. You would not expect to obtain such resultsas the above among diseased drunkards, whatever might be the modeof treatment; and to expect it from the system in vogue in InebriateAsylums of indolent luxury and laisser faire would be in itselfalmost a sign of imbecility. Either the common run of Inebriatesyou find in these special asylums are not diseased, or their cure is aphilanthrophic perversion of fact, or both. Probably both, and whenphilanthrophy sows falsehood broadcast, the furrow produces no cropof annual weeds, but deep rhizomes of untruth, which must be grubbedup with infinite pains and labour."I think I am perfectly justified in arguing the Inebriate Asylumquestion mainly upon the practice of the United States. " The Lancet has said of one of my statements, " It is absurd to drawfrom such facts any inference, except of the worthlessness of the statistics of failure which come to us from the other side of theAtlantic." But is it not fair to draw from such facts, also, some inference regarding the statistics of success? The evidence of thesuccess obtained by the Americans in the cure of drunkenness wasthe main influence which decided the character of the Report of Mr.Dalrymple's Committee, and the lines of his Bill were laid upon theirprecedent; and that very Inebriate Asylum for the City of NewYork, from which I drew the absurd inference, was one of the institutions cited as a model for our imitation . Up to this very moment themen who most loudly demand a change in our law largely affecting theliberty of the subject point to the statistics of success of the AmericanInebriate Asylums for the cure of drunkenness as their most weightyargument. Moreover, the Superintendents of the American InebriateAsylums have taken upon themselves a peculiar position as our instructors. They have banded themselves into an association for thepropagandism of their dogma that " Intemperance is a Disease; " andthis Association sent a deputation of two of its most prominent mem-1876.1 Occasional Notes of the Quarter. 273bers to inform and instruct our legislators respecting the great advantages which we might derive from imitating their proceedings. Ithink, therefore, that I am perfectly justified in making their practiceand their public statements the butt of my criticism .I feel differently towards the medical men and others who have esta- blished Inebriate Asylums in this country. They have had thewisdom or the modesty to refrain from any public demonstration.They have pursued their difficult and unsatisfactory path in comparative silence, and they have received no subsidies from the publicpurse. They have, without much parade, established private boardinghouses upon temperance principles, in which, no doubt, some benefit isobtained by individuals , and through them by the public.I feel , therefore, very little disposed to subject them to critical enquiry. When they step forward publicly to teach us the right way tocure the disease of drunkenness , and challenge comparison with theresults of treatment in lunatic asylums , perhaps I may have something to say. At present I have only to wish them better success thanI fear they have obtained, and to acknowledge the general modestyand credibility of their statements. For instance, in the debate uponDr. Alfred Carpenter's paper on Dipsomaniacs, read before the SocialScience Association, in March last, Dr. Ellis is reported to have saidthat "he had for the last fifteen years kept a private establishmentfor the reception of persons so diseased, and had had under his chargepersons of the highest position-ladies and gentlemen of title; buthis experience was that having passed a certain line, they were incurable. " But when I see the American inebriate doctors deputed toteach us how to change our laws, vaunting the absolute cure of 34 percent. of their diseased drunkards, and pushing their creed and theirsystem with an unblushing propagandism, and even challenging ourreal psychiatry with damaging comparisons; when some of these institutions, moreover, are supported by public funds, and the gentlemenmaking these statements are public functionaries, then the positionseems to be entirely changed, and anyone and everyone seems to havethe right to enquire into the credibility of such statements.It does not, therefore, seem absurd for me to mention, on theauthority of Dr. Macdonald, of the New York City Lunatic Asylum,situated in Ward's Island , that on the occasion of a visit to the CityInebriate Asylum, situate in the same island, he went into the roomsof four of the inmates, and was by each of them offered the choice ofspirits.Nor does it seem absurd for me to state that when I visited theWashington Union for Inebriates at Boston, I was told by Mr. Lawrence, the resident superintendent, that his chief reliance, as a curativemeasure, was placed in earnest religious exercises, accompanied bytemperance songs, supplemented occasionally with pills of cayenne pepper; that his patients had the run of the city, and that he had nomeans of preventing them from getting drunk out of doors beyond274 Occasional Notes of the Quarter. [July,their faithfulness to their word of honour. Nor was I surprised whenI met with a man at Binghampton who told me that he had beenunder treatment at this Washingtonian Home, and that, notwithstanding the religious exercises and the word of honour, he and mostof the other patients were in the constant habit of getting whisky ata snug spirit store close to the asylum.66Nor does it seem absurd to me to declare that at the great modelInebriate Asylum at Binghampton belonging to the State of NewYork, I was assured, not by one patient but by many, that theyhabitually got as much whisky as they liked by simply walking downto the outskirts of the town, just beyond their own grounds; and thatthe institution was good for nothing, except as a place to pick upin "—that is, to recover after a debauch. Nor was I surprised tohear from Dr. Congdon, who has replaced Dr. Dodge as the superintendent of this institution, that he used no medical nor moral treatment. Dr. Gray, of Utica; Dr. Burr, of Binghampton, and anothergovernor of the institution, whose name I forget, heard Dr. Congdonmake these admissions to me, and I was told at the time that the impression made upon them was so strong that Dr. Congdon's reignwould probably be a short one; which has proved to be the case.Is it, therefore, absurd to draw the inference that if 34 per cent. ofthe inmates of such institutions are cured by a residence of a fewmonths, without any real treatment, medical or moral, they have notbeen the subjects of disease of the brain, nor such patients as we meanwhen we speak of diseased or insane drunkards? That they may havebeen drunkards, and that they may have " picked up " and left the institution sober, may perhaps be conceded; but that they have beenadmitted with one of the most intractable and persistent disorders ofthe nervous system, and have been cured of it without the use of discipline or treatment, by leading for a brief time a life of indolentluxury, under a cloud of constant tobacco smoke, with cards andbilliards, and only ostensible abstinence from whisky, this, if true,would be marvellous.I must make an exception with regard to the Franklin Home forthe Reform of Inebriates at Philadelphia, under the charge ofDr. Harris. This was the only place I saw in America where honest,earnest work was being done, not for the cure but for the reform ofdrunkards. Dr. Harris repudiates the idea of curing that which is nota disease, and his system is widely different from the no- system which I remarked elsewhere. I will endeavour to give a brief sketch of hismethod.He has a set of three single rooms built apart, and which somehowhave got the soubriquet of " the barque." When a drunkard- not apatient, mind, but a drunkard-is admitted, generally very drunk,often , indeed, very ill from the effects of a long debauch, Dr. Harrisplaces him in the barque, and keeps him there in bed and in strict seclusion for three days-more, if need be, but three days are usually1876.] Occasional Notes 275 of the Quarter.found to be enough. While there he is at once cut off absolutelyfrom strong drink, not " tapered off," but cut off short. He is alsoplaced upon a limited allowance of water, namely, a pint a day. Thisis done to prevent vomiting-a frequent ailment with Americanwhisky drinkers-and his strength is carefully built up with strongsoups and other nutritious diet. At the end of the three days ofsolitary confinement in bed he is admitted into the residential part ofthe institution, to the influences of association with the other inmates,and to earnest exhortations to reform given him by the lay superintendent, and by members of the two committees -one of good men,the other of good women. At the end of a week, if he has picked uppretty well, he is urged to go to work again-not in the institution , butin the City-to face his enemy again, in fact, returning to the institu- tion to sleep. If, as is very often the case, he has drunk himself intopoverty and his family into distress, the members of the committeeswhom I will not call ladies and gentlemen, for their work is above suchterms-help him and his family with money and support, withstrenuous help and comfort: and the man must, indeed, be a brute who is callous to such influences.I will not say that the American is the most reasonable of men,but he is certainly one of the most reasoning, and, therefore, it willappear in no way strange that the inmates of the Franklin Homewith whom I conversed manifested a very different tone of feeling tothose whom I came across at other institutions. They were penitentand grateful. They leave the institution after a very short probation ,and I have no doubt that a very considerable amount of permanentgood is effected. Of course there are many relapses, but Dr. Harrisdiscourages repeated re-admissions.I should like to see institutions on Dr. Harris's principles established at Glasgow, Liverpool, or some other foci of spirit drunkennessin our country. They would need no change in the law, for Dr.Harris takes a written consent and indemnity from his drunkards onadmission; and if so utterly drunk that they cannot give it, an actionfor false imprisonment would scarcely lie for their three days' voyagein the barque. It is a reasonable and earnest effort at reformationmade without any false pretences, and when it does little good can scarcely do any harm. The drunkards are not coddled in luxuriousindolence, nor impressed with the pernicious idea that they are interesting but helpless objects of social and psychological science.They are told the bare truth, and treated, indeed, with the pity due tosinful men by men whom circ*mstance has only made less sinful; butthey are not pampered with false sentiment.I mark as an important difficulty, what you say, that "you cannot inall cases distinguish what is vice and what is disease in your drunkenpatients, any more than in many other of your insane patients." StillI think you must often be called upon practically to make such a distinction. Most men have some vice, and many men have a prominent276 Occasional Notes of the Quarter. [July,vice. When such men, having been insane, have recovered from theirinsanity, the old vice remains, though the madness has gone, and youhave to recognize that which it may perhaps seem rather paradoxical to call a healthy vicious state of mind. But so it is . At least Ihave found it so, and many a time have had the tough question forcedupon me to decide whether pride, or falsehood, or moroseness in convalescence, was a part of the natural character, or the remains ofmental disease; and I take it that, even during the disease, it is ourdifficult but essential duty to distinguish, as far as we can, the twoelements of the mixed condition. When a religious and modest womanbecomes blasphemous and obscene under child-bearing influences, wedo not think her vicious, nor do we attribute all the bad language andmisconduct of an insane prostitute to her malady. It is a difficultywhich you propound, but it is one with which we are bound to grapple,and does not appear to invalidate the necessity of drawing a broaddistinction between vice and disease.What is that distinction? Whereis the crux? The dignus vindicenodus? From the spiritualistic point of view the answer is easy;but what is the answer from our point of view-the physiological?As a guess at the truth, I would say that vice is a habit of the nervouscentres of energizing in an emotional direction , mischievous to the wellbeing ofthe individual and of the community, but consistent with healthynutrition, and not necessarily tending to diminish or destroy the vital activities of the individual. Disease I would define as a condition ofsome one or more parts of the organism, inherited or acquired, whichalways involves and implies an abnormal state of the nutrition of those parts, and does necessarily tend, if prolonged and increased, to diminish or destroy the vital activities of the organism . It will be no justobjection to this distinction that passion may cause heart disease, and so death; or that a man may carry many local diseases to the end ofa long life, terminated by the euthanasia of gradual decay. I thinkit gives us a fairly just idea of the brain condition in the two states of vice and madness, and supports my view of the way in which we may best prevent or oppose these two different conditions . In the onecase by preventing the formation of the habit, or , if it be alreadyformed, by attempting to establish a contrary habit-education and reformation. In the other case, by avoiding the causes of morbidchange, or, if the change have already taken place, by endeavouring to re- establish a healthy nutrition-preventive and remedial medicine.The relation of Drink to Insanity is extremely interesting and important, and so far as I know has never yet been investigated with any degree of thoroughness. In the following remarks, I am far fromproposing to enter upon an investigation of this kind, and yet, per- haps, with your help, and that of some other kind friends, one may,without much difficulty, trace the lines of attack.I use the simple English word Drink, meaning alcoholic drink ofevery kind; and not that of Drunkenness, because I believe that the1876.] Occasional Notes of the Quarter.277habitual use of more alcohol than is consistent with perfect health,although it may never at one time have been used to such excess asto cause absolute intoxication, is a fruitful source of all kinds of disease, more potent, perhaps, than a complete, but rare and exceptional,debauch.We have no verbal signs which distinguish the habit of drinkingfrom the state of intoxication, as the French have in ivrognerie andivresse, but we may agree to use the word Drink to imply alcoholicexcess in all its degrees and forms.Now, it seems to me that Drink may bear two very distinct relationships to the production of Insanity.It may be the direct cause of insanity as a toxic agent acting on the brain.It maybe one agent among many in the evolution of insanity.If in the old chemical decomposition which delighted our wonderingeyes in boyhood , we produce a zinc tree in a bottle, we get a fairlysimple instance of the operation of a direct cause, and we say that thebeautiful foliage- like precipitate is the effect of decomposition. Butif we compare this simple product of chemical change to a real vegetable growth-to a fern, for instance, which it so much resembleswhat a difference is there! The fern is evolved through countlessacts of causation which cannot be estimated, and there is no one actof which the most advanced biologist can say this is its cause .There are no doubt many cases of insanity caused by alcohol, notquite so simple in their production as the zinc-tree, but still easyenough to understand. The toxic agent, acting on the brain substance,changes its organic composition and deteriorates its function, and wehave insanity directly caused by Drink. These cases, I think, are onlyfrequent in populations where heavy spirit- drinking is a common custom; and according to my observations they exhibit the symptoms ofdementia rather than those of the more complex forms of aberration.But what shall we say of those infinitely more difficult cases tounderstand, one of which is referred to in your able report which Ihave just received? "When a man with a strong family tendencytowards insanity, who has drank hard previously, is thrown out ofemployment, and has not therefore sufficient food, and then becomesinsane, it is very difficult to tabulate the exact cause of his disease . ”( P. 10, " Morningside Report," 1875.)The distinction of causes into predisposing and exciting, remote andnear, physical and mental, &c. , will help us to investigate, but will notlead us finally to understand the curious and complex evolution ofsuch a case. Take the drink element, it is predisposing in the early historyof the case, exciting later on, it is remote to the insanity, near in theloss of employment, physical always, and yet a part and parcel of themental state, and the intricate manner in which this red thread runsthrough the tissue of the life, can never be wholly unravelled. If theprevious drink which did not cause insanity, had also failed to cause278 Occasional Notes of the Quarter. [July,loss of employment, with shame and grief, and semi-starvation, would the mental disease have been evolved?The drink, as you have stated the case, is the proximate cause ofloss of employment, and the remote cause of the insanity; but I thinkyou imply that the drink is continued through all the stages accordingto the too common history, in which case the estimate of its influencebecomes still more embarrassing. The evil begins in the inheritedvice of the organism, and as it grows up we get new influences, forming a composition of causes; not applied once for all, but continuingand producing progressive effects, and the history of the evolutioncomes nearest to that described in the 15th chapter of " Mills' Logic."" The case therefore comes under the principle of a concurrence ofcauses producing an effect equal to the sum of their separate effects.But as the causes come into play, not all at once, but successively, and as the effect at each instant is the sum of the effects of those causesonly, which have come into action up to that instant, the result assumesthe form of an ascending series; a succession of sums, each greaterthan that which preceded it; and we have thus a progressive effect from the continued action of a cause."It is on these lines, I think, that we may most reasonably hope toget somewhat nearer to the fortress of truth in the more complexcases of the disease which we study.With regard to Drink we may, perhaps, more conveniently arrangeour notions and enquiries under the three following heads:-1st. Drink causing madness directly.2nd. Some other influence [ as mental strain ] causing drink- craving and madness as concomitant results.3rd. Drink concurring and continuing with other causes, and pro- ducing a progressive effect, the end of which is the evolution of mad- ness.I by no means intend to assert that you can always pigeon- hole aconcrete case satisfactorily in one or other of these compartments, forthere will needs be some doubtful cases, and some hybrids; but thedistinction seems founded in nature, and likely to lead to increase ofknowledge.We have much to learn yet, even about the simple direct cases.I think we must assume, even in the more simple and direct causation of insanity [ except, perhaps, from immediate lesions of brain , asby blows or sunstroke ] that there is a certain condition of the organization which renders it possible. I entirely concur with what you saythat, " But for an original instability of brain function of some sort,it would take powerful causes of any kind to produce insanity, " &c.However powerful the causes, many people seem incapable of going madin the first generation to which such causes are applied, just as I haveknown three- bottle port bibbers who have never felt a twinge of gout.Without assuming the existence of so marked a state as that whichhas been called the insane diathesis, we must, I think, premise a cer-1876.] Occasional Notes of the Quarter.279tain state of the brain which renders it liable, under efficient causes ,to incur those changes of function which we call insanity. This ought,I think, to be considered a predisposing condition, not a predisposingcause; since a cause always produces an effect, but this condition is abarren soil, until the seed of mischief falls upon it. From this pointof view, I do not consider heredity a cause, unless it be so strong thatit would develop the disease under any circ*mstances; and even whatare called predisposing causes from disease or accident, it would seemright to view rather as conditions suitable to the operation of causes.Thus, a man who has suffered from sun- stroke may be quite rational,if he is exposed to no active cerebral excitement; but to the end ofhis life a very moderate amount of drink will make him maniacal.The sun-stroke cannot be regarded as the cause of the mania. Ithas merely been the cause of a certain state of brain , compatible withsanity if the food be simple, but not if it be poisoned . I think thecases of mania à potu from small doses of the toxic agents, which arerecorded by Dr. Hayes Newington, in the very interesting paper whichyou have so kindly sent me, are of this kind. I have myself met withmany such cases, most of those I have observed having followed woundsin the head or sun-strokes, or, at least, life in hot countries. They areexceedingly interesting as examples of the brain- condition which I amreferring to. I should certainly class the insanity in these cases ascaused directly by alcohol.I do not think these cases shift the bearings ofthe ethical questionas you suppose. It cannot make any difference in the morality of theact of drinking, whether it takes a quart or a quartern of whisky tomake a man drunk, or one bout instead of many to make him mad.If there be any difference, the greater guilt would seem to be incurredby the greater certainty of mischief, and the man who knows that hewill be turned into a maniac by one carouse, is more culpable in hisindulgence than those upon whom the evil steals with stealthy and uncertain steps.I do not understand Dr. Newington to assert that these curiouscases of mania à potu, from small doses of alcohol, are characterizedby what is called drink- craving, irresistible desire, &c. In my ownobservations it has not been so, and the upset has generally come in some accidental manner. I have never doubted that drink canand does produce insanity directly; and that in some cases a muchsmaller dose of the poison than usual should be efficient does notseem to change the boundary of vice and disease.It seems to me that my second pigeon-hole, built elastically as itought to be, will hold a very considerable number of the cases of insanity roughly referred to drink.The typical cases are such as one recently mentioned in a letter fromDr. Major of Wakefield, as " a pure case of recurrent mania which has been here five times, in whom one of the first symptoms of theonset of an attack has invariably been a craving for drink, which lasted280 Occasional Notes of the Quarter. [July,during the attack, and quite left her when this attack of mania was over."I take it that most, if not all cases of real oino- or dipso- mania, areof this kind; the symptoms of mental aberration, however, beingsubject to some variation, being most frequently mild forms of mania,but yet not seldom bearing the mark of emotional depression, butnever wholly free from mental disturbance. A sane dipsomaniac is acontradiction in terms.Here, also, we must have a suitable cerebral condition, not morbid,but morbific. A condition compatible with at least temporary health ,but susceptible to the influence of exciting causes, which are frequentlyextremely difficult, and, sometimes, in our present state of knowledge,impossible to recognize. There must be an exciting cause always andinvariably for every change of function, for no change can take place without a cause. To say that such and such morbid changes areperiodic, is only a verbal veil for our ignorance. It may be that inepilepsy there is a progressive alteration in the balance of certain forces, which needs the thunder-storm of a fit to restore the equilibrium; and in the typical forms of recurrent mania, some process ofthis kind may be going on during the interval of sanity; but evenunder this supposition, the final upset of the balance is the excitingcause. In many instances, however, of these recurring diseases, theexciting cause I have no doubt is of a more definite character; for,how shall we otherwise explain the fact that, with great care and quiet,the period is often passed. Very frequently it is a vexation or apassion, or an accidental emotional event of some kind or other. Notunfrequently it is some irregularity in the mechanism of organiclife. How little do we know of the small events which may determine such changes? A fatigue, an indigestion, a sexual excess.Anyhow, a positive cause of some kind must operate, or the braincould never pass from a state of healthy into a state of diseasedactivity, however susceptible it might be, and prone to receive impression. When the exciting cause, whether it be obvious or obscure ,has acted, drink and insanity are very frequently the concomitantresults. The man drinks because he is insane, and he is the moreinsane because he drinks. Therefore drink is not a mere symptom ofinsanity, like incoherence of speech. It is a symptom, but unless in- terrupted, it reacts as a new cause, and it is not wonderful that undiscerning persons should mistake it for the real and original cause,which has been something quite different.I am strongly inclined to the opinion that a large proportion of thecases of insanity in our pauper asylums in which the cause ofthe disease has been returned by the relieving officers as intemperance, are really instances of this kind. Up to the present time thelower class Englishman is pretty sure to resort to drink if he can getit, whenever he acts upon his unrestrained impulses, as when commencing madness blinds him to prudence and propriety. Moreover,1876. ] Occasional Notes of the Quarter.281when he does give way to drink, it is not in the privacy of his home,but in the glare of the tavern gas; and his intemperance becomes anotorious fact, which is very unlikely to escape the knowledge andattention of the poor- law officials through whose instrumentality hemust be protected and relieved.I know not what may be the case in Scotland, but in those countiesof England with which I am best acquainted, I am convinced that ifa lunatic of the lower classes has been drinking at all heavily, therelieving officer will be sure to know of it, and will be extremely likelyto put down intemperance as the cause of insanity, whether it be so ornot. It may be that the Scotch Commissioners are right in thinkingthat the percentage of insanity caused by intemperance should be calculated upon the admissions in which the cause has been ascertained and stated in the admission papers. But in England I think such amethod of reckoning would be misleading. With all our etiologicalknowledge, there are yet many cases of insanity in which we cannotdiscover the efficient cause of the disease; how many more then inwhich the imperfectly educated apprehensions of relieving officers wouldbe at fault! Hence this often long list of cases in which no causehas been assigned. But depend upon it, when the pauper lunatichas been drinking heavily, there never is any lack of an assigned cause,whether it be a real cau e or only a symptom of his mental state . Ido therefore think that the proportion of alcoholic cases admitted intoasylums will come nearer to the truth, if compared with the totalnumber of cases admitted, than if calculated upon those only inwhom the causes of insanity are supposed to have been ascertained .Acurious and instructive table might be obtained by comparing thepercentage of drink cases in the asylums in different parts of theUnited Kingdom with each other, and with the institutions of foreigncountries, wherein reliable statistics can be obtained . I have onlyat hand at the present time very imperfect materials for such a table,but they seem to be sufficient to indicate the extraordinary amount ofdifference in the part played by drink in the production of insanity in different populations.As a standard for comparison , let us take Morningside, in whichyou have been kind enough to ascertain for me that during the lastthree years 878 cases have been admitted, of which the causes areassigned in 568 instances. In 112 cases intemperance is the assignedcause, being 13 per cent. of the whole admissions, but 20 per cent. of the known causes.66 A very fair comparison with Morningside will be the RichmondAsylum in Dublin, in which 53 cases are attributed to Intemperanceand Irregularity of Life," out of a total of 1039, of which number,however, the cause was "not known in 687 cases-that is drinkwas the cause in 5.1 per cent. of all the cases, but in 15 per cent. of the known causes.99In the Friends' Retreat at York, there were 41 admissions and disXXII. 19282 Occasional Notes of the Quarter. [July,charges [ including deaths] , of which 32 had causes assigned; in threeinstances, the cause was intemperance, being 9.4 per cent. in the cause known cases, and 7.3 per cent . of the whole numbers.In the Nottingham Hospital for the Insane, 34 cases were admitted, discharged, and died, among whom the probable cause wasassigned in 29 instances , of which 7 were attributed to intemperance,being 25 per cent. in the cause- assigned cases, and 20.6 per cent. inthe whole number. It does not appear whether the 15 cases of hercdity are included in the 34 or have to be added to them.Of the County Asylums in your own old Asylum for Cumberland,in 142 cases admitted, the causes were unknown in 64, and the casesattributed to intemperance were 6, or 4.2 per cent. on the wholenumber, and 7.7 per cent. of the known causes.In the Devon Asylum, of 285 admissions, discharges, and deathsduring the year 1875, the cause was ascertained in 238 instances, ofwhich 20 were attributed to " Drink and Dissipation," being 8.9 percent. of the ascertained causes, and 7 per cent. of the total number.In the Dorset Asylum, out of 134 cases admitted and discharged,the cause was ascertained in 81 instances, of which 9 were from" Intemperance and Dissipation, " being 11.1 per cent. of the ascer- tained causes, and 6.7 on the whole number.In the Warwick Asylum, of 249 cases admitted and discharged[by recovery or death] , the cause was ascertained in 206 cases, ofwhich 32 were attributed to intemperance, being 15.5 per cent. on theascertained causes, and 12.8 on the whole number.In the Hants Asylum, 275 admissions and discharges contained 233instances of causes assigned, of which 13 were attributed to intemperance, being 5.57 per cent. of the causes assigned, and 4.73 of thewhole number. This proportion seems very small in the county whi hcontains Portsmouth and Southampton.It will be interesting to compare these percentages with those of American Asylums.Dr. Kirkbride, in his Report just received, publishes the supposedcauses of insanity of the 7167 cases admitted into the PennsylvaniaHospital since Jan., 1841; in 4301 instances, the cause was supposedto be ascertained, and in 637 of these cases it was intemperance[excluding opium and tobacco cases ] , being 14.78 per cent. in theascertained causes, and 8 88 per cent. on the total number admitted.In the State Lunatic Asylum for Pennsylvania, at Harrisburgh,3821 patients had been admitted since the opening of the Asylum, ofwhose insanity , in 2065 cases, cause was assigned, and in 101 casesthis cause was intemperance, being 49 per cent. on the cause-knowncases, but only 2.64 per cent. on the total of the numbers admitted .A very remarkable difference in the percentage afforded by largenumbers in the Pennsylvania Hospital, and in the Asylum for thesame State. During the past year 178 patients have been admittedinto the Pennsylvania State Asylum, of whom 104 had cause assigned,but in only three instances was that cause intemperance, being 2.881876.] Occasional Notes of the Quarter.283per cent. of the cause-known cases, and only 1.63 per cent. on thenumbers admitted.At the State Lunatic Hospital, Northampton, Massachusetts, 150patients have been admitted, in whom cause of insanity was assigned in 89 cases; in 10 instances that cause being intemperance, or 11.23 percent. of the cause-known cases , and 6.6 per cent. of the total number.In the Hospital for the Insane, Halifax, New Brunswick, the number admitted and discharged in 1875 was 188, in 78 of whom the causewas unknown; in seven cases the cause assigned was intemperance,being 7 per cent. in the cause-known cases, and 3.2 on the whole number.In the Minnesota Hospital for the Insane, this year's report statesthat 1196 patients have been admitted since the opening of the hos- pital, of whom, in 852 instances, the cause was stated. In 57 casesthe cause was intemperance, being 6.7 per cent. on the cause-known cases, and 4.8 per cent. on the total admissions.I have only one more recent report at hand, which gives a CauseTable. It is that for the Criminal Asylum at Broadmoor, and thisreport differs from all others which I have seen in differentiating thecases attributed to intemperance: 15 cases are attributed to intemperance simply; 2 to intemperance and blow on head; 1 to intemperance and hereditary predisposition; 2 to intemperance and tropicalclimate; 1 to intemperance and death of husband; 1 to intem- perance and domestic troubles; total, 22 drink- caused causessimple or complex out of 70 cases admitted and discharged, of whom 61 were cause-known cases. The percentage of drink-causedcases among criminal lunatics is, as might be expected, very large,namely, 36 per cent. of the cause-known cases, and 31.4 per cent. onthe whole number. I have only this day [May 11th ] observed thedistinction which Dr. Orange has made in his report between thesimple and complicated causation of insanity from intemperance, andam much pleased therefore to find that I have the supportof hisopinions to the need of the troublesome enquiry which I have beenasking you and other of my friends who have the means at hand tomake into the etiology of insanity from drink. I am sorry that Ihave not yet received much of this information which has been kindlypromised.Dr. Duckworth Williams gives the last year's experience of Hayward's Heath for 1875, as follows:-Drink simplyMales.Ditto operating on hereditary tendencyDitto operating on pressure of businessDitto operating on family troubleDitto operating on debauchery .811112284 Occasional Notes of the Quarter. [July,Drink [doubtful].Female.Dr. Parsey gives the experience of the Warwick Asylum on admissions only for 1875, as follows:-Admissions-1. Cases directly the result of thetoxic influence of drink uponthe brain2. Indirectly with physical diseaseor mental trouble .3. With heredity for insanityM. F. Total.67 87 154 515 5 104204222- -9 7 16In three other female cases without heredity for insanity, one orboth the parents were drunkards.I am inclined to think that heredity from intemperance is a lessimportant factor of insane drunkenness than it is generally supposed to be.The children of drunkards are grievously exposed to other causesof brain-mischief besides heredity, especially to the influences of aturbulent home, and to want of food and proper care during themiserable years of a neglected childhood. It is remarkable that outof 800 idiots admitted into the Earlswood Asylum, Dr. Grabham hasonly found six instances in which it was stated that intemperance ofthe parents was the probable cause of the idiocy, and in two of thesethere was also hereditary insanity . He thinks that the truth in thismatter may be often concealed, which is probable enough; but hisfacts form a striking contrast to those which have long been acceptedon the highly respectable authority of Dr. Howe.However influential in the conduct of life a truth may be, howeverwholesome its full force, it is morally wrong and practically mischievous for it to be overstated, which I fear has been done with regard tothe heredity of drunkenness. Moreover, if it be admitted that thetendency to drink is transmitted from one generation to another, andthat the children's teeth are set on edge because the parents haveeaten sour grapes, it does not prove that such an inherited tendency ismorbid, for vice also is heritable. As La Bruyère says, " Il y a desvices que nous ne devons a personne, que nous apportons en naissant,et que nous fortifions par l'habitude; il y en a d'autres que l'on contracte, et que nous sont étrangers."Magnan's chapter on Dipsomania, in his remarkable work on Alcoholism, seems to support my view, although the eminent author accepts1876.] Occasional 285 Notes of the Quarter.the prevailing theory that dipsomania is a particular form of instinctive monomania, arising, most frequently, from heredity, while alcoholism is a simple state of poisoning, manifesting itself in the samemanner in all, even in the brute as in the man.This distinction will be admitted to be one which ought to be made,if facts exist in nature to support it; that is, if there be a class oflunatics affected with the instinctive monomania of drunkenness, withcomplete absence of other signs or indications of unsoundness of mind.It is remarkable, however, that when Magnan produces his evidence,it is destructive of this theoretical distinction. He says—"Le dipsomane avant de boire, se trouve dans les conditions analogues à celles du melancholiaque; il est triste, inquiet, il dort mal,perd l'appetit, éprouve de l'anxiété précordiale; c'est un aliéné ordinaire, mais après quelques jours d'excès, l'intoxication se produit et ledipsomane se présente avec le délire alcoolique que nous connaissons;il a hallucinations pénibles, du tremblement, d l'insommie, de l'embarrasgastrique, &c. , et ce n'est qu' après la disparition des accidents aigusque le diagnostic se complète.'99These remarks he supports by an interesting case which had comeunder his treatment at Saint Anne. A female patient, who, onadmission, is pale, agitated, and crying from fear; she hearsassassins who wish to strike her; she sees at her side the heads ofthe victims of Pantin; she believes herself covered with vermin ,and shakes her garments; she hears the voices of her parents,&c. , &c. Hands trembling, tongue white, epigastrum painful. Nosleep. Hallucinations incessant. The delirium disappeared in fivedays.One certainly would say of this patient, " c'est un aliéné ordinaire.'But the history of the case given was that for thirty years the womanat certain periods had become sad, interesting herself in nothing, incapable of work, sleeping ill , with no appetite, pain in the stomach increased by the sight of food; she has an ardent thirst, and drinkswine from the first day, getting it secretly; she drinks until she falls;she keeps up her drunken state for several days. After the access shereproaches herself, and re-commences her regular and sober mode oflife. Formerly the attacks were separated by intervals of fifteen oreighteen months, and at this time drunkenness was the only symptom. More recently the attacks have come on every three or fourmonths, and the alcohol acting more continuously, hallucination anddelirium have been developed. She had attempted suicide.Nowallowing this history to be true, which, in one point is an immenseassumption, what is there in the case to show that this woman was nota common periodic drunkard, falling very gradually under thedominion of her vice until it resulted in disease, and she became an ordinary lunatic? The one great assumption to which I refer is thatduring the long intervals of her attacks she was a sober woman. Letit be remembered that in this country and in France drunkards are286 Occasional Notes of the Quarter. [July,allowed by all who know them to be the most inveterate fabricatorsand deceivers in all matters and questions relating to their vice. InAmerica it is different, and the word of honour of genteel inebriatesis implicitly accepted by the confiding physicians who undertake theirFor my part, I will never trust the word of a drunken man,still less that of a drunken woman, whether palliating their debasem*nt or promising reform. All that M. Magnan records from hisown observation about his alcoholic patients I receive with undoubting faith; but of all that he tells of what they have said aboutthemselves I have the deepest mistrust, or unbelief.cure.Magnan borrows from Trelát's work another case, which, as he says,makes the distinction between dipsomania and alcoholism stand outvery clearly. As it is considered a typical case and affords a goodexample of the credulous manner in which the drunkard's advocatesaccept apologetic inventions for sober fact, I shall give it in full:-Dipsomaniac. Mother and Uncle Dipsomaniacs."Madame Na person of serious character. She had hadduring her life many establishments, which have always been wreckedfrom the same cause. Habitually regular and economical, she was.seized from time to time by an irresistible access of inebriate monomania, which made her forgetful of everything-of interests, duties,family and which ended by precipitating her from a position ofample means into one of complete ruin ."One could not without lively compassion hear her recital of the efforts she had made to cure herself of an inclination which has beenso fatal to her. When she felt her access coming on she put substances into the wine which she drank, which were best fitted toincite in her disgust at it. It was in vain. She even mixed excrementsin it. At the same time she spoke insulting words to herself-' Drink, then, wretch; drink, then, drunkard; drink, villainouswoman, forgetful of your first duties, and dishonouring your family.'The passion-the disease-was always stronger than the reproacheswhich she addressed to herself or the disgust which she tried toproduce. In the last years of her life she was operated on, withsuccess, for a strangulated hernia, and died afterwards of disease ofthe heart."I am inclined rather to feel lively compassion for M. Trelât that hehas become the historian of such a creature, than for Madame N―,though I wonder somewhat that an experienced alienist did not seethat if Madame N- had actually mixed excrement in her drinkshe was probably quite insane. If she did this thing without the intention to deceive she was mad; if she did not do it she was merelyfalse. Of course one cannot tell from the history which of the two itwas; but I think that you or I should have ascertained without muchdifficulty, if we could have had the woman under observation.1876.] Occasional Notes of the Quarter. 287By being mad, I do not intend to imply being in a state of monomanie ebrieuse, or the moral insanity of drink, but real aberration ofmind, with appropriate intellectual and emotional and physicalsymptoms, the being un aliéné ordinaire, in fact, as M. Magnan puts it. My position is briefly this—that what is called Dipsomania iseither a vice leading to disease in the ordinary pathological sequence; orit is an actual and recognisable form ofdisease of the brain , with evidenceofits existence more cogent than the mere desire for drink.With regard to the irresistible nature of the propensity which issupposed to prove its morbid origin and to mark it as a moral insanity, it is somewhat strange that the same quality has not yet beenattributed to the opium- craving, with which it is most strictly cognate.One would say that the desire for his drug in the opium eater isfar more intense than the craving of the drunkard for his dram, andthat his sufferings are keener if the desire be not gratified; and yetso far as I know, Opiomania has not yet been invented as a new form of moral insanity. If there be such a form of insanity, it has beenoverlooked, in a manner one would not expect in the recent andmost interesting paper on Opiophagism from the learned pen oflate Commissioner Browne. Tobacco craving also is bad enough whenan inebriate smoker has his pipe put out by medical ordinance; andI can answer for it that snuff-craving is no joke under the same cir- c*mstances. But these must be trifles compared with opium-craving,which, however, we know to be not irresistible even in its utmost intensity. Neither is drink- craving, if the motive for resistance begreater than the motive for indulgence. Bowring's story in " Bentham" is not so bad on this point-" A countryman who had hurt his eyes by drinking went to a celebrated oculist for advice. He foundhim at table with a bottle of wine before him. 'You must leave off 6drinking,' said the oculist. 'How so?' says the countryman. Youdon't; and yet methinks your own eyes are none of the best.' ' That'svery true, friend,' replied the oculist, but you are to know I love my bottle better than my eyes.'999"The letter which I sat down to write to you, in answer to your interesting criticism on my little casual speech, has spun itself out intoan article, which I hope will be acceptable for the pages of the Journalwhich you so ably edit; and if so, perhaps you will allow it to retainits epistolary forms which must be my apology for the freedom ofstyle which I have permitted myself to use.Believe me to remain,Very sincerely yours,Dr. Clouston.JOHN CHARLES BUCKNILL.288 [July,

PART 11.-REVIEWS.

Philosophy without Assumptions. By THOMAS PENYNGTON KIRKMAN, M.A., F.R.S. London: Longmans, Green, and Co., 1876.

Mr. Kirkman has decided convictions, and does not hesitateto express them in plain-spoken language. He criticizes theprincipal teachers of the growing school of materialism in anunsparing fashion; and those who assent not to his propositions and arguments may not be at all sorry to see theviews of these gentlemen assailed with vigour and vivacity.It will do no harm to put them on their defence from a philosophical standpoint. Their easy triumph over unwise theological opponents, or rather the triumph of scientific thoughtin their persons, has not been altogether good for them; someof them having raised their eyes so far above their feet thatthey seem not to see where they are walking, and evincing aself- sufficiency which becomes them as ill as it became the theologists whose bigotry they reprobate. It must be confessedthat those who pursue the study of the physical sciences doappear, in their enthusiasm for their special work, frequentlyto lose sight of that which is the end of all science, and topropound as sufficient for human instruction, guidance, andconduct, that which is practically a negation of anything likea doctrine adequate to embrace the phenomena of humanfeeling and conduct. Men will have some faith to live by.Revolutions in human conduct do not appear to have comefrom the intellect in times past; again and again that whichseemed the foolishness of the simple has confounded thewisdom of the wise; and it is not impossible that, when thestudents of physical science have made it all so plain thata wayfaring man, though a fool, cannot go wrong, if he will only keep his eyes open, some untaught person " out ofGalilee," a friend of publicans and sinners, who happens to beinspired by strong moral sympathies, will stir up a wave offeeling which shall sweep over the paths, and hardly leave atrace of them behind.Mr. Kirkman is indignant with the philosophers who setout with an assortment of abstract terms, which they neitherdefine nor comprehend exactly, and insists that no man whoundertakes to teach " ought to employ an abstract term,1876.]Reviews. 289much less an abstract trope, in which ambiguity is possible,until he has an exact meaning as well as use for it, and isready to impart that meaning to the student whom he hasprepared to comprehend it, or else to show him how to findthe meaning for himself." It must be acknowledged thatthere is a sting of truth in the following remarks:-

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David Hume wrote a famous chapter on the Idea of Necessary Connexion, which contains not a word of explanation either of the adjective Necessary, or of the trope Connexion, which appear in thesubjects and predicates of his dogmas; except that in one page thetrope is made more intelligible by printing it CONNEXION; and heproves it at last to be absolutely without sense. Of all the marshallers of abstract truths whom I know, Immanuel Kant is king. He goes out to sea with a wonderful display of bunting inscribed withgenerals and abstracts in -ung and -niss and -heit and -keit; and then,after steaming away for 273 pages, it comes into his head that a littledefinition may be useful; whereupon he runs up more bunting, andgives us the pleasure-and this is all he gives-of reading under hisleading German terms their Latin equivalent is -tus and -tio."He is particularly severe upon Mr. Herbert Spencer, whoseassumptions, inconsistencies, inexact employment of terms ina double sense, and errors he exposes with hearty vigour.

The phraseology of this author evokes the following amusing comment:- "Evolution is a change from an indefinite incoherent hom*ogeneity to a definite coherent heterogeneity, through continuous differentiations and integrations." Id est Anglicè. Evolution is a change from a nohowish untalkaboutable all-alikeness to a somehowish and in-generaltalkaboutable not-all-alikeness by continuous somethingelsification and sticktogetheration. Can any man shew that my translation is unfair? When that is shewn, I will make a becoming apology for the unfairness.And again:-I am convinced that he and his admirers are familiar with dozensof long words in -eity and -ality, in -ility and -ivity, and -ation , aboutwhose definitions they seldom trouble themselves; especially thoseimperial terms, the differentiation, and the integration, and the coordination, and the re-differentiation of the simultaneities and theserialities, of the progressions , the coherences, the relativities, and thecorrespondences. Why in the world need they trouble themselves?Those long- tailed abstracts know how to take good care of themselves:290 [July, Reviews.you may knock them about in heaps as you please; they never fail totumble up as clear and perfect as when new from the mint, and at aglance you can distinguish them, and swear to them again. Timeenough to bother yourself about exact definitions, applications, andverifications when you have finished philosophising in general.But it is in a chapter on the Will, in which he criticiseswhat Mr. Spencer has written concerning the doctrines ofpersonal identity, and freedom of the will, that he comes toclose quarters, and delivers some uglily effective thrusts. Thefollowing extract may serve as a sample:-Here the reader may well ask, Is there nothing in this section besides the dogmatic assertions that you have quoted, with their decorations of absurdity—is there nothing like argument for the demolition of subsisting personal identity? I am happy to say there is one,though but one, argument: it is only a little one, and the reader shallhave it, word for word. We read in this same section: " Either theEgo, which is supposed to determine or will the action, is present inconsciousness or it is not. " That is promising, and looks like closequarters; that is verily the way in which a good reasoner opens an exhaustive argument. He goes on: " If it is not present in consciousness, it is something of which we are unconscious-something,therefore, of whose existence we neither have nor can have any evidence?" That you say may pass for true, if it is not very profound.Let me entreat your attention to the remainder. "If it is present inconsciousness, then, as it is ever present, it can be at each momentnothing else than the state of consciousness, simple or compound ,passing at the moment!"* You all seem puzzled. I will give him afair chance; I will read it once more. You are bothered still: youask me whether there is not some printer's blunder in the third part;the very question I should ask if in your place. . . . How canthe fact that is ever present, and not passing, be a demonstration that it is nothing else than what is passing at the moment? To all thewits I have this is deplorable nonsense. And if it were sense, whereis the argument that he promised us in that logical flourish at thebeginning? He wants to prove to us that the Ego is nothing elsethan the state of consciousness passing at the moment.Andhe provesit simply thus, by shouting out, louder than before, " It can be nothingelse!" To me it is " helpless, hopeless nonsense all. " Here we seewhat a figure Mr. Spencer cuts when, alighting from his balloon, hetries, what he does not attempt once in three hundred pages, to go into a definite position on solid ground, aud handle his logical weapon atclose quarters. He seems dreadfully puzzled about which is the rightand which the wrong end of it.

• The italics are ours: we have placed them, in order to accentuate the con- tradiction which Mr. Kirkman fastens upon, because we have omitted some of his argument.

1876. ]Reviews.291There is much more of the same sort, for which we mustrefer readers to the book itself. Nor is Mr. Spencer the onlyperson whom the author belabours; Mr. Matthew Arnold,Professor Tyndal, and John Stuart Mill are hardly less severelyhandled. It is a pity, we think, for the sake of his argumentsand the points which he makes, that his style is not a little lessrollicking, and his language a little more sober and temperate; we have no sympathy with that affectation of courtesyin controversy which induces a person to flatter his adversarywhile pulling his arguments to pieces, as well as he can; butMr. Kirkman's style will offend some readers, while othersare not unlikely to think that he is joking, and to fail, therefore, to give the serious consideration which they deserve to some of his criticisms.What is Mr. Kirkman's " Philosophy without Assumptions?"That is more than we can venture to explain in the space atour disposal. It might be described, not unfairly, perhaps,as a scepticism of everything, except certain so-called fundamental deliverances of consciousness. Here is a propositionwhich will indicate its nature:-" The only force which isdirectly given and immediately known to me is my own willforce; and all my knowledge of other forces acting in the Cosmosis mediate, and found by me in logical inference." Mr. Kirkman, though a clergyman, has no fear of doubt; he outdoubts the physical philosophers, showing them that theymake not a proper and thorough use of scepticism , and thatthey are vanquished with their own weapon when it isrightly used. Here are some sound remarks concerningdoubt:-If you would learn to reason closely, you must learn to be a gooddoubter. Doubt, determined doubt, is the only key which unlocks thecaskets of certain knowledge. We have so many lame philosophersbecause we have so few thorough doubters. It is not the spirit ofdoubt, as we bishops and parsons sing, which hinders the progress oftruth and religion; but the spirit of assumption . Why have we allthese disgraceful divisions, wranglings and heartburnings in scienceand theology? It is not because men will doubt too much, but becausethey will not doubt enough. It is because they hate the trouble ofdoubting in themselves, and resent its reasonable demands in others,that we are flooded with sham philosophies, superstitions, andinfidelities.Another quotation, which shall be the last, summarises theauthor's conclusions against the materialist philosophers:---292 [July,Reviews.Here lies their blunder, that they conceive the stupendous forces ofnature, and along with them other human will and consciousness, tobe all alike, directly, separately, and independently, given to them.They fancy themselves beings of a superior world, floating in the air,and looking down on man and the surrounding energies all objectivelysubmitted to them, alike human desires and human will, along withthe other activities of heaven and earth, for their inspection and comparison. But the truth is, that no force whatever is given to them,but as a function of their own will-a function so to speak of the formw.f. (w. ), where w is the acting will - force-a function vanishing withw; that is to say, that if they were deprived of all consciousness andmemory of will, no conception whatever of verified force would remainin them. Nor can they eliminate this w from their expression of anyforce, or from their reasonings about it. They may talk of the lightning's speed, or of the distance from earth of the furthest nebula, orof the living force of planets or of suns; but all these fine words areintelligible only because they suggest multiples of their own remembered will-effort. Will is not a force given to them externally amonga number of other more commanding forces equally observed by them;nor can it be found or described as a resultant or product of suchforces. The truth is , that no force of the external world is everproperly and directly observed , but rather inferred by them from theirconsciousness of baffled will.The substance of Mr. Kirkman's book, when not purelycritical, is a professed demonstration of this theory.

Philosophy and its Foundations: with an Appeal to Spiritual Psychology. London: Simpkin, Marshall and Co. 1876.

When we read some of the high- reaching metaphysicalspeculations which are contained in this essay, for which theauthor modestly begs a fair and serious consideration, in theevident conviction that he has thrown a flood of light uponquestions that have so long perplexed the minds of men;when we see English men and women stand for hours towait for, or rush in eager crowds to cheer frantically, a passing carriage because it contains two persons who are privileged by the laws of the country to style themselves RoyalHighnesses, or read of the frantic rush which these samepeople will make to get possession of the cherry stones whicha Royal Highness has spat out after eating the cherries;-weare so little in accord with the thoughts and feelings whichanimate beings who so think, feel, and act, so utterly in- sensible to any common sympathies, that we sometimesfeel a grave doubt whether we actually belong to the1876.]Reviews. 293same species, and, if so, whether it be not to a morbidvariety of it. If such sympathies be physiological, it isplain that the want of sympathy must be pathological, thatis, if we are of the same species. The question then is,whether all human beings in a civilized land are really of thesame species, or whether those who are almost always findingthemselves in a miserably small minority are not branchingoff into the development of a new species, of a morbid orother sort.The author will perhaps not thank us for placing him,though it be only for purposes of illustration, in the samesentence with those who made so mad a rush upon thecherry- stones; nor do we mean thereby to do more thanindicate how far removed his line of thought is from what wecan sympathise with. But when he speaks of something, orrather somebody, who " sits the Absolute all- conditioned on thebosom of the absolute unconditioned," we ask ourselves indespair whether such words have definite meanings, orwhether we are intellectually deficient.The unconditioned is neither subject nor object, but pure spirit asnegation, manifesting nothing, and in itself capable of manifestingnothing; yet having the inherent attribute of potentiality or thecapacity of manifesting the powers of positive condition when positive condition is introduced. The prime or primitive conditioned isboth object and subject in one: the object being the foundation of thephysical which is necessarily in him, and the subject being the cognition or mental counterpart thereof. We cannot separate the objectiveselfhood from the subjective selfhood, and yet we may well distinguish them. The cognition of all that is in self is the subjectiveappropriation of the objective. This, of course, constitutes absolutecognition; for if this objective selfhood constitutes primarily theabsolute foundation of objective being in the universe, the cognitionof this selfhood implies absolute knowledge. This selfhood is limitedas to the essential form, but unlimited as to endless development ofbeing from self:-the creation of objective worlds being but thephenomena of conditions combined and built together out of primordial and eternal personal subsistence; and the formation of minorsubjective intellectualism being but the framework arising in immediate connexion with the objective economies with which they stand connected, and whose experience they possess.This passage embodies the author's philosophy. Torender it more intelligible to the reader, he goes over groundwhich has been often gone over, and gives a short accountof the speculations which have been entertained on the samegreat subjects by some ofthe more prominent philosophers-294 Reviews. [July,Descartes, Spinoza, Leibnitz, Kant, Fichte, Hegel, andSchelling.His speculations are not all so high and abstruse as thosewe have quoted; and the reader, if he has the courage to goon, will find matters become more easy to understand. Forthe author is not a pure idealist, but will have his feet onsome positive ground; he disavows the doctrine of pureinnate ideas, and maintains " that all our ideas are directlyor indirectly given us from the external world, or are grounded as intuitions formed by a combination of theseideas." The following passage will serve to show how firm ahold he keeps of fact even in his speculations: -Mr. Hume pronounces " the tie or connexion cause and effect to bearbitrary," but it is no more arbitrary than calling a spade a spade.We might call it a broad palm of iron attached to a handle of wood,for digging the ground; but this would only be an awkward attemptto point to the elements in combination for the serving of a purpose.In causality exists a tie of the elements, and in virtue of the tie we have the elements as factors, producing a result or a phenomenon as atotality. What the tie is in the conjunction, we can only explain bysaying that, if the combination be a chemical one, such is theiraffinity; and if it be mechanical, such is their fastening. The inward idea is but an expression of the outward fact.In the latter part of his essay he treats of mind and moralsin their foundation, maintaining that the grand prerogativeby which man is distinguished from the lower animals is theintuition of relationships. This power of vision in the loweranimal is, as a rule, confined to self; in man, it is equallyapplicable to not-self.The last chapter or section of the essay deals with Scriptural Psychology, and has far too many capital letters in itspages for our taste. It is all about spirit, soul, and body,showing what each of them is and how they are related toone another.A Philosophical Treatise on the Nature and Constitution of Man. By GEORGE HARRIS, LL.D., F.S.A. London:Bell and Sons. 1876.This treatise occupies two formidable volumes, one of whichhas 410, and the other 566 pages-altogether, therefore,nearly 1000 large and closely printed pages. Some notion of1876.] Reviews. 295the care and labour which has been bestowed upon its composition will be conveyed by the statement that the Indexitself fills 62 pages. The author tells us, indeed, that he hasdevoted to it not merely the occasional leisure of a few years,but the attention and study of the best period of his life." It was commenced during early youth, carried on throughmanhood, and only completed in his later days. " And hegoes on to say that " all literary works of man, like theliving works of God, which grow up before our eyes, and areintended to endure, are produced by slow degrees, and by agradual putting forth of shoots. The mushroom, on theother hand, which springs up in a night, fades in a day."For its purpose he has been observing all his life and drawing knowledge from every quarter, as the bee sucks honeyfrom all sorts of flowers-from crowded courts and the solitude ofthe country; the varieties of travel and the casualtiesof a professional career; from the remarks of the vulgar, notless than the conversations and reflections of the highly cultivated; from the habits of the brute creation; even from theocean's depths and the planets themselves; and, finally, fromthe sweet and engaging flowers of poetry, not less than thehard rocks and gloomy caves of philosophy and forbiddingmetaphysical discussion.It would be a presumption, from which we shrink, toattempt to criticize in a few pages a work of this magnitude,which has such a vast scope as the entire nature and constitution of man, and which has had so long a gestation. Ourreaders will appreciate this hesitation when we inform themthat on opening the first volume we came upon sectionstreating ofthe " Infinite Capacity of Spiritual Intelligence, "the " Intercourse between Spirits," the " Intelligence andLanguage of Spirits. " Descending from these higher beingsto man, the author discusses at length all the faculties ofwhich he is possessed , and their functions; and whatever thereader may think of the views propounded, he cannot fail towonder at the industry displayed and the conscientious carewith which all sorts and conditions of writers are quoted.As the author informs us, " during the progress of the presentwork, many bundreds of minds have been dissected by theauthor, and their various functions attentively examinedwhile in full operation. This is nevertheless a species ofvivisection which may be performed without cruelty or evenpain, and of which the patient, however sensitive, is wholly296 Reviews [July, .unconscious." Should any reader desire to see a vivisectionof the author's mind, he must conduct it for himself; for wedo not think that our results , if we ventured to undertake it,would justify so painful an operation.The Mechanism of Man: An Answer to the Question, What am I? By EDWARD W. Cox, Serjeant- at-Law. Vol. I.The Mechanism. London: Longmans and Co. 1876.The design of this book is to show that there is somethingin man other than his material structure; a distinct entity, bywhich the material structure is intelligently controlled anddirected; in other words, that man has, or is a soul. Serjeant Cox's faith in the existence of a soul was, he says, atone time shaken by what he calls the arguments of the greatscientists of our time; he determined, therefore, to make forhimself a laborious and careful study of the facts and phenomena upon which he supposes science to base its denial,and, as a result of that study, he proposes now to prove, instrict accordance with the methods and rules of science, thatman is not an automaton, but a soul.In the course of his scientific studies he has made acquaintance with the doctrine of the molecular structure ofmatter, and he immediately discerned in it the possibility ofthrowing a new and bright light upon operations previouslyunintelligible, and of explaining phenomena, before wrapped in mystery and marvel. For as matter is formed of molecules, so are molecules formed of atoms, and while our sensescan perceive molecular structure they cannot perceive atomicstructure; when matter, therefore, ceases to exist as molecular structure and becomes atomic, it is no longer perceptible—“ matter is , in fact, non-matter, itself aggregated into thedefinite form we call molecular. " But non-matter is as real asmatter-is by no means a nothing; it is, in fact, matterwhich, by having been resolved into atoms, has become imperceptible, as Jack the Giant-killer became invisible byputting on his magic coat."If the molecules of which Mont Blanc is made were to besuddenly resolved into atoms, the mountain, without theslightest change in shape or bulk, would instantly vanishfrom our perceptions. We should cease to see it or feel it.We should even walk through it without the slightest con-1876.]Reviews. 297sciousness of its presence. But there it still would be as itwas, in the same place, the same in size and shape-in everyparticle identical with the Mont Blanc that just before hadconfronted us. But because it is now atomic it is immaterial,and being therefore imperceptible by our senses, we shouldcall it Spirit. If a prophet were to declare its presence, wemight have faith in his assertion, but there would be no evi- dence to any sense of its actual existence. It would be tous a spirit mountain. " Let the wave of an enchanter's wandcombine the atoms into molecules, in an instant Mont Blancwould appear again, visible, palpable-a mountain mass of matter.Look well to your footsteps, reader, for the astute andlearned Serjeant is leading you by a way that ye know notinto consequences which may occasion alarm, when they areperceived. Admitting his remarkable scientific discovery,you will be asked whether, when we cease to exist as molecular structure and become atomic, it is not permitted us tocombine our atoms into molecules, and so make ourselvesagain perceptible to human senses? May we not be permitted to revisit the glimpses of the moon after " that fellserjeant death " has laid his arresting hand upon us? Wellmay Serjeant Cox let slip an anticipatory hint of triumph."There are problems of Psychology that may not be so insoluble as they seem." For here is spiritualism justified byscience, and Psychic Force demonstrated " in strict accordance with the methods and rules of science. "The Serjeant is a stern upholder of the importance offacts,and severely censures the scientists for their inability to distinguish exactly what is and what is not a fact. He wouldhave them imitate the exact and critical procedures of law inthe trial of a case. He is prepared, in accordance with hisprinciples, to exhibit a genuine molecule of matter to anyonewho may wish to have matter made visible to him in thatform, or at any rate to exhibit some one who has actuallyseen it, although, with a lawyer's dislike to hearsay evidence,he would only resort to this latter kind of evidence underspecial circ*mstances; he is prepared, also, we believe, notto show the invisible atoms-seeing that they are imperceptible-but while demonstrating that they cannot be perceived in any way, to demonstrate at the same time theirexistence and their combinations, and how they may bewalked through without the least consciousness of theirpresence.XXII. 20298 Reviews [July, .He goes on, after settling what matter is and what nonmatter is , to discuss the entire mechanism of man-tells ushow we grow, how we live, how we sicken, and how we die;what mind is, what is its mechanism, and what are its functions; what the soul is, where is its dwelling-place, and whatis its shape after death. Yes; the soul, he declares, musthave some definite shape, and there is no reason why itshould change its shape when it enters upon its new phase ofexistence after death. Has the hunchback a crooked soul?Has the amputated body an amputated soul? These arequestions which he shirks not to consider and answer. Thesoul must have power, he demonstrates in accordance withthe strict methods and rules of science, to penetrate the mostsolid substances: "it is as certain as any fact in nature that,if permitted to revisit this world, it could come into a roomwith closed doors and stand in the midst with even morefacility than the material body when living could haveentered through the doorway. " Alas, poor ghost! that hasattained not rest and peace in the grave, but art doomed fora certain term to walk the earth and give attendance atspiritual séances. Serjeant Cox is the president of a societywhich calls itself the Psychological Society of Great Britain:it is a society which certainly cannot lack material for investigation; for it is evident that its members must themselvesfurnish instructive studies in psychology.PART III.-PSYCHOLOGICAL RETROSPECT,1. English Retrospect.We greatly regret that the following notice of Reports of Asylumsfor 1874 should have been postponed, through pressure on our space,till now:-ABERDEEN. -Dr. Jamieson, like many superintendents, objects tothe number of incurable cases placed under his care. He says:-Observation tends to the conclusion that the operations of this hospital,as of others of a like nature, are liable to be influenced by a growing inclination to remit to the charge of an asylum for the insane variouscases of mental weakness sometimes accompanying the latter stages ofseveral physical diseases, which properly should be cared for at home,or be put under treatment in infirmaries and incurable hospitals .particular the associated debility of body and dulness of mind, whichIn1876.]299 Psychological Retrospect.in so many is connected with advanced years, is too frequently sent tofind its termination amongst the insane."Dr. Jamieson does not say where he would propose to place suchpersons. It may be that there is as much true humanity displayed inprolonging the life of the incurably insane as in the management ofacute cases.AYR.-There is nothing in this report calling for special notice,except the fact that three of the staff of servants entered the asylum aspatients. One most striking omission in this report is the absence ofthe statistical tables of the Medico- Psychological Association . It isthe only new asylum in Great Britain where they are not to be found.We would urge Dr. Skae to remedy this next year.BERKSHIRE.—This asylum, though opened so lately as 1870, isnow almost quite full, and it is necessary to consider the question ofenlarging the accommodation. When we consider that out of 101 admissions no fewer than 43 had been detained in workhouses forvarious periods, we can sympathise with Dr. Gilland in his protestagainst this system. He says:- "Upon this subject it may be remarked that the natural inference to be deduced from the experienceof the last twelve months in this asylum appears to be that theasylum is yearly becoming more of a lazaret for the incurable andworst cases of mental disease that have already been sifted, so tospeak, by a probationary residence in the workhouse, and that whilecurable cases are detained in those institutions to their manifestdetriment for indefinite periods, some, who have become obnoxious onaccount of filthy habits, and others who are apparently in a dyingstate, are removed to the asylum, the latter at considerable risk, andwith no other effect than to hasten the impending fatal result. Andwhether this bad system has been fostered by the recent enactmentwhereby the Unions will be recouped by the State to the extent offour shillings per week for each patient placed under asylum treatment, is a question well worthy of consideration, and one to which nodoubt some would be inclined to give an affirmative reply. "The report of the Medical Superintendent extends to thirty- sixpages. It is possible that greater brevity and less detail would securemore readers.BRISTOL.-Typhoid fever having appeared in this asylum, it wasfound that the typhoid poison existed largely in the asylum watersupply. During 1873 and 1874, 21 cases occurred, causing three deaths.Plans for the enlargement of this asylum have received the necessary approval, and will shortly be carried into effect.CHESHIRE, MACCLESFIELD. -One or two subjects of considerableimportance are noticed in Dr. Deas' report of twenty- eight pages. He300 Psychological Retrospect. [July,points out forcibly the evils of placing recent cases in workhouses.We have already given Mr. Ley's and Dr. Gilland's remarks on thissubject, but from its importance produce further testimony in thesame direction . He says: -" I have reason to believe that thisobjectionable practice still largely prevails in certain Unions—inspite of the capitation grant from the Consolidated Fund. A great deal is made of the undoubted fact that cases recover in the Workhouse wards; as well, it is said, as they would do in the asylum, andthus the workhouse and the asylum come to be regarded, as insome sense, rival institutions . The asylum may be better in somerespects, but then it is undoubtedly more costly! As long asthis feeling prevails, I doubt very much if even the Treasury bonuswill have a very decided effect; and the asylum will still continue,to a large extent, to be reserved for the ' bad cases,' or thosewith whom the treatment in the workhouse has failed , whetherviewed from a legal or a general point of view. The workhouseshould either be an asylum de jure as it is de facto, or it shouldcease to be an asylum at all . I cannot help thinking that if attentionwere once fairly called to this matter, the public would be startled tofind how systematically the provisions of the Lunacy Act are evaded;and that every day people are practically admitted into and detainedin asylums without any legal formalities whatever. If it be grantedthat workhouses should not be used for the reception of recent casesof insanity, a legislative enactment would be necessary, forbidding infuture any persons of unsound mind being admitted into a workhouse unless transferred from an asylum by a proper order. To meet caseswhere there was a deficiency of asylum accommodation, temporarylicenses might be given to workhouses, to receive cases under aproper legal order and certificate . "Dr. Deas objects to special dormitories for epileptic and suicidal patients. He attempts to support his position by quoting Dr.Strange, and states further: " I laid certain considerations before theCommittee, leading me to doubt the wisdom of such an arrangement;and my objection was two-fold -first, the plan was bad in itself as aprinciple of treatment, and secondly, that it would be extremely difficult, if not impossible, to carry it into practice, except to a verylimited extent. In substance, I said that it was opposed to soundprinciples of treatment to congregate together, even at night, numbersof patients differing in every possible respect, except they could be alllabelled as either epileptic or suicidal. I pointed out how great thedifferences were between the different classes of epileptics-somequiet and cleanly, some violent and degraded, &c .; and I speciallydwelt on the impropriety of associating suicidal cases together, insisting that our aim should be to place them with lively, cheerful cases, orcases so sensible that their assistance might be useful, mentioning,also, the well- known fact that the suicidal impulse is undoubtedly infectious, and also imitative.1876. ] Psychological Retrospect 301 .TheWith regard to the practical difficulties I pointed out -first, the difficulty of finding any part of the asylum where the plan could be carriedout, except very partially; and, secondly, the amount of moving ofpatients backwards and forwards which it would involve , the risks thatwould thus be run, and the discomfort which would be caused.Committee endorsed these views; but the opinions of the Commissioners were in no way altered; and after further correspondence, thematter dropped, the Committee finally expressing their willingnessgradually to increase the number of night attendants, so as ultimately to have one in each block. In two Reports, however, whichthe Commissioners have made since, on their annual visits, they againrefer to the matter, and strongly urge some steps being taken to carry out their views."Now something has been done; and I wish to indicate exactlywhat it is, and how far I feel disposed to go in the direction indicatedby the Commissioners. As I have already said , in one of the wardsI have collected together a certain number of the worst class ofepileptics, and some go to sleep in that ward from the infirmary, which is close at hand. These patients are themselves classified into twogroups, and occupy two dormitories." One of the night nurses sits in the room between these; and herduties are limited to that ward, and to visiting No. 3 Ward, where themore violent patients are, in conjunction with the other night nurse.No suicidal patients sleep in that ward, as such. A similar arrange- ment is about to be made on the men's side. But although this is allthe length I feel disposed to go, to meet the views of the Commis- sioners, I would go much further in another direction. Therecannot be a question, I think, that the ordinary amount of nightnursing thought necessary in an asylum is far too little, and had the Commissioners tried to institute a reform in this direction,I should willingly have backed up their suggestion. One greatflaw in what I may call the epileptic and suicidal ' plan, is thatattention is solely paid to certain classes of cases to the exclusion ofmany others equally important and urgent. Moreover, to my mind,it is putting the cart before the horse, to bring the patient to thenurse, instead of sending a nurse to the patients. To do this, viz. , tohave a separate night nurse in each ward, while it would secure themain objects of the Commissioners, would at the same time accomplish many others equally important, and remove a blot from ourasylum management." In very many cases of insanity, all the symptoms are much aggravated at night; and I have no doubt whatever that more systematicnight nursing would not only promote treatment and recovery inrecent cases, but would tend to tranquillity and contentment amongstthe chronic ones, and thereby diminish difficulties, and save expensein the checking of destructive or uncleanly habits. To enumeratesome of the duties which would devolve on such a night nurse: there302 Psychological Retrospect. [July,are the epileptic patients who must sleep in single rooms, even if youassociate some together; suicidal patients; special cases of illness;restless and sleepless cases. In attending to such, in giving nourishment to one, a drink to another, medicine to a third, covering up apatient who is restless, making the bed of another more comfortable,attending to the personal wants of those who cannot or will not helpthemselves; and in many other ways ample work could be found, andI believe a great amount of good effected. "Would Such independence of opinion, expressed so argumentatively andtemperately, "with reasons given, " is a healthy symptom.that it were more common.CHESHIRE, UPTON.-Means are being taken to provide an amplewater supply in case of fire, and the insurance on the building hasbeen increased to £ 70,000 . Various additions and structural improvements have been made at a cost of £3,000.The following paragraph is interesting as bearing upon the subjectof night supervision of epileptics, &c .:-" Now that we have had experience of the system of special night supervision for a period ofnearly three years, I take the present opportunity of stating that Ihave found it fraught with great benefit to the patients of thecharacter above mentioned, and that I cannot too strongly recommendit. In fact, since the introduction of the system here, there has notbeen a single instance of a patient dying in an epileptic fit during thenight."DERBY. -We entirely agree with Dr. Lindsay when he says-" Itis to be regretted that deception is still occasionally resorted to bythose conveying patients to the asylum. The patient is told that heis being taken a trip to Scarborough, that he is going for a drive inthe country, or that he is going to see a doctor and then return home.With the insane, as with the sane, honesty is the best policy.Candour and truthfulness should invariably be observed."Concerning " Derbyshire neck," it is remarked that 11 females,being 12 per cent. on the total female admissions of the year, wereaffected with goître. It would appear, however, that the popularname really is a misnomer, and Derbyshire neck is more common inYorkshire than in the county from which it takes its title. The disease appears to be most frequently associated with melancholia;more than half of those admitted at Mickleover during 1874, suffering from goître, laboured under this form of mental disease.A system of continuous night supervision of epileptics has been established. Dr. Lindsay reports that his experience of this arrangement is all in its favour, and that he has had no difficulty as regardsthe patients or attendants in bringing it into use.DUNDEE. The following paragraphs in Dr. Rorie's report furnishmost important evidence on the question of the transfer of lunatics to the workhouse:-1876.]303 Psychological Retrospect."Of the patients who have left the asylum not recovered, 28 weretransferred to the lunatic wards of poorhouses. As ten years havenearly elapsed since this means of disposing of the insane came intooperation in this neighbourhood, a suitable opportunity is afforded ofexamining how far the expectations formed of this system have beenrealised. These wards were opened in the belief that many patientswere in this asylum, and in that of Montrose, of so harmless and incurable a character that they could be maintained at less expense thanwas incurred in keeping them in asylums; and so advantage was takenof the provision made by the Lnnacy Act of 1862 for the reception ofpauper lunatics into lunatic wards of poorhouses who were not dangerous, and did not require curative treatment; and the mode oftransfer selected was that of obtaining the sanction of the Board ofLunacy, granted on the strength of a medical certificate given by theMedical Officer of the parish. At first difficulties were experiencedin deciding on the suitable patients, in consequence of the ambiguousnature of the statutory terms: for while, on the one hand, it was noeasy matter to say when a lunatic sent to an asylum, and thusremoved from the possibility of doing harm, ceases to be dangerous;on the other, it was scarcely to be expected that the parochialMedical Officer, at a single visit, could declare that the patients hador had not ceased to be capable of deriving benefit from asylum treatment. These difficulties, however, were overcome, but in a manner,it is to be feared, scarcely in accordance with the spirit of the LunacyAct; for when it was proposed to remove patients to these wards, theplan hitherto adopted has been for the Inspector of Poor, accompaniedby the Governor of the Poorhouse, to visit and examine all thepatients belonging to their parish, and to select those considered to bemanageable. The Medical Officer of the parish was then sent to reexamine and certify those selected , and the necessary sanction of theBoard of Lunacy was then obtained. It will thus be seen that theselection of the patients has virtually rested with the Inspectorof Poor and the Governor of the Poorhouse; and the result, it needscarcely be said, has been that, instead of the harmless and thosenot requiring curative treatment, the class of patients secured forthose wards has consisted of the useful, manageable, cleanly, andorderly, and, in many instances, of convalescent cases, the burden ofwhose treatment during the acute and dangerous phase of their illnesshad been borne by the asylum; while the fatuous and paralyticpatients, for whom little can be done in the way of curative treatment,have been systematically rejected, in consequence of the expense andtrouble that would have been incurred in attending to their necessarywants. The patients removed have, therefore, been in a preeminently favourable condition; and it now remains to be consideredwhether the economy so much expected has been realised, andwhether the patients themselves are benefited by the change or thereverse.304 Psychological Retrospect. [July,For many years statements have been made by the parochial authorities, from time to time, which appeared to exhibit an importantsaving in the maintenance of pauper lunatics in poorhouses, as compared with asylums; such as, that while 9s. 6d . per week was chargedby the Dundee Asylum, the cost of the patients in the poorhouse wardswas 5s. 6d. But a very superficial examination only was required todiscover the source of fallacy; for while the 9s. 6d. charged by theasylum covered all expenses, the parochial rates were arrived at byexcluding salaries of officials, attendants, &c. , and by deducting acertain sum as representing the value of work done by the patients.More correct information has been recently published as to the actualexpense incurred in keeping pauper lunatics in poorhouses, and it willbe seen that it must be regarded as extremely doubtful whether anymaterial saving has been effected at all, especially when the differentcharacter of the patients in asylums and those in poorhouses is bornein mind. Thus, at a meeting of the Committee of Management ofthe Liff and Benvie Parochial Board, held on the 26th May of thisyear, the Chairman reports, inter alia, as follows: —"About a week orten days ago there was a communication from the City Parish of Edinburgh, requesting them to go very carefully into the cost of lunaticskept in poorhouses, with a view of bringing the matter again beforethe Exchequer. The Inspectors, at the request of the sub-committees,did so, and it was found that the cost of food and clothing in Dundeewas about 5s. 4d. , and in Liff and Benvie, 5s. 5d.; while the wholecost, including management, &c. , was 8s. 4d. in Dundee, and 8s. 6d.in Liff and Benvie, " or 6d. per week more than was charged by theAsylum when the lunatic wards were first opened."Now, will the result to the patients be found more satisfactory? Inestimating the effects of the treatment of the insane, the most reliabletest which can be applied is a consideration of the rate of mortality and of the causes of death. Valuable information on this subject issupplied in the Annual Reports of Her Majesty's Commissioners inLunacy, and these returns show that from the 30th December, 1864 ,to the 30th December, 1872 , 68 patients were admitted into the lunaticwards of the Liff and Benvie Poorhouse, and 150 into those of Dundee; and that of the former 19, and of the latter 40 patients havedied, or 27 per cent. of the whole number; while the correspondingcalculation for the Asylum gives 15.5, or, if the patients admitted ina moribund or confirmed paralytic condition be excluded, only 11.88per cent. It is difficult to understand why so great a difference in therates of mortality should exist, but in many instances it would appearas if the mere transference of the patients from the one institution tothe other was sufficient to cause death. This seems to have been particularly the case in the male patients first transferred to the Liff andBenvie Poorhouse: 6 were removed in 1864, 8 in 1865 , 2 in 1866,and 1 in 1867; 16 of whom were patients who had, while in theDundee Asylum, for many years enjoyed good, and in some instances,1876. ]305 Psychological Retrospect.robust health; yet of these, 1 died in 1865, 2 in 1866, and 7 in 1867;10 out of the 17, or nearly 59 per cent. of the whole, within a period of three years. This mortality was made the subject of a special investigation by the Board of Lunacy, but no adequate causes wereelicited . It is worthy of remark, however, that a large proportion ofthe deaths in poorhouses have arisen from phthisis, pneumonia, bronchitis, diarrhoea, dysentery; diseases of comparatively rare occurrencein this Asylum, and generally considered to be the result of exhaustion, undue exposure to cold, and insufficient nourishment. 17 ofthepatients sent to the poorhouses were returned to this Asylum as un- suitable."Dr. Rorie appends the following note to his report:-" In consequence of the discussion which has ensued since the above report wasread, two tables have been prepared, and are appended; one showingthe yearly mortality of the pauper patients in the Asylum and in thelunatic wards of the Dundee and Liff and Benvie Poorhouses, and theother the comparative mortality, corrected by Table XV.: both calculated on the average number resident. By this mode of calculation itis impossible to arrive at the same precision as when the mortality is estimated on the numbers under treatment: 1. In consequence of thepatients in the lunatic wards of poorhouses being stationary, whilethose in the asylum are the reverse; 2. Because fully 50 per cent. ofthe asylum mortality occurs in the treatment of acute and recent cases,which are not received into the lunatic wards of poorhouses; and 3.In consequence of the patients removed to these wards being a selectclass. Whatever mode of calculation is adopted, the result wouldappear, however, to be the same, namely, that during the eight yearsending 1872-that is, so far as statistics have been published-nearlydouble the actual mortality has taken place in the lunatic wards ofthese poorhouses than has occurred in the Asylum. "EDINBURGH MORNINGSIDE.-Extensive structural alterations arehere in progress or in contemplation, and a determination is expressedby the managers to place the establishment in harmony with the advanced views of the day.Dr. Clouston reports concerning the cases admitted: -" The numberwhose malady was characterized by depression of mind was most unusually large. I find no fewer than 88 under the head of Melancholia,a number greater by 70 per cent. than the average number classifiedunder that heading during the previous ten years, though, as we haveseen, the excess of admissions this year was only 14 per cent. Manyof the worst of these cases were more desperately intent on takingaway their own lives than any patients I ever had. The ingenuity,determination, and persistence of this suicidal propensity in some ofthem would scarcely be believed by any one who had not experiencedit. Some of them had, in addition, the impulse to destroy those nearthem; and the treatment and management of this combination ofcirc*mstances is, as you may imagine, attended with no small difficulty306 Psychological Retrospect. [July,and danger to all who have to do with them, and occasioned thegreatest anxiety to myself. One patient tried to swallow everythinghe could lay his hands on, from the ink used by his fellow inmates ofthe ward to write their letters , to any small stone he could pick up.One day, before we knew his propensities, he swallowed 82 smallstones, weighing 24 ounces, and was none the worse for it. Hepickednails out of the wood-work, and tried to push them into his heart,and tried to starve himself so persistently for months, that he had tobe fed with the stomach-pump. He required two attendants, one byday, and the other by night, to be with him all that time. Anotherman broke a piece of the tumbler out of which he was drinking, andinflicted a wound, fortunately slight, on his throat in a moment; andafterwards, when closely watched, would attack his attendant, to provoke him, he said , to kill him, so that he had to have two attendantsall the time near him. We have had a number of such cases duringthe year, any one of which I should formerly have thought bad enoughto be the worst case in two or three years."The statement of the number of melancholics admitted during theyear led to a lively discussion in the Edinburgh newspapers, as towhether this had or had not resulted from the religious revival movement under Messrs. Moody and Sankey.FIFE AND KINROSS. -So far as we know, no other asylum hasadopted the " open-door" system, introduced here by Dr. Batty Tuke,three years ago, and continued by his successor, Dr. Fraser. In thereport by the Medical Superintendent, it is stated that he has "nohesitation in saying that the introduction of this system will mark an era in the history of the treatment of the insane." Dr. Fraser describes the system as follows: -" As you are well aware, there are nohigh boundary walls surrounding the ground, and the entrancegates stand always open. To make this system as clear as possible,let me suppose that a visitor calls and wishes to see through theasylum. He is received at the front door, which will be found open;he is then conducted through the whole of the male galleries, containing over 90 patients, and thence via the dining hall, through fiveof the other galleries on the female side, also containing over 90patients, without once coming upon a locked door. Not only is therethis free communication inside the house, but the outer doors of themain ground corridors, which open out on the terraces, are also unlocked. The male convalescent building, which contains from 20 to25 patients, has its doors open shortly after 6 a.m. till 8 p.m. Theinmates are, of course, on parole. Two galleries in the female department still remain under the old system of locked doors. Thoughnot necessary for the majority of their inmates, yet the erratic andmischievous tendencies, as well as the excitement of some three ormore in each division, render locked doors necessary."Greater contentment is, I believe, the result of the innovation I have1876.]807 Psychological Retrospect.just referred to-the sense of confinement, or, in other words, of im- prisonment, of which even a lunatic is conscious, is absent. Theasylum is converted into a home and a hospital." A greater number of escapes and accidents would à priori beexpected from this state of freedom. The escapes have been nine innumber, and there are only two which can be attributed to open doors.Four accidents, none of any import, except the suicide previouslydetailed, have occurred during the year, but none in any way attribut- able to this system."INVERNESS.-Dr. Aitken says a careful analysis of the dismissals hasshownthat in 6 cases the recovery was due to residence, in 6 to hygiene,in 6 to hygiene and medicine, and in 19 to medicine alone. In all thesecases, it has been observed as in former years, in which medicine canunhesitatingly be set down as the principal element in the restorationof the patient, the recovery has taken place within a more limited time than in those who are indebted for their mental health to otherinfluences available in an hospital for the insane. Thus, after withdrawing the exceptional case, whose excitement may be said to haveexhausted itself after a residence of 6 years and 9 months in theAsylum, and dividing the cases into the various categories underwhich the different influences affecting the recoveries have been classified above, it has been found that those who owe their recovery tomedicine were only resident, on an average, a little more than 5 monthsin the asylum; whilst on an average the recoveries due to hygieneand medicine were resident for 11 months and 2 weeks; those to residence 28 months, and those to hygiene alone 29 months. Anotherproof of the further beneficial effects of the medical treatment of insanity was accidentally brought out in considering the subject of readmissions, in which it was found that of those who had recoveredunder medical treatment, only 1 in 13 had returned to the Asylum;in those whose recovery was due to mere residence, 1 in 4 had returned; whilst of those who had been restored to reason by removalfrom exciting causes, most of them had to be again placed undersupervision. Such a result is certainly encouraging, and points moreand more to the necessity of asylums becoming in reality hospitals forthe insane, not mere places of retreat after the disease has becomeincurable, hospitals in which treatment is actually carried out, and notmere communities of perfect discipline, in which the so- called moraltreatment is abused , not used, and their end supposed to be obtained ,and success judged of, by the comparatively large number of theiremployées. However therapeutic means act, whether in some casesthey exercise a direct curative influence, or whether, as in the case ofsome remedies, they subdue the more violent symptoms, andothersgive the system time to recover its lost equilibrium, is a matter of indifference, the result is the same, the benefit to be derived is undoubted.The permanency of recovery from the use of drugs, in comparison308 Psychological Retrospect. [July,with the recovery from other influences, is an entirely new field ofinquiry, and one deserving of thorough investigation in the presentadvancing state of experimental medicine as applied to the treatmentof mental disease, and is a question which could not, perhaps, besettled by the statistics of any single institution, but only by observations extending over a long series of years. The evidence, however, obtained in this Asylum, and founded on nearly 200 recoveries,certainly gives the strongest support to the opinion above expressed ofthe happy influences of medical treatment. It is undoubted that thecases recovered by such means have had a duration of more than amonth less, at least, than those calculated as attributable to mere residence, hygienic conditions, withdrawal from exciting causes, orthe influence of mere moral discipline; and, such being the case, it can easily beunderstood how the curtailment of the destructive influences of mania,or the equally destructive loss of tone in melancholia, may be followed bythe best results. and give an assurance of permanency in recovery whichcannot be anticipated when the disease is more prolonged.2. German Retrospect.I. Recent Progress in the Histology, Physiology, and Pathology of the Central Nervous System. By WILLIAMSTIRLING, D.Sc.C.M., M.D., Demonstrator of PracticalPhysiology in the University of Edinburgh.On Thermal Influences proceeding from the Hemispheres of theCerebrum (Vaso-motor apparatus of the Cerebrum) .- Drs . Eulenburgand Landois (" Centralblatt, " No. 15, 1876) operated on dogs, andthey found that young animals were specially well suited for theirpurpose. The estimation of the temperature was taken thermoelectrically by means of a Meissner- Meyerstein's electro - galvanometer.As thermo- electrical elements, two varnished Dutrochet needles wereemployed. After opening the skull and exposing the surface of thebrain, the grey matter was destroyed by means of red- hot copper wiresto the depth of 1-14m.m. The animals were kept deeply under chloroform . When a certain portion of the brain was to be stimulated , theanimal was curarised, and the brain was stimulated by induction shocks, two fine platinum wires serving as electrodes. The chiefresults were the following: -I.-Destruction of certain regions of the anterior lobes of the brain,corresponding to the temporal region, caused at once a considerable increase of the temperature in both contro-lateral extremities. The increase of temperature occurred immediately after the completedestruction of the corresponding parts of the surface of the brain,often before the animal awoke from the chloroform and before it made1876.] Psychological 309 Retrospect.any spontaneous movement. The increase immediately after theoperation may be 5-7°C, in other cases only 1-2°C.II. The thermal areas for the anterior and posterior extremities are separated from each other. The area for the fore foot lies somewhat more anteriorly, and somewhat external , close to the lateral endof the sulcus cruciatus. Destruction of the super- sylvian gyrus hasno thermal effects.III.- In successful cases, after the animal awakened from the chloroform, there was generally disturbance of motion, and it seems that theportions of the surface of the brain which have this thermal actionmust lie in the neighbourhood of the corresponding motor areas.IV. The increase of the temperature is in nearly all cases clearlypronounced for a long time after the injury, sometimes even forthree weeks; generally, however, it returns to the normal on thesecond or third day. Localized electrical stimulation of the aboveareas, with sufficiently weak currents, is accompanied by a small andtemporary diminution of temperature ( 0· 2-0· 6°C) in the contro-lateralextremities .The authors are of opinion that these facts justify the conclusion thatthere is a vaso-motor apparatus in the grey matter of the brain, andthat it partly represents the central terminations of the vaso-motornerves which run in the pedunculus cerebri.On the Functions of the Cerebral Hemispheres. C. Carville andH. Duret (" Archiv. de Physiolog. ," 1875, p. 352, and " Centralblatt, " No. 52) .-The first part of this very extended research containsan historical review and criticism of the experiments hitherto made on the function of individual parts of the brain. The authors rejectentirely, and with justice, too, the results of the experiments of Fournié (obtained by injecting chloride of zinc into the brain of theliving animal) . Even the results of Nothnagel's experiments they discard (dilute chromic acid).The second part of the paper is devoted to an experimentalcriticism of the results of Hitzig and Ferrier: the idea of Schiff thatthe movements caused by stimulation of the surface of the brain arereflex, the authors regard as not supported by fact. They cite experiments performed on living and dead brains to shew that on a certainpoint of the surface of the brain localized currents extend bothlaterally and in depth. Two platinum needles connected with a verysensitive galvanometer were placed on the surface of the brain, orpressed several m.m. into it . On applying weak induction currents tocertain parts of the surface of the brain, the galvanometer needle was more or less deflected . Nevertheless, a localized action of the currentis to be assumed, in as far as stimulation of parts of the surface of thebrain discharges different and quite distinct movements, when onlyweak currents are employed-a fact already sufficiently pointed out byHitzig. With regard to the action of anesthetics, the authors agreeon the whole with Hitzig. A further series of experiments is given to310 Psychological Retrospect. [July,shew that the integrity of the grey matter is not necessary for the occurrence of circ*mscribed movements, experiments which were performed in a similar manner by Braun and Putnam. The experimentsare new which prove that complete extirpation of the corpus striatumdoes not hinder the occurrence of movements on stimulation of thesurface of the brain, and that distinct bundles of the centrum Vieussenii conduct the excitement from the brain to the periphery.Further, some results of Ferrier are corrected which were obtained byemploying too strong a current. The extirpation experiments do not shew anything new. The authors come to the conclusion that thecortical centres are replaced after their destruction in the grey matterof the same hemisphere.Further experiments are connected with elucidation of the functionsof the corpus striatum and optic thalamus. Concerning the latter theauthors confirm the experiments of Ferrier, according to whomelectrical stimulation of these structures does not cause either pain ormovement. In studying the function of the corpus striatum, onemust specially bear in mind the nucl. caudatus and the corpus lenti- culare. Electrical stimulation of the nucl. caud . yielded the authorsthe same results as Ferrier, viz . , contraction of all the muscles on theopposite half of the body; complete extirpation caused a greatweakening of the opposite half of the body (frequently falling to oneside) , and a movement in a circle in which the animal always executedthe same movements with the sound feet, and rotated around theaffected ones like a top. On injuring the internal capsule completeparalysis of both extremities of the other side occurs. This occursupon injuring the first two-thirds of the anterior portion , which liesimmediately under the ventricular surface of the nucl. caud. Sectionabove the same produces only incomplete hemiplegia. Destructionof the posterior part of the capsula interna (between thal. op. andnucl. lentic. ) produces hemi- anesthesia of the opposite half of thebody.The authors from their experiments attempt to locate the probableposition of the different centres in the cortex of the brain in manthus: The centres for the different movements of the upper and lowerextremities lie in the middle of both upper posterior central convolutions, in the middle of the anterior central convolutions, and in thewhole of the upper temporal lobes.The centres for the movements of the neck and head lie in theposterior part of the first frontal convolution, where they unite with the anterior central one.The most probable centre for the muscles of expression and eyelidslies at the place of junction of the second frontal convolution with the anterior central one.The centres for the movements of the tongue, jaw, and lips arefound placed in the third frontal convolution ( Broca) .Single centres for the movements of the eyeballs are placed, accord-1876.] 311 Psychological Retrospect.ing to Ferrier, in the gyrus angularis. The first tempero- sphenoidalconvolution has probably a relation to the organ of hearing.Lastly, the authors give a series of experiments which have apathological importance; coma occurs most easily in extensivehæmorrhage into the centrum semiovale; perhaps with hemorrhageon the convexity, and specially of the frontal lobes. If an intraventricular hæmorrhage stimulates the ependyma of the ventricle,tetanic convulsions of the extremities of the opposite sides of thebody result. With hemorrhage at the base, stretching towards themedulla, the phenomena of general tetanus are always to be observed atthe moment of the attack.On the Effects produced by Electrical Excitation of the Brain.Bochefontaine (" Gaz. Méd. ,” No. 35 , 1875) stimulated, by means of an electrical current, the frontal convolution in front of the sulcuscruciatus, where it bends round the sulcus. The result was contraction of the spleen, of the small and large intestine, of the bladder,dilatation of the pupil, hyper- secretion of the submaxillary gland. Ifthe submaxillary gland is separated from all its nervous connections,except the sympathetic fibres which pass to it, if the above part of thebrain is stimulated, thick saliva flows from the canula, but in a much smaller amount than when the connection with the seventh nerve isintact. The same occurs during death by asphyxia, the poisoned blood acts like stimulation of the brain on the sympathetic fibres .On the Influence of the Excitation of the Brain on the Beats of the Heart. Lépine (" Gas. des hôp. ," No. 90, 1875) found thatstimulation of the surface of the most anterior part of the cerebruminfluenced the heart beats of the dog. If the left vagus was dividedin a curarised dog and the right surface of the brain was stimulated,the number of heart beats was unchanged; if the left side, on thecontrary, was stimulated, the number of heart beats was diminished,and the height of the pulse sank.Syphilitic Disease of the Cerebral Arteries. O. Heubner ( Leipzig,1874. 8vo. pp . 238. Four plates. " Centralblatt, " No. 22, 1875 ) .—The spot in which syphilitic disease of the cerebral arteries most commonly occurs is the non-vascular part of the artery which lies imme- diately below the endothelium within the fenestrated membrane. Atfirst several nuclei appear here imbedded in a finely granular matrix;then long spindle-shaped cells appear which, according to the author,do not arise from the vessels, but are developed from neighbouringparts, especially the endothelium; further development occurs partlyby the increasing division of the pre- existing cells, partly by thefurther apposition of the proliferating layer of endothelium. Thecellular proliferation always constitutes the greater part of the newmass, the inter-cellular substance the less; gradually the endothelialcovering is raised from the fenestrated membrane, but almost alwaysunilaterally; sometimes this occurs in so localised a fashion thatactual tumours project into the lumen of the artery.In the mean-312 Psychological Retrospect. [July,time the proliferation increases, spindle cells are applied to spindlecells, and the lumen of the artery becomes narrower and narrower.The cells begin by close apposition to form a thick layer. Sometimesflat cells and giant cells appear, accidentally , round cells are to be seen,which wander in from without and appear to favour the nutrition ofthe new growth. The narrowing of the lumen becomes always morepronounced and leads at different places to thrombosis . The new formation begins to be organized and to undergo involution. In thefirst case a sort of vascularization is formed by the new formation ofcapillaries in the peripheral parts of the tumour, and a completenewly-formed fenestrated membrane appears under the endothelium inall probability proceeding from the latter. The whole new formation becomes differentiated into two layers , an inner one consisting of compressedgiant cells, and an outer one of connective tissue formation. It is asif a new vascular wall was formed in the old artery such as we see atother places, e.g. , bones where syphilis leads to a genuine new formation of tissue by proliferation. In opposition to this process oforganization in other cases retrogressive changes are observed. Thenew-formed tissue becomes poorer in cells , the inter- cellular substancebecomes changed into fibrous connective tissue, and cicatricial contraction occurs, which lead to narrowing of the tubes. In fact, thevessel may become changed into a thin thread of connective tissue,which ultimately is torn asunder, so that complete obliteration of theorgan occurs.This syphilitic affection of the arteries is quite distinct from the atheromatous processes. The latter process always lasts many years,even, perhaps, tens of years, whilst in the syphilitic affection considerable disease of the intima leading to occlusion may develop in a fewmonths. Further, the character of the atheromatous processes is notthat of a new formation, but that of a genuine hypertrophy. Thereis only an increase of that tissue of which the intima consists . Allfurther changes are of a retrogressive nature, such as fatty degeneration and calcification. The two diseases are quite different in theirorigin, result, and anatomical condition . Of course an atheromatous process may occur in the arteries of a syphilitic person. This occurslike atheroma, almost only in old persons, whilst the degeneration ofthe cerebral vessels in young individuals results from syphilitic new formation.In the following chapter the author treats of the physiological importance of the syphilitic arterial affection. The normal circulation inthe cerebral arteries is fully discussed . In as far as the importance ofthe syphilitic disease of the arteries depends essentially on the closureor narrowing of the lumen of the vessel, the action of this latter process is specially considered. By occlusion of an artery, a variation inpressure occurs in the cortex, and thus is explained the sudden loss ofconsciousness , apoplectic attacks, syncope, &c .; but as the circulationin the cortex is soon again restored, so the effect is only temporary.1876.]313 Psychological Retrospect.Much more important, however, is the action of occlusion of the arteryon the basal area supplied by it; for the vessels, according to theauthor's investigation , are actual terminal vessels in Cohnheim's sense.We observe that here partly by infarcts, and partly by softening,deep lesions of the brain- substance and corresponding loss of the cerebral functions occur. Forthe most part, as the great ganglia arechiefly affected, we have to deal with motor disturbances, and withirreparable hemiplegia. As the closure of the vessels is generallysudden an apoplectic seizure is of frequent occurrence.The effects of simple narrowing of the arteries are much more complicated. Here we have to deal with changes in the elasticity of the wall, caused by the appearance of new formations in it. The bloodcurrent flows no longer in elastic, but in rigid tubes: thus, the movement of the blood in the network of the pia becomes slower, and consequently that in the whole cortex is affected . This leads to interference with the sensorium, &c. Here a gradual compensation mayoccur, and hence we see that such disturbances pass off.The closing chapter consists of observations on the pathology oftheaffection. Etiologically it is of importance to notice that this disease.occurs in the very latest stages of syphilis. The shortest time of itsappearance after infection may be three years; once only half a yearelapsed: then there occur cases where 4, 5, 12 , and 20 years intervene. Only cases of pure disease of the arteries are taken into account. Generally the disease is extensively distributed, the anteriorcerebral arteries being specially affected . Sex and age are quite irrelevant. The individuals were partly young ( 22) , partly old (51 ) . Thesymptoms are introduced by prodromal phenomena. Most commonlythere is at first headache of great intensity, so that sleep is interferedwith. Sometimes there was simple sleeplessness without headache;then vertigo occurred, and generally temporary disturbances of consciousness, a sort of epileptoid attack. The demeanour and temperare changed; intelligence and memory are temporarily weakened, andthere are pronounced weakness and relaxation. Great excitability andoften absent- mindedness sometimes precede the attacks.The disease itself generally begins with an apoplectic attack, followed by an epileptic or semi-paralytic condition. At the moment ofseizure the patient falls down unconscious, or there is only slight vertigo,nay, even sometimes no disturbance of consciousness at all. Paralysis of one side is one of the most common symptoms of syphilitic arterial disease. With few exceptions the cerebral nerves are free;generally the arm is most powerfully affected, and the leg somewhat less so. The course of the hemiplegia is constant when the fatal issueappears, soon thereafter. In cases of longer duration, it improves,and may even disappear. Unilateral contractions and unilateral painswere often observed, the former produced by the stimulation of thegreat ganglia.The second chief group of phenomena is concerned with the effectXXII.21314 Psychological Retrospect. [July,on the higher mental functions, i.e. , on the energies of the grey cortex;these disturbances occur in all cases . The characteristic thereof is theincompleteness of the severe phenomena.Consciousness is affected, but not abolished; voluntary activity isimpaired without all voluntary impulses disappearing; there is a condition in which the patient seems partly asleep, partly awake, andsomewhat dreamy. Between delirium and delusion the understandingsuddenly returns; speech becomes slow and stuttering; in some casesthere is genuine aphasia; all these conditions may be completelyhealed after a time, and then reappear, such as occurs in no otherdisease of the brain; more rarely there are general convulsions,vomiting, fever.The syphilitic indications are often found in other places in the formof gummata, ulcers of the skin , and affections of the mucous membrane. In other cases adenitis alone was present, or even no sign ofsyphilis. Death was sometimes accelerated by amyloid degeneration of internal organs.Those cases in which the disease of the arteries is not pure, but iscomplicated with syphilitic new formations within the skull run asimilar course, only here there are circ*mscribed paralysis of individual cranial nerves.The duration of the disease varies greatly. Some cases were fatalin from 24 to 36 hours; others 1 to 3 weeks. Generally the diseaselasted from 1 to 3 months, with specific treatment 6 months, evenseveral years. The prognosis is always dubious: when coma occursabsolutely unfavourable; therapeutically energetic inunction and large doses of potassium iodide are indicated.Experimental Investigations on the Simplest Psychical Processes.—S. Exner, Pflüger's Arch. , vii. , 601 , viii , 526 , xi. , 403 , and 581 , and Centralblatt, 1874 and 1876.The author's experiments relate to the time which is necessary "toreact in a conscious manner to a sensory impression; " he calls thistime the time of reaction ( " Reactionszeit") . In order to measurethis time the moment when a stimulus was felt, was indicated bymeans of the right hand depressing a board whose movements werewritten upon a revolving cylinder; the moment of stimulation wasalso indicated upon the cylinder. The author found that, as a rule,under conditions as nearly equal as possible, slow moving and studiousindividuals have the shortest time of reaction (the smallest value was0.1295 sec. , ) the stimulus being applied to the left hand. In orderto obtain a short time of reaction, the greatest attention is necessary.The resulting contraction is then executed to a certain extent involuntarily. The sensorium is prepared by central changes for the reaction,and a certain time is required before these changes again disappear.Long-continued experimentation tends powerfully to exhaust one. Ifthe stimulus is very strong, or if the sensation is new to the experimenter, the time of the reaction is very much shortened. The same1876.]315 Psychological Retrospect.result is obtained if one is excited artificially, and then one reacts justlike after a fright. The point of application of the stimulus is of verygreat influence. The sparks of light produced by passing an inductionshock through the eye were constantly most rapidly replied to;from the right to the left hand more slowly than from the left tothe right, and slowest of all when the toes of the left foot were stimulated. The time of reaction diminishes with the strength of the stimulus and with increased practice, and increases with fatigue. Teaand morphia had no effect; on the other hand, with a strong dose ofwine the reaction was executed with unconsciously greater violence,and the time of reaction increased , whilst the experimenter believedthat the opposite was the case.The time of reaction , which in the author's experiments on differentindividuals varied from between 0,1295-0,9952 sec. [ from the left tothe right hand], yielded very constant results in the same individual ,and is composed of several factors. The rapidity of the conduction insensory and motor nerves, together with the time necessary for thedischarge of the muscular contraction, are all known from the researches of previous authors. The shortest time of reaction withdirect electrical stimulation of the retina, was not inconsiderably(0,0213 sec. ) less than that by stimulation by means of the image ofan electric spark. Nevertheless there are sources of error in these investigations, one of the most important being the impossibility of choosing stimuli of equal strength in comparative experiments. The sensoryconduction of the spinal cord was estimated by comparing the time ofreaction on stimulating the toes and stimulation of the fingers. Therapidity of the conduction is equal to 8 meters per sec., whilst themotor conduction—so calculated that at one time the signal was givenwith the hand at the other with the foot-gave a value of 11-15meters. The time during which the centripetal excitation becameconverted into the centrifugal " the reduced time of reaction" wasfound to be equal to 0.0775-0.9426 secs . It determines the differences in times of reaction in different individuals and under differentconditions.In the above experiments, in which the reaction occurred after amomentary stimulus, the time of reaction indicates the error in theestimation of the time. It may be very nearly estimated in successive experiments (to 0.01 sec. ) whether this error increases or diminishes. If a stimulus is applied to a sensory organ it does not actsuddenly, but if we take care (e. g. in rhythmical stimuli whose succession can be easily learned, or in astronomical observations) to react sosoon, that the moment of signaling coincides with the impression madeon the organ of sense, the error is nothing, but the variations fromthis mean are very considerable. This agrees with the experience ofastronomers that the " personal difference" becomes smaller whendeparting from the ordinary method , the sudden disappearance of astar is used as the moment of signaling.316 Psychological Retrospect.[July,In a second paper the author seeks to estimate the time which is necessary for the discharge of a reflex act. He selected the reflextime for marking, and produced this by a method fully detailed in theoriginal , at one time by an electrical spark passed in front of the eye,at another by electrical stimulation of the fibres of the trigeminus.In the former case the reflex excitability was not only greater, but wassubject to more considerable variations than the analogous time ofreaction. In the latter case it was not inconsiderably smaller, butvaried relatively more than the former. The reflex time becamesmaller with increase of the stimulus.The author is also convinced that similar physiological processesare connected with the reflex and reactionary phenomena.If strychnine is given to a frog, and its nervous system be stimulatedby passing a slyte into it at different heights, then the contractions ofthe gastrocnimius whose movements are written on a revolving cylinder, follow after varying times. The time of reaction is greatest andtolerably constant on stimulating the cerebrum, and mid-brain; itbecomes suddenly smaller after stimulation of the medulla oblongata,and with stimulation still further down it diminishes very gradually; again it becomes suddenly smaller on stimulating the pointwhere the periphral nerve passes into the cord. From this the authorconcludes that the result of a stimulus applied to the brain becomesaccelerated in the cerebral ganglia, that after leaving these it traversesthe spinal cord with considerable rapidity, and before it passes intothe roots of the nerves it again suffers an acceleration .Two successive stimuli acting upon an organ of sense, are onlyknown not to be simultaneous when the time which elapses betweenthe beginning of both does not fall below a certain limit. The cog- nisable difference in time between two such sensory impressions, the author characterises , are "the smallest difference." The smallestdifference will vary according to whether the successive sensory impressions are applied to the organ of sense or to analogous elementsof a paired organ of sense, or to elements of different sensory organs.I. Sense of Sight.-The smallest difference on stimulating the same elements of the retina has been investigated by several authors. Itamounts to about 24 sec. from experiments on Plateau's discs; by electrical stimulation of the same fibres of the optic nerve this time is less than sec. The arrangement was so made that thecentral parts of the retina lay in the area of the greatest ten- sion of the current. When the Neef's hammer of the inductionmachine made 60 vibrations per second, the impression of light wasstill not continuous. It is therefore obvious that the fibres of theoptic nerve are less sluggish than the retina. In different elements ofthe retina the periphery conducts itself differently from the centre.Two points on the central part separated by 0.011 m.m. from eachother, were stimulated by light from an electric spark, and the small- est difference was 0.044 sec. If the observer ( Myope) removed to1876.]317 Psychological Retrospect.such a distance that the two spheres of light around the sparks overlapped each other, the smallest difference with the same arrangementof the apparatus was only 0.015 sec. , because in this case one obtainedthe impression of a movement, and the direction of such a movementis much more exactly recognised than the earlier occurrence of a spark.The smallest difference is independent of the size of the pictureson the retina, of the distance from the retina, within certain limits,and also of the intensity of the light. For the peripheral part of theretina, with a certain distance between the pictures and the retina, anapparent movement was not to be avoided.If the picture on the retina lay 3 m.m. above the other, as manybelow the forea centralis, the smallest difference was 0.055 sec. , withlateral fixation 0.049 if one of the two signals was chosen as thefixed point, then the smallest difference between the centre of theretina and a point of the retina 6 m.m. removed therefrom, was0.076 sec.; if the observer fixed with both eyes the slit of a screenwhich was placed in front of the signals, and protected each eye fromthe spark, then the smallest difference 0.017 sec. an apparentmovement was noted .-=II. Hearing. - Vibrations are intermissions which are made knownto us by a group of sensory elements . Helmholtz says the vibrationsbetween h " and c 6266 can still be heard, there are 132 per sec. , thesmallest difference would therefore be 0.0075 sec. In as far, however,as in this case, 16 partly very weak vibrations of the tympanum occurbetween two pauses, Exner imagines that the time during completepauses might be still smaller. A Savart's wheel, with only threeadjacent teeth, which struck a piece of sheet iron, was turned with avelocity which increased till the double stroke became converted intoa single one. The smallest difference for two stimuli of short duration was reckoned from the rapidity as = .002 sec. The cracklingof two electrical sparks was heard separately when more than .002 sec. separated them. The smallest difference for different elements ofthe same ear is less than 0.1 sec. , because Helmholtz's quaver soundedquite well when 8 to 10 shocks per sec. were given. Exner imaginesthat here also a smallest difference varying essentially, would be found if the two tones were only once sounded. The smallestdifference between the two ears is 0.064. Two elastic balloons werestruck one after the other, by means of an elastic spring. Theseballoons were provided with tubes which, by means of an adapteraccurately fitted the auditory meatus, both springs were dischargedby means of a pendulum. With regard to the senses of touch, taste,and smell, the author refers to the researches of other observers.Smallest difference between dissimilar organs of sense. —As the signalfor the eye an electric spark was used, for the ear the sound from abell; when a sensory impression affected the eye and the ear simultaneously, the auditory impression was sooner felt than the visual one.The smallest difference in Exner's case was 0 16 sec. When the318 Psychological Retrospect. [July,visual impression preceded the auditory one-from the opposite 0.06secs. the visual impression occurs even somewhat later than the senseof touch. In another communication the author shews that thematerial changes which are the cause of different visual impressionse.g., after- picture-do not take place in one and the same part of theoptic apparatus. By electrical stimulation of the fibres of the opticnerve it can be shewn that the positive similarly coloured after- picturemust occur in the retina, and indeed all after-pictures take place in theretina. The retina is divided into two sensory zones; to these a thirdzone must be added in order to explain the phenomenon of the electrical rays of light (Pourkinje), which one sees on observing a burning coal in the dark; this coincides anatomically with the layer ofnerve fibres . The phenomenon itself, according to Exner, results from the passages of the excitation from one channel to another.Changes in the Cerebral Vessels under the Influence of the ExternalApplication of Water. -M. Schüller (" Deutsch. Arch. f. Klin . Med. "xiv. 566, and " Centralblatt, " no. 36, 1875) trepanned the skull ofrabbits, and found that an obstruction to the out-flow of venous blood ,disturbance of the respiration , or pressure on the abdomen, producedstrong injection of the pia mater. After section of the vagi this effectwas not produced, on account of the preponderance of the inspiratorymovements. Fear and pinching, generally produced narrowing of thevessels, sometimes after previous dilatation . Ice applied to the exposed dura mater produced marked narrowing of the vessels, whichwas much weaker on the side from which the cervical sympathetic andthe ganglion supremum were excised . Cold applied to the abdomenproduced an instantaneous dilatation of the vessels of the pia on theuninjured side, and generally no change upon the injured side.A moist, warm compress on the abdomen, on the contrary, pro- duced narrowing, which was succeeded by dilatation upon thecompress cooling . Complete immersion, as a general rule, acted likea compress. The injection of cold, and generally also of warm waterinto the rectum dilated the vessels. Packing with the wet sheet,whereby the animals became sleepy, was followed by a very temporarydilatation, which gradually passed into constriction . Similar resultswere obtained during opium narcosis, but not by dry packing.Rubbing of the abdomen or back is accompanied with constriction orvarying changes in the calibre of the vessels, but in a weaker degreewhen the sympathetic and the ganglion supremum are extirpated.The changes above described occurred also in curarised animals,although in this case the filling of the vessels of the brain was somewhat less pronounced. After section of the sympathetic at the secondvertebra, there is a pronounced dilatation of all the vessels of the piamater, and the application of water was without any effect upon it .Cold directly applied to the freely exposed cutaneous sensory nervoustrunks which issue upon the back produced constriction; heat, dilatation of the vessels of the pia mater on the same side. Section of1876.] Psychological Retrospect 319 .individual cutaneous nervous trunks was accompanied by a temporarydilatation of the vessels of the pia on the same side.The blood-pressure in the carotid, from manometric observations,rose rapidly when cold water was applied to the abdomen , and thenfell considerably; with warm water application it was just the reverse,with flat variations.The occurrence of all these phenomena is explained by the authorthrough the changes in the supply of blood to the vessels of the piain consequence of a constriction or dilatation of the peripheral currentareas in the skin. The movements of the heart and respiration areonly indirectly concerned in the result, at one time assisting at anotherhindering. The reflex influence of the thermal stimulation of thecutaneous nerves upon the vessels of the pia mater is , according to theauthor, of subsidiary importance, and acts rather in an inhibitory manuer. The second phenomena which occur with long duration ofthe stimulus, and which are exactly opposite to the initial phenomena,may be explained by the changes in the conditions in the cutaneous vessels and their consequences.From the results of his experiments the author draws the followingconclusions regarding the therapeutical employment of different applications of water to the human organism. It produces ( 1 ) a restitution of the normal vascular tonus ( especially of the brain); ( 2 ) therestoration of normal blood and lymph currents in the brain; (3)diminution of overfilling of the brain with blood; (4) the restorationof the normal nutrition of the nerve elements; and (5) of the normal reflex relation between the cutaneous nerves and the brain. In the insane a " methodical " water-treatment is for the most part not to betrusted, because one cannot say how far the resistance of the cerebral blood-vessels is to be depended upon.Changes in the Brain in Traumatic Inflammation. - L. Popoff (" Virchow's Arch. ," xiii, 421 , and " Centralblatt," no. 38, 1875 ) under v.Rechlinghausen's direction examined the brains of twelve individualswho died of abdominal typhus. In all there were changes of an acuteactive inflammatory character in the vessels, in the neuroglia, and inthe ganglionic cells . In the first of these, viz. , the vessels, the cellsin the walls, or the fat and pigment cells applied to them, were in astate of proliferation , in the neuroglia division of the nuclei, and inthe ganglion cells both active proliferation processes and penetration of wandering cells . The former manifested themselves in division andincrease in number of the nuclei, then in division of the protoplasm,whereby the individual parts either did or did not possess a nucleus.With regard to the occurrence of wandering cells it is to be remarkedthat they lay partly round the cells ( in the so-called perivascularspaces) and partly also within the nerve cells, and by the penetrationof such cells, division of ganglion cells is often brought about. In thepreparation these wandering cells fell out of the ganglionic cells, sothat these latter appeared as if perforated . Beyond being in and320 Psychological Retrospect. [July,around the ganglion cells these wandering cells were arranged in rowsaround the vessels , and here and there along the nerve fibres , but stillpreferably on the ganglionic cells.Essentially the same changes are to be observed in inflammatoryprocesses, and specially in traumatic inflammations, which were produced in a variety of ways upon dogs and rabbits , only here the activechanges in the nerve elements were more pronounced; whilst intyphoid fever the penetration of the wandering cells was in full operation before the proliferation phenomena in the ganglion cells occurred,and in addition many granule cells appeared which were quite absentin the case of typhoid fever. Very interesting are the experiments inwhich the author injected colouring matters, specially China ink, intothe brain. This curious result was obtained, that a short time afterthe injection the chief mass of the pigment lay in the ganglion cells ,which had evidently taken it up by virtue of their own forces, aswandering cells containing pigment which could have accounted forthe pigment were absent, and as nothing similar could be produced indead brains. At this time granule cells were still absent, but theywere present in large quantities, and enclosed the pigment, afterthe inflammation had lasted longer, whilst the pigment could not, orcould only in a very slight degree, be detected in the nerve cells . Theauthor concludes from this that the granule cells which generallyoccur in the brain in acute inflammation are ( in part at least) changednerve cells.In another paper in the " Centralblatt " the author records theseresults of the examination of the brains of three patients who died ofexanthematous typhus in the wards of Professor Botkin, of St.Petersburgh. In this disease also the author finds ( 1 ) That there isa similar collection of the wandering cells in the perivascular spacessuch as occurs in abdominal typhus; ( 2 ) There is also penetration ofthe wandering cells into the ganglion cells, and division of nuclei inthe latter; ( 3 ) Infiltration of the neuroglia with young wanderingcells; (4) The proliferation phenomena in the walls of the vessels are more pronounced and extensive here than in ileo-typhus. Infiltrationof fat and pigment in the vascular walls may also be observed.Capillary extravasations are sometimes to be noted; ( 5 ) An interesting, but at the same time very striking result is the formation intyphus, of small nodules in the substance of the brain. They were found in the cortical substance of the cerebrum, cerebellum, corpusstriatum , etc. , and were 0.105-0.18 millimètre long, and 0· 075-0· 09millimètre broad; they often had a rounded form . These noduleswith a low power presented appearances very similar to miliarytubercle. Like the latter they were found generally, though notalways, next the vessels . With high powers (300 diameters) thesenodules were seen to consist chiefly of indifferent newly formedelements which could not be distinguished from lymph-corpuscles orwhite blood- corpuscles. Sometimes they consisted of such corpuscles1876. ]321 Psychological Retrospect.alone, and this specially in the peripheral finely granular layers of thecerebrum and cerebellum. Where, however, in fibrous tissue nervouscellular elements were present in considerable proportions, as in otherlayers of the cerebrum, in the corpus striatum, other elements, nearlyas large as the nuclei of the ganglion cells entered into their composition . The changes already described in the nerve- cells are often very pronounced around these nodules . In the first described form ofnodule, consisting of indifferent elements like white blood- corpuscles,there is never a finely granular degeneration of the central part to be observed as is often seen in tubercle. Neither giant- cells nor aspecial stroma were to be observed. These nodules, from their character and origin , are apparently completely analogous to the nodules,described by Wagner as occurring in some parenchymatous organs,such as the liver and kidneys in abdominal typhus. These nodules were observed in two cases out of the three. The relation of thesenodules to the brain- symptoms, owing to the epidemic being at an end ,was not made out. In both cases the patient died on the fourteenthday (" Lond. Med. Recd. , " 1873 ).Physiology of the Cerebellum. -H. Nothnagel (" Centralblatt," No.22, 1876) , from a series of experiments on the cerebellum of rabbits,has arrived at the following conclusions:-(1 ) The cerebellum can bestimulated mechanically by a minimum puncture with a needle.(2) The motor phenomena can be discharged from different parts of the hemispheres and from its vermiform process. It is not necessarythat the deeper parts adjoining the crura should be stimulatedmechanically. ( 3) Mechanical stimulation of one hemisphere of thecerebellum produces motor phenomena first on the one and then on theother side of the body. The same is produced by injury to one sideof the vermes; stimulation of the vermes in the middle line producessimultaneously motor phenomena on both sides . (4) One mayremove (a) the greater part of one hemisphere, ( b ) greater part of bothhemispheres, i.e. , with the exception of the direct continuation of thecrura, (c) or the entire anterior and upper part of the vermes, and theanimal may remain several days without shewing any symptomsthereof. (5 ) Destruction of a distinct portion of the vermes, however,produces intense continued motor disturbances which agree with thosedescribed by Flourens.On Disease of the Brain. F. Karrer and C. Stark (" BerlinKlin. Wochenschr. , " 1874, Nos. 31 and 33) .- K.'s case relates to astrumous girl suffering from melancholy, who several months beforeher death had had spasmodic seizures without loss of consciousness.The spasms at first only affected the right arm, later the muscles ofthe neck on the left side, and ultimately passed into complete epilepticattacks with loss of consciousness. On post- mortem examinationthere was found tubercular meningitis, and in the posterior part ofthe left hemisphere a greenish- yellow coloured area 4 c.m. long and nearer the middle line three or four similar nodules. The area affected322 Psychological Retrospect. [July,the surface of the gyrus occip. primus. Whilst the right hemispherewas quite free, there was a greyish- yellow coloured nodule the size of apin's head on the margin of the left median frontal convolution. Thepartial spasms of the right arm, according to the author, were due toirritation of the cortex from the presence of the tumour in theposterior part of the brain, which physiological experiments, however,have not yet shewn to be motor in function.In S.'s case continued contractions in the muscles supplied by theleft facial nerve, and also in the masticatory muscles supplied by themotor branch of the fifth, occurred in a woman suffering from progressive paralysis . The extremities on the left side were only temporarilyand very slightly affected, and only when the contractions of thefacial muscles on the left side were very strong were the right side ofthe face and the right hand affected . Later a temporary lateralturning of both eyeballs towards the left, in which position they exe- cuted quick spasmodic movements from right to left . Post-mortemexamination shewed several parts of the surface of the brain excavatedinto little pits; these pits represented cystic dilatations of the pia, andthere the surface of the brain was irregular and atrophied. Theauthor lays special weight upon a cyst lying in the upper part of theright sulcus præ - centralis, which compressed the root of the secondfrontal convolution and the lower part of the anterior central convolution; and by its gradual compre sion excited these parts, which, bythe stimulation of the centres for the left facial nerve, the muscles ofmastication on the left side and the straight muscles of the eyeballcould have produced the symptoms described.Aphorisms on the Pathological Anatomy of the Central NervousSystem. R. Arndt (" Virchow's Arch. , " 1874, lxi. 508-516) .I.-Pigmentary degeneration of the grey sheath of the nerve fibresin the intervetebral ganglia of a patient suffering from tabes.II.-Tubercular degeneration of the grey sheath.III.-Division of the axial cylinder.IV. Nerve fibres with nuclei.The author has found nerve fibres in the brain, spinal cord, andspinal ganglia, whose axial cylinders contained oval nucleated and nucleolated structures. By embryological investigations he has convincedhimself that normally, at a certain period of development, such struc .tures occur not only in nerve fibres, but also in the processes ofganglionic cells, but that they ultimately disappear completely. He,therefore regards these nerve fibres as imperfectly developed, and ashaving remained at a lower stage of development, and having foundthe former only in the insane, the latter only in paralytics, he is inclined to seek the cause of congenital neuro- and psycho -pathic diathesis in this retardation of development.On the Alterations of the Central Nervous System in a Caseof Chorea, associated with Mental Aberration . C. Golgi (" RivistaClinica, " 1874) , in the introduction , discourses on the different facts1876.]323 Psychological Retrospect.which appear to shew that chorea is of central origin . ( 1 ) Heredityofchorea. ( 2 ) Hereditary relations of chorea to other diseases of thenervous system. ( 3) Origin of chorea from psychical causes. In addition to these three causes there ought specially to be mentioned thosecases of chorea in which psychical changes are added to the disturbances of motion; in fact, a survey of the literature shews that thegreater number of pathologists ascribe a central origin to chorea.In most of the cases where a post-mortem examination was made,changes in the central nervous system were detected , but of so varied anature that up to the present time no distinct relation betweenthe chorea and any distinct anatomical nerve centre were detected . Thecase communicated by the author refers to a man who was bornof an hysterical mother, and who died at the age of 42 of pneumonia.In his youth he had indulged much in baccho et venere; at the age of32 chorea appeared, at first accompanied by maniacal excitement. Inthe first two or three years periods of complete remission, as well ofthe motor as of the psychical symptoms occurred; later the remissions disappeared altogether, and the disturbances of motion becamechronic; at the same time a chronic condition of mental weakness,incapacity to follow regular instruction, difficulty in articulating words occurred. The year before his death furious delirium set in;the autopsy shewed the following: -A thick false membrane coveredthe whole of the right hemisphere, the pia mater was generallygreatly thickened , the frontal and temporal convolutions weremoderately atrophied; their ganglion cells were sclerotic, atrophied, orhad undergone fatty-pigmentary degeneration. The ganglion cells ofthe corpora and the large ganglion cells of Purkinje of the cerebellumwere calcareous; the posterior and lateral columns of the spinalcord shewed a secondary descending sclerosis .In his critical observations the author refers to the great similarity between the pathological results of this case and the pathological anatomy of dementia paralytica. In this case also, just as indementia paralytica, the interstitial connective tissue of the cortexwas increased, whilst the ganglion cells had undergone degeneration.Specially noteworthy is the calcareous degeneration of Purkinje'scells; this has only once been described before by Roth. In thecase of Golgi the fatty degeneration was not, as is usually the case,limited to one area, but it had a thoroughly diffuse character in as faras here and there single cells or even single processes of cells wereaffected.On Epilepsy. Rinke (" Berlin Klin. Wochenschr, " 1875, No.37) .- Rinke had a case where a soldier who had just recoveredfrom typhus had epileptic seizures every evening. The author, byan experiment analogous to that of Brown- Séquard (stimulation ofthe skin of the neck in guinea pigs rendered epileptic), sought toproduce attacks in his patient, which was successful when astimulus, e.g. , mustard plaster, was applied to the skin between the324 Psychological Retrospect. [July,levator scapulæ and sterno-mastoid muscles. The experiment alsosucceeded when the patient, by the use of bromide of potassium, hadremained for months free from spontaneous attacks.On the Psychoses of the Pregnant and Puerperal Conditions. -C.Fürstner ( “ Arch . für Psych., " V.S. 505 ) observes that in pregnantwomen melancholy chiefly occurs, mostly running a simple andfavourable course when occurring in the earlier months, of a severe andmore protracted form in the later months of pregnancy. Of the puerperal psychoses melancholy proper is the principal form, mania the rarer. The author gives in both especially favourable prognoses; asto the question whether there is a special form of disease peculiar topregnancy, the author answers in the affirmative. Its characteristicsign he regards as an acute, intense setting in of the first symptomswhich in a few hours, and even in less time, may go on to completedelirium, accompanied by the most pronounced motor excitement.This delirious condition seldom lasts longer than three months; ischaracterized like its acute beginning by extremely pronounced sensorydelusions, and then passes tolerably rapidly into a somewhat " stupid"stage. This latter description, however, only relates to the appearance presented by the patient. She takes notice of what surroundsher, motor impulses occurring quite suddenly which interrupt thestupid condition are to be explained by the sensory delusions. Convalesence often occurs very rapidly, corresponding to the disappearanceof the sensory delusions . An abortive form of this disease, occurringquite as often when the first stage is only developed, lasts from six toeight weeks, not passing into the stupid stage but out into recovery.The prognoses of the complete as well as of the abortive form is generally favourable.Transmission of Artificial Alterations to Two Generations. -E.Dupuy (" Gaz. Med. , " No. 33, 1875) shewed the Society of Biologyof Paris guinea pigs, which presented the peculiar changes in themedulla following section of the cervical sympathetic . These guineapigs were the offspring of animals which had inherited this peculiarityfrom their parents originally operated on. Here, therefore, there wasa transmission of an artifically produced condition to the second generation.On Induced Somnambulism. -Ch. Richet (" Journ. de l'Anat.," 1875 ,p. 348) has made his experiments on about forty persons (includingtwo men) , and concludes ( 1 ) That we can, by so-called "magneticlines, " as well as by fixing the attention on a shining object, and byother empirical but little known and unreliable procedures, produce aneurosis analogous to somnambulism. (2) This is with difficultyproduced the first time, it generally appears when the process is repeated several times. If it has been once produced then it can beeasily produced again . (3 ) All the phenomena to be thus observedmay be explained by known physiological and psychological facts, andmay be observed to a greater or less extent in some intoxications1876.]325 Psychological Retrospect.(alcohol, chloroform, Hachisch) , and in different nervous diseases(hysteria, epilepsy) . (4) Specially characteristic are the phenomenaof hallucinations, which can be produced, as often as one wishes, representing a complete automaton, so that the person affected is subjectto the will of the experimenter, and feels sensations about which onespeaks to him.Development of the Corpus Callosum and Fornix. - Dr. V. v.Mihalkovics (" Centralblatt," No. 19, 1876) .Amyl-Nitrite. -Kelp (" Deutsch. Arch. F. Klin. Med. , " xv. , p.602) has given this substance in doses of five drops two to four timesdaily to five patients (three men, two women) suffering from melancholia stupida, without having produced the slightest result on thepsychical condition of the patients.On a Case of Protopathic Spinal Muscular Atrophy. - Charcot andGombault (Type duch*enne Avar, " Arch. de Physiol. , etc.," 1875,No. 5) had an opportunity of observing a case of long - standingprogressive muscular atrophy. The disease had, in the course of morethan twelve years, led to the disappearance of the greater numberof the muscles of the upper arm and shoulder in the patient, a womanof about 50 years of age. The lower limbs were tolerably well preserved. Their very complete investigation of the nervous and muscularsystems yielded the following results:-The cerebrum, cerebellum,pons, and medulla oblongata with its nuclei were unchanged . Thegrey substance of the cervical and dorsal spinal cord was muchchanged, the degeneration gradually diminishing upwards and downwards from the lower part of the cervical enlargement. There thenerve cells and the nerve fibres which traverse the grey anterior hornin all directions had disappeared. The capillaries of these parts wereenormously developed, the walls of the smallest and largest vesselsthickened. The lumbar portion of the spinal cord and its lateralcolumns were normal; there was sclerosis of portions of the cordclose to the exit of the anterior roots in the cervical and dorsal region.The ganglion cells occurring there were enormously diminished in size,without processes, more pigmented than normal, but still containingnucleus and nucleolus. The anterior roots of the cervical region wereatrophied; sheaths either empty or often filled with large nuclei tookthe place of the normal fibrillar contents; the posterior roots appearednormal. In the peripheral nerves more than two thirds of the nervetubes had disappeared; the greater number of the muscles of theshoulder girdle and upper extremity were atrophied; there was simpleatrophy of the primitive bundles without coarser changes of the fibres,or any extraordinary development of the inter-fibrillar adipose tissue.The author proceeds from the stand point that the affection of thegrey matter of the spinal cord is the primary part of the process in thisdisease, or, as he calls it, proto- pathic muscular atrophy or tephro- myelitis.Asymmetry ofthe Grey Matter ofthe Spinal Cord.-P. Schiefferdecker326 Psychological Retrospect. [July,(" Arch. f. Micr. Anat. ," xii. , p. 87) has found that in perfectly healthyspinal cords, and without any functional disturbance being observedduring life, a not inconsiderable asymmetry of both halves of the grey substance, both as regards form and position , may occur. Theformer case refers to a dog, the latter to a man. In both cases theasymmetry was distinctly limited to single vertebræ; in the dog tothe region of the second cervical and the seventh dorsal, in manto that of the sixth cervical and the fourth to the sixth dorsalvertebræ.Anastamoses of Nerve Cells in the Spinal Cord.-A. Willigk. Virchow's Arch. , lxiv . , p. 163, describes four cases of undoubted anastomosis of nerve- cells from a diseased spinal cord ( Embolism) . Thesewere undoubtedly normal conditions, which, on account of the smallamount of sclerosis of the inter-ganglionic substance, were easilydetected.On the Course of the Fibres in the Spinal Cord. P. Schiefferdecker(" Arch. f. Mikr. Anat. , " x. , 471. ) arrives at the conclusion that thefibres of the spinal cord are so arranged that they serve to connectthe different parts with one another in the most varied manner. For this purpose they pass partly out of the white substance in differentways into the grey, and partly become mixed with the latter in the most different manner.Fibres which spring from different parts of the white substance goto the same part of the grey substance, or vice versa. Fibres havinga different destination , and which take origin in the same part of thewhite substance, pass in different ways into the grey, or pass at leastinto it at the same height. In the grey substance they form partlysimple networks without ganglion cells, partly processes, which unitethe different parts with each other, such as the anterior and posterior commissure.On the Condition of the Nerve Cells in Embolism of the Spinal Cord.A. Willigk ("Prager Vierteljahrsschr, " 1875, iii . , s. 41 ) .-In the neighbourhood of small, thickened sclerotic vessels of the spinal cord,plugged up by emboli, the author found in the grey substance pronounced proliferation of fine fibrillar connective tissue, rich in cells,in whose neighbourhood well- preserved ganglionic elements werescarce, their place being taken here and there by amorphous hyalinebodies, without nucleus or processes. Similar changes were exhibitedby Clarke's column . The changes in the anterior horns, however, weremost interesting; whilst the greatest number of their large multiplarcells presented throughout a normal appearance, there existed closebeside them faintly glancing cells, whose body was only partly colouredby the carmine, and also completely colourless cells of enormous size,which, with a low power, appeared like masses of colloid matter, butwhich, under a high power, exhibited distinct processes and a palenucleus. In the neighbourhood of such diseased cells, a thrombus ofsmall vessels was generally to be found. The neighbouring tissue ,1876.]327 Psychological Retrospect.however, was unchanged, and exhibited no trace of proliferation ofconnective tissue. Here, therefore, in consequence of embolism, disease of several nerve- cells had occurred which may, perhaps , be regarded as genuine colloid degeneration.On the Pathology of Sunstroke. K. Köster (" Berlin Klin Wochenschr," 1875, No. 34).- In the case of a soldier, who died fromsunstroke, found the following appearances: Extravasation of bloodinto the ganglion supremum of the right cervical sympathetic; theganglion was increased to about double its volume, its nerve fibreswere separated one from the other and broken up; small hæmorrhageswere found in the lower, larger ones in the upper part of the rightsympathetic. In and around both vagi, in the sheaths of bothphrenics, there were also extravasations, and at the lower part of theneck in both parotids there was hæmorrhageinto thevascular sheaths;the brain was slightly hyperemic; under the ependyma of the leftventricle there were several small ecchymoses; the lower lobe of theright lung was infiltrated with blood; ecchymoses were found underthe peri- and sub-cardium of the left ventricle.The author describes similar results as occurring in the case of asyphilitic woman where excessive increase of temperature could nothave been the cause of death. The author makes future observersaware of the possible occurrence of disturbances of the vaso-motorand respiratory nerve centres which must occur in a pronounced formin patients suffering from sunstroke.On the Pathology of the Cervical Sympathetic. P. Guttmann(" Berlin Klin. Wochenschr, " 1875, No. 32) observed that in the caseof a man of about 40 years of age, suffering from tubercle, the left half of the face and the neck became covered with sweat whenever hetook even moderate bodily exercise. The left half of the face andspecially the left ear became red, and the temperature in the left external auditory meatus rose several tenths of a degree above that inthe right; atrophic disturbances were not observed on the left side,but they were clearly pronounced in the left eye, which was prominent, freely movable, while the conjunctiva was strongly injected,and tears sometimes flowed more readily from the left than fromthe right eye; the left pupil was wider than the right, but was sensitive to light; vision was normal.This case is of interest, because of the abnormal secretion ofsweat on one half of the face, and also because the phenomena are ofa vaso-motor nature dependent upon the sympathetic and pointing toa paralysis of the corresponding fibres; whilst the occulo- pupilarphenomena must be regarded as the result of a stimulation of thecorresponding fibres. The area of the left facial, trigeminus, andocculo- motorius (no disturbance of accommodation) was throughoutintact; there was slight sensation on pressure in the region of the leftcervical sympathetic, probably indicating a chronic inflammatory con- dition of this nerve trunk.328 Psychological Retrospect. [July,3. American Retrospect ( continued).The Chicago Journal of Nervous and Mental Disease. Vol. I.,October, 1874.October, 1874. No. 4. Pathology of the Vaso- Motor NervousSystem (Lecture iv) , by J. S. Jewell, M.D. Cases of Hysteria,Neurasthenia, Spinal Irritation and Allied Affections, with remarks byGeorge M. Beard, M.D. A Case of Hydrophobia in a Child, byAddison H. Foster, M.D. On the Action of Certain Medicines on theCerebral Blood Vessels, by Dr. Max Schneller. On the DilatingVaso-Motor Nerves, by Prof. Fr. Goltz . Notes on the Nitrite ofAmyl,by Dr. J. Crichton Browne. REVIEWS, & c. , &c. , &c.Vol. II. 1875.January, 1875. No. 1. Pathology of Epilepsy, by J. S. Jewell,M.D. Aphasia, by A. D. Rockwell, M.D. Researches on the Functions of the Brain, by M. M. Carville and Duret. Illustrations ofHeredity: Influence of both Parents on the Children, by Prof. RansomDexter. The Management of Delirium, by J. Milner Fothergill, M.D.The Automatism of Memory and Association in Pathological Somnambulism, by Dr. E. Mesnet. REVIEWS, &c. , &c. , &c.April, 1875. No. 2. The Relations of the Nervous System to theUterus, by J. S. Jewell, M.D. Nitrite of Amyl in Epilepsy: Experimental and Clinical Observations, by J. H. McBride, M.D. The Movements and Innervation of the Iris, by Dr. H. Gradle. Angina Pectoris,by J. H. Hollister, M.D. REVIEWS, &c . , &c. , &c.July, 1875. No. 3. The Movements and Innervation of the Iris,by Dr. H. Gradle. Some Practical Observations on Exophthalmic Goitre and its Treatment, by Roberts Bartholow, M.D. The Athero- matous Process in its Relations to the Brain, by Karl Hertzka. On theHypodermic Administration of Ergotine in Certain Cases of Acute Mania, by Dr. A. H. Von Andel. REVIEWS, &c. , &c. , &c.October, 1875. No. 4. On the Existence of Definite Motor Centresin the Cerebral Cortex, by J. S. Jewell , M.D. Pathology of Drunkenness: Is it a Disease or a Moral Delinquency? by N. S. Davis, M.D.Two Cases of Exophthalmic Goitre associated with Chronic Urticaria,by D. Duncan Bulkley, M.D. On Chronic Subacute Neuritis, by H.M. Bannister, M.D. Paralysis of the Vagus, by Franz Riegel.REVIEWS, &c., &c. , & c.It will not be necessary for us to notice the majority of the papersgiven in the tables of contents, as they are chiefly systematic lectures,translations and reprints, but there can be no doubt that the " ChicagoJournal " must be most interesting to its readers as each number con- tains a 66 Periscope," giving excellent and full abstracts of papers on1876.] Psychological Retrospect.329-1st, the anatomy and physiology of the nervous system; 2nd, thepathology of the nervous system and mind, and pathological anatomy;and 3rd, therapeutics of the nervous system and mind.Cases of Hysteria, Neurasthenia, &c.Dr. Beard is engaged in preparing a work in which he hopes tounify those diseases of the nervous system usually known as functional,and " to show that they have in general a common pathology, a common history, a common group of symptoms, and a common therapeutics." He " shall seek to show that these diseases, or symptomsof disease-or, as they might, perhaps, with better justice be called,results of disease-are expressions of a common nervous diathesis;that they are liable to run into each other, and to act vicariously toeach other; that they are a part of the price we pay for civilization, being confined mostly to the enlightened peoples of modern times. " Dr. Beard treats all these affections on the same generalprinciples, and depends mainly on general faradisation and centralgalvanisation. Internally, he uses preparations of phosphorus andcod-liver oil, and sometimes arsenic . He uses largely cod -liver oilemulsion, and has seen good results from the oxide and phosphide ofzinc and chemical food. Externally he employs ice and hot- water bagsto the spine and cautious counter- irritation.Illustrations of Heredity.Whatever value may be attached to the cases detailed by Dr.Dexter, his general propositions are reasonable enough.1. The natural healthy constitutions of father, mother, and theirancestors, are blended in their offspring.2. The offspring of healthy individuals are likely to inherit the castof the more strongly constituted parent, or the particular organs most highly developed as they may appear in either of them.3. In the acquired constitutional change, whether of disease or development, the impression may be so strongly made that the tendency to reproduce it again is stronger than to resume the normal condition.4. Strong mental impressions of either parent, though of comparatively short duration, may prove to be dominant in the offspring.5. There may be a duality in some instances, of mental impressionsin the offspring on the same subject, having resulted from conflictinginfluences in the minds of the parents.6. That parties whose ancestors have been drunkards, and who areconstitutionally affected from that influence, show it in the lineamentsof their bodies, as well as in their mental peculiarities.Two cases are given in illustration of the fifth proposition. Thesecond case is so amusing that we reproduce it verbatim, leaving thereader to judge as to the value of such a history.N. J., the subject of the following peculiar history, has attained the22 XXII.330 Psychological Retrospect. [July,age of about forty; both he and his ancestors were healthy, industrious and intelligent.Although alcoholic beverages were used quite sparingly by hisparents, the mother when pregnant was in the habit of using themseveral times daily until her confinement. But just before becomingpregnant with the subject of these remarks, her eighth child, a strongtemperance movement was instituted in the section of country in whichhis parents resided . His father being a minister, was naturally expected to take the lead in the good cause. Both parents takingan active part in the endeavour to suppress the use of alcoholicliquors, of course forbade the accustomed use of the beverageeven in the delicate situation in which she had now become. Duringthe latter months of gestation, a great conflict ensued between theappetite for the beverage to which she had been accustomed, and themoral restraint to which she had subjected herself. The appetitegrowing stronger as gestation advanced, was a source of great discomfort; but the moral restraint and the power of the will held the entire mastery.The effect upon the offspring was specific. The boy when quitesmall was often the object of observation. Quite to the surprise ofhis parents he manifested the same peculiarities of appetite and sentiment that possessed his mother during her stage of gestation withhim. If there was any spirituous liquor anywhere near him, he wouldbe frantic to get a drink of it, but strange as it may seem, would beglad when it was placed beyond his reach .This gentleman reports, and his veracity is perfectly reliable, thatfrom his earliest recollection he has always had a strong appetite anddesire for alcoholic liquors, but is cognizant of the accompanyingautomatic action of the will, which enables him to abstain from them.He says that he has a conscious sensation within his own mind, thatthe desire for these liquors is coupled in his mind's action with thewill- power that enables him to abstain from their use. In short, hehas a duality in the operations of his mind transmitted from hismother, and exactly as she had them.Nitrite of Amyl in Epilepsy.As the result of clinical and experimental observation, Dr. N. Brideconcludes that those cases of epilepsy in which there is a distinct auraare the cases in which the nitrite of amyl promises most good.1876.] 331PART IV.-NOTES AND NEWS.QUARTERLY MEETING OF THE MEDICO- PSYCHOLOGICAL ASSOCIATION, HELD AT GLASGOW.A meeting of the Medico- Psychological Association was held on the 3rd March in the Hall of the Faculty of Physicians and Surgeons, Glasgow. Present: Professor Gairdner (who presided) , Drs. Yellowlees, Alex. Robertson,Clouston, Anderson, J. A. Campbell, Coats, Fred. Skae, Rutherford, Wickham,Charles Skae, Stewart (Kirkintilloch), Jas. Maclaren, Dove, McCalman, and Stainthorpe. Letters of apology were received from Drs. Howden and Batty Tuke.The CHAIRMAN said that the Association was always welcome when it met inGlasgow, though not many of their brother practitioners attended unless thesubjects to be discussed were of very special interest. The first thing on thecard was the exhibition of pathological specimens.Dr. M'LAREN exhib ed the cast of the head of a microcephalic idiot child,whose father and mother were drunkards. This creature was perfectlydevoid of intelligence, and very badly nourished . It lived a sort of vegetative existence.The cast having been examined,The CHAIRMAN then proceeded with his own communication, which he said hemade quite as much in the hope of receiving as of giving instruction. It was one of those communications which might be said to be entirely founded onfacts. It would be very easy to preface it by a pretty long discussion or dis- quisition upon the different subjects that would come under observation. But as a mere statement of the facts would occupy time, he would omit all kinds of preliminary remarks, with the exception of these few. The forms of nervousdisease, of which he had got the living illustrations downstairs, were in two cases, he thought, forms that all present would recognise as having certain re- lations of comparison with general paralysis of the insane. One of the patients,however, was not only very sane, but he was a man quite above the average in his mental balance. He was a man, whether regarded from the side of intellector emotion, rather superior, and seemed to be as sane a man as was going. As to the other man, there had not been such a long period of observation. Hebelonged to a lower grade of society, and was altogether a lower type of man.He was also a man who might have injured his system in various ways. Hewould not defy any of the gentlemen present to find some lurking insanity about this man. But roughly speaking he was a sane man. These two were thecases which bore a certain relation to general paralysis. The object of this communication was not so much to discuss the subject as to place the cases before the meeting and to invite the remarks of the members present upon thediagnostic distinctions between these two cases and general paralysis. He hadrepeatedly met with cases which puzzled him in this way. But meeting them as he did, entirely almost from the side of general consulting and hospital practice, it seemed to him that he approached them as it were from a different side from the members who must have a far greater experience of cases of whichinsanity was the principal element. It appeared that by combining their ob- servations they should both gain-that is by bringing side by side the observations of a general hospital physician with those of gentlemen whose field of observation lay within asylums. The third case was one which he brought there, simply for the purpose of comparison. It was not a case of his own.was under the treatment of Dr. Finlayson, who, he had hoped, might have beenhere to-day, but who was necessarily detained elsewhere. Any explanationsIt332 Notes and News [July, .that were wanted might be had from the report in the Journal (see p. 256) , or fromMr. Stainthorpe, who had the reporting of the case and who was present. Itwas a typical case, in most respects, of locomotor ataxy. It was many years since he had his attention drawn to the difference between general paralysis and locomotor ataxy as regards the mode of progress. A good many years ago,when the British Medical Association were meeting at Oxford, he formed alittle party to go through some of the asylums in London, with the view oflooking at that point. Mr. Lewes, the well- known author, and Dr. Baxter were of the party. Two or three hospitals were visited. It struck him at the timethat considerable obstacles were encountered in getting into Hanwell-indeed,it was closed practically to them for the purposes of observation on account of some crotchet-but they made their way to Colney Hatch, and took observa- tions. They were impressed with the differences between locomotor ataxy andgeneral paralysis with regard to the mode of progression-differences that hadbeen pointed out by duch*enne in his well- known book. He (the Chairman) had brought this case for the purpose of comparison. To begin, then, the first case he wished them to notice was that of a man, aged 50 years, a watchmaker (see p.250). This was the man who, to the Chairman's mind, was emphatically sane andquite able to appreciate every word which was said to him. The summary of his case was this: Defect in articulation and gait, observed nine months ago,followed by imperfections of the minuter movements of the fingers which his occupation as a watchmaker brought into prominence; sensibility absolutely intact, whether of the legs or arm. The gait was characteristic of locomotorataxy; but as the man would be seen that day there would be recognised aconsiderable similarity with general paralysis . The intellect and emotions had been set down as sound. He was a temperate man, with no marked tendenciesto excess, either sexual or alcoholic. The only ground upon which sexual excess could be presumed was that his wife never had any children. She miscarried the first time, and it was supposed she had received some injury in the uterus. His physical conformation was robust, and there was no trace of fever since he came. The other points in the case were accessible in the report.But perhaps the best way would be to bring the man up, and then any questions could be answered about him. He had always enjoyed good healthtill the present illness, which began about two years and a-half ago with adifficulty of walking and performing the minuter manipulations of his occupa- tion. It was eighteen months since he experienced defective articulation,which had made gradual progress , and was worse now than it had ever been.There was no inequality in the pupils, and all the special senses seemed to be perfect When he stumbled it was always to the left side. He always madesuch a case walk the plank, which was the navy test for drunken men.Hisgait was worse going down hill . He could walk pretty well with his eyes shut;and standing with the eyes shut he did tolerably well.The patient was then introduced, and, in answer to questions put by the members, he said that the first thing he noticed was that he got stiff and could hardly walk. His speech was good a long time after that. The first thing henoticed was in the shop, when he told the boy to go for two sixpences for ashilling. He could not pronounce the word “ sixpence." Patient then pronounced imperfectly the words " perpendicular," " Constantinople, " and "truly rural."The CHAIRMAN-I think the linguals are the worst.The patient further stated that the right hand was all right, but the finger next to the little finger of the left hand shook. He was sometimes restless inthe legs and feet. He never had a fit in his life, and he heard perfectly with both ears. He could show both gums and could whistle. He pronounced"practising " with difficulty. His grasp was perfectly strong, and there was no great tremor. His friends did not think he had altered in the expression of his face, but they noticed his speech and walk. He had never taken any1876.] Notes and News. 333stimulants since he felt this, but a glass of porter. He got tired after walking half a mile. He had never a pain in his head, but he had a queer feeling in the whole of his head. He never heard funny noises, nor did he ever see flashes of light. He never got a fall or hurt. He was 50 years of age,and was of an anxious temperament, and took his business keenly to heart. He had no darting pains in his legs . He had a custom of shooting his leg in bed.Both his hands gave way at the watchmaking at the same time. The right hand was pretty good yet. It was the left hand that went first. He did not know when his father died. As a watchmaker he constantly used the magni.fying glass to the right eye. He thought he saw as well with the one eye as with the other. His taste was quite correct. He had always been pretty sober.The CHAIRMAN-His pulse is not strong. The sensibility on the left side is quite natural.Dr. CLOUSTON-I think the sensibility on the left side of the face is impaired.The CHAIRMAN-It is the right that Dr. Yellowlees and I made out.The patient then left, and the CHAIRMAN showed the writing before and after his illness, and said that there was a brother who had some kind of paralysis.The patient was remarkably free from emotional sensibility.Dr. STAINTHORPE-It was found that when discussing theological questions he could hold his own quite well, and he conducted his business till he came to the hospital.The CHAIRMAN-The arteries are probably a little senile; but there is nothingmore marked than you would expect from his age. The pulses are rather feeble as compared with the heart's action. There is no great change in the symptomssince he came under observation; but they are rather better. He has been on strychnine.The CHAIRMAN said that the next case was one which came to him within afew days afterwards. It was sent to him by Dr. Gorman, of Rutherglen, notto be treated in hospital, but to know whether it was a case of locomotor ataxyHe (the Chairman) answered at once it was not a case of locomotor ataxy; butwhile he said that, he always admitted it was very difficult to know what it was:-" T. H., a man of 45 years of age, a miner. Progressive imperfections of gait and articulation resembling in some points general paralysis, but devoid of insanity; gait not that of locomotor ataxy. Tremors in the right fingers, but steady grasp and no distinct paralysis; no tremors of lips; handwriting un- steady; muscles not at all atrophic; no imperfections of speech. There wasjust a possibility he had syphilis at 19 years; but pretty distinct history of sexual excess in marriage life, he admitting that he had had intercourse withhis wife every day for years. Absolute negation of history of alcoholic excess;indeed, strict temperance; physical conformation average; instability of gait,disorder of articulation, together with such want of control of right arm as toincapacitate him for work since the beginning of September. According to his wife's statement, it appeared to take origin in a seizure of some kind, in which he bit his tongue. He had himself a perfectly distinct recollection of the occur.rence . The tongue was severely bitten and bled considerably. His ownexpression was that his teeth ' went faster ' than his tongue. He had never been Bo much disabled as at present."" The patient was then admitted, and said that he never walked more than four miles, and that it was the arm that first went wrong; rather the tongue and then the arm. At least he noticed it in his speech first.It come gradually on, and always increased. All this was after he hadbitten his tongue. He had no pain at all; but he had many a time a pain in the head. If he was stooping he had a sore back. This was before hisillness, and had nothing to do with this. He had no flashes and darts of pain through him. He could not say whether it was long or short words that puzzledhim. He could not pronounce the word ' corruptible ' at all. The patient pro-334 Notes and News. [July,nounced distinctly ' Constantinople ' and ' perpendicular. ' If he took time hecould speak well enough; but if he spoke fast his speech went away, and oneword came upon the top of another. The patient then pronounced three times pretty well the words ' truly rural. ' The patient then said that sometimes hehad great pains in the right side of his neck. There was a want of feeling inthe lips on the right side. His memory had been bad for 20 years. He neverhad any rheumatic pains. He had not the slightest emotional tendency. Hewas always ticklish. He had no family by his second wife, but a large one by his first one. He could see well enough that day, but he could not see well thetwo days before yesterday. He did not think he had the sense of smell as well as he had before."The patient then withdrew.The CHAIRMAN said that the third case was a typical case of locomotor ataxy,and that nothing more could be said about it except the details:-" D. R., aged 37 years. The case was one of Dr. Finlayson's. The locomo- tor ataxy was about nine months' duration; no distinct paralysis, but great loss of balancing; no distinct shooting pains; atrophy of the optic nerve of theleft side with reduction of the field of vision; tightness across the abdomen; dimi- nution of sexual desire; some affection of the bladder and rectum, causing urgency in attending to their calls; preservation of the sense of temperature;diminution of the sense of weight. As a remarkable contrast between this case and the first it was brought before the members. Tested by weight, a quarter- pound suspended over the right foot could be appreciated, while nothing under one pound could be felt by the left foot. The man first introduced felt half an ounce with either foot. This man, with his best foot, did not feel anything less than a quarter of a pound. He had improved a little under medical treat- ment. The patient said that he never noticed a double vision till his attention was drawn to it. He could see much better when he shut the left eye; butwhen he opened the right one it caused mistiness to come over the other one.His speech was not at all affected . He felt it from the thigh downwards. He could not write steadily. He was a gunmaker. He was more affected in the left than in the right leg. He got tired very soon."The patient then withdrew.Dr. CLOUSTON said that they were much obliged to Dr. Gairdner for having brought these cases before them. But he had not the same difficulty in his ownmind with regard to such cases as some people seemed to have. He did notattach "insanity" necessarily to general paralysis. General paralysis was adisease with certain characteristics-especially motor characteristics and thequality of progression frombad to worse. According to his ideas of general para- lysis, he would say decidedly that the first two cases were cases of that disease.They were affected as regards their motor centres exactly as general paralytics were. If in these cases there was mental weakness, there would be no roomfor hesitation. There were certain kinds of disease which puzzled them attimes. He had been puzzled in the diagnosis between general paralysis and alcoholism, cases of tumours of the brain, and syphilitic disease of the brain.Latterly he had a very curious case under his care-it was that of a cab-driver,about the age for the occurrence of general paralysis. He was a reckless man,having indulged in all kinds of exhaustive excesses. In addition, he had syphilis with secondary symptoms. He began by having the symptoms of loco- motor ataxy. That evidently went upwards. He had the articulation ofgeneral paralysis; but along with this the locomotor symptoms-the peculiar walk and diminished sensibility, and want of the sense of weight. He was paralysed on one side more than another. After death there werefound distinct pathological signs of locomotor ataxy, and there were foundalso the ordinary pathological signs of general paralysis. In addition, there was an enormous mass of degenerated brain-tissue on the side opposite to thegreatest paralysis. In the whole anterior lobe of one side, slightly fibrous1876.]Notes and News.335grey gelatinous substance was observed, so that there was no connection be- tween the convolutions on the one side, and the convolutions on the other.Now, he considered this case was a complication of the two diseases and of syphilitic arteritis as well. His own opinion as to the real nature of general paralysis was, that it was a disease of the convolutions of the brain, and that with- out this there could not be general paralysis. Hence there was this difficult utter- ance, caused at first by fibrillar tremblings of the muscles of articulation, these being symptoms indicative of disease of the convolutions of the brain which constituted general paralysis. In addition, we had, in a few cases, locomotor ataxy, and in rare cases the absence at first of decided mental symptoms.But he was extremely sceptical as to the absence of mental symptoms. He had never seen a case in which, from the beginning to the end of the disease, there had been the absence of mental symptoms. He would unhesitatingly pronounce that the two patients first seen would become imbecile before they died. If there were not delusions, there would be the occurrence of imbecility, and the emotional nature would be to a considerable extent impaired . The special point he wished to impress was, that general paralysis consisted in a certain pro- gressive disease of the convolutions-probably the outer layer of the convo- lutions. He would not attach any great importance to mental or other symp- toms except these progressive symptoms of articulation were present.had known of cases of so-called recovery in general paralysis, where mental symptoms passed off to anybody but the experienced eye, and those patients appeared quite as sane in intellect and emotion as the two patients that had been seen just now.HeDr. YELLOWLEES was not quite disposed to go so far as Dr. Clouston. Whenhe saw the first man he said, " Look out for that man's mind, I do think it willgo. " There were many brain conditions which he could not define. He thoughtthat everyone who had lived long in asylums had been surprised that a certain case had developed general paralysis which at first he did not know was generalparalysis. Although going back over the history of the case one did not findanything to justify it, yet general paralysis had grown under one's eyes,engrafted upon something else. In other cases, though you knew the man was unwell, yet his condition was such that you could not say there was anything insane about him. But you could prophesy what his future would be. As to thethird case, it was quite apart from the other two, and did not call for remarks.Dr. ROBERTSON felt that their ideas regarding general paralysis were still in an unsettled condition, very much owing to the late observations connected with the discoveries of Hitzig and Ferrier on the surface of the brain. He had a-doubt in connection with the cases submitted as to really where the mischief hadarisen-whether the symptoms, which apparently began with paralysis of the lower extremities, were referable to the spinal cord was a different matter.By-and-bye the disease might spread from the different motor centres such as the motor centre of the arm, the leg, and speech, and involve the mindgenerally; or, again, they might consider that in these first two cases, about which there was any doubt, having begun and advanced in the spinal cord, the disease might gradually grow upwards until it involved the surface of thebrain, so that general paralysis passed upwards from below instead of down- wards from above. He did not knowthat they could come to a conclusion upon that point, in the cases of the kind which Dr. Gairdner had shown them. He thought there was fair room for doubting which might be the course. It certainly struck him that the first of these cases was a case of disseminated sclerosis as found very much in post-mortems. With regard to the diagnosisof general paralysis from locomotor ataxy, he did not think there could really be any difficulty in ordinary cases. He never had had any difficulty in the diagnosis of such cases. Still, it was known that cases of locomotor ataxy might have mental symptoms superadded. A very eminent writer describedthree cases in which the disease began as locomotor ataxy and general paralysis336 Notes and News [July,.developed afterwards. The difficulty with him (Dr. Robertson) was as to thesituation of the lesion in these cases-whether they were to consider the lesion was really in the lower part of the motor apparatus, or if it had commenced in the convolutions.Dr. RUTHERFORD said that there might be mental weakness, although it wasnot very well marked. He thought that mental symptoms would follow. Asto the first case, two years ago, the symptoms commenced in the lower limbs. Hethought if we could examine just now, there would be great degeneration in the posterior columns of the cord. In the second case, we have the epileptic formof the attack. He had no hesitation in saying these are cases of general paralysis, and the chances are that mental symptoms will follow.REPARATIVE POWER IN INSANITY.Dr. CAMPBELL read a paper on the " Reparative Power in Insanity." (See p. 222., " Original Articles .")Mr. WICKHAM also thought that the reparative power of the skin was wonderful, while Dr. YELLOWLEES was of opinion that their experience must corrobo- rate the statements of Dr. Campbell.Dr. CLOUSTON had a case under his care of a female general paralytic whowas not merely paralysed, but had contraction of the muscles beginning on oneside and extending to the other. The digestive power was extraordinarily per- fect. The chief actions were when you got near her mouth, she opened it like young birds which wanted food. Possibly this perfection of the digestive power of general paralytics, with advanced paralysis and advanced enfeeblement of mind, was a proof that the disease was in the convolutions of the brain. He was not aware that in locomotor ataxy the digestive power wasat all so good. Did it occur to the members that this power of repair was in the soft parts and not in the bony tissues. He had noticed in general paralysis,where there were bed sores, that spinal symptoms were most apparent. Whenyou have spinal symptoms developed you have a tendency to bed sores.MASTURBATION.Dr. YELLOWLEES said that they would all agree that of all cases those of masturbation were most obnoxious . There were many cases which they were notable to cure if they could not correct the habit. It seemed to bethe vexation ofasylum life that patients should, before their very eyes, get by this habit from bad to worse. They had all perplexed themselves about this vice, and endeavoured to prevent it. Recently he had tried something in the way of a preventive, which he brought forward, in order that the members might be got to essay it as well. He had tried this mode in a dozen cases, and so far as it hadgone he was very much satisfied with the results. The oldest case was 18 days.The suggestion was founded upon the anatomical fact that the prepuce was anatomically necessary for the erection of the penis. Its anatomical use was to give a cover for the increased size of the organ. If you prevented the prepuce going to that use, you would make erections so painful that it would bepractically impossible and emission therefore extremely unlikely. What he had done was to deal with the prepuce at the very root of the glans, to pierce it with an ordinary silver needle, the ends of which he tied together. He had the case of a lad who was so extremely addicted to masturbation that hismother begged him to do what he could to prevent it. He used the apparatus first in the case of this boy, with most excellent results. He had been masturbating night and day, and he was now so well that he was working as a car.penter. Dr. Yellowlees further said that he had eleven more patients all going about with wires in their penises. There was only one case where he had to take it off, the wire causing a good deal of irritation. But he took it off with1876.]Notes and News. 337the intention of putting it on again. But one man had had it on for 18 days,and had no irritation at all to speak of. None of the other cases were givingany trouble in that way. He felt certain they were for the present, and whilethe wire remained , alsclutely debarred from the habit of masturbation. Thesensation amongst the patients themselves was extraordinary. He was struck with the conscience- stricken way in which they submitted to the operation upon their penises. He meant to try it upon a large scale, and go on wiring all mas- turbators . The moral effect of it in the house was excellent, and one man wasBeen weeping over his in anticipation of its disablement. The wiring was so simple that it could do no mischief. He believed it was effectual. It was asilver wire.Dr. SKAE- Is it a case of life -long wiring?Dr. YELLOWLEES-No. I think if we could get them to stop masturbating for a few months, they would be cured . You can keep the wire fixed as long asyou like. We have found bullets remaining in the bodies of persons for a long time. One of the patients removed the wire; but unless you get a roughstone to rub it, it remains. Only in one of the twelve has the wire been taken out.Dr. ROBERTSON-If anything can be suggested to prevent patients frompractising this vile habit, which is the cause of insanity in many cases and aggravates the disease, it would be of very considerable importance. We knowvarious things have been tried previously, such as blistering the penis, croton oil, &c. but without effect: and various medicines are given with the view of moderating or repressing the desire. Dr. Yellowlees' experience is short; butso far as it has gone it promises to be successful. We shall be interested to hear the result of these cases. Should they continue to prove beneficial in repressing this habit, I have no doubt we will be all glad to try it.STOMACH PUMP.Dr. YELLOWLEES showed a stomach pump of his own invention. One of the advantages claimed for it was its perfect simplicity. It was an ordinary bottlein which the prepared food was placed . The propulsive power was obtained by blowing. No one could form an idea of the ease with which food passed intothe stomach in this way. There was a perfectly clear passage without taps or valves, so that biscuit, mutton, or what one liked, could pass through the tap.There was also the advantage of the food passing into the stomach with agentle flow, whilst there was less danger of vomiting. He had often used the same kind of thing in Wales. He could get minced meat through the pipe.Dr. CAMPBELL This subject was discussed at the last meeting in Glasgow.I think Dr. Skae used to let a patient starve for a number of days.Dr. ROBERTSON-There is a case quoted in the " Journal of Mental Science, "where feeding by the stomach pump was carried on for sevenyears.What wasthe result?Dr. YELLOWLEES-The man went to Dr. Rutherford, and died (a laugh) .Dr. RUTHERFORD-Of phthisis contracted at Gartnavel.After some further discussion, the proceedings concluded with a vote ofthanks to Dr. Gairdner for presiding, and to the Faculty of Physicians and Surgeons for the use of the hall for the meeting.MEDICO-PSYCHOLOGICAL ASSOCIATION. -QUARTERLY MEETINGHELD AT BETHLEM ROYAL HOSPITAL, MAY 10TH, 1876.The Quarterly Meeting of this Association was held on Wednesday evening,May 10, inthe Board Room of Bethlem Royal Hospital.Among the members and visitors present were-Dr. Rogers, Ernest Hart,Esq., Dr. Maudsley, Dr. Orange, Dr. Wilks, Dr. Harrington Tuke, Dr. Hack338 [July, Notes and News.Tuke, Dr. F. Blandford, Dr. L. Down, Dr. Rayner, Dr. Stocker, Dr. Klein, Dr. Savage, Dr. Willett, Dr. Brushfield , Dr. Paul, Dr. Johnson (Tunbridge Wells) ,Dr. Frederic Hy. Ward, Dr. R. Acton, Dr. William S. Tuke, Dr. Henry F. Wins- low, Dr. Chas. S. W. Cobbold, Dr. Fletcher Beach, Dr. John Warwick, W.Clement Daniel, W. Wagstaffe, Esq , Dr. Joseph Seaton, Dr. George Mickley,Dr. F. Schofield, Dr. J. E. M. Finch, Rev. Dr. Dawes, Dr. Koeppe, Dr. Forbes Winslow, Dr. Claye Shaw, Dr. W. Rhys Williams.On the motion of Dr. MAUDSLEY, seconded by Dr. WILLIAMS, Dr. Rogers took the chair.Dr. WILLIAMS stated that, since the annual meeting last August at Dublin,no quarterly meeting had been held. It seemed not so easy in London as it wasin Edinburgh to get a meeting together, or to get any gentlemen to read papers here. But they had the promise, for that evening, of two or three very interesting subjects to be brought forward by Dr. Shaw, Dr. Hack Tuke, Dr. Fletcher Beach, and others. The first business, however, was that of mentioning any cases of interest within the knowledge of the members present. He had in- tended, for his own part, to describe a very interesting case of insanity accom- panied with syphilis; but as there would be enough of other matters to fill upall their time, he should reserve it, perhaps, for some other mode of publication.SYMPTOMS OF INSANITY DURING INCUBATION OF FEVER.Dr. HARRINGTON TUKE read a letter he had received from Dr. W. C. Hills, ofthe Thorpe Asylum at Norwich, giving the following account of a case recently under his care, which he thought was of a very unusual character. He had not,in his twenty years' experience of County Asylums, met with a similar case,and he wished to be referred to any work in which such a case was mentioned: -"F. G., aged 32, was admitted January 22, 1876, in a rest ess, stubborn state;could not sleep, or answer questions rationally; was destructive and dirty in his habits, and muttered incoherently. These symptoms lasted only till the third day after his admission, when scarlet fever rash was seen on the neck and chest,which extended on the following day over the trunk; there was a slight sore throat. The interesting point, however, was the entire cessation of all mental disturbance as soon as the exanthems became developed. From that time untilthe date of his discharge, March 28th, he exhibited no further symptoms of mental aberration; he gained flesh, and worked in the garden. He stated,which was confirmed by inquiry, that there had been a child ill with scarlet fever in the house whence he was brought. I have seen cases which were deli- rious, &c. , during the period of incubation, but I never saw one evincing suchactive symptoms of insanity as to require a removal to an asylum. This patient was respectably connected , but of rather feeble intellect."Dr. HARRINGTON TUKE added that he had himself seen a rather similar case,that of a young lady, to whom he was called at the Charing Cross Hotel, and whom he found, as he thought, with typhoid fever, but a distinguished surgeonwho was with her said that she was mad. They differed in opinion about it,but it really was typhoid fever; for within two days the typhoid rash came out,and there were no more symptoms of a disposition to suicide or any mental aberration.Dr. WILLIAMS said there was a case somewhat analogous last year in Bethlem Hospital. A patient was admitted suffering from acute mania. The medicalgentleman who sent her in was one of large practice, but he gave them no hint of any other disease in this case. Within twenty- four hours of her admission,she had scarlet fever rash fully developed . She was afterwards removed to the scarlet fever hospital, and got well.Dr. SHAW mentioned that, upon one occasion, he went to see a woman whowas in a maniacal state, and had delusions; he was informed that she came fromwhere there was smallpox, and he suspected there might be some poison of it in1876.]Notes and News. 339her system. He had her watched, and within three days she developed small.pox.Dr. RAYNER asked whether, in the case mentioned by Dr. Williams, or in theothers, there was any hereditary predisposition to insanity? It was answered that no information had been got upon that point.The CHAIRMAN said that several such cases had occurred within his own experience. There was one quite recently, last year, in which there were symp.toms of mental disturbance, the patient continually getting out of bed, andgiving much trouble; but something about it induced him to put it down as acase of fever, instead of ordinary mania; and the result showed that he wascorrect. The medical man who had signed the certificate, afterwards told himthat he also was in doubt about it at the time, but that he signed it with the lesshesitation, because in the workhouse infirmary there was no room for this patientin the fever ward. The patient was carefully examined every day, withoutdetecting any rash on the body, but there were the abdominal symptoms of typhoid fever. A few years ago there was a case of simple pyæmia, whichseemed to be of spontaneous or idiopathic origin, accompanied with symptomsof insanity. It resulted in death, and the post- mortem examination showed pus in every organ, including the heart. In the workhouses in Lancashire, wherelunatic patients were commonly kept too long before sending themto an asylum,there would more likely be time to find out any case which was merely caused by a fever.STRUCTURE OF PALATE IN IDIOCY OR IMBECILITY.Dr. SHAW read a minute account of his observations and measurements ofthe height and width of the palate, in relation to the dimensions of the skull,in a large number of cases of congenital idiocy or imbecility. He exhibited alittle apparatus contrived for the purpose of taking such measurements, anddiscussed the subject in all its details , combating the notion, set forth in many books, that a highly arched palate is a characteristic feature of the conformation usually found to accompany a deficient capacity of brain. ( See Pt. I.,"Original Articles.")The CHAIRMAN thought it would be interesting to know what other gentlemenmight have observed with reference to the matter so ably investigated by Dr. Shaw. If anyone had examined, for instance, the form of palate which occurred in cases of goitre or cretinism, a report upon it would be of service.Dr. LANGDON DOWN said it was a subject to him of particular interest.He had long been accustomed to look into the mouths of idiots or imbecilesfor that palatal structure which he had found, in a great number of cases,to be co-existent with mental deficiency. In a paper which he published twelve or fourteen years ago the measurements were given of two hundred imbecile and idiot patients, compared with those of two hundred other persons. At that time the opinion which Dr. Shaw now rejected was not at all controverted, and it was confirmed in a paper by Dr. Granville, of Paris, from the observations he had made; but there was another person besides Dr. Shaw,who had since controverted it. He had had a visit from a leading Americandentist, who told him that he had read a paper before a society at New York,contending even that a narrow high- arched palate was a sign of genius and high intellect, as it was often found in very clever men. He took that American gentleman to see about ninety patients, whom he examined one after another; and theresult was quite to convince him that the idiots of England, at any rate, had such palates as he described. Dr. Shaw was a very careful observer, but there were two likely causes of fallacious observation in these instances. In accidentalcases of idiocy, such as were caused by meningitis, or by some casualty of early life, the high-arched narrow palate would not be met with; the observationsshould rather be confined to the cases of congenital idiocy. Another circum-340 [July,Notes and News.stance which might lead to mistaken conclusions was that there were twodistinct types of facial conformation among idiots, one class having a broadpalate, but the majority had the narrow, high-arched palate.Dr. HARRINGTON TUKE said this question was brought before him in the caseof Mr. Windham, one of the reasons assigned for that gentleman's insanity being that he had an excessively arched palate. He then made some inquiriesupon the subject, and he thought there could be no doubt that a large palate, in combination with other peculiarities of structure-in the ears and teeth, for example was a symptom to be taken into account, though it might not be im.portant taken alone. A gentleman he knew, who died not long ago, had an idea that idiocy in children was produced by the habit of sucking the thumb, and some one might fancy that this habit was associated with a peculiar form of the palate; but there was not much reliance to be placed on such suppositions.Dr. SHAW replied , acknowledging the friendly tone of the criticisms his paper had received. What he had intended to affirm was this, that persons were tobe found with a badly formed palate, who had all their mental faculties in aperfectly sound condition; while there were, on the other hand, microcephalic idiots, whose palate would be found, instead of eight-twelfths or nine-twelfths of an inch, not more than four-twelfths of an inch high. The upper part of thecranium might be perfectly formed, and there would be no defect of brain,notwithstanding the existence of a high- arched palate. The palate bones of an idiot from birth might be of that formation which had been regarded asbelonging to persons of ordinary mental capacity . His conclusion, therefore ,was that there was no necessary connection between the palatal structure and the amount of mental power.THE HISTORY OF BETHLEM HOSPITAL.Dr. HACK TUKE read an interesting antiquarian and topographical account of the successive foundations of Bethlem, from the year 1247, when the Priory ofSt. Mary of Bethlehem, in Bishopsgate, was founded by Alderman Simon Fitz-Mary, on through its several transformations and removals, to the presentinstitution , in which the Medico- Psychological Association was that evening assembled. With the aid of maps, old prints, and drawings, furnished by Mr.G. H. Haydon, of Bethlem Hospital, he gave a clear explanation of the precise localities, and in some instances was enabled to showthe plan and aspect of the ancient buildings. (See Pt. I., " Original Articles.")Dr. WILLIAMS moved a vote of thanks to Dr. Tuke, and in so doing took occasion to remark that it had often been asked, why should not Bethlem Hospital be removed into the country? He wished it to be generally knownand remembered, that Bethlem Hospital actually had an institution in the country, the establishment for convalescents, situated in one of the most de- lightful parts of Surrey, which gave accommodation to forty patients. That establishment would vie with any similar institutions in England for healthinessand agreeable surroundings. He finished by expressing regret that there was not time for the reading of a paper which Dr. Beach had prepared, but which he hoped would find publication elsewhere.The CHAIRMAN then declared the proceedings of the meeting at an end; but a vote of thanks was unanimously passed to the Resident Physician of Bethlemfor the use of the room by the Medico- Psychological Association, and for the hospitality towards its members that evening assembled.The following Microscopic Specimens were exhibited at the meeting by Dr. Savage:Normal brain, various convolutions.دو cords, human and of lower animals.Cerebellum prepared by Dr. Sankey's method,1876.]Notes and News. 341Sections of intermediate regions of cord, medulla, and pons.Sympathetic in health and in general paralysis.Dura mater, with effusions of blood on surface in general paralysis.Sciatic nerve in general paralysis (Dr. Ward).Sections of brain from case of cerebritis with mania."" 99 "9 chronic mania."" دو "" acute mania."" 33 39 sclerosis (Charcot).99 39 melancholia with giant cells .Section of brain and cord from diabetes, showing the changes along thecourse of the vessels, described by Dr. H. Dickinson.Sections of cords from tetanus.Sections of cords from general paralysis, showing " colloid " and " amyloid "changes, wasting, fatty degeneration, fibroid degeneration, and changes in the cells.Brains in general paralysis, showing wasting and fibroid excess, with degeneration of the cells.Sections of cord from a dement, with old hemiplegia, with secondary wasting of right lateral column.Sections of brain of three cretins from Clapton Asylum (Dr. Beach), in which there were demonstrated similar conditions hitherto undescribed. (There area greater number of large round cells in the superficial (3rd and 4th) layers of brain, with few fusiform cells. Around the cells there are large numbers of large spaces. The general appearance of the brain resembles rather that of the lower animals than that of man) .Carmine injection of the various organs of guinea pigs.Microscopes of a new form resembling Hartnach's and also their students'microscopes and other interesting instruments were exhibited by Messrs. Beck and Co.Correspondence.SIR, I hope you will excuse my sensitiveness if I ask leave to correct a slip in your report of what was said by me at the branch meeting of our Associa- tion, held at Edinburgh on the 14th of December last. I am not prepared to state that there are no cretins in Scotland. What I intended to convey to themeeting was that, if goître and cretinism had no necessary connection, I couldnot see how the existence of cretins in Scotland could be proved. I certainly said that I thought there were " no Kalmucks in the East," but I added the words "of Scotland."Larbert, Stirlingshire,April 23rd, 1876.I remain, &c. ,W. W. IRELAND.Appointments.APLIN, A., M.R.C.S.E. , has been appointed Assistant Medical Officer to theNotts County Asylum, Snenton, Nottingham.ASHE, I., M.D., has been appointed Physician- Superintendent and Governor of the Central Criminal Lunatic Asylum, Dundrum, vice MacCabe, appointed aMedical Inspector under the Local Government Board, Ireland.BowES, J. I., M.R.C.S.E. & L.S.A., has been appointed Assistant Medical Officer to the Northampton County Asylum.BURTONSHAW, T., M.R.C.S.E., L.S.A.L. , has been appointed Second AssistantMedical Officer to the Essex Lunatic Asylum, Brentwood, vice Powell, ap- pointed First Assistant Medical Officer of the Kent Lunatic Asylum, Barming- heath.342 Notes and News.DUTT, B. L., M.B., C.M., has been appointed Assistant Medical Officer to theSomerset County Lunatic Asylum, Wells, vice Dove, resigned.HETHERINGTON, C. E., M.B., T.C.D., has been appointed Resident MedicalSuperintendent of the Londonderry District Lunatic Asylum, vice Ashe, appointed Physician Superintendent of the Central Criminal Lunatic Asylum,Dundrum.MACLAREN, J., L.R.C.S.Ed., Senior Assistant- Physician, Royal EdinburghAsylum, has been appointed Medical Superintendent of the Stirling District Asylum, vice F. W. A. Skae, M.D. , resigned on his appointment to a Commis- sionership in Lunacy for New Zealand.MCKENZIE, G. H., M.B., C.M. , Resident Surgeon, District Infirmary, Ashton- under- Lyne, has been appointed Senior Medical Assistant at the GloucesterCounty Asylum, vice Dr. J. A. Philip, appointed Superintendent of the Lincoln Lunatic Hospital.MILLSON, G., M.R.C.S.E., L.R.C.P.L. , Medical Superintendent of the Hamp- stead Asylum, has been appointed Medical Superintendent of the Northampton County Asylum, Northampton.MOODY, J. M., M.R.C.S.E., has been appointed Junior Assistant Medical Officer to the Brookwood Lunatic Asylum, vice Thomson, resigned .THOMSON, Dr. W. A., Junior Assistant Medical Officer of the BrookwoodAsylum, has been appointed Assistant Medical Officer of the Kent County Asylum at Chartham, near Canterbury.THE MEDICO- PSYCHOLOGICAL ASSOCIATION.The Annual Meeting of the Medico- Psychological Association will be held atthe Royal College of Physicians, London (by permission of the President and Fellows), on Friday, July 28th, under the Presidency of Dr. Parsey. Noticesof Resolutions to be proposed, or Papers to be read should be sent at once tothe Hon. Sec. , W. Rhys Williams, Bethlem Royal Hospital, London.The Editors regret that they have been compelled, by pressure on their space,to postpone the publication of Clinical Cases, Reviews, some German Retrospect,and Review of Asylum Reports (1875) , some of which are in type.ERRATUM. In April number, page 47, line 16, for " Maine Island Asylum,"read " Maine Hospital for the Insane."No. 99. (New Series, No. 63.)THE JOURNAL OF MENTAL SCIENCE, OCTOBER, 1876.[Published by authority ofthe Medico- Psychological Association. ]CONTENTS.PART I -ORIGINAL ARTICLES.William H. Parsey, M.D.-President's Address at the Annual Meeting of theMedico- Psychological Association, held July 28, 1876. ·D. Hack Tuke, M.D.-On the Prevalence of the Causes of Insanity among the Ancients. · ·PAGE.· 343• 361381389• 406• 416T. S. Clouston, M.D.-On the Question of Getting, Training, and Retaining the Services of Good Asylum Attendants.Torquato Tasso..· ·Ringrose Atkins, M.D.-Case of Sudden and Complete Aphasia, &c. •Joseph Lalor, M.D.-Some Remarks as to Providing Increased and Better Means for Educating the Insane of all Classes. · ·Dr. Peddie and Dr. Bucknill: Letters on the Relation of Drink and Insanity. 421Clinical Notes and Cases. -The Therapeutic Action of Hyoscyamine. -Recur- rence of the same Erotic and other Delusions in a Patient after being Twenty Years dormant. 434-441Occasional Notes of the Quarter. -Dr. Bucknill on American Alienists. -Intem- perance and Insanity.-An Imposing Female. -Good Effects on the Poorer Classes of the Insane of Frequent Visits by Relatives. -Insanity and Crime.-Insane or not?-Marriages between First Cousins.PART II . -REVIEWS.441-457The West Riding Lunatic Asylum Medical Reports. Edited by J. CRICHTON BROWNE, M.D.PART III.-PSYCHOLOGICAL RETROSPECT.1. German Retrospect.2. English Asylum Reports-1875.•PART IV.-NOTES AND NEWS.Report of Annual Meeting of the Medico-Psychological Association, held at the Royal College of Physicians, London, July 28th, 1876.-Idiots and Imbe- ciles.-Appointments. -Correspondence, &c. • •458• 464479487-506The Journal of Mental Science.Original Papers, Correspondence, &c., to be sent by Book-post direct to Dr. MAUDSLEY, 9, Hanover Square, W.English books for review, pamphlets, exchange journals, &c. , to be sent either by book post to Dr. Maudsley, or to the care of the publishers of the Journal,Messrs. J. and A. Churchill, New Burlington Street. French, German, andAmerican publications may be forwarded to Dr. Maudsley, by foreign book- post,or to Messrs. Williams and Norgate, Henrietta Street, Covent Garden, to the care of their German , French, and American agents: -Mr. Hartmann, Leipzig;M. Borrari, 9, Rue de St. Pères, Paris; Messrs. Westermann and Co., Broad- way, New York.Authors of Original Papers receive three extra copies of the Journal by Book- post. Should they wish for Reprints for private circulation they can have them on application to the Printer of the Journal, Mr. Bacon, Lewes, at a fixedcharge of 30s. per sheet per 100 copies, including a coloured wrapper and title- page.The copies of The Journal of Mental Science are regularly sent by Book-post (pre-paid) to the ordinary Members of the Association, and to our Home and Foreign Correspondents, and the Editor will be glad to be informed of any irregularity in their receipt or overcharge in the Postage.The following EXCHANGE JOURNALS have been received:-Annales Médico- Psychologiques; Zeitschrift für Psychiatrie; Verhandllungen der Berliner Medicinischen Gesellschaft; Archiv für Psychiatri- und Nervenkhrankeiten, herausgegeben von Dr. L. Meyer und Dr. C.Westphal; Correspondenz Blatt der deutschen Gesellschaft für Psychi- atrie; Irren Freund; Psychiatrisches Centralblatt heransgegeben von Vereine für Psychiatrie und forensische Psychologie in Wien; Medizinische Jahrbücher, herausgegeben von der K. K. Gesellschaft der Aerzte,Vienna; Revue des Sciences Médicales en France et à l'Etranger; RevuePhilosophique de la France et de l'Etranger, dirigée par Th. Ribot;Revue Soientifique de la France et de l'Etranger; Annales et Bulletin de la Société de Médecine de Gand; Le Progrès Médical; Archivio Italianoper le Malattie Nervose e per le Alienazioni Mentali; Annali Frenopatici Italiani Giornale del R. Manicomio di Aversa e Della Società FrenopaticaItaliana Diretti dal dott. Cav. B. G. Miraglia; Medizinische Jahrbücher (Zeitschrift der K. K. Gesellschaft der Aerzte in Wien); Rivista di Discipline Carcerarie in relazione con l'Antropologia, col Diritto Penale, &c., diretta Da Martino Baltram Scalia; Rivista Clinica Di Bologna, Diretta Dal Professor e Larigi Concato e redatta Dal Dottore Ercole Galvani; the American Journal of Insanity; The Journal of Nervous and Mental Disease; TheBritish and Foreign Medico- Chirurgical Review; the Dublin Quarterly Journal; The Lancet; The London Medical Record; The Practitioner, amonthly Journal of Therapeutics, edited by W. L. Brunton, M.D., F.R.S.; theMedical and Surgical Reporter, a weekly Journal, by D. G. Brinton, M.D.; the Medical Times of Philadelphia. Also the Morningside Mirror; the York Star; Excelsior, or the Murray Royal Institution Literary Gazette,THE JOURNAL OF MENTAL SCIENCE.[Published by Authority ofthe Medico- Psychological Association. ]No. 99. NEW SERIES, No 63. OCTOBER, 1876. VOL. XXII..PART 1.-ORIGINAL ARTICLES.President's Address, at the Annual Meeting of the MedicoPsychological Association, held July 28th, 1876, at theRoyal College of Physicians, London. By WILLIAM H.PARSEY, M.D., Lond. , Medical Superintendent of theWarwick County Asylum.GENTLEMEN, -Before entering on any matter that I maybe able to bring under your notice in the form of an addressfrom the Chair, a very pleasurable duty devolves on me, oneon which I wish I were able to express myself in adequateterms. I have to thank you-which it was not in my powerto do this time twelve months-for the honour you then conferred on me in electing me to preside, for the coming year,over this large Association of my respected and valuedfellow workers in our department of Medical Science. But,whilst thanking you, I cannot help regarding myself as anunworthy recipient of the honour. I cannot forget thatthough the earliest period of my study of the treatment andmanagement of the insane dates back for five and thirtyyears, and my connection with this Society for nearly thirtybeyond the oral information that I have been able to impartto the younger members of our profession, who have been.my coadjutors in my duties, I have contributed little towardsthe advancement of that important and fundamental objectof its formation , " the diffusion of a more extended knowledge of insanity and its treatment. "I can merely say that I have conscientiously endeavouredto develop, in the Asylum of which I have for the lastquarter of a century had charge, the more enlightenedchanges in general management, hygiene, and medical treatment that have, year by year, been making such steady progress since the time that it was my good fortune to be arecipient of Conolly's earnest and eloquent instruction in hisclinical teaching at Hanwell; instruction, that it was in myXXII.23344 The [Oct. , President's Address,power to mature by associating myself, a few years later, atthe Devon Asylum in its earliest days, with one who hassince attained so high a position in our specialty, myesteemed friend, Dr. John Charles Bucknill.I have referred to my early reminiscences, hoping that afew words on some of the changes now in the probable, orpossible, course of adoption for the more comprehensivetreatment of the insane, from an Asylum Superintendent,who has been witness of all that has been effected, since theinauguration of the radical changes, due more especially toConolly, may have sufficient interest to occupy your attentionand to elicit useful remarks and suggestions from some ofmy colleagues, whom I have the honour of addressing.I am aware that, whatever practical subject I propose tomyself, I am only going again over oft-trodden ground. Butit is not every one, called upon to perform the functions ofthe office with which you have invested me, who is giftedwith the power to make an occasion like this the vehicle fornew ideas, and new chains of reasoning, elaborated from hisown originality of thought; though I do not forget that suchmen have occupied this chair, and given to their addresses atone that plain workers like myself cannot hope to emulate.The first fruit of the enlightened teaching of Pinel, and ofhis great English disciple, Conolly, the foundation of all subsequent advances in our dealings with the insane, of all thesuperstructure of non-restraint in its widest acceptation, wascompassed when we began unreservedly to admit the influenceof the material element in the causation and progress ofmental disorder, and to recognise a certain capacity in thoseafflicted with it for the exercise and enjoyment of personalresponsibility and personal liberty; and when the conviction.grew upon us that the diseased mind is only very exceptionally so perverted as to be altogether beyond the influenceof those kindlier attributes and more genial sympathies,which at its normal standard of health would induce a readyresponse to the varied remedial agencies with which it is inour power to surround it.That these principles were slow in gaining general recognition must, however, be well known to all whose experiencecarries them back to the years more immediately succeedingthe great Hanwell experiments. For even among those whowere enthusiastic in their resolve to banish mechanicalrestraint from their treatment, attempts to further amelioratethe restraint of utter isolation, and wearing monotonousroutine, were not, for a long time, framed on the broad basis1876.] by WILLIAM 345 H. PARSEY, M.D.of trust in the latent self-controlling principle and recuperative power of the insane mind. They were confinedto cautious advances in the direction of extended occupation,social comfort, and amusem*nts. Approaches to the exerciseof personal freedom, save in the pursuit of some out orindoor avocation under rigid supervision, were exceptionalindeed. And I well remember the sense of responsibilityunder which I laboured, when, on finding myself at thehead of an Asylum, I determined to inaugurate themingling of the sexes in social dances and other homelyamusem*nts, the liberty to walk about the country withtheir attendants, and other such apparent trifles , conduciveas much to the freedom of action, as to the personal anddomestic comfort of those who constituted my new charge.I acted under a sense of fear and trembling lest there shouldensue, in various bugbear shapes, mishaps, which experience,gradually gained, has taught me to regard with as much unconcern as would now the latest Asylum Superintendent;who, profiting by the cautious advances of his elders,finds it difficult to realise how much that is recognised inthese days as part of the routine order of the life of theinsane, could ever have formed a subject for anxiety ormistrust.But Asylums were then few in number, and their inmatesbut as it were a handful, compared with the crowded populations of the numerous structures that have been calledinto existence through the length and breadth of the landin the last few years. Facilities for intercourse, and for theinterchange of opinion and experience, were small and rareindeed, as the earlier promoters of this Association cantestify. And the still lurking belief in the necessary perversion for evil of the insane mind, exercised an unconsciousdeterrent influence; all tending to clog the earlier steps ofour more zealous workers, even though the veil had alreadybeen raised by such men as Pinel, Esquirol, Tuke, Charlesworth, Hill, and Conolly.But I must not waste your time over matters like these,which, by tradition at least, must be familiar to all whom Iam addressing. Nor need I dwell on the progressive expansion that has been taking place in our ideas of the management of the insane, until, at last, the pendulum of opinionseems to be so enlarging its arc as to be inducing in theminds of some, at least, of our younger and more enthusiastic fellow-workers, a belief that what has now become the old346 The President's Address, [Oct. ,familiar system is , after all, an over-grown mistake, which itis part of their mission to re-adjust on new lines, or re- castin an entirely altered mould. What I would to-day moreparticularly submit to your attention, is a few words on themeasures that may be most likely to satisfy the social requirements of that large section of the now recognised insanewhose existence, as a special State care, was not contemplatedby the framers of our present lunacy laws. So far as themore active phases of mental disorder are concerned, thebeneficial influence ofthese laws has given to our treatmentan impress which is gradually being accepted as a model byall other civilised countries. But it is only of quite recentyears that a knowledge has been spreading among us of thelarge number of persons of diseased mind that have become aburden on the community, but for whose due care the institutions that have been organised under our present legislation are scarcely adapted. It is impossible for those engagedin the public treatment of the insane to be insensible to thegrowing tendency, fostered of late by peculiar circ*mstances,to shelter many of them within the walls of our CountyAsylums, though their mental condition does not warrant socostly a form of management. And their number is so increasing, and has attained such proportions, that, if weconcede their claim to legislative interference, the time ofthis meeting may not be wasted, if, from the great experiencethat attaches to it, and from the somewhat varied phases ofthat experience, some fresh expression of opinion may beelicited as to the best modes of dealing with them withoutprejudice to those on whom must fall the cost of their maintenance, or to their own well- being, or more especially totheir personal liberty.There are many practical questions of detail involved inour present conduct of asylums, on which such diversity ofopinion exists, that I could willingly have been tempted togive themthe preference in what I have to say to-day; moreespecially the advisability of doing without, or with newer arrangements of, airing courts; of dispensing with lockeddoors in our asylums; or of absolutely eliminating from our treatment the use of seclusion in a darkened and fastenedroom in certain conditions of dangerous excitement, or in some ofthe exhaustive forms ofbrain-irritation with which weare all, in the course of our experience, made more or less familiar. And within almost the last few weeks has beenopened up to us another subject of unusual interest, that may1876.] by WILLIAM H. PARSEY, M.D. 347well occupy the deliberations of this association, in the unlooked for results of the personal observations of our eminentcolleague, Dr. Bucknill, in some of the public asylums of theNorthern Continent of America, and in the more serious arraignment, made under the authority of the Editor of " TheLancet," for abuses that we might well have hoped couldnot exist at the present day in any institution for the insaneamong an English- speaking race. But it would not be anact of justice for a representative body like this to enter onthe discussion before ample opportunity had been offered tothe distinguished alienist physicians of the United States topronounce upon these statements, or to rebut the gravecharges that at present must be felt to hang over them. Wemay well follow the judicious course adopted by Dr. Bucknill,and, possibly, avoid what might otherwise drift into anangry and embittered controversy, in reserving our commentsuntil both sides of the question have been fully and temperately stated.I have rejected these somewhat tempting topics in consideration of what I think to be the comprehensiveness ofthe subject I have chosen, which, just at present, seems to have become too much one for discussion outside ourspecialty; while we, who ought to be able to speak on itfrom practical knowledge, may be, perhaps, prejudiciallypassing it over in silence, or, at least, not according to it the consideration it demands at our hands.I take for granted that our modern old-fashioned asylums,if I may be excused the term, are not going to be superseded; but that, if with our present knowledge we are todeal successfully with the acute, and with a large proportion of the chronic phases of insanity, all the resourcesthat they can command must be considered not only desirable, but, in large measure, essential. Beyond this comesthe question as to the most judicious, and at the same timemost justly economical, methods of disposing of that portionof the insane for whom, by general agreement, such resources are neither essential nor absolutely desirable.In rural counties the workhouses are so small as to affordno conveniences for the addition to them of lunatic wards,except by the entailment of a complicated expenditure, underdifficult combinations of neighbouring Poor Law Unions.And if the details of such combinations could be satisfactorily adjusted , there are probably few among us who wouldexpect them to result in any but a dwarfed, badly organised348 The [Oct.,President's Address,arrangement, with more than the disadvantages inseparablefrom the lunatic wards of our large urban workhouses, andno redeeming feature to set off against the many pettyinterests and crude opinions that would obtrude themselvesinto all questions of management and expenditure. Neitheris it probable that we should give much favour to any schemeby which, under some simple additional legislative enactment, two or more rural counties, with scattered populations,should have power to combine for the erection, under theLunacy Commission, of comparatively inexpensive chronicasylums, of sufficient capacity to ensure a proper economy, toclear the workhouses of their imbeciles and dements, and torelieve the parent asylums of those among their more permanent inmates who could be equally well cared for under suchsimpler and less expensive machinery.Under some conditions a proposition of this kind maycommend itself to our consideration. But where those, forwhose immediate benefit it would be carried out, must bedrawn from populations scattered over very extended areas,objections suggest themselves that should make us hesitate inaccording to it any but a very qualified approval. Conspicuously the long distances that a large proportion of the patients ,many feeble and aged, would have to be conveyed; thetediousness of long journeys from districts often onlypartially opened up by railways; the thorough stamp ofchronicity that must attach to such an establishment; andthe injustice both to patients and their friends in thealienation that must be gendered among them by the breaking up of all family ties in removals to such distances fromtheir old homes as would preclude all future personal intercourse between them. The real practical nature of thislatter hardship can scarcely have failed to force itself on theattention of asylum officers who have temporarily, or otherwise, relieved neighbouring counties of the charge of some oftheir insane poor; and, in the interests of both justice andhumanity, it carries with it a weight of objection that is, unfortunately, scarcely like to meet with due appreciation fromthose who are not conversant with the daily routine ofinsane life. When the question is one of mere expediencyto meet a passing emergency, the objections that I havementioned are matters of minor consideration; but in dealing with measures of a lasting nature, that ought to be expected to continue in force for generations instead of years,they rise in significance, and should, in my judgment, have1876.] by WILLIAM H. PARSEY, M.D. 349sufficient weight entirely to negative any such arrangementas I have referred to.In thickly populated and concentrated districts, on theother hand, where existing asylums have already attainedsuch proportions as to preclude the desirability of any furtherenlargement, or to depreciate their usefulness as curativeestablishments, from the necessity for merging the individuality of the patient in the general grouping of classification, it is, I think, worthy of consideration whether supplementary asylums, involving a less costly expenditure bothin structure and in maintenance, may not, with advantage,be brought into use as adjuncts to those already existing.So far as sites are concerned, there should be little difficulty in obtaining them conveniently disposed both asregards propinquity to what may be considered the ParentAsylum, and suitable location for the districts they would have to serve. Nor should the difficulty be greater in sofacilitating, through the medium of a common ManagingCommittee, the mutual interchange of patients, in accordance with the varying phases and development of theirdisorders, as to relieve the subordinate asylum of anysupposed detrimental consequences arising out of the stigmaof chronicity that might otherwise attach to it.Under the Local Government Board, and with our presentlegislative enactments, the development of such a systemmust be impracticable. Independently of the existing objec- tionable divided control of the insane by two State departments, and of possible abuse, from the detention in them ofpersons not really mentally afflicted, were the managementof these asylums not regulated by the lunacy laws, the localexpenditure would necessarily be larger than that incurred for treatment either in workhouses or in our present CountyAsylums. And in the interest of the unification of thegovernment of the insane as a class demanding a specialcare, disconnected from that of ordinary bodily infirmity, orof poverty in any other of its varied forms, it is fortunatethat through the Lunacy Commission alone could they beworked with adequate economy to command the approvaleither of the guardians of the poor or of the ratepayers.Should the principle of Government aid under the LunacyLaws be so established as to justify a confidence in its permanence, the insane poor of the large urban districts mightbe disposed in asylums of different grades, so manipulated asto deprive none of them of the character of being curative350 [Oct. , The President's Address,establishments; whilst all would be embraced under oneGovernment department, and their maintenance become adivided charge between the general community and the contributors to the local rates and burdens. The extent to whichthe principal asylum would be relieved would depend onvarious contingencies incidental to the localities; but the usefulness of the secondary ones could not fail to be felt in thatthey would supersede the lunatic wards of large workhouses,which, notwithstanding the care that has been bestowed onthe better adaptation of many of them, cannot be divested oftheir radical defects in having their insane inmates cooped upin the midst of crowded populations, without space for out orindoor occupation, or the fresh and varied scenes so indispensable for them.An illustration of the pressing necessity for more satisfactory measures, in dealing with the insane poor in ourdensely populated centres of manufacture, may be found inBirmingham, the great capital of the Midlands, with itsyearly increasing population, already approaching fourhundred thousand. The large majority of its residents, asin all other manufacturing centres, are members of theartizan and labouring classes, who, when overtaken eitherthemselves, or in their families, with the calamity ofinsanity, are altogether unprepared to cope with its anxietiesand expenses, and compelled to seek the assistance of theparochial rates. Its over-crowded asylum shelters about sixhundred and fifty patients. There are about two hundredand fifty others in the lunatic wards of its workhouse; andmore than another two hundred scattered among theirfriends about the town.This is a sad catalogue for such a population, the saddestpart being, to my mind, that some two hundred of these unfortunates should be confined to the wretched tenements, orsuffered to wander about in the crowded streets and filthycourts of this densely populated borough; in which, however,under an enlightened appreciation of the advantage of sweeping sanitary improvements, many acres of its disease- gendering habitations are already condemned to be swept away.Such a community, the representative of such vast wealth,some millions of which it is now investing in the endeavourto make itself a pattern of what a large, well-organised townof the present day should be, ought to be, and doubtless is,prepared to adopt in a liberal spirit any course that matureand experienced deliberation can demonstrate as the most1876.] by WILLIAM 351 H. PARSEY, M.D.desirable for dealing with its insane poor; and already theproposition has been under consideration to build a chronicasylum sufficiently distant from the town to receive fivehundred of them. But were it enabled, without sacrificingits claim to the Government aid given to the older asylums,to combine with some of its contiguous over-populatedmining districts, an asylum might be erected as comprehensive as, and without the defects of, those at Caterham andLeavesden, affording, perhaps, the most effectual means ofremoving from a large community a notorious blot on itsministration to this class of afflictions among the poor.Of the measures for dealing with the less demonstrativeamong the insane, none has obtained so much favour withthose who have a right to speak with authority in thenorthern part of the kingdom, as the " Family Treatment"now being carried out in Scotland . South of the Border ithas also attracted no small attention, in some measure fromits supposed economy, more from the liberty of action accorded to those treated under its auspices, and fromthe sort ofanalogy existing between it and the great Belgian Colony ofGheel. A certain prominence, consequently, attaches to theconsideration of such merits and advantages as are claimedfor it; and I hope to be able to give them that prominenceto-day to the extent that my available information justifies.If we would clearly comprehend the amount of extensionproposed to be accorded to this form of treatment, as well asthe mental and physical characters of those among the insanewho would be recipients of the domestic freedom and comfortthat it proffers to them, it is well first to have a correct idea ofthe machinery by which it is set in action. And, gatheringmy information from the very instructive and comprehensiveAppendix to the Seventeenth Annual Report of the ScotchCommissioners in Lunacy, which embraces the special reportson single patients by the able Deputy Commissiouers, Drs.Sibbald and Paterson, I believe I am correct in laying downas the basis of this form of treatment the powers conferredby the legislature on the Scotch Board to grant speciallicenses, without the payment of any fee or sum in respectof them, to ordinary cottagers and small householders forthe reception and detention in their homes of poor lunatics,subject to such rules and regulations as the Board may appoint. These rules are sufficiently simple. Licenses can beobtained through the ordinary Inspectors of the poor, underthe sanction of the Board; the number of lunatics in any one352 The [Oct. ,President's Address,house not being allowed to exceed four. It is rare, however,for these cottagers to be provided with sufficient house roomto accommodate four additional inmates; a number, moreover, in Dr. Sibbald's experience, sufficient not only to doaway with the purely domestic character of the arrangement,which is its leading feature, but even to overwhelm anddestroy the family life. It is, therefore, resolved for thefuture to limit the number, as far as possible, to two. And, toguard further against the evils ofover- crowding, and unsuitable associates, every application for a license has to be accompanied by a statement of the number and size of theapartments in the dwelling, and of the number of its saneinmates, including children.These are simple precautionary measures; but there is anadditional very important, indeed essential, recommendationmade by the Board, one on the faithful execution of whichmust depend, in a great measure, the practical success ofthe whole scheme-that all Inspectors of the poor, who havelunatics boarded out in special licensed houses, shall becareful to exercise a direct personal supervision , both overthe holders of the licenses, and over the patients entrustedto them. And, it may be added , though there is no rule forthe exclusion ofyoung women of child- bearing age, the Boardof Lunacy is stated to be particular about granting its sanction when the risk of pregnancy exists.This, with due provision for remuneration, constitutes thewhole working machinery; and as the system must still beregarded as on its trial -eminently satisfactory, so far as ithas progressed, in the opinion of those who have so enthusiastically fostered its development, and, as it were, committed themselves to its successful issue; imperfectly understood, or, perhaps, too adversely criticised by others, who,viewing it from a different stand point, may be tempted todepreciate it, possibly without due consideration- it behovesus to exercise all proper precaution in the selection of materialfrom which to form an unbiassed judgment as to the place itis likely eventually to occupy among our available resourcesfor the care and treatment of the insane.Fortunately in Professor Jolly, of Strasburg, we are able toapply to a critic recognised on all hands as possessing, in aneminent degree, the qualifications for giving an unprejudicedstatement of the result of his personal investigations, intheir adopted cottage homes, into the minute details of thedaily life in which these people pass their existence. But, as1876.]353 by WILLIAM H. PARSEY, M.D.his observations should not be unknown to the members ofthis Association, I shall do no more than just summarise hisconclusions, in order to bring them to your minds in such aform as will serve to keep together the thread of this enquiry.And, though some of them apply more particularly to theinsane poor at the colony, if it may be so termed, of Kennoway, where the Edinburgh patients are located, they may betaken as conveying a good, and even favourable, view of thissystem in its entirety; as these patients, from their number,their comparative concentration, and their accessibility, mustnecessarily be as well cared for, and as favourably circ*mstanced, as any that could be selected from among the ratherlarge number of insane poor thus treated, and scattered overdifferent parts of Scotland. We gather from him that theboarding-houses are mostly the plain one-storey cottages ofthe labouring classes, some of them with a bed in the cooking as well as in the other rooms. The bedding was clean, andthere was no distinction in domestic arrangements betweensane and insane; and the insane moved about with comparative freedom in the houses and neighbourhood. Here, aselsewhere, there was a marked predominance of the female sex.The males were generally physically helpless imbeciles , incapable of really useful work. The women were sometimes engagedin knitting, sewing, or assisting in the housework, but veryfew gave the impression of being able to earn by their workany appreciable part of their maintenance. Nearly all ofthem were over forty years of age, the greater number overfifty, and the few of child-bearing age were entrusted only tofamilies furnishing special guarantee as to suitability. Theforms of insanity observed were exclusively imbecility anddementia, and all were harmless and inoffensive. Dirtypatients were excluded, as also those suffering from seriousbodily ailments. His opinion was very favourable to thisform of treatment for the class of inoffensive patients he metwith, but only for that class. From an economic point of view,it did not encourage any hope of reduction of expenditure.These observations appear to me sufficiently indicative ofthe mental conditions to which, under careful supervision,this " family treatment " may with advantage be extended;but I would supplement them with others made for myself,with more leisure than I could have bestowed, by anesteemed personal friend, a Scotchman, and member of ourprofession, though not of our specialty, in whose judgment,impartiality, and discretion I have implicit confidence.354 The President's Address, [Oct. ,His account of the village of Kennoway is sufficientlyinteresting to bear transcribing:-"It has a population ofabout a thousand inhabitants, chiefly of the labouring class .It is healthily situated, about three miles from the shoresof the Forth, and is several hundred feet above the sea level.The death rate, compared with that of neighbouring parishes ,is low; and, from its situation and healthfulness, it is wellsuited for a home for invalids. About twenty houses in all,in and about the village, are authorised to receive lunatics .Many ofthem are comfortable, and decidedly superior to thehouses from which the lunatics have been brought, but othersare inferior both in comfort and accommodation. Any onemay signify to the Inspector of the poor for the parish hiswillingness to receive lunatics, and, from what I can learn byenquiry in the village, several who have the charge of one ormore boarders are but poorly qualified for that office. Thepatients are mostly old and imbecile, and, as a class, give theappearance of being more fitted for treatment at home thanfor confinement in an asylum. They are generally treated asmembers of the family, and take their meals at the sametable. This privilege, however, is entirely at the discretionof those in charge; and there appears to be a great defect inthere not being a proper guarantee, nor apparently a sufficientone demanded by the authorities, as to the comforts of thehouse, the quality of the food, and the good character andgeneral fitness for their duties of those entrusted with thecare of the patients. And, I believe as a consequence of this,there was the greatest difference in the quality of foodsupplied in the various houses. In one house, kept by amost intelligent woman, the patients, four in number, seemedto have every comfort: the rooms were clean, airy, and wellfurnished; the diet consisted of tea and bread and butter, ortoast, for breakfast; broth, beef or pork, and potatoes fordinner, with a simple pudding every second or third day inaddition; bread and tea in the evening, and bread and cheeseat night. As a contrast to this, one case was mentionedwhere those in charge left the imbeciles during the summer,when outdoor work was abundant, to dine off tea and bread,with perhaps a red herring. So far as the parochial authorities are concerned, these people are not required to do anywork; some of them are invalids, and cannot work; noneof them appear capable of doing much, but those withwhom they are boarded may make them do such workas they are capable of, and appropriate the gains . The kind1876.] by WILLIAM H. PARSEY, M.D. 355of work they engage in is helping in the housework, actingas water carriers to the public, carrying coals, gatheringleaves from the adjoining plantations for bedding pigs, ormaking manure, and winding pirns for weavers. With themoney they earn the men may buy tobacco, and the womentea, or it may be taken from them. It does not appear to bespent in drink, though there are several public- houses in theplace, and restrictions on their freedom are very limited.They generally go out in couples, and, without any attendance, take free exercise in and around the village. Thereappears to be too great facility for any one to apply for andget these patients put under their care, without specialenquiry being made, or guarantee given, of their fitness orthe suitableness of their houses; and, at present, the superintendence or supervision appears to be somewhat lax. A.mistake is perhaps made in trusting too much to the honourand kindness of the guardians, who are themselves but poor. "Accepting the accuracy of the information gathered fromthese two careful observers, I believe I have been able tosubmit to you an accurate sketch of the " Family Treatment"as carried out at Kennoway; and do not see occasion to addany comments of my own on its merits or demerits. Neitherone nor the other appear to have escaped them; and fromtheir judicious remarks it is easy to estimate the real valueof much in it that is good and sound and worthy of imitation, and to note the points of weakness, which, if notjealously guarded against, would, as its lines became moreextended, pave the way to abuses that would be fatal to itsusefulness. Its weak points are certainly not so formidablebut that we may occupy ourselves usefully in an endeavourtoget some approximate idea of its utility, under such modifications as experience may suggest, as a substitute for someof the arrangements now in force in the southern division ofthe kingdom .In Scotland it comprehends nearly twenty-two per cent. ofthe pauper insane population; about seventy per cent. beingmaintained in the Royal, District, Private, Parochial, andState Asylums; and the remainder, nearly eight and a-halfper cent. , in the lunatic wards of poorhouses.In England and Wales we find nearly sixty-one per cent.in County and Borough Asylums, Registered Hospitals,Licensed Houses, and State Asylums; more than twenty- seven per cent. in Workhouses, including those in the GreatMetropolitan Local Government Asylums; and rather over356 The President's Address, [Oct. ,twelve per cent. boarded with relatives and friends. So that,taking these as the broad lines of distribution, we find theproportion of insane poor maintained in asylums in Scotlandto be materially greater than that of those similarly circ*mstanced in England. If, therefore, the " family treatment "were developed in the latter country in the same ratio as it isamong our northern neighbours, it does not appear that anyrelief should be expected for our existing crowded asylums.The benefit would accrue, in great measure, to those whoselot it has hitherto been to pass their lives within the walls ofour workhouses; and whether such a redistribution would beacceptable to the authorities of these institutions would, Iam afraid, depend very largely on economic considerations.It will be well , therefore, not entirely to ignore the pecuniary aspect of the question as between English workhousesand Scotch family treatment.The County of Warwick, with the distribution of whoseinsane population I have been for many years familiar, maybe taken as a fairly typical English county; being centrallysituated, and embracing within its Poor Law Unions allleading groups of population, the urban, the mixed, and thestrictly rural; and the cost of maintenance of its insanepoor in workhouses, not including the items embraced in theLocal Government grant, varies from three shillings and sixpence to six shillings a week, four and sixpence being thatgenerally prevailing; six shillings that for the Borough ofBirmingham.Omitting the most destitute parts of Scotland, the Isles,and some equally poverty- stricken parts of the Highlands, theweekly charge made under the Family Treatment " forboard and general care, independent of clothing and medicaland general supervision , is a trifle higher; it varies betweenfour and threepence and six and sixpence; six shillingsbeing about the average for the patients from the more important towns and wealthier districts, those represented inthis country by the occupants of the insane wards of theBirmingham Workhouse.Now it is scarcely probable, considering the domestic habitsof the two countries, that in England the " Family Treatment " can be carried out on the same principle as in Scotlandat any lower cost than its higher scale of expenditure, thatis, five to six shillings a-week, in addition to what would berequired for clothing, and for medical and general inspection;which latter being the great safeguard of the system cannot1876. ]357 by WILLIAM H. PARSEY, M.D.fail, if efficiently performed, of adding to the expenses. And,if these estimates are correct, a change in this direction isscarcely likely to commend itself to either our urban or ruralauthorities so long as they can find space in their existingworkhouses and cognate institutions; or continue the defective, but economical, English system of boarding out withrelatives, now largely practised in some parts of England.In many rural counties it is not uncommon to find under thislatter form of treatment numbers larger than are retainedunder care in the workhouses, and proportionately quiteequalling those under family treatment in Scotland; whilein the great urban counties they sometimes amount to buta tithe of the occupants of the insane wards of workhousesand of the workhouse asylums. It is in these latter countiesonly that the great mass of the chronic and subacute cases,instead of being sent to the county asylums, are crowded intotheir workhouse wards; and that the proper care of the insanehas such difficulty in keeping pace with the demands of therapidly increasing population; the rule, indeed, being prettygeneral that afaultyboarding- out system prevails in the Englishrural districts as largely as does the " Family Treatment " inScotland; while in our densely populated localities thismeans of disposing of them has for obvious reasons found butlittle favour. I say for obvious reasons, because to those conversant with the crowded and unhealthy tenements which themajority of the poor in London and our large provincialtowns are still obliged to occupy, and with the filth and immorality with which they are contaminated, the idea ofboarding-out among them inoffensive pauper imbeciles anddements, though protected by every reasonable safeguard,must be altogether repugnant. Independently ofthe hygienicdefects of their surroundings, under the care of the best disposed and most conscientious Guardians, their liberty couldbe but nominal. It could not be extended beyond their immediate homes without exposing themto the mocking sportof the idlers who abound in such localities, if not to the moreserious contaminations of immorality and vice. And conditions, so damaging to both mental and physical health,would have little to counterbalance thembeyond this supposedliberty. Indeed to my mind the idea of extending theFamily System to such localities is simply to be mentionedto be condemned . If any such practice is to be adopted forthe large urban districts, it can be only in the form of scattering their people over more thinly populated neighbouring358 The President's Address, [Oct.,localities, far from their natural guardians and from thosewho are legally responsible for their supervision . Theywould be under the care of strangers, influenced, doubtless,in most instances by good though not disinterested motives,and fitted or not, as chance might have it, for the responsibilities they undertake. And, though such a course might,with great care, have very satisfactory results as a mere philanthropic experiment extended here and there to a fewdozen picked cases, it would have within itself all the elements of failure if attempted to be applied on a scale commensurate with the requirements of any of our large centresof population; the difficulties of selection, distribution, and,more especially, of efficient supervision would be insurmountable.In the rural districts, however, we may well take patternfrom our Northern brethren, and endeavour to improve, andin some measure to extend our boarding-out practice, as has,I believe, already been accomplished in one or two of ourEnglish counties. It is a mode of life that harmonises withthe previous habits of those for whom it might be adopted;and probably the only great obstacle to its extension wouldbe found in the increased expenditure it involves. Its efficiency would be enhanced if, by legal enactment, such patientscould be readily transferred between the cottages and thecounty asylum, the power of transfer being vested in theAsylum Medical Officer and visiting Justices. And, were thelocality for boarding- out restricted to a radius of not manymiles from the Asylum, which in most counties could be arranged with little difficulty, most of the necessary supervisionand control might advantageously be exercised by its officers.In addition to this, an absolute power of removing patientsfrom the care of unqualified or negligent guardians, vestedin the Visiting Committee, might ensure the organization of asystem that ought to reduce to a minimum the dangers ofimperfect or improper management, from which the Scotchsystem does not appear to have entirely freed itself. And Iam sanguine enough to think that, could the financial difficulty be arranged, our rural workhouses might be altogetherrelieved of their insane element; those boarded-out under ourpresent loose system might have their position greatly improved; and these numbers might be augmented by an appreciable proportion of our present Asylum inmates.But, though by no means insensible to the value in ourrural districts of an improved boarding-out system, abuse in1876. ]by WILLIAM H. PARSEY. M.D. 359the detail of working is not my only ground for hesitation inconnection with its greater extension. It is not unreasonableto anticipate that by a too unguarded movement in this direction the risk might be incurred of swelling the catalogue ofoffences against the law, already too large, as an outcome ofthe unrestricted freedom of action of the unrecognised, oronly partially recognised, insane. Our local public journalsmake record, week after week, of one or more suicides theresult of mental unsoundness; but we rarely trouble ourselvesto bear them in our memories, or ascertain their proportionto the population among which they occur. The value,however, of such statistics is not unimportant in connectionwith this question of extended liberty; and, through thecourtesy of the coroners, I am able to give the number ofthese unfortunate occurrences in my own district in the year1875. The ascertained suicides, forming subjects of enquiry,were thirty-four out of a population of less than three hundred thousand. In fourteen of these the state of mind wasrecorded as unknown; one was attributed to delirium tremens; and nineteen to "unsoundness of mind " or "temporary insanity; " a rather startling number, which mightprobably have been diminished had a proper discretion beenexercised in consigning to an Asylum some of these unfortunates, before their mental disorder had culminated in solamentable a calamity. And there is a sufficient ground forthis opinion, as in the Asylum fed by the same population,though the suicidal element is always enough pronounced toto be an unceasing source of anxiety, but two undoubted, andone questionable suicide , have occurred among its patients inmore than four and twenty years. Again, appealing to ourexperience as alienist physicians, and passing over the manyminor offences so frequently recorded against persons of disordered or enfeebled intellect, we can have little difficulty incalling to mind painful, and not unfrequent, instances ofgraver breaches of the law committed by them, involvinglamentable destruction of property, irreparable calamities,and too often loss of life . Only within the last twelvemonthsI have added to my personal experience of homicide underinsane impulse one of painful detail, in which a poor simpleton, who had been allowed to pass some forty years withhis relations, earning a precarious livelihood by irregularlabour, regarded by his neighbours as " crazy " and " mad,"imbued, or I may say saturated, with a popular belief of hisdistrict in witchcraft and witches, to whose malign influences XXII.24360 The [Oct. ,President's Address,he attributed all his real and imaginary grievances and ailments, ended by sacrificing his liberty, and would, if theruling of his judge (Bramwell) had been adopted by thejury, have been found guilty of legal murder, for killing witha pitchfork, in what in a sane man would have been an unprovoked and revolting manner, a poor harmless woman,eighty years of age, one of his imaginary tormentors.In considering the question of increased personal libertyfor the insane we must not divest ourselves of such experiences; nor should we treat them lightly before the generalpublic. On the contrary, it is occurrences like these thatconstitute one of the dark shades in the picture of the lifeof the insane under family treatment. They can scarcely behoped to be eliminated, whatever judgment and forethoughtmay be exercised, from among the masked, I might almostsay mysterious, consequences of mental alienation. Andthey constitute, to my mind, the gravest difficulty to be contended with in the endeavour so to extend this family treatment as to substitute it largely for the more watchful careand management attainable in Asylums.That we are not yet approaching finality as to the bestmethods of dealing with the insane, and that the question isa complicated one cannot but be admitted; and the solutionof the problem is not simplified by the diversity of intereststhat have to be consulted in the regulation of their disposal.I have endeavoured to frame my remarks in a measure tosatisfy the conditions resulting from this diversity of interests .I have avoided all reference to benevolent or philanthropicpropositions , of necessarily limited or local bearing, or to existing long- established modes of dealing with them characterised by a similar impress. In our present state of civilization and social distribution it is scarcely probable that asecond Gheel can assume a leading prominence in any of themore densely populated European States; and almost impossible that a sufficient number of Gheels should be establishedto satisfy our present requirements. And as to special industrial communities, they can have a practical value only asadjuncts to or offshoots from existing more extended arrangements. Possibly some difficulties might be simplified werewe working under a greater concentration of controlling interests, and the insane poor recognised as wholly, instead ofpartially, a state charge. An enlightened and well- constituted State department might at least divest itselfof the present somewhat complicated and incongruous machinery under1876.]361 by WILLIAM H. PARSEY, M.D.which all tentative changes have to be made. But this is amere speculative question into which I have no desire toenter. I wish to do no more than submit, and leave in yourhands, the practical question that I have endeavoured to makethe leading subject of the observations, which, by virtue ofthe office you have conferred on me, I have had the opportunity of addressing to you.On the Prevalence of the Causes of Insanity among theAncients. By D. HACK TUKE, M.D., F.R.C.P. •The relative extent of the causes of mental disease inancient and modern society is a problem of profound interest. The study of it is one mode of approaching theconsideration of the question of questions for medicopsychologists -whether among the peoples of the highlycivilized portions of the globe at the present day morepersons do or do not become insane than among the nationsof antiquity. The inquiry involves the search after and themarshalling of some facts which are not in themselves medicalor psychological, but facts, nevertheless, which lead up tothe directly medical and psychological result indicated by the title of this article.Obviously the first question is, what are the acknowledgedcauses of Insanity? and the second, were these present infull force in the ancient world-as full force as in themodern one?That the forms of disease to which the human race isliable may vary in character and intensity in different agesand in different nations will not be disputed. I put asidefor the present the question of fact-one difficult for obviousreasons to ascertain - whether antiquity presents us with aswell marked examples of madness as we witness in our ownage, or whether the references made to the disease byancient physicians, historians, and poets, except when theyspeak directly of the causes of insanity, indicate a familiarity with its symptoms. I shall only consider theà priori question, whether, having regard to the main andwell- known causes of insanity on the one hand, and theconditions of ancient life on the other, there is reason toinfer that it was as extensively prevalent in the earlier asin the later ages of the world? It is the question ofpresumption and probability we have to study. The362 The Causes of Insanity among the Ancients, [Oct.,historical facts are not now in view. It is only needful torefer here in the briefest possible manner to the grand andsalient causes of insanity, in order that we may have themclearly in mind in studying the manners of the severalnations we shall pass in review; for it would be impossibleto enter into the consideration of each of these causes indetail.Broadly then we may thus enumerate them: -Intoxication, whatever the poison employed may be.Weinclude the action of alcohol and allied stimulants, not onlyon the individual taking them to excess, but upon the offspring; the condition of the children again causing furtherdegeneracy in the succeeding generation. If, on this causealone, we can arrive at anything like a decided conclusion,we shall have advanced far to the solution of the problem before us.Then we have defective nourishment, leading to exhaustion and mal-nutrition of the nervous centres, to degeneration of the race, idiocy, &c. , as witnessed in anymiserably under-fed population. The degeneration andinsanity attributed to intermarriages opens up a questionstill to a large extent subjudice, and it is extremely difficultto trace this cause in reference to its relative influence inancient and modern nations. Hereditary insanity is ofcourse left out of account, because it pre-supposes theexistence of that of which we are in search. In connectionwith defective nourishment we place bad sanitary arrangements of all kinds- overcrowded and filthy dwellings; theconditions universally acknowledged to cause sooner or latera thorough depravation of the bodily organs, and thereforeof that upon which the integrity of the mental facultiesdepends.Next we have various causes, chiefly moral, but partlymixed in character, which excite or depress the emotionsprofoundly, as a dissolute life or depraved habits, domesticsorrow and misery, commercial speculation and losses, religious excitement, disappointments in love, and the worryof life in general-overwork.Lastly, intellectual strain, which, if the least potentof causes, when rigidly eliminated from all emotionalaccompaniments, may by the infraction of the laws ofhealth in other ways -as in causing loss of sleepprove highly injurious. This distinction explains inpart why it does not appear as a prominent factor1876.] by D. HACK TUKE, M.D. 363in the statistics of the etiology of insanity. It must alsobe remembered that the reports of asylums which are published are as a rule those which refer to the non-studyingclass of the population . Often and often the nervous systemis greviously injured by the follies and excesses of educationalwork, involving undue mental tension, and that strain onthe memorywhich is induced by high pressure examinations;but insanity is not the usual form which this injury takes.It may not unfrequently be a predisposing, but it is notoften the immediately exciting cause. Hence, when insanitydoes supervene, the latter, whatever it may be, gets all thediscredit which the former ought to have had, in part atleast, and is therefore sometimes overlooked. And aboveand outside all these exciting causes is that peculiar mentalconstitution in which there lurks the subtle insane poisonor liability to insanity, which renders its possessor prone tobecome mad when brought into conflict with any one ofthese causes, and without which they often prove harmless.Whatever conclusion we arrive at as to the extent of thecauses of insanity at any period of the world's history, wouldat the same time affect the question of the prevalence of aninsane diathesis. If we have reason to conclude that theformer are present in full force, we may be sure that thelatent tendency to an outbreak of madness will be induced.The causes of the accumulation of insane persons in anation, in other words, of existing as distinguished fromoccurring insanity, present a highly important, but distinctsubject of inquiry.Here, in the enumeration of the causes of mental disease,the question so often asked, and so often answered differently,arises-Does civilization favour the increase of insanity?Our answer to the general question, what is the presumptionin favour of the prevalence of insanity among the ancients,drawn from the presence of the acknowledged generators ofthe disease, would largely depend upon the reply; if we wereagreed upon what civilization is, and upon whether the ancientsor the moderns are the most civilized, in the signification ofthe term so decided upon. But we are more likely to avoidreasoning in a circle, and escape the difficulties which surround the subject, from the loose and contradictory ideasattached to the term, if we look rather, though not exclusively, at the causes of insanity unquestionably known to us,because present in the midst of the state of society with whichwe are familiar, and which we call modern civilization, than364 The Causes of Insanity among the Ancients, [Oct.,at civilization in the abstract. If we were to speak and argueof a perfect civilization, it is clear that we should mean a verydifferent thingfrom that which constitutes the mixed conditionof modern society. All our pauperism and drunkenness wouldbe excluded, and the highly educated, moral, and religious portion of society would remain to represent the idea. Butif we were to apply the term to the actual state of so- calledcivilized Europe, we should have emphatically to include themas striking features of its character, and this, be it observed,not at all as the remains of a previous barbarism. Our replyto the question as to the influence of civilization, will, therefore, largely depend upon the sense in which we employ it.If it excludes vice and want, it gets rid of prolific causes ofinsanity, and its influence must be highly beneficial, even though there may be some unfavourable causes set in actionin the very process itself. If, however, on the other hand,we allow it to include the condition of the whole populationof a civilized nation , thus comprising those who may be bothpoor and vicious, but who are intimately engaged in advancing the progress of the country in its onward march in wealthand in the arts, and whose state is, to a certain extent, conditioned by the advance of modern civilization , then, indeed,must the reply to the question at issue be largely unfavourable.To civilize, according to the definitions ordinarily given, isto instruct in the arts of regular life-to reclaim frombarbarism-to advance the art of living together in civilsociety; and if this were all, civilization might consist, evenwhen its conditions were fulfilled , with intemperance and dissipation, and a large amount of pauperism. It might, in fact,accord with much, or, indeed, all that which forms the actualcivilization of our day. An ideal civilization, however,would be something much higher than this, and would, intheory at least, be antagonistic to all these evils. It wouldimply something more than the mere acquisition of knowledge or the refinements of life.It is necessary, therefore, not to lose sight of these twomodes of viewing civilization-the one as ideal, the other asactual. In attempting, however, to decide upon the probabilities of the prevalence of insanity in remote periods of theworld's history, knowing, as we do, that there is a frightfulmass of mental disease among the European and Americanpopulations-at least as much, if not more, than is found inother and less civilized countries-it seems the most practicalmode of proceeding to enquire into the social condition of1876.] by D. HACK TUKE, M.D. 365ancient peoples, as compared with our own, satisfied that sofar as it is found to have been similar, the former may safelybe inferred to have been no strangers to the inroads of mentaldisease. For ourselves, civilization, whenever the term isemployed, is not used to denote an abstract and theoreticalstate of society, which implies perfection, but the mixed condition which accompanies and helps to constitute modernsociety, as presented to us in the civilized nations with whichwe are all familiar.If we say that civilization is accompanied by an increaseof insanity, it is civilization so understood which we mean.Clearly a theoretically perfect civilization, even though itshould render the organ of the mind more sensitive in somerespects to derangement, might, by the fulfilment of the lawsof mental and bodily health, largely, if not wholly, neutralize the danger.Having glanced at the most prolific causes of mental disease, and stated our belief that modern civilization allowsof, if it does not, in some respects, foster the growth of certainrecognized factors of insanity, we proceed to consider whetherand how far the state of the world in olden time contained thesame elements of mental disorder, the same dangers to lossof mental equilibrium .That these causes were, to a great extent, absent in theearly period of the world's history -in prehistoric times-isclear. From intellectual strain and its concomitants, the manof the Stone Age was certainly free. From club blows inbattle his brain was much more likely to suffer.Intoxication. -It is difficult to form any positive opinion asto what, if any, form of intoxication prevailed in primitivetimes. We see from Genesis how soon it crept into the oldworld, and we know that among savages someform of inebrietyis common, The Sonthals, one of the aboriginal tribes ofIndia, perform their religious observances in a state of intoxication. But the latter instance, coupled as it is with the ritesof religion, is scarcely to the point. Mr. Stanley speaks ofAfrican savages who live wholly on a milk diet.

Tylor, in reference to certain mental phenomena producedby drugs in the West India Islands, at the time of Columbus,describes the effect of snuffing up the " cohoba " powderthrough a cane. It produced intoxication; the object inview being to obtain an ecstatic condition, in which oracular"Primitive Culture. " Vol. ii, p. 377.366 The Causes of Insanity among the Ancients, [Oct.,utterances would be given. The Omagnas were and are inthe habit of using narcotic plants, causing intoxication fortwenty-four hours, accompanied by extraordinary visions .To obtain these, the Californian Indians also gave their children narcotics. In North Brazil the same custom prevailed.The seeds of Datura Sanguinia were used by the DarianIndians to induce prophetic delirium . The Peruvian priestsused a narcotic potion, " tonca; " the plant having also the name of " huacacache," i.e., fetish herb. Delirium andvisions were induced by the Mexican priests with " ololiuhgni." The above writer observes that tobacco was used forthe same purposes in both North and South America, thesmoke being swallowed by the native races to cause completeintoxication. It was regarded as supernatural ecstasy by thesorcerers of Brazil and by the North American Indians. Thatthese, or similar practices, if known in prehistoric times,would be injurious to mental health, is indeed possible. Atthe same time they are, in these instances, limited apparently to the priests, and do not imply that these drugs wereemployed by the mass ofthe people. The reader will recall theobservations of Cook in regard to the natives of Otaheite,where they expressed a liquor from the avaava root . Severalchewed it till it was soft and pulpy, then spat it out into aplatter, watered it, according to different tastes, strained it ,and drank it immediately. Though intoxicating, Cook sawonly one instance in which that effect was produced, as thenatives drank it with great moderation. They would alsosimply chew it. Cook observed that an old native could walkvery well in the morning, but required leading home by twopeople in the evening; hence, he says, he concluded that thisroot had the same effect upon him that wine has on Europeans.Although, however, he says that the old people seldom satdown without preparing a bowl of this delicious mixture,there was evidently no general intemperance. Lastly, andmuch to the purpose, from the fact that savage hunters andfishers are probably fair representatives of the rude primitiveraces, the hunting Indians of North America and the Australians had no intoxicating liquor.With regard to drunkenness, then, and, we may add, immorality of a kind conducive to insanity, it is certain that whilethere may have been means employed to induce inebriation,and while the standard of conjugal morality would be whollydifferent from what obtains amongst a civilized nation, therewas not the curse of alcoholism in the form known at a later1876.] by D. HACK TUKE, M.D. 367period of the history of the race; nor were there the multifarious and nefarious vicious indulgences, which in differentand what are called more civilized conditions of society sapthe mental powers and are the fruitful source of certain forms of mental disease.Defective Nourishment, Poverty, &c. -Of poverty—at least,that grinding, reckless, drunken poverty and squalor, withwhich we are familiar in our large towns and in some of therural districts, the primitive inhabitants of the world musthave known nothing. They might sometimes find it hardwork to make the chase yield all they would desire, but prolonged poverty, of the kind we have indicated, was surelythen unknown. The curse of civilized pauperism was yet tobe experienced. It is difficult to conceive that the conditionsof life under such circ*mstances would favour attacks of insanity, or the generation of the insane diathesis. And, indeed,the strong presumption that such a race would be littlesubjected to the main causes of insanity, either predisposingor exciting, is confirmed by what we actually know of savagesat the present day; and, granting that such savages may notexactly represent the inhabitants of the Stone Age, therewould be an à fortiori argument in favour of the comparativeimmunity from insanity enjoyed by the latter. Althoughthe objection may be, and has been made, that the fact escapesthe observation of travellers, yet, with a very large allowancefor this source of fallacy, it seems to us impossible to doubtthat their testimony suffices to prove that insanity is rareamong uncivilized tribes. The evidence is so uniform , thatwe cannot but allow it great weight.Then as to intermarriage. In small clans and tribes, marrying in and in may be supposed to have often endangered theirvigour, and tended to cause degeneration. If, however, thecustom of existing races of savages may be taken in proof, thepractice of exogamy which prevails in many tribes may haveprevailed in early ages. This custom is, in fact, regarded bysome as only explainable as a reformatory movement to breakup the intermarriage of blood relations (Morgan) . Theadvantage of crossing would, Sir J. Lubbock considers, soongive a marked preponderance to those races by whom exogamywas largely practised . " When this state of things had goneon for some time, usage, as M. Lennan well observes, wouldestablish a prejudice among the tribes observing it—a prejudice strong as a principle of religion, as every prejudicerelating to marriage is apt to be-against marrying women368 The Causes of Insanity among the Ancients, [Oct. ,""66oftheir stock.' We should not, perhaps, have à priori expectedto find among savages any such remarkable restriction, yet itis very widely distributed; and from this point of view wecan, I think, clearly see how it arose.' It is surprising alsoto find that in Australia no one may marry a woman whosefamily name is the same as his own, although in no way related . † Du Chaillu asserts that it is " an abomination "in Western Equitorial Africa for the members of the sameclan to intermarry. If, then, endogamy was really rarerthan exogamy, the tendency to mental degeneration in prehistoric times may have been confined within narrow limits .As we write, Mr. Stanley's narrative in the " Telegraphrecords the endogamic practice of an African tribe. Theyare," he writes, " extremely clannish, and allow none of theirtribe to intermarry with strangers . Mr. Huth, in hisrecent original and able work, says that the only instanceson record he has met with in savage nations of any evileffects being attributed to consanguineous marriages arethose of the Kenai, the East Indians, and the Hawaiians,and he dismisses them as inconclusive. He tries to show thatthe reason many nations have prohibited such marriages is notfrom having observed any evil result; that many communities have lived without crosses, and without any excess ofdisease; that the statistics on the subject are worse thanuseless; and that as far as experiments on animals go, theyshowthe harmlessness of these marriages; and that deterioration through the chance accumulation of an idiosyncrasy,though more likely to occur in families where the marriagesof blood relations are habitual, practically does not occuroftener than in other marriages, or it would be more easilydemonstrated. The influence of consanguineous marriagesupon the production of insanity and idiocy is at any ratenot so certain as is usually supposed, and therefore if inpre-historic times, as among some savages, kinship was disregarded, it would not be safe to assert, in the presentundetermined state of the question, that there was moreliability to mental disease under such circ*mstances than inmodern civilized society.Causes Chiefly Moral. -To religious perplexities, commercial speculation, and to political excitement, the man of theDrift Period was certainly a stranger. He might, indeed,

• Op. cit. , p. 69.

+ Cf. Mr. Lang's " Aborigines of Australia."" The Marriage of Near Kin," by Alfred Henry Huth, 1875, pp. 8 and 358.1876.]369 by D. HACK TUKE, M.D.suffer terror from his belief in evil spirits, but probably thiswould be generally removed by the simple belief in charmsto counteract their malign influence . Peril to mental healthfrom theological doubts and perplexities, would, at any rate,be unknown. Mr. Tylor, in a letter to the writer, says thathe does not think there is any likelihood that the fears ofmisery of the soul after death, which act so strongly in thecivilised world, had any appreciable effect in upsetting thesavage mind; and that though the notion of a future life ofthe ghost is strong (connected with the appearance of thedead in dreams) among the savage tribes who are best known,anything like a moral judgment after death seems faint orabsent, and so it may have been among the Drift people;but that still, if the theology of modern savages is any typeof that of these early people, madness would already have atheological aspect, and might be influenced by religious ideas.With epilepsy, convulsions, &c. , mania would be regarded asdemoniacal possession, and the utterances of the patient asdue to a demon. We must not, then, ignore entirely theeffects of a belief in ghosts and demons. Mr. Tylor inclinesto think that savages really do fear horribly these phantomswho pervade their world and are especially numerous andactive in the dark. Still, he would not go so far as to saythat dwelling on these bogies often or ever drives savagesmad, though an aggravating influence on morbid states ofmind. While he believes that the sensual excesses of savagesmay be counted as causes of insanity, he thinks decidedlynot to the extent obtaining in civilised or luxurious nations;being such as belong to a state of physical health ( the weakerbeing killed off) , rough food, active athletic life, and absenceof stimulants. It should be remembered that while want ofmoral control would tell unfavourably, absence of conflictbetween moral principle and actual practice would tellfavourably as regards insanity. To disappointments inlove they would also be almost or entirely strangers.affections of savages are so little developed and cultivated in this direction, that they would escape the dangerous shocks and blights to which they are exposed incivilized nations. They would probably have no institutionof marriage. "True love," observes Sir John Lubbock," is almost unknown amongst the lowest races; andmarriage in its lowest phases is by no means a matterof affection and companionship. Among the Koussa Kaffirs ,Lichtenstein asserts that there is no feeling of love inThe370 The Causes of Insanity among the Ancients, [Oct.,marriage. In North America, the Tinne Indians had no wordfor " dear " or " beloved," and the Algonquin language isstated to have contained no verb meaning 66 to love," so thatwhen the Bible was translated by the missionaries into thatlanguage, it was necessary to invent a word for that purpose. " He cites a French writer to show that the Samoyedesof Siberia show little affection for their wives and " daignentà peine leur dire une parole de douceur." Many other instances might be adduced to illustrate this remarkable fact,but these are sufficient to show that in one very importantcirc*mstance the early races would not be so much exposedto the causes of insanity as more civilized nations are.Passing from wholly uncivilized men to a higher grade,we may apply the same tests to the state of society depictedin the early and some of the later books of the Old Testament,and thence to Egyptian, Greek, and Roman society, theproblem for solution being whether the character and extentof their social condition were such as to render it highly porbable that they were subjected to the same causes of insanityas ourselves , or causes equally potent.Intoxication.-Noah planted a vineyard, and what followedis of especial importance to us, because in it we are obligedto recognise one of the frequent causes of insanity. WhetherNoah was often drunk we do not know, but it may safely beinferred that it was no unusual thing for his immediate, aswell as his subsequent, descendants to be intoxicated.tIn Deuteronomy, the parents of a rebellious son are commanded to bring him to the elders of the city and say, " Thisour son is a glutton and a drunkard, " in order that he shouldbe stoned. The fact that Eli thought Hannah drunk when shecame into the temple, the simile of David " stagger like adrunken man, " and of Isaiah " as a drunken man staggerethin his vomit, " and his complaint that he was the song ofthe drunkards, and the remonstrance of Joel, " awake yedrunkards, weep, and howl"-these facts show how wellknown was the sin of drunkenness.From all this we see clearly that intemperance wasquite sufficiently prevalent among the Hebrews to cause acertain amount of mental disease; at the same time there isample proof of its not having been the scourge of society' Origin of Civilization," Third Edition. , p. 126.+ Later on, vineyards are constantly mentioned. Horne observes that the wines of Canaan being heady were commonly mixed with water. The luxurious prepared it with spices (Edersheim).1876. ] by D. HACK TUKE, M.D. 371which it is among so many nations of the West. The Jewbears the character of being sober at the present day. Mr.Stallard, in his able work on " London Pauperism amongstJews and Christians, " says that drunkenness is rarely thecause of distress among the former, and that a Jew's sobrietygives him a marked advantage in all branches of commonlabour. "The visitor of the Jewish district is forcibly struckwith the consequences of this sobriety. The houses of thepoor are, on the whole, more cleanly, more tidy, and morecomfortable than amongst the poorest English. The childrenare always better clothed and more cleanly, their round andruddy faces presenting a strong contrast to the pale andscrofulous countenances of English children living in the same overcrowded courts. Everywhere in theJewish houses there is less of that squalid destitution whichis the result of intemperance. Nowhere is it possible to findJewish men and women with bloated and waxy faces, standing at the doors of public-houses, as do the sots whom nocharity can help, no philanthropy reclaim. Home is thecentre of their happiness, and the love of the family isworthy of all praise. Desertion is comparatively rare, andbrutal violence to the women and children utterly unknownamongst them " (op. cit. p. 11) . Edersheim says the Jewswere very moderate in their potations, except on festiveoccasions, and maintains that drunkenness was not one of the national sins.•Defective Nourishment, Poverty, &c . , as shown in the mode oflife. The lives of thepatriarchs unquestionably indicate a condition of life which, compared with our own, was exceedinglysimple, although by no means savage-one much more inaccordance with nature, far less moulded by artificial wants.It is true that Abraham was " very rich in cattle, in silver,and in gold," and also in men servants and maid servants,yet he runs to the field on a well- known occasion and fetchesa calf for his guests, and it would seem even dresses it hinself. As the custom was, he stood, and they took theirmeal under the tree, as is done to this day in the East.Rebekah comes forth with her pitcher on her shoulder at the well to meet Eleazer. There is, indeed, a remarkablemixture of the primitive simplicity of pastoral life withcertain luxuries, or at least elegancies, for even thenAbraham's servant presents her with ear-rings and with bracelets. These, however, may have been nothing morethan the ornaments worn by savages at the present day.372 The Causes of Insanity among the Ancients, [Oct. ,Rachel tended the sheep; and Jethro's daughter had thecharge of his flocks, although he was a prince. They weredwellers in tents, like the modern Arabs, and occasionally incaves, like Lot and his daughters, and in houses of stone, ormud, or wood. We read, indeed, as we extend our survey toa later period of Hebrew history, of ivory palaces in thePsalms, and of the ivory house of Ahab, probably housesonly ornamented with ivory, but any way indicating someartistic development. Then as to dress, we find garmentsmanufactured from wool and flax mentioned in Leviticus andProverbs, while the wealthy indulged in fine linen and purpleor scarlet silk. Rings and seals were frequently worn evenin early times, and we read of chains on the neck, and ticklingornaments on the feet. Rebekah's bracelets we have alreadymentioned. Men also wore them-as Judah and Saul. Jezebelpainted her face or darkened her eyes with the powder oflead ore. Looking- glasses of polished brass were in use.Then, as to the occupations of the ancients of the Bible,they were, we well know, mainly pastoral and agricultural—in the early times, almost exclusively so. The people wereshepherds and husbandmen.Moses was a shepherd . A judge in Israel -Shamgar- wastaken from tending the herd, and Jephthah from the sheep.Gideon left his threshing floor. Even when Saul was king,we find him coming out of the field after the herd, at thetime he was informed of the danger in which a certain citywas. David was brought from feeding the ewes. Oneking-Uzziah-is stated to have been a lover of husbandry.Elisha was called from the plough. Amos was a herds- man. Women of quality, so to speak, also, as we have seen,tended sheep. There were in early days artificers in ironand brass, in instruments of music also, and afterwardsthere are occasional indications of art. The golden calfshows some artistic power. In "Chronicles " we read, afterJoshua's death, of the valley of Charashim, where the craftsmen dwelt. Chariots were built, images sculptured . Smithsare mentioned in the days of Saul as being seized by thePhilistines, and they and craftsmen (in addition to barbers,bakers, potters , and fullers) were carried away into captivityby Nebuchadnezzar. Horne says that among the Hebrewsartificers were not, as among the Greeks and Romans, slaves,but men of rank and wealth. He points out that althoughbefore the Israelites entered Canaan Bezaleel and Aholiabexcelled in their workmanship of the tabernacle, they seem1876.] by D. HACK TUKE, M.D. 373to have been without successors, for in Solomon's time,although at leisure for art, they had no professed artists ableto undertake the work of the temple, and had, therefore, tosend to Hiram, King of Tyre, for a skilful artist. In science,their knowledge was probably less than that possessed bymany nations, but Job and Solomon must have had considerable acquaintance with natural history. However deficientin art and science without foreign help, their civilization wasshown in their literary compositions, and especially theirpoetry. We have only to recall the Song of Moses, that ofDeborah, Barak, and Hannah, the lamentations of David overSaul, and Jonathan, to say nothing of the Psalms, Proverbs,Canticles, &c. In those schools of which we read first in thebook of Samuel, the law must have been carefully taught,and instruction must have been given in music. By thetime of David, and yet more of Solomon, very considerableadvance must have been made in knowledge and civilization .We also witness the development of luxury and of the vicesincidental to such a state of society as must have existedunder Solomon. Those referred to in the book of Proverbsmust have had a certain influence in producing mentaldisorders. We can speak no longer of primitive simplicity,although we might still contrast the society of Jerusalem atthis period with that of our modern capitals .As to poverty, it was said indeed that the poor shouldnever cease out of the land, and the poor are very frequentlymentioned in the Jewish writings. Some, at least, in thedays of Solomon were observed to become poor throughdrink. " The drunkard shall come to poverty." It is not,however, to be supposed that the depths of poverty andmisery familiar to ourselves were reached by large masses ofthe people. Beggars, properly speaking, except thoseafflicted with disease, were unknown in Palestine, and toa great extent are so still among Jews.*Causes Chiefly Moral. -As regards profligate immorality,the references to it are numerous enough, but, as a whole,the Jewish nation cannot be regarded as having stood low in this respect. As to other emotional excitors and depressants, they no doubt exercised a certain influence in thedirection of insanity, but still a limited one compared withthat of modern society. The same remark applies to intel- lectual strain.Take next Egyptian civilization. Nothing can be more

• Edersheim's " History of the Jewish Nation, " &c. , 1857.

374 The Causes of Insanity among the Ancients, [Oct. ,wonderful; and the more we know of it, the more wonderfuldoes it appear. The earliest writings of Egypt (some ofthem the earliest writings in the world) reveal a social con- dition and a state of morals which leave no room for doubt asto the remarkable advance made in civilised life centuriesbefore Abraham visited Egypt. The question is, was it ever comparable to our own in its character and extent? Werethe great causes of madness present in our age in powerfulaction among the Egyptians? To glance rapidly at the firstquestion, look at their proficiency in some of the arts. TheEgyptians, although principally an agricultural people, were remarkable for their inventions, and as manufacturers werecelebrated for their fine linen, cotton and woollen stuffs , andtheir taste in porcelain and gold and silver articles, while the cabinet makers turned out excellent work. * Pharaoharrayed Josephnot only in fine linen, but put a gold chainabout his neck and a ring upon his hand. Many of thebracelets, rings, and ear-rings discovered in Egypt, which areat least four thousand years old, show the advance made in goldsmith's work. In the Leyden papyrus the followingcurious satire on the luxury of the day occurs; at least it seems reasonable to regard it in this light, “ Allmanner of jewels are found on the necks of slave women;honourable women and mistresses of houses are saying' would that we had enough to eat. "" The hieroglyphics onobelisks, &c . , were sculptured in a way which surprises theworkman of the present day with his tools of exquisitelytempered steel, as I have been assured by the proprietor ofwell known granite works in England. Their rich sculptureand the beautifully clear execution of their drawings werecombined with a knowledge of the harmony of colours.Geometry would seem to have originated with the Egyptians.Mathematics are said to have made almost as much progressat the time of the earliest extant monuments as at a muchlater period. Then the ancient Egyptians are generallybelieved to have invented the art of writing. Through theirpower of committing their thoughts to paper, we know (from the "Book of the Dead " ) what their sentiments were inregard to the future, and that they believed in the immortality of the soul. They cultivated the study of Medicineand Surgery, and their second King (Athothes) wrote uponAnatomy, while another Egyptian composed six books on

• Wilkinson's " Ancient Egypt, " Vol . ii, pp. 109. 247

1876.]375 by D. HACK TUKE, M.D.Medicine. Each doctor practised his particular branch;some were oculists, some dentists , some treated internalmaladies. The mummies show that the art of stopping teethwith gold was known to the Egyptian dentists. If of Medicine they had a remarkable knowledge, and if in Divinity—notwithstanding their degraded notions in regard to theworship of animals-they had certain conceptions of a loftyand spiritual nature, so also the high character of theirLegislation has always been admitted and admired. Thecondition of the women in any country is regarded withjustice as some test of the degree of its refinement. Theyare represented in the Egyptian sculptures as engaged in weaving and using the spindle, but they were no meredrudges. They were not obliged to remain in seclusion, orif they left the house, to wear a veil as in the East; nay, itwould seem, according to Diodorus, that so great was theirinfluence and position that it was actually agreed in themarriage covenant, among other things, that the wife shouldhave control over her husband, and that no objections shouldbe made to her commands, whatever they might be *—a fineprecedent for the advocates of women's rights in our ownday.The Egyptian women were, as Mahaffy shows, good musicians, and versed in some of the other arts and sciences.But if they spun and sewed, they sported at ball and danced;and this writer thinks that their education cannot have beenvery great, because they have left no literary compositionsbehind them. He also points out that their best knowncharacters, whether they appear in history or are depicted inromance, are by no means good, and contrast unfavourablywith the women of the Bible.Recalling now the main causes of madness mentioned on aprevious page, were they, let us enquire, largely presentamong the ancient Egyptians?Intoxication. -In a very old papyrus in the BritishMuseum occurs unmistakable proof that the ancient Egyptians were no strangers to drunkenness. Here is a most interesting passage from a letter written to a teetotaler of thatday, who had evidently not kept his pledge:—"Whereas it has been told me that thou hast forsaken books, anddevoted thyself to pleasure; that thou goest from tavern to tavern,smelling of beer, at the time of evening: if beer gets into a man, it

• Wilkinson, op. cit. , vol. ii. , p. 223.

XXII. 25376 The Causes of Insanity among the Ancients, [Oct. ,overcomes his mind. Thou art like an oar started from its place, whichis unmanageable every way; thou art like a shrine without its god,like a house without provisions, whose walls are found shaky. Thouknowest that wine is an abomination , that thou hast taken an oaththat thou wouldst not put liquor into thee. Hast thou forgotten thy resolution?"*The custom which prevailed at their feasts of handinground a small wooden image with the words " Behold this,eat, drink, and make merry; when thou art dead, such shaltthou be" (a commentary, by the way, on " If in this life onlywe have hope, let us eat and drink, for to-morrow we die"),illustrates the drinking customs of the Egyptians on publicoccasions. It is stated that at the Egyptian banquets eventhe ladies were carried home by their attendants drunk. †""Wilkinson regards it as highly improbable that the Egyptians were in early times immoderately fond of delicateliving, or at any period committed the excesses commonamong the Romans. The example of the priests favouredmoderation. Still, before 1600 B.c. the indulgence of thehigher classes had almost reached the pitch attained by thelater Pharaohs. Diodorus and Plutarch assert that theirprimitive simplicity succumbed to luxury as early as KingMenes the First. They were guilty of excesses, " especially,"this Egyptologist asserts, "in the use of wine, both orprivate and public occasions, which is not concealed in thesculptures of Thebes; and in later times, after the conquestof Egypt by the Persians, and the accession of the Ptolemies,habits of intemperance increased to such an extent, andluxury became so general among all ranks of society, thatwriters who mention the Egyptians at that period, describethem as a profligate and luxurious people, given to an immoderate love of the table, and addicted to every excess indrinking. They even used excitants for this purpose, andhors d'œuvres were provided to stimulate the appetite; crudecabbage provoking the desire for wine and promoting thecontinuation of excess (op. cit. , vol. ii . , p. 381; and"Athenæus," vol. i., p. 56).دوIn consequence of the quantity used being so muchgreater than what was made in Egypt, a large importation from Phoenicia and Greece was, according to Herodotus, required in his day. It appears that among the rich not only

• Eleventh Letter of the Papyrus Sallier I., British Museum; translated by

Mr. Goodwin (" Prolegomena to Ancient History," by Mahaffy, p. 293) .+ Wilkinson's " Ancient Egypt, " Vol. ii.1876. ]377 by D. HACK TUKE, M.D.was wine the favourite drink, but a beer called zythus, madefrom barley, and flavoured with lupin, &c. , was in greatrepute. Athenæus, himself an Egyptian (flourishing in thethird century after Christ) says of this beer that those whodrank it were so pleased with it that they sang and danced anddid everything like men drunk with wine.* For our presentpurpose, it would be particularly interesting to knowwhetheror not the mass of the people drank it. Athenæus saysthe poor drank it because they could not afford wine.Wilkinson thinks that the peasants in all parts of Egyptpartook of it, though in a less degree in the abundant vinedistricts; but as Herodotus maintains that it was only usedin lieu of wine in the lowlands, where corn was mainlycultivated, it is by no means certain that its use was general.Herodotus records that " Mycerinus, the Egyptian, havingbeen told by the soothsayers that he was fated to livebut a short time, used to light a great number of lamps whennight arrived, and spend all his time in drinking and luxury,relaxing neither by day nor by night; and when he withdrew into the marshes and into the groves or wherever heheard that there were meetings of young people to amusethemselves, he always got drunk. Amasis, also, another ofthe Eygptian kings, was a very hard drinker indeed. "+From the foregoing it is but too clear that there was quitesufficient drunkenness to cause a considerable amount ofmadness; at any rate, in the more luxurious age of Egyptianhistory, for the distinction must always be borne in mind,in this enquiry, between the early and the more civilisedperiods of a nation's history. To confound under the term" Egyptians " the people of a less and more advanced civilisation would be misleading, although as to large periods oftime, the embracing of populations separated by thousands ofyears would be of less consequence in Egypt than in anyother country, perhaps, except China. Granting, however, thefact of drunkenness among the Egyptians, some in the earlyand more than a little in the later periods of their history, Icannot find evidence to prove that the labourers, native orforeign, were maddened by bad beer-certainly not by worsegin-into frenzy, or into the committal of crimes such asfigure every day in our police courts. Are not theseluxuries more especially reserved for the British labourer?His Egyptian prototype did not enjoy, we may safely assert,"The Deipnosophists," vol i. , p . 56 (Bohn's Ed. ) .Herod. Bk. II. Athenæus, vol . ii, p. 692.378 The Causes of Insanity among the Ancients, [Oct.,the grand privilege of being frequently off " on spree " whenhe might be at work; nor did he, we may confidently aver,revel in the enjoyment of that liberty so dear to Britons,so gladly accorded to them, and so scrupulously protectedand defended by certain members of Parliament, of being somuddled by Saturday night's and Sunday's drink as to beunable to go to work on Monday morning.Defective Nourishment, Poverty, &c. -In regard to the extent of poverty among the lower classes in Egypt, probablytheir toil was sufficiently paid in food to prevent actualpauperism, and yet they appear to have been " miserable inthe extreme" according to Mahaffy, who suspects that thismay have been an important cause of the gradual decay ofEgyptian and other early civilizations."The Fellaheen, " writes a friend of ours now travelling inEgypt, " are miserably poor, being ground down with taxation,a large part of the produce of which must be spent bytheKhedive upon the innumerable Palaces, for himself or hissons. I have little doubt that all that is wanted to maketheir people prosperous is a reduction of taxation, and thegradual inroad of education, for they are a very fine race.Possibly the little which is required to make life tolerable insuch a climate as this, might be a hindrance to advancement.They eat three quickly consumed meals of dry brown bread,and a mash of peas, and this seems enough to develop veryfine muscular frames. One cannot help wishing that something could be done toward the better government of thesepoor people, who have been under the bonds of a perpetualsuccession of oppressors from the earliest ages. I expect inold Egypt the mass of the population were in much the same state that the Fellaheen are in now. The representations oflife on the walls of the Temples depict what we see every dayin the fields and on the river banks. "We must admit that "the miseries of the old Egyptianpoor are only transmitted to us by the boasts of recklesskings who so loved their ownglory, and to magnify their deeds,that they confessed the reckless waste of human life withwhich they completed their eternal monuments, and thatthere were great social sores, great sorrows of humanity,covered with a surface of unjust and heartless splendour. "*The suffering of those engaged in mines was no doubthorrible, if the account given by Diodorus may be trusted.

• Social life in Greece, p. 75.

1876.]379 by D. HACK TUKE, M.D.They were prisoners of war, and notorious criminals, and notthe ordinary slave, to whom they are said to have been kind,and the murder of a slave was punished with death. Theseminers were bound in fetters, compelled to work day andnight; and overseered by soldiers . No attention was paid totheir persons; they were naked; and, " so wretched, " saysDiodorus, " is their condition, that everyone who witnesses itdeplores the excessive misery they endure. No rest, no intermission from toil, are given either to the sick or maimed;neither the weakness of age nor women's infirmities are regarded; all are driven to their work with the lash, until atlast overcome with the intolerable weight of their afflictions,they die in the midst of their toil. Such," adds this graphicwriter, " is the method of extracting the gold on the confinesof Egypt, the result of so many and such great toils . Nature,indeed I think, teaches that as gold is obtained with immenselabour, so it is kept with difficulty, creating great anxiety,and attended in its use both with pleasure and grief." Butwhatever their poverty and poor food, their sufferings -andthese evidently ended in death rather than madness-theywere not of that particular kind which affect so large a number of our own labourers, both agricultural and manufacturing-those bound up with England's accursed pauper drunkenness being, we had almost said, worse than all the plagues ofEgypt put together.Causes chiefly Moral. -In regard to emotional excitementthere is no reason to suppose there was, even among theclasses above the labourers, that hot and breathless strugglefor a livelihood-that speculation and gambling in variousforms which mark our business life. Contrast the constanttendency to change which characterises English society, withthat which existed in Egypt. It was fixed, stereotyped .The strange thing about Egyptian civilisation is , that therewas no gradual advance to higher and higher states, but thatfor thousands of years the people continued in essentially thesame condition, civilized it is true, but never making vigorousstrides beyond. The range of knowledge traversed by thestudent in Egypt, however remarkable, will bear no comparison with that required in our own day. What we calllearning must have been very much restricted to the priests.It was their interest to confine it to themselves, in order tomaintain their superiority over the masses of the people, andmake a good living out of their wisdom. Zincke observes,that the Egyptians eliminated the elements of political and380 The Causes of Insanity among the Ancients, [Oct.,social change, by arranging society in the iron frame of caste,and by petrifying all knowledge in the form of immutabledoctrine.* The ruling power decided what every man was tobe, and what every man was to do. The system was both acause and effect of the condition of their society. One thirdof the land belonged to the monarch, one-third belonged tothe priestly caste, and one-third to the military. A profession or business usually descended from generation to generation. The office of embalmer, for instance, might behereditary for some hundreds of years. From another pointof view, that of slavery, we might with the above writer saythat this system divides the society of Egypt into two greatcastes, assigning to one, leisure, culture, the use of arms,government; to the other, denying them all participation inthese advantages and employments, it assigns absolute subjection, labour, and just sufficient food. Hence uniformsocial order, and little sensational excitement. Political heat,commercial panics, religious perplexity, where were they inthe good old days of the Pharaohs? There was in all probability comparatively little morbid sensitiveness, little sentimentalilty, self-consciousness, or the imaginary, but noless real, anxieties and cares of an over-strung mind. As regards the morality of the Egyptians, we are not in possessionof much definite information, but are not aware that theywere in any way remarkable for profligacy. The union ofbrother and sister was permitted. We cannot, however, withcertainty assert that this custom would entail mental degeneration. Polygamy was allowed. There was no restriction,says Diodorus, except for the priests. Yet the privilege doesnot appear to have been frequently taken advantage of.Herodotus found in his day, that most of the Egyptians hadonly one wife.Intellectual Strain.-The remarkable advance of theEgyptians in knowledge of various kinds could not have beenattained without considerable study. What amount of toiland moil this study involved, it is impossible to say; but wecan have no doubt that it was small compared with the standard of the present day. As a cause of insanity we maysafely place it low. Sleepless nights from over- workedbrains, were, we may well suppose, infrequent.It is obvious, then, on a general review of the state ofAncient Egypt, that the people attained to a high rank of

• "Egypt and the Khedive," p. 275.

1876.] by D. HACK TUKE, M.D. 381-civilization, and that there certainly were not wanting someof the recognized causes of insanity to which we have referred-especially drunkenness . Whatever the vices of the Egyptians were, they were no doubt intensified in their laterhistory. Still I think the conclusion is fair that while it resembled the civilization of England and some modern countriesin important respects -those, indeed having special bearingon the question before us-it did differ in degree sufficiently to affect results. We think that on the one hand there musthave been a strongly marked difference in regard to the intensity of mental pressure, including in this the emotions aswell as the intellect; and on the other, in regard to thatshameful drunken pauperism which accompanies our own boasted civilization.(To be continued .)On the Question of Getting, Training, and Retaining theServices of Good Asylum Attendants. By T. S. CLOUSTON, M.D., Physician- Superintendent, Royal EdinburghAsylum.(Read at the Annual Meeting of the Medico- Psychological Society, held at theRoyal College of Physicians, 28th July, 1876.)There were in Great Britain in the beginning of 1875about 72,000 insane persons registered and under control.For the care and treatment of these there are at least 6000paid officials, whose sole duty it is to act as their attendantsand nurses. This is reckoning them as one to twelve patientsover all, the usual proportion in County Asylums; the numbers less than this in Poorhouses being made up for by theextra number employed in the care of the wealthier classes.There is no available source from which I can ascertainprecisely the changes that take place among attendants inGreat Britain, but in the thirteenth report of the ScotchCommissioners in Lunacy (for 1871), a table is given(p. xlviii) showing the changes that had taken place amongattendants in Scotch institutions for that year. Includingvoluntary resignations and dismissals, they amounted to281 , out of a total of about 500 employed; that is, thelength of the services of each attendant was on an averageless than two years. I think it will accord with the experience of most asylum medical officers, that attendants don't382 Asylum Attendants, [Oct. ,stay on any better now than they did five years ago, andit is my own opinion, formed after an experience in bothcountries, that attendants remain longer in the service inScotch Asylums than they do in English. It is a fairinference, therefore, that the changes among attendants inGreat Britain now are no less frequent than they werein Scotland in the year 1870, and therefore it may bemost safely assumed that there were 3400 changes amongthem last year, and that the average period of their services is less than two years.I am perfectly aware, of course, that the duration of theservices of many attendants is much less than a year,thus running up the average number of changes, and thatthere is, in all Asylums, a stable nucleus in the staff ofattendants, as well as a floating ever-shifting plasma.I have no means of verifying the fact by statistics, butthe universal testimony of Asylum Superintendents is thatof the new entrants into the service, by far the majorityhave never been in Asylums before, and are therefore totallyinexperienced in the management of the insane. The sametestimony is equally strong, and almost as unanimous, thatthis raw material, out of which they endeavour to makeattendants on the insane, is most difficult to get good atpresent.It requires no words of mine to show that this state ofmatters is most unsatisfactory to those who have the man- agement of Asylums, and is most detrimental to the insane,interfering with the comfort and happiness of some of them,prolonging the malady of others, preventing the recovery of anumber, and causing risk to the lives of not a few. I shouldnot much exaggerate if I said that this attendant question isat present the question of questions to many of us at the head of Asylums. I feel certain that the discussion of it here isneeded, and that the comparison of our experiences andthoughts in regard to it will be good for us all. This paperI have ventured to bring before the meeting solely to excitea discussion of the matter, and so to bring out the ex- perience and ideas of our senior members. Which ofus would not feel a burden lifted off us, and sleep moresoundly at night, if we could think that our patients wereall under the care of experienced, intelligent, and trustworthy attendants? Would not the absence of that suspicion with which we instinctively go round our wards,sweeten our lives and liberate more energy and sympathy in11876.]by T. S. CLOUSTON, M.D. 383doing our daily medical work? Ifwe could see in each of ourattendants a well-principled person, intelligent enough tounderstand the reason of his rules, and the unreason of hispatients; with sense of duty enough to make him do hiswork as well when we are away as when we are looking on;with vigour of mind enough to compel the respect of hisfellow attendants and his patients; with tact and temperenough to get on smoothly and have his own way with themtoo; with kindness of heart enough to put himself in theposition of his patients at times; with self- control enoughnever to do more than blow some of them up, when theyneeded it; with observation enough to see and report thechanges in their mental and bodily state to the doctor; withadaptability enough to cheer up the depressed and curb theexcited in the same breath; and finally with physique andhealth strong, with a gracious presence and pleasantsympathetic manner-if each of us could see all this embodied in each of his attendants, should we not feel as ifit were an easy thing to manage an Asylum, and not so sada thing after all to be insane? As I try to realize the idealAsylum with such attendants, it seems indeed one of thehighest embodiments of human philanthropy. Alas! I fear such an institution is far removed from those over which wepreside.But to return to real life. Are six thousand beings suchas I have described to be got for love or money in GreatBritain? I question it; but, what is the same to us, theyare certainly not to be got to enter asylum service as attendants. We have, therefore, to look for a somewhatlower ideal; but if even this is too high, I am quite sure mostof us have one far too low.orOne or two facts familiar to us all are worthy of notice inpassing. Which of us has not found a very uneducatedperson with no advantages of up- bringing-the sondaughter of a poor cottager-to turn out an excellentattendant? Who has not found a smart, educated, intelligent, bright- looking young man perfectly useless in thewards? Who has not had experience of a well- principledperson of the best character, moral and religious, turn out adead failure? My experience cannot be quite peculiar insometimes finding a well brought up educated girl failentirely with a lady when one who entered the service as ascullery maid succeeds to perfection. Do we not find that awoman entering the service at forty will sometimes make a384 Asylum Attendants, [Oct. ,first-rate attendant, and a girl of sixteen do equally well withthe same case? Have we not all every day experience ofthe fact that a man brought up in the country will sometimes be a failure, while one from a town will do well? Is itnot the case that at times we find a man or woman withoutany sort of experience whatever a first-rate attendant in amonth? Such facts show most strongly that persons ofdifferent stations, characters, educations, experiences, andages will all make good attendants, and that, therefore, ourfield of choice is not a limited one. This is a very importantand very satisfactory fact to us all in the outset of our searchfor our six thousand. But they show as clearly that somesort of natural aptitude for the work is necessary in allcases, without which nothing else will do.Are there any special motives that influence our attendants to enter asylum service? I think there are none,except those that influence people in seeking situationselsewhere. I fear one of the most common ideas in theirminds is that the work is not hard. In the course of thirteenyears' experience as an Asylum Superintendent I have justhad one person assign as a reason (and I constantly ask thequestion) that she wished to do good to her fellow creatures;and the circ*mstance was so unprecedented that I regardedher with much suspicion, and cross-questioned her mostsharply to detect any lurking hypocrisy. I am glad to say she turned out and is still one of the best nurses for the sickinsane I ever had. Can we expect to get six thousandpersons to act as attendants from such (so called) highermotives? I think not. We may give up the notion as chimerical at once. Indeed most of us could not fail to havea sense of much incongruity in our presiding over institutionswith such a staff. I know of few members of this Association who took to asylum life from " higher motives" alone,however much those motives may influence the way our workis done. We cannot expect from others what did not influence ourselves.It would seem a mere truism that we ought to get as welleducated and as well brought up men and women as we can,and yet your experience will be greatly different from mineif it has not led you to be very guarded in employing anyman who, with a good education and better position in life,comes to you seeking an engagement as an attendant. Asthings are at present, such men are generally failures elsewhere before they come to us. " In the case of females, we do,1876.] by T. S. CLOUSTON, M.D. 385especially for private patients, get good attendants from theclass of teachers, farmers' daughters, and governesses, but byno means invariably so. I have asked many head attendantsand matrons, and the almost constant answer I received was,that the best raw material they got was, in the case of men,from the class of farm servants, fresh from the country; andin the case of women, from the class of domestic servants ofthe better sort. Is this really the best raw material for ourattendants, or is our standard at present too low? I am decidedly of opinion that at least for our pauper asylums this isthe best material. Far better get the best of such classes thanthe worst of a higher grade. But do we get the best ofthose classes? I fear not. There is no doubt that a lady'smaid or housemaid of respectability and experience wouldlook on it as a great come down to take service as an attendant. I fear we often get the sort of men who are too idleto work hard, and the sort of women who go as servants tohotels and lodging-houses. This is undoubtedly a most seriousmatter, and all of us who have the welfare of our patients atheart must deplore the fact and strive hard to raise thestandard. The attendant of the future, if he is to excelthat of the present, must have good material in him, andmust be a good specimen of his class. To get such a personto come to us it is quite certain that in the first place wemust offer rather better rates of pay than can be readily gotelsewhere. Our work is not attractive. Will this alonetempt him to come to us, and when there keep him?experience of many asylums where the pay is above thewages of the district shows that it will not keep him. It isnot a mere money question. All of us have had good attendants leave us when we have offered an addition of fivepounds to their wages to stay.TheWhat sort of first experience in an asylum is apt to makethe best attendants? I have generally found it to be one ofthis kind: A young man, after being spoken to by me veryseriously as to the responsible nature of his duties , &c. , ishanded a copy of his rules, told to read them through carefullyat once, and is sent to be junior attendant in the admissionward, where there is a good old charge attendant, who takesan interest in him, and whom he sees obviously taking aninterest in the individual patients. He sees day by day newpatients arriving, and being examined by the doctor. Hehears the charge attendant questioned about their stateand symptoms, and soon he himself is asked by the medical386 Asylum Attendants, [Oct.,officer as to the symptoms of the patients he has charge of. Hesoon comes to look on patients in some degree from the doctor's point of view, takes an interest in them from this higherand professional point, and turns out not a mere machine forkeeping order and cleanliness in the ward and carryingout the general arrangements of the institution, but a trueguardian and friend of his individual patients. Now why has this man turned out well? I think the reason is that hehas been subjected to the right training when he first entered on his duties. He has been educated to look on his.patients and his work from a professional or special point ofview, just as a doctor is educated to look on his work. Thisis the only way, I believe, of getting over the disagreeablethings in any kind of work. But even in the case I havetaken, how unsystematic and hap-hazard is the training!How many new attendants are pitchforked into wards full ofdements, where they are never asked a question by the doctorabout the individual patients, where they come under theinfluence of bad attendants only experienced in bad ways?Howcan we expect them to turn out good attendants? Is itnot in the experience of us all that a man whom we haveaccidentally spoken more to, and asked questions of, from hishaving an interesting case under his charge, has from thattime come out in a newlight and developed qualities he nevershowed before? A new way of looking at his patients hasbeen roused in him, and a new interest in his work begotten.Now if these are facts, can we not devise and elaborate asystematic professional training for attendants in all ourlarge asylums? Subjecting each one to a regular education,not only as to the routine of his ward duties, but much morein regard to the forms of the different kinds of insanity,their nature, and their appropriate management and treatment; could we not in that way produce, in some degree,our own point of view of insanity and insane patients in thecase of the attendants? Who, that has seen a well-trainednurse manage a fever patient, can fail to see the importanceof this intelligent, professional mode of looking at a patientand his disease? This training would weed out the personswithout the special tact and adaptability for the work, moreor less of which must be innate before any one can make agood attendant.But coming more to details. Could we not have, in everylarge asylum, one ward in which all new attendants shouldbe trained? Could we not have in this ward a person of1876.] by T. S. CLOUSTON, M.D. 387intelligence and experience to have charge of it, and give thenovices instruction in the routine of his ward work? Couldwe not have one of the medical officers spend a special timeeach day in instructing them as to the mental peculiarities,habits, and diseases of the different kinds of cases, draughtingin succession into the training ward for this purpose a typicalsuicidal melancholic, an acutely excited case, a generalparalytic in his different stages, an epileptic, a low dement, amasturbator, a delusional case without excitement, &c. , givingthe novice charge of each of these in succession, making himwalk with him, work with him , sleep with him, and eat withhim, the doctor and chief attendant examining the novice,and teaching him every day as to the things to be knownand done, making him feel and realise that here was ahuman being with a certain disease, which it was hisbusiness to look into and know how to manage? Could henot go with his patients to see their relatives when theycame to the asylum, and find out why and how this diseasearose? Could not one of the medical officers once a week,during the winter evenings, give a lecture to all the staff onthe brain and mind, their functions, diseases, and theirtreatment? Can any one doubt that such a training for anattendant would not be better than the present mode? Why,then, should we not attempt it on a large scale? Surely ourcounties are rich enough to afford the extra expense. Thecomfort and assistance of having reliable men and womenabout us would far more than repay all the trouble it wouldgive us.Supervision of our attendants in our wards is no doubtmost important, but I believe that if we offered enough payto begin with to draw good raw material to us, and thenmoulded it in this way to our own views, there would be lessnecessity for watching our wards with the feeling of detectives. On this question of training I am especially anxiousto have the opinion of every member of this Association incharge of a public asylum.But, having got our attendant, and trained him, how canwe keep him? I must not delay so long time in discussingthis question as the other.My own impression is that we must carry out, in somedegree, the following things before we shall get our attendants to stay in our asylums, doing their irksome and disagreeable duties for many years running.1. Provide a rising scale of pay up to a really good amount,388 Asylum Attendants. [Oct.,certainly not less than £50 a year as the maximum in tenyears.2. Give pensions to all those who become sick, or who servelong, at about twice the relative proportion to pay, as in theCivil Service.3. Make provision for changing attendants from one asylumto another, one institution getting the benefit of the surplusof another district; the pay and pensions counting as if nosuch change had been made. I am certain we lose for ourpatients the services of very valuable trained attendants,whose desire for a little change, or temporary ill- health, ormisunderstandings with fellow-attendants or officials makethem leave us, but who would be delighted to go to anotherasylum taking the same rank.3. Develop and encourage an esprit de corps among attendants as a class, making them proud of their profession, as weare of ours. I should like to see them get diplomas fromtheasylums where they were trained, and that they should get upan association of attendants extending all over the kingdom.4. Provide facilities in the matters of houses, suitabletimes of leave, &c. , and for the marriage of at least one halfof our male attendants.5. Encourage any kind of promotion to head attendantspositions, to good places in charge of private patients, or inprivate asylums, &c.6. Encourage by some special means provident habits.Next to good principles, I have always found saving moneythe best thing in an attendant. Such a man is not a rollingstone.7. Make their lives as pleasant as possible by good accommodation, days off duty, annual holidays, social gatherings, means of amusem*nt and instruction, and, above all,reasonable facilities for satisfying the social cravings of human nature.8. Bring systematically and directly to bear on them theelevating influence of the better educated officials, such asthe medical officers, chaplains, matrons, &c. I am certainthat the chaplain should be a more valuable official in anasylum than he commonly is. How many asylum chaplainspreach to the attendants, now and then speaking to them ina direct and real way as to their special temptations, andsetting before them a high ideal of duty?1876.]389Torquato Tasso . *"Peace to Torquato's injured shade."CHILDE HAROLD. Canto IV, Stanza 39.There is no error in opinion or judgment, no widespread prejudice, so difficult to eradicate or overcome as onethat is founded on sentiment, and when the sentiment is agenerous one, seeking to make some atonement for supposedinjustice done in the past, in thought or in deed, the prejudicewill be apt to cling the more tenaciously. " Peace to Torquato's injured shade, " exclaims Byron in his heart-stirringlines--but was this a just apostrophe? Nobly gifted, deeplyafflicted and unfortunate though he was, was Tasso indeedinjured, as implied, by his fellow man? Most sad and sufferingas his life became, we may be committing a deep injustice inasserting it to have been brought upon him by cruelty or evenunkindness; and a fair impartial review of his whole life andcirc*mstances would seem to reveal a far different history.This has been most forcibly impressed by reading the pages ofone who from the outset seems to have believed in the grievouswrong done to Tasso by Alfonso d'Este, and to have viewedevery event by the light of a preconceived opinion; while toone coming without opinion formed to the perusal of thesepages, ignorant until then of the course of events, they wouldseem, we think, strikingly to set forth the very oppositeview; the very facts the author brings forward in evidence ofhis assertions seeming to furnish the strongest indicationsof a contrary explanation. To any one coming with evena moderate knowledge of mental disease to the study of thissad life, it will surely seem one in which the tendency to,and at length declaration of, this malady can be most clearlytraced out from the very early days of Tasso down to thevery last hour of his life. This is not to disturb the shadeof Tasso, rather to yield it the desired rest; for who wouldnot rather think of him as bowed beneath the weight of asad inscrutable affliction sent by no mortal hand, than as thevictim of cruelty and injustice, which would indeed have beenscarcely human in their refinement, but of which we mustconsider Alfonso d'Este may have been most unjustly accused?If we follow through in review the course of Tasso's life,we shall see how the usual forerunners and indications oftheillness that at length more fully declared itself are presented

• The Life of Torquato Tasso. By the Rev. R. Milman. In 2 Vols.

390 Torquato Tasso. [Oct. ,to us-the melancholy, the extreme self-exaltation and inordinate love of praise and distinction; then the disorder ofhis bodily health immediately preceding suspicions of enmityand danger; his restlessness and flight from Ferrara, andhis unreasonable return to it had his suspicions and fearshad true cause and foundation. It is also to be notedthat Tasso in his calmer hours seemed aware of his real illness-did not deny it but rather alluded to it, in his lettersmore than once adverting to his deep melancholy, his alarmsand suspicions. It is not requisite to take the statements ofSerassi or others, supposed to write as friends of the d'Estefamily; but simply following the narrative as here set forth byone who takes so different a view, it unfolds to us the gradualdevelopment of this illness in Tasso, sad indeed to mark whenwe remember the mind that was " here o'erthrown; " and thisseems to have been sincerely felt and lamented by Alfonsoand also by others whom Tasso, in his morbid state of mind,imagined to be inimical to him. But much as there may havebeen to admire and to love in Tasso, it is evident that hiswas not a healthy tone of mind nor a nature wholly admirable or loveable. He alludes to his own desire of being preeminently honoured; and this exacting spirit might wellcreate dislike and anger in those who did not appreciate sohighly his noble talents as to view leniently these defects inhis, in many respects, superior and noble nature.It is not needful to dwell minutely on the early years ofTasso, though they were indeed marked by a marvellous precocity. At six months old we are told he began not merely tomove his tongue, but to speak. His great susceptibility likewise early manifested itself, and was fostered rather thanallayed by the circ*mstances of his religion, as it is said thatat nine years of age he made his first communion, “ participating in the mystery with the deepest fervour and devotion,though not fully understanding it." While still very younghis ardour in his studies was great, and at Naples, under the instruction of the Jesuits, he attained some proficiencyin Greek; in reading, speaking, and writing both prose andverse, he attained such facility as at ten years of agepublicly to recite some of his own compositions.His father's chequered and wandering life had necessitateda temporary separation from his wife and family, and, unableto accomplish his desire of rejoining them, he determined onhis son Tasso coming to him. The parting between hismother and himself was an anguish to both, and they were1876. ] Torquato Tasso. 391never destined to behold each other again. He became thesharer of his father's vicissitudes, but also the object ofthat father's solicitude and pride and love, and Tasso maintained for his father throughout life and for his memory afterdeath the strongest regard and affection .For some time his father would appear to have been anxiousthat his son should be trained to some decided occupationor profession, and not live as he had himself done, dependentupon the favour of princes-a courtier's precarious existence. Torquato eagerly availed himself of the opportunities of acquiring learning and knowledge which his father,in spite of straightened circ*mstances, provided for him; buthis father's desire that he should be settled in the legal profession was wholly repugnant to him. At Padua, whilehe attended in form the lectures upon law, he gave far moretime and attention to those on philosophy, poetry, and eloquence, and indeed was composing an epic poem when insupposed attendance on law lectures. * Soon after this, atBologna, he began his great epic the " Jerusalem Delivered. "His father's pride and delight in his son's achievements andsuccess in poetry probably reconciled him to abandoning hisother views for him, though he saw, in that event, no otherprospect than that Tasso should enter on the courtier's lifewhich he had so often deprecated.His father would seem soon after this to have exerted himself to make interest with his own former patron CardinalLuigi d'Este, to whom by his directions Torquato had already dedicated his " Rinaldo. " After some interval theCardinal gave Torquato an appointment among his gentle- men, and summoned him to Ferrara so that he should arrivebefore the expected entry of the Arch-duch*ess of Austria, thebetrothed of Duke Alfonso the Second, the Cardinal's elderbrother. Thus, at twenty years of age Tasso arrived atFerrara and was evidently almost at once taken into extremefavour by the d'Este family. Cardinal Luigi remained himselfabsent at Rome, and Tasso would seem to have been in constant attendance at Alfonso's court, and to have been distinguished by the greatest kindness, not from the Duke alonebut from both his sisters, the Princesses Lucrezia andLeonora. In the society of the Princesses he now passedmany hours, reading to them his own poems and composingsonnets in celebration of their even minutest doings and occuDuring his first year at Padua, he wrote his first epic poem " The Rinaldo."XXII.26392 Torquato Tasso. [Oct.,pations. They obtained for him the privilege, regarded asa coveted distinction, of dining at the "tavolo ordinaria," thedaily table of the Princes themselves. And here for a briefperiod we may behold Tasso in the happiest portion of hislife, beloved and honoured, distinguished by the affection andkindness of the d'Este family; he had attained a position hehad himself coveted, and realizing in a measure his owndreams of pre-eminent favour and distinction-and this atonly twenty years of age. It is worthy of note here that evennow, at this age, and in these happy circ*mstances, Tasso'staciturnity and gloominess, and his great absence of mind arealready spoken of as being very manifest; it is said that"he could when he pleased " (rather, we should imaginewhen sufficiently wrought upon and drawn out of himself bythe excitement of society and that emulation which had suchpower over him) " throw the greatest brilliancy and charmboth of manner and eloquence over his carriage and conversation in society."Tasso had thus early attained almost the summit of hiswishes, and if we now trace the sad decline and fall of all hishopes, we shall have to seek the cause far more from withinthan from without, and be forced to admit that, allowingeven for rivalries, jealousy, envy, or even also for maliceand detraction, which the great honour and distinctionin which he was held may have drawn upon him from lessfavoured aspirants, the real cause of his future calamitieswas the disastrous malady that beset him; the morbidtone of his mind being, perhaps, more fed and fosteredin his exalted position than if he had remained obscureand unknown. Tasso himself admits the insatiable loveof praise and self-exaltation that existed in his nature.We find him acknowledging in a letter:-" I marvel that Ihave never written down the promises which I make myself,and the gifts and the graces from emperors, kings, andmightiest princes, which I am always imagining and forming at my will. " Such a nature, possessed with so exaggerated a notion of its merits, and such prolific imagination ofrewards and honours showering upon it, would be injuriouslyexcited and moved by many honours and distinctions actuallybestowed upon it, rather than beneficially influenced and madereally happier.With regard to the alleged attachment of Tasso to thePrincess Leonora, upon which, according to some, all hismisfortunes hinged, the most substantial arguments in1876.] Torquato Tasso.393proof of its existence seem to be many exaggerated expressions in poetry, in which, it must be observed, it isnecessary often to infer that Leonora was the object of them.Had she been certainly so, this, indeed, would not renderthem a proof of any weight-the hyperbolical language ofpraise and adulation of that age must be taken into account; in fact, Tasso could not well have used strongerlanguage than in praise of Alfonso at a time when, according to his biographer, he had conceived a well-foundedhorror and distrust of the Duke; and in the days of his firstfavour with the d'Este family it was his custom to recordtheir doings in lyrical effusions, devoting his talents toexalting and extolling them-not Leonora alone, or evenprincipally or specially, but her sister also, and the Duke himself.On the whole, it must be said that the proofs of any realattachment on his part to the Princess Leonora would seemto rest on very slight foundations, if indeed they can be saidto have any true ones. On the contrary, the supposition ofit is at variance with much in his own conduct, and withexpressions in his letters to intimate friends, while many circ*mstances in the conduct of herself and her own nearestrelations -the Duke himself and the Princess Lucreziarender the fact of it, or of their having entertained anybelief in it, wildly improbable. Is it conceivable that when,later on, Tasso's illness was first coming on, had the Dukebeen acting in anger towards him, and had he believed in theexistence of a presumptuous attachment, he would haveallowed him to accompany him to Bel-riguardo, and to be thespecial guest of Princess Leonora herself, by her invitation?Surely it is far more reasonable and consistent to supposethat they saw in the change that came over him, with deepregret, the dread malady that threatened their honouredfavourite, and sought to avert the impending calamity,and to soothe him by timely rest and absence from Ferrara.This is somewhat anticipating what is to come hereafter.But in tracing the further steps of his sad life the question must arise whether in this point also and throughoutthis matter injustice has not been done to Alfonso andthe d'Este family; failing to see whereinthe Duke manifested displeasure or illwill, we rather find much concernand solicitude, and patience and consideration too, shownin his treatment of Tasso, more especially when we rememberhow in those days madness was viewed, and how the victims394 Torquato Tasso. [Oct. ,of it were shunned. And quite consistently we may believealso that Alfonso may have at last felt and evinced irritationwhen Tasso refused to submit to treatment, persistentlyreturned to Ferrara, to fly from it again, spreading abroadhis belief of Alfonso's wish and intention to compass hisdeath.After a time Tasso was summoned suddenly to the deathbed of his father. Even here one might trace his inability tobear much painful strain in life, as we read that his anxietyduring his father's illness, and his grief at his death, broughton a dangerous illness. On his recovery he returned toFerrara, and from thence, at the close of 1572, accompaniedthe Cardinal into France, and at the Court of Charles receivedfrom the King and from others many marks of distinctionand favour. Here something of that restlessness of spirit,which was to manifest itself so greatly hereafter, first declared itself; a suspicion likewise of the dislike and enmityof others towards him evinced itself, without any real groundapparently for his entertaining such a belief. We are told—" Tasso moreover was beginning to be desirous of quittingthe service of the Cardinal, or rather of returning to Ferrara. He speaks in one of his letters as if Luigi wereangry with him, but no sufficient reason appears why heshould be so. " Mr. Milman supposes that the Cardinal mayhave withdrawn his usual allowance, or given other tokens ofdispleasure, when he found that Tasso wished to leave him;but unless any more reason than is given in the textexisted for such a supposition, it is hardly borne out.Tasso requested his dismissal, which the Cardinal granted,wishing him, however, to defer his departure for a while;the subsequent illness of the Cardinal further delayed it;but in December they left France together, and arrived atRome, where, as his biographer admits, the reality of angeron his patron's part would seem to be little proved, Tassohaving been kindly and honourably entertained in the houseof that patron's uncle, the Cardinal of Ferrara.The poet's desire was to obtain a situation in Alfonso'sservice, and to this the two Princesses contributed their aid.The Duke willingly accorded his wish, allowing him a specificsalary, and conferring a greater benefit on him in exempting him from any particular duties, that he might haveleisure for his studies, and for the completion of his greatpoem. How unlikely that, either the Princesses shouldhave urged, or the Duke have acceded to, his wish to enter1876.] Torquato Tasso. 395his service, had any attachment existed, or have been evenerroneously supposed to exist, between himself and thePrincess Leonora! Now, in temporary quiet and repose at theCourt of Ferrara, he finished his poem, " The Aminta, " andit was represented at the Court with every requisite accessory,including the choicest music, Tasso himself directing all, andItaly resounding with applause.In this record of his life, so greatly is it dwelt upon thathe suffered much persecution and neglect, much afflictionand want, that we cannot but remark how often we learnthat honours and praises were lavishly showered upon him;even affluence was sometimes his, and at other times pressedupon him, but rejected by him: he could not rest evenwhen in possession of it. That he did at length suffermuch distress and poverty is too true; but this came aboutthrough actions of his own, not avertible by others, and tooprobably beyond his own control. At this juncture of somuch applause and renown, we are told that " from this timethe origin of his misfortunes is dated. His triumph andrenown, and favour with the Royal Family, awakened thejealously and malice of the courtiers. They began tolay their trains from this moment of his prosperity. Theywere, for a season, carefully disguised; but, before long, theirworking was only too evident, and from that hour Tasso wasnever altogether free from suspicion and alarm." But it isnecessary, in no captious spirit, to bear in mind that at aboutthis time his bodily health had begun to suffer; he had accompanied his patron Cardinal Luigi to Venice, and in thehot, unhealthy season had succumbed to an attack of ague,from which, or its consequences, he suffered during manymonths. As the bodily effects wore off, the mind would appear to have become more morbid and disturbed . Now wefirst hear of his return of restlessness, of his wish to quitFerrara, without assignable cause for doing so, and of hisdesire to go to reside in Rome. We are told that " he musthave had strong reasons for projecting this change of residence," and that " it is plain that he had strong suspicions ofimpending danger; " but we are afforded little reason for oneor the other of these assertions. It is said, however, thatsome interruption of his correspondence with Scipio Gonzaga took place about this time; and Gonzaga, to whomTasso had written of his danger and his fears, seems to havebeen desirous that he should exchange the service of Alfonsofor that of the Grand Duke of Tuscany, and on Tasso's396 Torquato Tasso. [Oct.,arrival in Rome Gonzaga exhorted him to do so. To this,however, he would not accede, purposing ultimately toreturn to Ferrara; and, in justice to him, it must be remembered that, in the first instance, he desired to visit Rome,and did travel there and to other cities also, that he mighthave the opportunity of obtaining the judgment and criticisms of poets, and of others whose opinions were of value to him, upon his poem of "Jerusalem Delivered." But in themidst of his own anxiety with regard to the bringing out ofhis poem, and the ardour and impatience with which it wasbeing looked for by others - showing the renown to which hehad already attained-the calamity of increasing illnessseems to have come upon him. His biographer reverentlytraces the afflicting hand laid upon him, chastening and correcting him just as his character needed such purifying andchastening; we must needs, however, see the real outcome ofthe tendencies of his nature, which had been latent orpartially manifested for years.From this time we find him pursuing a very restlesscourse, and constantly influenced by vague and, apparently,in great measure, groundless fears and suspicions, severaltimes quitting Ferrara, sometimes in almost a horror of apprehension, but anon, without change of circ*mstances towarrant it, voluntarily returning there again, or earnestly desirous of doing so. There does seem to have been somesecret interference with his papers, for what purpose itdoes not appear; it may be that as his strange suspicionsand assertions had already gained some publicity, therewas an endeavour made in his absence to seize upon hispapers to discover what assertions he might be making inthem. The discovery that his papers and locks had beentampered with, wrought to a still higher pitch Tasso's disturbed state of mind, and he began to dread accusations ofheresy before the Inquisition. He meditated flight, yetstill lingered at Ferrara, and himself appealed to the tribunalof the Inquisition to forestall the terrible denunciation hedreaded. We read that " His justifications were accepted,and the Duke caused some favourable expressions to beconveyed to him, as if to cure him of his terror. " Throughout it is the same: the Duke with apparent considerateaffection trying to allay his fears, to soothe and calm him;and it was at this time that the Princess Leonora receivedhim as her guest for some days at a palace of her familybeautifully situated on the river Po.1876.] Torquato Tasso.397His biographer would have us look even on this visit as asnare set in his way, but there seems no just cause for soconsidering it. Tasso returned from it only little improved,and terrible fears of being secretly made away with grewstronger and stronger. Soon after, he meets, in the court ofthe ducal palace, the (as he believes) treacherous friend whohad been an actor in the searching of his papers, and expostulates with him; the friend replies in anger, and, it is said,with revilings and insolence; Tasso strikes him in the face. Asubsequent encounter takes place; Tasso is slightly wounded,though defending himself victoriously against three or fourcombatants. Tasso appeals to the Duke for justice. Mansosays that Alfonso had him arrested, but Serassi affirms theDuke to have been full of attention and kindness . Tassohimself says that he had remained in his room some days,but had paid a visit to the duch*ess and to the PrincessLeonora. Soon Tasso believed that new enemies werearising, and he was induced to go to Modena for a time.The change and congenial society there for a while did himsome good, and temporarily had some effect in lessening hisdisquietude. He was then again greatly disturbed byreceiving a forged letter, purporting to come from his greatfriend Scipio Gonzaga, but full of reproaches and scornfultaunts against his poem and his own character. Tasso mustdoubtless have incurred the enmity of some who executedthis cruel forgery to distress him; at the same time he wasfrom many receiving the most flattering letters and verses.He again returns to Ferrara, then again thinks thatmalicious eyes are following him, and is anew filled withdread of the Inquisition .About this time he appears to have dwelt much upon hisspiritual state, passing in reviewhis past life, rejoicing in hisrenouncement of the sins of his early life, and, one is temptedto say, morbidly analysing his past doubts and feelings, as amind and temperament like his would be prone to do. Thencomes the remarkable confession: " And often I heard,horribly resounding in my imagination the angel trumpetsof the great day of rewards and punishments. And I sawThee sitting upon the clouds, and heard Thee speak thealarming words, ' Depart ye cursed into everlasting fire,' andthis terror pressed so heavily upon me that I was frequentlyforced to impart it to a friend or acquaintance; and if inconfession I omitted any fault from negligence or shame,however trifling and unimportant, I would reiterate the398 Torquato Tasso. [Oct.,confession again and again, often repeating the general confession also." And so he proceeds to comment minutely onhis state of mind and feelings in a similar strain to that sooften heard by those who have listened to the coherent selfreproaches and subjective revelations of diseased minds, inhis case heightened by the vivid imagination of a poetand the terrible beliefs of that age. Meantime, thoughhis fears and suspicions still abounded, his renown seemsto have been increasing. He was possessed with an intense jealousy of any rivals to fame, and, one would say,had an insane attachment to his patrons-an exacting one,full of suspicions and doubts of them, yet uneasy whenvoluntarily absenting himself from them; doubtless in thosetimes, when those who had offended were secretly put todeath and no certain tidings were ever forthcoming, therewas enough to work terror in one who imagined he had givenoffence and was suspected of treason, but the proof is notmanifest of any enmity or secret evil design on Alfonso'spart towards Tasso. It much more strongly appears thatgreat consideration and forbearance were shown, true concern felt at the failing of so great a mind, and that bothregard and sorrowful compassion led Alfonso and thePrincesses to try many means to restore his mind or alleviate his state; but in all probability his mind was so full ofstrange suspicions and jealousies, that Tasso's presence hadbecome a danger, and reluctantly, at last, some restrictionwas forced to be placed upon him.He was arrested one evening in the rooms and presence ofthe duch*ess of Urbino on a charge ofhaving, in a fit of frenzy,seized upon a knife and raised it against one of the attendants,and he was then confined in some rooms overlooking the courtyard of the Palace. Maffeo Veniero writes to the Grand Dukeof Tuscany that he had drawn his knife upon a servant in thepresence of the duch*ess, and says that he was apprehendedrather with a view to the cure of his disorder than forpunishment; and it would be difficult to conceive a morevalid cause for interference, or that any milder course couldhave been pursued . Reflections that the evil Tasso had beendreading had now come upon him, as if from evil machinations against him, truly seem out of place and unjust at sucha crisis . Keenly he felt his confinement, entreated and supplicated to be released, promising to have himself cured; forit is needful of special remark that Tasso himself admittedthe illness his biographer would, as if a disgrace to him,1876. ]399 Torquato Tuss0.deny. The Duke consented that he should return to his ownapartments on condition of submitting to medical treatment.He renewed his expressions of compassion, and after a timedesired that he should accompany him to his country palaceof Bel-riguardo. Tasso's accomplished biographer strangelyseems to view all in a similar light to that in which Tassothen did, as a subtle art and design with evil intent on theDuke's part, this being exactly the view that a man inTasso's state of mind would take of the most simple acts ofkindness; but it does cause surprise that a biographer,years after, should dispassionately coincide in such unreasoning beliefs and imaginations. Alfonso is held up as a veryadept of wicked art and design in all his words and acts atBel-riguardo. Apparently the time passed with him thereconvinced the Duke of the hopelessness of Tasso's state, andthe impossibility of leaving him at liberty. He was then, byAlfonso's directions , carried back to Ferrara, and confined inthe convent of St. Francesco.On the Duke necessarily fell all the responsibility oftaking this step, and on him, apparently, has also fallenthe odium even to the present day. It was not likely thatTasso himself should believe in the necessity or admit thejustice of the course taken, yet he does seem to be in ameasure conscious of his state and need of treatment,though he writes to Alfonso that he is not so much madas Alfonso deceived. "You believe," he says, " that youhave delivered me from the Inquisition , and I am only themore entangled in it. " The Duke forbids correspondencewith himself or writing to the duch*ess. Tasso findinga moment when he was unguarded, escaped from theconvent. He managed to make his way across the Romanterritories and over the mountains of the Abruzzi intoSorrento, where he had a sister, Cornelia Sersale, a widow,residing. Here he remained almost in hiding, as it wouldappear that he was under sentence of condemnation for treason in Naples. The entire quiet, rest, and change of scene,and the companionship of his young nephews and nieces,had a most beneficial influence on his state, and he became much calmer and better for a while; but ere a yearhad passed, the old restlessness came upon him, andthe determination again to return to the place he had fledfrom, although allowed to dwell unmolested in peace where he now was. We are told that the Princess Leonora wroteurging his return to their Court, but this is at variance with400 Torquato Tasso. [Oct.,the declaration of the Duke. " If he proposes to return, wewill condescend to receive him; " but goes on to say that hemust acknowledge his melancholy humours, consent to keepquiet, and to put himself under treatment; that if he againutters such words as he had formerly done, and refuses medicaltreatment, " we shall forthwith banish him from our states,with a charge never to return any more." But in spite ofthis, and of the warnings and persuasions to the contrary ofhis friends and relations, Tasso was bent on returning to Ferrara, and did so in the February of 1578. But he is nosooner arrived there than he is bitterly disappointed at findingthat no apartments are assigned to him, and that he is notreceived at Court. He again fled from the place, and thistime to Mantua, but the Duke refused to receive him. Theignorant fear of madness which then prevailed was probablythe cause of the coldness shown to Tasso occasionally in hiswanderings, when, uninvited, he appeared at other courtsafter leaving Ferrara. Vincenzo Gonzaga, the Duke's son,however, showed him much kindness and regard, but he hadnot much in his power to do for him, and the unhappy Tassofell into great poverty. He wandered to Padua, to Venice,everywhere an unwelcome guest, all shunning and dreadinghim as one " from himself ta'en away." One nobleman at Venice interceded for him with the Grand Duke of Tuscany,in whose service Tasso then desired to be. This appeal was unsuccessful.Tasso went to Urbino, where he might, as far as can beseen, have rested in safety, the Duke of Urbino being fullof kindness and affection. Here he writes the strange statement that to return to Ferrara is in his power, for thathis departure tormented Alfonso, who had sent a gentlemanby post after him to prevail on him to return. If this wereso, probably the many assertions and accusations made byTasso against the Duke may have influenced him in makinghim unwilling that Tasso should be wandering from Courtto Court, spreading these assertions . Tasso goes on to addthat since his departure " there have been many princeswho would have gladly received me into their service, " whichstatement is quite at variance with the picture we have hadset before us of the distress and want which he had suffered,and is possibly rather due to his exalted and erroneousimagination than to facts. Tasso, discovering that therumour of his madness had spread far and wide, besoughthis friends, and especially Scipio Gonzaga, to banish this1876.] Torquato Tasso.401false imagination; but is it usual that the fact is admittedas truth by him who is the victim of the disease? Speedilycame the old return of restlessness, and at this time he atfirst admitted the necessity of, and submitted to, somemedical treatment; however, after a while suddenly andsecretly he set forth from Urbino, travelling towards Savoy,as under the Duke of Savoy he had now determined toseek shelter. On the way he was hospitably entertained,and probably recognised, his wanderings being by this timewell known; his appearance was striking, his stature unusual, and his features must long have been made familiarby portraits to those who had never hitherto beheld him.At Turin he was thus recognised by Angelo Ingegneri,a distinguished Venetian. He introduced him to the palaceof the Marquis d'Este, who had known Tasso in former daysat the Court of Ferrara, and who now received him withthe greatest hospitality and kindness. Others, too, ofrank and distinction vied with him in honouring Tasso,and would gladly have received him into their houses.Nowhere do we trace neglect or unkindness, and yetagain the eternal unrest seizes upon him, and the unreasoning desire to return to Ferrara, from which he hadtwice fled in such apparent terror and horror; again hespeaks and thinks only of returning, of " undeceiving andconciliating Alfonso. " Those about him earnestly dissuadehim-entreat him to remain in quietness and happiness atTurin. Alfonso sends the reasonable intimation that he iswilling to receive Tasso back if he will submit to medical treatment and to his guidance and direction. Tasso is dissatisfied,speaks again of Alfonso as of him who " guided him, whoimprisoned him, who promised to him, who deluded him,"-still seems tohavethought some " glorious return " should havebeen his to Ferrara; yet his friends cannot long succeed indetaining him at Turin, and the celebration of Alfonso'sthird marriage determined him on returning. He returnsagain, and miserable is it to read of his position there, so different from the once exalted one he had held, and so differentfrom his own imaginings, for, blind to all the sad changeswrought in himself, he dreamed that to repair to the samescenes must be to recover the happiness and the distinctionof the never-to-be recalled past. The author speaks, as a reproach to the d'Este family, of their doors being closed againsthim-no promises fulfilled. But it would seem to be alwaysin a season of returning excitement that the wild desire to402 Torquato Tasso. [Oct. ,return to Ferrara came upon Tasso, and be was at that timeprobably most unfit for the notice and honours he then mostcoveted. Miserable and suffering, Tasso breaks out in lamentations and reproaches against the Duke and his Court. ByAlfonso's order he is again apprehended, with many expressions of the Duke's concern. Why are we to believe themotherwise than sincere? In former days he and his family hadhad Tasso constantly with them, had shown him unwontedkindness and favour, and when it was impossible to retain him with them on the old footing had forborne to interfere with him or lay any restraint upon him as long as itwas practicable. We must charitably believe Tasso's statewas a sorrow to them, but that his illness had increased.He is now declared to be mad, and placed in the Hospital of St. Anna, in which the insane of various classeswere confined. And here indeed it is too likely his miseryin the then wretched condition of such abodes -unclassified,untended except by ignorance, and that instigator of cruelty,fear-may need no heightening of exaggerated languageor sensational terms to depict it; too well, to those whohave knowledge of these things, are the horrors of suchplaces in even much more recent days known, and appallingwould it be to Tasso's refined, sensitive, and exalted natureto find himself amid such surroundings. But to attributethis to cruelty or even want of feeling on Alfonso's partwould be most unjust. They knew no other course, norrealised madness but as something terrible, utterly removing a human being from his kind. Far later, fearfulwere the revelations of the state of some of the ItalianAsylums. Thankful we may be if even yet reform has comein all of them; we know that much later than Tasso'stime it had not so come in England. His condition insuch an abode was indeed most pitiable, for there is no doubtwhatever that he was perfectly well able to estimate the horrorof his position and of his surroundings.There is abundant evidence of the illness that existed--Tasso himself at times was aware of and admitted it; but hespeaks with anguish—and it is an anguish to read- of hisfearful dread of endless imprisonment, and how the indignities to which he was subjected increased it-the foulness ofhis dress, his hair, his beard, the filth and damp around him,and the awful solitude. This last do we not fail sufficiently torealise even now for those who are thus isolated, though without the horrible and degrading aggravations of those days?1876.] Torquato Tasso.403His biographer feelingly and truly reflects: " He had lovedrenown, society, the sweet face of nature, the praise of men, the affection of women. He had been delicate in hisfood, particular in his dress, fastidious in his person. Hehad a dread, we have seen, as many imaginative personshave, of confinement, of scorn, of solitude. The cell inwhich he was shut up, was narrow, dim and unfurnished;there was no prospect from it. His only objects of viewwere the blank damp walls around him, and " the gate evershut in his face!" a terrible picture indeed-all the more terrible as being probably true. It was the usual treatmentpursued in the ignorance of those days; it in nowise provesthat the lamented Tasso was falsely said to be mad. Milmanwonders that his biographers speak often so lightly of hiscalamities. He cannot surely have reflected how custom dullsthe power to realise torture and cruelty systematically inflicted, and knew not perhaps how, not in Tasso's day only,but, much later on, those esteemed as mild and benevolenthave complacently been aware of miseries enacting undertheir own sanction and taken no step to alter them. Tasso hadwriting materials accorded to him, which in such times must,one would imagine, have been an exception especially made in his favour. Doubtless the use of them was an infinite resourceto him. His biographer remarks on his courage and self- command in being able to use them; but, on the contrary, itwill be well known how in such states of mind as Tasso'sthen was, such a means is eagerly grasped at andabundantly employed, as by him, in letters of entreaty for release, and also even in original compositions; sothat we marvel not, even in those terrible circ*mstances,to learn that he composed poetry and elaborate philo- sophical dialogues. Ill -judged and miserable as was thesystem and treatment, it is no wonder the unhappy Tassolanguished and grew worse; at the same time he wouldhardly seem to have been intentionally neglected or forgotten, but received occasionally a visit; one from Vincenzo Gonzaga, the young Prince of Mantua, which cheered andreanimated him for a time. He wrote again after the visit,and described the communion he held, in imagination, withspirits in his solitary cell. It is evident that Tasso heardvoices at this time, and also that he was in some sort awareof his alienation of mind, though hardly able to understand what it was or whence it had arisen; he seems to havefelt it might be a malady allied to genius. He was conscious404 Torquato Tasso. [Oct. ,of a deep melancholy possessing him and writes-" Thosewho are melancholy, not through any malady, but bynature, are of singular genius, and I am melancholy fromboth causes. "A great trial came to him at this time in the publication,without his knowledge or consent, and in a most imperfectcondition, of his great poem, "Jerusalem Delivered, " towhich he had looked forward to bring him lasting renown.He had delayed its publication in order to bring it to greaterperfection. The edition was printed in Venice, CelioMalaspina having obtained possession of those parts of thePoem which had been submitted to the perusal of his master,the Grand Duke of Tuscany. Soon after this the PrincessLeonora, who had been gradually declining, died. Tasso hadduring her illness transmitted to her a message expressive ofdeep grief at her illness. It is surely a straining indeed forhidden motives and influences to conceive, as his biographerdoes, that Tasso's reluctance to lament her illness in verse,arose from a knowledge of the danger of his doing so, andstill more far-fetched to suppose, as he inclines to do, Leonora's failing health to be attributable to Tasso's confinement, or that it was in any way, but coincidently as to time,connected with that. As for Tasso himself, sincerely as hemight have been attached to both the Princesses, his owntroubles at this time far outweighed probably all other sorrowand losses; his health was weakened, his long imprisonment and the apparent almost oblivion into which he hadnow fallen had reduced him to hopelessness . Shortly beforethis time Montaigne had visited him and writes, " I had evenmore indignation than compassion when I saw him atFerrara in so piteous an estate, a living shadow of himself and of his works."But his poem of " Jerusalem," now published, was praisedon every side; still the unhappy author was languishing inhis miserable " estate. " Whether his condition mentallynow became somewhat ameliorated and led to an improvement in his treatment, or that it had been represented toAlfonso how dreadful this treatment really was, he was removed to a better apartment, to which another was afterwards added, large enough, he said , " to walk in and philosophize. " Prince Vincenzo Gonzaga again visited him, andTasso began to be hopeful of release; Maurizio Cataneo,Secretary to Cardinal Albano at Rome, giving him encouraging assurances from his master, and wisely urging him to1876.] Torquato Tasso. 405speak and write of Duke Alfonso with greater respect. Hereceived also a letter from his sister Cornelia, telling him ofher being again married, and she and her husband, FerranteSpeziano, gave Tasso pressing invitations to come to them atNaples; a cousin, also, of Duke Alfonso's, lately married tothe Marquis of Massa and Carrara, charmed with Tasso'spoem, obtained permission for him to pass a day at her villa.Here he entered with enjoyment on some of the old subjectsof discourse, and it must have seemed as life to the deadindeed to find himself in scenes of refinement, and againparticipating in intellectual converse, after the way inwhich he had lately lived. His confinement was, however,still continued; but had Alfonso been purposely wrongfully confining him and declaring him to be insane, knowing him not to be so, he would have jealously excluded himfrom the sight of others, instead of allowing them, as hedid at this time, to flock to see him. That some of thesevisitors, even those distinguished by ability, should havethought him to be quite sound, is no proof that he was so,when we take into consideration the notion of madness then,and much later on, or even now commonly entertained—thata man could no more converse at any time or on any subjectas a rational being if mad, and that one who had the powerto do so could not certainly be mad.Amongst others who thought much of him at this timewas Angelo Grillo, a monk of Monte Cassino, a philosopher and a poet; he seems to have gone to Ferrara onpurpose to help and comfort Tasso, to have obtained leavefrom Alfonso to visit him as often as he wished, and tohave spent whole days with him, doubtless, indeed, muchconducing, not to his comfort alone, but to his restoration. Tasso, also, from various quarters, received manypresents in money at this time. His bodily health hadnow terribly given way, and in his weakened state his mentaldistresses and apparitions beset him again more powerfully.He writes thus to a professor of medicine at Padua, whoseadvice he desired-" It is many years since I have been unwell, and what my complaint is I know not; nevertheless,I certainly judge myself to be ill. But whatsoever is thecause of my disorder, its effects are these: intestinal pain,with somewhat of a flux of blood; ringings in the ears andhead, sometimes so strong that it seems to me as if therewere in it one of those clocks which strike; unceasingmental images of all kinds, but all painful, which disturb me,406 Torquato Tasso. [Oct. ,so that I cannot apply my mind to my studies for fiveminutes together. And the more I force myself to attend,the more I am distracted with those changing apparitions,and sometimes, with most violent disgusts, rising up in meaccording to the various fancies which present themselves.Besides this, after eating, my head fumes and burns, and inall the sounds which I hear, I keep imagining a humanvoice, so that it very often seems as if inanimate things werespeaking to me." He was advised to submit to a cautery inthe leg, to abstain altogether from wine, and to have recourseto broths and gruels; but Tasso was not willing to followthese prescriptions.Angelo Grillo exerted himself earnestly to promote Tasso'srelease; Alfonso had Tasso brought into his presence, andpromised that before long his liberty should be given him.Under some care and supervision he was now allowed to goforth occasionally to pay visits and attend spectacles and alsomass and confession. Then after a while he was again muchmore secluded, and not permitted to be visited so freely;perhaps too much had been attempted, and an unfavourable change in Tasso's state caused this renewal of greaterseclusion. A. C. M.66(To be continued. )Case of Sudden and Complete "Aphasia " and PartialRight Hemiplegia," Lesion of " Broca's Convolution, "with a Small " Haemorrhage " in Substance of CorpusCallosum, &c. By RINGROSE ATKINS, M.A., M.D., &c. ,Assistant Medical Officer District Lunatic Asylum , Cork.The particulars of the following case may be sufficientlyinteresting to place on record, as bearing on the morbidanatomy of aphasia, and, further, as illustrating the negativeresults which follow localised destruction of convolutionsposterior to the " Fissure of Rolando. " The patient, an elderlyimbecile female, had been an inmate of the Cork DistrictLunatic Asylum for the last forty-five years. She was invariably quiet and docile, clean in her habits and person, andsufficiently rational to answer ordinary questions addressed toher quite correctly. She spoke slowly, and with emphasis, butalways used the right words to express her meaning; andthere was never any noticeable defect in her speech, so far as1876. ] Case ofSudden and Complete Aphasia.407her powers of conversation went. She had a peculiarly longand pointed tongue, which she took a pride in exhibiting, andwhich she was able to protrude to an enormous extent. Therewas no loss or deficiency of motor power whatever, and up tosome little time before her death her general health was excellent. On December 29th, 1875, she suffered from a severeattack of erysipelas of the face and scalp, which was, however, subdued in a few days by inunctions of mercurial ointment and liberal support. During this time she becameextremely dull and apathetic, being with difficulty roused;but on being pressed could still answer questions rationally.As the erysipelas passed away she returned to her formercondition, being quite as well and as intelligent as before .On March 19th , 1876, she became affected with a cough; andon March 21st she rose in the morning as usual, and enteredthe day- room of the ward, and a few minutes after she wasnoticed by the attendant to be nodding her head in a peculiarway, being seated in an arm-chair near the fire. On beingspoken to, it was found she had become quite stupid andspeechless, being unable to utter a word; and on raising herthere was evident loss of power in the right limbs.On myseeing her shortly after, I found her stupid, though easilyroused when spoken to, and she then apparently recognisedme, and made attempts to speak, but could do no more thanmumble inarticulately. The lips -normally flabby-were inflated at each expiration; she could or would not protrudethe tongue when asked to do so, either from inability or notunderstanding what was required; there was great difficulty,almost amounting to inability, in swallowing, the fluid regurgitating. The limbs of the right side were partiallyparalysed; on raising the arm she could retain it in thatposition for a little while, but had no power over the hand,the wrist dropping. There was no apparent loss of sensibility, as she endeavoured, and could partially succeed, indrawing away the leg when the skin was pinched; reflex excitability, as tested by tickling the soles of the feet, beingsimilarly unaffected . There were no muscular spasms orconvulsions. Towards evening she became brighter, and onthe next day regained, to a certain extent, the power ofswallowing. For the next few days some improvement tookplace in the motor symptoms, the right arm and leg possessing more power, as she was able to extend and flex the limbspartially when requested to do so; whenever she attemptedto get out of bed and stand without assistance, she used to XXII.27408 Case of Sudden and Complete Aphasia, [Oct. ,roll round from right to left, shewing the little support whichthe right leg afforded. Meanwhile chest symptoms set in:being unable to bring up the secretion, the lungs and bronchifilled, and she gradually sank and died, mainly from thiscause, on March 31st, 1876, ten days after the seizure, thespeechlessness having in the interval been permanent, whileshe had regained considerable power in the right side and become brighter; at no period, however, being as intelligent asshe was previous to the attack; generally lying in an apathetic state, and only rousing herself when spoken to.Post-Mortem Examination Two Days after Death. - Theskull was unsymmetrical, and retained infantile characteristics; the right parietal bone was bulging, the left somewhat flattened; the occiput was projecting, and the sutureswere quite distinct. On removal of the calvarium , whichwas of normal thickness, and easily cut through, the duramater was found to be intimately adherent to the bone atthevertex over the longitudinal sinus, strips of the membraneremaining when the latter was removed; the dura mater wasalso attached to the arachnoid at either side of the greatlongitudinal fissure, but capable of being separated withouttearing the latter membrane, and was not elsewhere considerably thickened or opaque. About 4 ozs . of saniousserum escaped during the removal of the organ. The piamater was not thickened, or much congested, and wasgenerally easily stripped from the convolutions, which wereatrophied and widely separated . On raising the tip of thetemporo-sphenoidal lobe of the left hemisphere, a number oftortuous vessels were seen lying on the inferior surface of theposterior part of the frontal convolutions running outwardsinto the fissure of Sylvius: one of these vessels was completely blocked with granular detritus, and could be traced,feeling cord-like under the finger, running in the pia materto the region of the island of Reil: that membrane couldnot be here raised from the convolutions without bringinga portion of the brain substance with it, owing to localisedsoftening having taken place. The convolutions thus affectedwere the tip and lower portion of the posterior part of the thirdfrontal at the edge of the sulcus præcentralis and a smallportion of thetip of the anterior central gyrus (Ecker) , whereit joins with the third frontal and posterior central gyrus toform the operculum; and the softening extended inwards, so asto cause a patch as large as a florin on the surface of theisland of Reil. The brain substance in these places was1876.] by RINGROSE ATKINS, M.D. 409much diminished in consistence, breaking down when touchedwith the finger, and coming away with the pia mater as thatmembrane was removed. The remaining convolutions of theleft hemisphere, though shrunken and widely separated bybroad and shallow sulci, shewed no other localised lesions .The convolutions of the right hemisphere were similarlyatrophied, and the superior parietal lobule for an inch and ahalf of its length, as it ran parallel to the posterior centralgyrus, was broken down throughout its entire thickness intoa greyish-black pulp, in which minute black dots were scattered, and to the surface of which the pia mater was intimately adherent. This lesion was evidently due to oldhæmorrhage. Involving the first and portion of the secondoccipital convolutions was a perfectly similar patch of pulpysoftening as large as a florin, and separated from the formerby several healthy gyri. The ganglia at the base of thebrain and the medulla oblongata were healthy; the vessels inthis situation were studded with patches of atheroma. Ondissection of the organ, a small clot, of about the size of athreepenny piece, was found in the substance of the corpuscallosum, a little anterior to its centre, and about half aninch to the left of the middle line ( the raphé): this was composed of three minute encapsulated clots quite separate, butlying in close contiguity to each other, and nearer to the inferior than the superior surface of the corpus callosum, occupying a position in it corresponding to the posterior third ofthe left corpus striatum, but not visibly affecting thisganglion. The clot was in no way connected with the lesionin the third frontal convolution, but was in a line runninginwards, and a little backwards from it towards the ventricles; the latter and their ganglia were quite normal. Thebrain substance generally was anæmic. A small portion ofthe softened substance of the third frontal convolution,examined in the fresh state, shewed the nerve cells to be inan advanced condition of pigmentary degeneration . A prepared section through the blood clot and the surroundingtissue parallel to the surface of the corpus callosum shewedthe fibres of the latter to be separated and broken; smallamorphous particles of hæmatoidin were scattered outsidethe capsules of the little clots in great numbers, togetherwith collections of fine yellow granules quite similar to thosefound deposited on the nerve cells in pigmentary degenerationof these structures . The walls of some of the minutevessels were coarse and thickened, and their outline irregular,410 Case of Sudden and Complete Aphasia, [Oct. ,being pouched and puckered here and there, with collectionsof nuclei scattered on them. Two little globular bodies wereobserved, which, from their similarity in structure to thevessels, and from the fact that a minute arteriole was continued from one of them, were, no doubt, aneurismal forma- tions which had become broken off from the vessels on whichthey had been formed. Several of the larger vessels drawnout from the brain substance near the site of the hæmorrhageshewed their coats thickened and twisted, with granularmasses and particles of hæmatoidin deposited on them, andat one spot was a group of plates of cholestearine.Remarks. This case is interesting, not only as addinganother to the already numerously recorded instances ofaphasia in which a lesion of the third left frontal convolution has been found post mortem, but also as being anexample of hemiplegia brought about by hæmorrhageinto the corpus callosum-a very rare situation for such to occur in . At first sight the lesions in the left hemisphere would appear cæteris paribus to sufficiently accountfor the prominent symptoms, the softening in " Broca'sconvolution " for the aphasia, and the clot in the corpuscallosum (by its influence on the corpus striatum beneath)for the partial right hemiplegia. When, however, weconsider the differences in the nature, extent, and dates.of origin of these lesions, and at the same time hold inview the simultaneous incidence of the aphasia and thehemiplegia, there are, I think, some points requiring explanation, which may be sufficiently interesting to brieflydwell upon, as bearing on important questions in cerebralphysiology.The late researches of Heubner shew that the thirdfrontal convolution is supplied by the first branch of thesecond order from the middle cerebral, and the island ofReil by an arterial network from the pia mater which ischiefly derived from small lateral twigs of several branchesof the arteria fossæ Sylvii . Hence, as one of these lattervessels, directly traceable to the region of the island of Reil,was found completely blocked and cord-like, it is probablethat the softening was the result of thrombosis, perhaps ofmore than one vessel in this situation, which took placeduring the attack of erysipelas of the face and scalp-a notinfrequent occurrence in that affection. If this be so, whythen did not the aphasia happen either at the time of thethrombosis, or, at least, pari passu with the consequent1876.] by RINGROSE ATKINS, M.D. 411degeneration? Its delay until the occurrence of the hemiplegia shews that in all probability the cause giving rise tothe latter was also a factor in the production of the suddenspeechlessness; and the explanation of this seems to me tobe somewhat as follows: The lower part of the inferiorfrontal convolution being destroyed was unable to perform itsfunctions, hence (adopting the hypothesis of Dr. Broadbent)the "way out " through the fibres connecting this part withthe corpus striatum could not be brought into use. Theupper portion of the convolution, however, still retaining itsfunctions, to a certain extent, through the connections ofmany of its cell processes, " words " there formed passed tothe motor nerve nuclei, partly by the radiating fibres fromthe corpus striatum with which this portion was still connected, but, to a greater extent, by the callosal fibres -on ahigher level -to the right inferior frontal, and thence throughit to the right corpus striatum, where they became translatedinto motor processes; the two centres being then bilaterallyassociated and co- operating together, and the right graduallycoming by education to take a larger share in the per- formance of their function than its injured fellow. On theoccurrence of the hæmorrhage in the corpus callosum, thecommissural fibres became broken, and hence the "wayacross " from the left to the right centre was interrupted,followed by complete loss of their functions; the left corpusstriatum being at the same time paralysed either from theeffects of the " surprise " or shock with which the entirehemisphere, weakened generally by atrophic changes, wastaken, or by some pressure exerted on it by the clot lyingabove it. Thus the partial right hemiplegia was produced,the fibres connecting this ganglion with that portion of the third frontal convolution which still retained its functionbeing at the same time paralysed; and hence the completeaphasia. As this condition of surprise passed off, or, as thepressure exerted by the clot diminished, as the latter becameencapsulated, the corpus striatum regained its power, andthehemiplegia gradually subsided; and had life not terminatedcomplete recovery would in all probability have ensued. Notso, however, the aphasia, as the " way across " to the associated centre was permanently cut off, and the progressivesoftening would prevent the resumption, by the fibres fromthe corpus striatum, of their conducting power; hence hadlife continued the speechlessness would have almost certainlybeen permanent. Although this view explains the part412 Case of Sudden and Complete Aphasia, [Oct.,which the hæmorrhage into the corpus callosum played in theproduction of the sudden and complete aphasia, yet there can,I think, be little doubt that had this hæmorrhage notoccurred, loss of speech must sooner or later have ensued asthe softening spread, involving the third left frontal convolution more and more to its complete destruction .The lesions which I have been just considering alsoappear to me to account for the paralysis of the tongueand lips which was present. The experiments of Ferrierhave shewn that the motor centres which preside over themuscles concerned in articulation are situated in regionscorresponding in geographical position, and which, bothanatomically and physiologically, he regards as the hom*ologues of the lower frontal convolutions and the island ofReil in man. Now, in cases of aphasia following destruction of these parts -from the fact that the speechlesspatient is unable to express his ideas by written symbols-it is probable that the very centres for word- memoryare destroyed. Therefore, it would appear likely that thelatter are situated in the same convolutions as the centreswhich preside over the muscles concerned in articulation,although, as is well known in most aphasic patients, themuscles of articulation and mastication are generally unaffected a fact explained by the existence of co-operatingcentres in both sides which regulate the action of thesemuscles. Yet, in the present instance, this rule was departedfrom, "inflation of the lips " and " difficulty of swallowingpersisting. This apparent anomaly is also accounted for bythe inability of the centre on the right side, owing to the interruption in the commissural fibres of the corpus callosum, tobecome cognisant, as it were, of the loss of function of theleft centre-the leading side-and, consequently, to carry onalone the functions requisite for the performance of voluntarymovements in the muscles which they govern.""The effects of injury or disease on the corpus callosum areas yet but little known, this being a rare situation for suchto occur in; and when it does happen, not admitting ofpositive diagnosis. Hence its peculiar functions are comparatively obscure, but little having been added to ourknowledge on this point since the paper by Sir JamesPaget in the Twenty-Ninth Volume of "The MedicoChirurgical Transactions," on a case of imperfect corpuscallosum, &c. As the result of his study of a number ofcases somewhat similar to that recorded by himself, he1876.] by RINGROSE ATKINS, M.D. 413inclines to the opinion that the corpus callosum, like theother commissures in the brain, serves to ensure unity orharmony of action between those parts of the brain betweenwhich they are placed, and that it is not a centre of action from which similar, and, therefore, harmonious influences proceed to each side; but formed of conductors by which a part on one side of the brain is informed, as it were, of the state of some part on the otherside, and probably is induced into the same state, a view inwhich Drs. Carpenter and Ferrier coincide; the former considering it not improbable that the corpus callosum comes intoaction in enabling " either hemisphere singly to do the work-to a certain extent of both; " the latter suggesting that incases of aphasia, where the destruction of the third left frontal convolution has occurred, recovery of speech may ensue,according as the third right frontal becomes educated to takethe lead, possibly through the agency of the corpus callosum.Minute anatomical investigation has now shewn that the system of the corpus callosum consists exclusively of commissural fibres between corresponding and identical regions ofthe opposite side of the cortex; hence a breach in the fibrespassing direct from one series of convolutions across to theother, would necessarily interrupt the power of conductionpossessed by these fibres, and materially interfere with theco-operation of the centres between which they passed, andprevent the assumption by one of the functions of both,either in whole or part, should the destruction of either occur.This probably only obtains in those centres containing movements which cannot be brought into action independently onboth sides, and as the muscles of articulation are, to a greatextent, thus functioned , it is possible that an important part ofthe work of the corpus callosum-at least of the anterior half-maybe to enable the right side centre, governing the movements of articulation, to follow and assist its leader on theleft; and if, as I have already remarked, the centres whichpreside over the muscles concerned in articulation are situatedin the same region as those containing the organic seat ofthememory for words, the commissural fibres would also comeinto action in the co- ordination of the highest mental actsoriginating in these centres. If this be so, what then willbe the effect (if any) of a lesion of this portion of the corpuscallosum without any disease of the speech- centres themselves? Will the left centre, when uninjured, and merely414 Case of Sudden and Complete Aphasia, [Oct. ,cut off from communication with the right, be able to perform all the functions alone?On examining the histories of the recorded cases ofdefective corpus callosum, in which the condition of thefaculty of speech is mentioned, I find that in a case describedby Dr. Knox, in the " Glasgow Medical Journal," April,1875, the patient-an idiot woman-was unable to articulate, and never recognised her attendants, and here thecorpus callosum was scarcely perceptible anteriorly, whileposteriorly it was merely represented by a very slightridge about a tenth of an inch in depth, the external convolutions of the hemispheres being numerous but smalland defective in various respects. In a case reported byMr. Mitchell Henry (" Med. Chir. Trans. ," Vol. xxxi. , p.243) , in which the anterior portion of the corpus callosumwas also entirely absent, the patient-a boy-" when suddenly questioned on any subject, would appear bewildered ,and require some moments before giving a distinct reply; "and in a case quoted from Mr. Solly, by Sir J. Paget, wherethe entire corpus callosum was absent, the subject, a lad of17, was said "to have had no power of reviving or comparing impressions on his mind," although Sir J. Paget saysthis was " disproved by the fact that he could read, and wasfond of a particular class of books." In Sir J. Paget's owncase, recorded in the paper already alluded to, the anteriorportion of the corpus callosum, though defective, was stillrepresented, and the patient, a young girl, is stated to have,"after leaving school, always read in a headlong way, veryfast, sometimes missing words, and not staying to correctherself. " In three of these cases, the anterior half of the corpus callosum was entirely absent; and in each thereappears to have been a difficulty in the co-ordination of themental act concerned in speech. The first "was unable toarticulate," the second " required some moments before hecould reply to a question ," and the third was, to use hismother's expression, as stated by Sir J. Paget, generally"boobyfied " when speaking; while, in the fourth, where aportion of the corpus callosum was still present, there doesnot appear to have been a similar difficulty; it is not improbable, therefore, that these defects in the faculty of articulate language may have been due to the absence of thoseconducting fibres passing from centre to centre. Might it notbe possible, then, that in certain cases where a sluggishnessin the power of speech occurs, or a loss of memory for, or the1876.] by RINGROSE ATKINS, M.D. 415omission of certain names or words from sentences, the usingof wrong words, or syllables, in conversation, either alone orwith temporary hemiplegia, may depend on hæmorrhage intothe corpus callosum, partially injuring the commissuralfibres, and causing the transient paralysis by its influenceon the corpora striata below, as in the present instance.The presence, however, of the power of articulate language,to a greater or less extent, coincident with congenital absence of the corpus callosum, shews that under such cir- c*mstances this structure is not absolutely necessary forthe exercise of that faculty to a certain degree; whetherin such exceptional cases each centre becomes during theprocess of development endowed with the power of actingalone, and that in the normal state of things, this not beingthe case, acquired disease will have a different effect, is amatter of speculation. The fact that destruction of a considerable portion of the left centre, together with a breachin the fibres of the corpus callosum, caused complete aphasia,supports the view, however, that that centre is the leading ordriving side, and that the right centre cannot act withoutbeing informed, as it were, of the condition of the left.Passing from the lesions found in the left hemisphere, inthe case under consideration, to those in the right, wehave an illustration of the negative results which localiseddisease in the convolutions posterior to the fissure of Rolandomay give rise to. The patches of softening found in theinferior parietal lobule, and in the occipital gyri, wereindicated by no motor disturbances, nor, indeed, by anyspecial symptoms which could be referred to such. Theweakened condition of the mind was doubtless due to thegeneral atrophy of the convolutions, but there was no depression or melancholia, as has been stated by SchroederVan der Kolk to follow disease of the posterior parts of thebrain, nor were there any symptoms of disturbance of thenutritive functions, as has recently been observed by M.Joffroy in a case, the particulars of which he brought beforethe Societé de Biologie. Whether the final effusion in thelungs, which directly caused death, was dependent on thebrain disease, a view recently advanced by Nothnagel, is amatter of speculation. The absence of motor disturbanceis in accordance with the experimental results obtained byFerrier, who found that irritation of the posterior lobes ofthe brain, both on their external surface, and on theirinternal or hippocampal surface, as well as irritation of the416 Case of Sudden and Complete Aphasia. [Oct.,gyrus fornicatus, always failed to produce outward manifestations; expressions of pain, however, being generallyelicited in the experiments recorded, pointing to thoseregions as being connected with sensory functions.EXPLANATION OF PLATE.FIG. I. NERVE CELLS UNDERGOING " PIGMENTARY DEGENERATION," FROMSOFTENED PORTION OF BROCA'S CONVOLUTION, ' HARTNACK ' Oв: 8,oc: 4 X 650.a a aFIG. II.Double contoured nerve fibres broken and bulbous .'MINUTE ANEURISMAL FORMATIONS IN CORPUS CALLOSUM ADJACENT TO THE CLOT, HARTNACK,' OB: 7, oc: 3 X 300.In the section the two little bodies lay near each other but were notin the same field,' therefore to include both in the drawing they have been brought closer together than they really are.Some Remarks as to providing increased and Better Means forEducating the Insane of all Classes. By JOSEPH LALOR,M.D., Physician Superintendent Richmond DistrictAsylum, Dublin.(Read at the General Meeting of the Medico- Psychological Association,July 28th, 1876.)A Special Committee, apppointed by the Charity Organization Society, have had under their consideration for a considerable time the subject of placing Institutions for Idiots,Imbeciles, and Harmless Lunatics on the most comprehensive and satisfactory footing. The investigations of thisCommittee, and the report to be made by them to the ParentSociety, will be likely to have much influence on the determination of many questions in which our Association has adeep interest. The Committee have evinced laudable anxietyto obtain advice and information, and to consider their subject cautiously, thoughtfully, and impartially. I think theyhave, in consequence, the strongest claims on the confidenceand thankfulness of our Association. Froma communicationmade by the Committee to the Social and Statistical Societyof Ireland, and from being furnished, through the kindnessof Dr. Hack Tuke, with copies of its agenda up to this, Ihappen to have become acquainted with the views of theCommittee, and I propose to avail myself of the opportunitythus afforded, by making some remarks on a few of the conclusions they have arrived at. I shall, however, try to do soin a way that will not, by any means, hamper the proceedingsof the Committee, or the full and free expression of their11R.ATKINS M.D.Fig.Fig 2.PLATE ILLUSTRATING DR ATKINS CASEDEL. AD NAT

1876.] Some Remarks as to Educating the Insane.417opinions; but which may conduce to a community of opinion,and a co-operation in action, or, at least, to a friendly andharmonious rivalry between the Charity Organization Societyand our Association, calculated to produce most desirableresults.I believe that the Committee have arrived at the conclusion that adequate provision for all the idiots and imbecilesin England and Wales, of the poorer classes, whether juvenileor adult, cannot be made without the intervention of theState; and that adequate provision should include the education of all educatable idiots and imbeciles. I trust that thisAssociation will not have a single dissentient from this conclusion.Two propositions, resting on opposite principles, have beenmade, and discussed before the Special Committee of theCharity Organization Society, when it considered the administrative arrangements desirable for meeting fully the educational requirements of all the poorer classes of imbeciles,idiots, and harmless lunatics . The two principles in questionare, whether the requisite machinery should be provided inthe existing lunatic asylums, known in England as County andin Ireland and Scotland as District, or in new institutions altogether disconnected , and specially established for educationalpurposes. In this Association and amongst the public at large,I believe that a similar variety of opinion may exist.I would submit, 1st-That if County Lunatic Asylums,* bywhich name I would wish hereafter to be understood as referring to these asylums, are to rank as institutions providedwith full means for the cure, improvement, and care of theinsane, they must have at hand appliances for educating allsuitable cases undergoing treatment in them, and, 2ndly,That advantages are offered in county lunatic asylums forthe education of the poorer classes of the insane, whichshould be availed of.To controvert the first proposition, it must be proved thatmoral and mental treatment has no place in the cure, improvement or care of the insane. At the present day, or inthe past, such an assertion has not, that I know of, beenmade. There may be differences of opinion as to the machinery by which moral and mental treatment ought to beconducted, whether by simple discipline, by schools, or byliterary or industrial or religious instruction, but the broad

• Known in England as County, and in Ireland and Scotland as District Lunatic Asylums.

418 Some Remarks as to Educating the Insane, [Oct.,principle that it should form an important part in the treatment of the insane, is undisputed.In reference to the second proposition, I beg to submit asfollows:-Assuming that the insane should reside in the institutions where those of them who may be educatable are toreceive instruction , four things appear necessary; 1st, suitable residences; 2nd, suitable staff for ordinary purposes;3rd, suitable staff for educational purposes; and, 4th, suitable accommodation for the same. County Lunatic Asylumsappear to me to be at present good institutions for the cure,improvement and care of the insane poor in all respects,except that of education , and in my mind they only want tohave added to them the appliances specified under the thirdand fourth of the above heads, to complete the means required for the full treatment of all forms af mental ailmentamongst the poorer classes . Much saving of time and expense would result from making those additions in preferenceto founding establishments totally new and separate.It is to be apprehended, also, that totally new and separateestablishments for educational purposes might be wanting inthose special structural and staff arrangements, necessary tomeet demands sure to arise when epilepsy, or a tendency tosuicide, or violent excitement are present in the educatableclass of the insane.The expense of double sets of buildings and fittings foradministrative purposes, for religious service, and for recreation, would be also saved or lessened by uniting all classesof the insane on the same grounds, in buildings detached,but adjoining and under one administration, both local andgeneral.Arrangements are quite practicable, by which separationof the several classes of the insane from one another mightbe provided for as effectually in one connected institution asin disconnected buildings.I would earnestly appeal to my medical brethren joinedwith me in the care of the insane, and in the membership ofthis Association, to seize the favourable occasion that nowoffers of uniting their efforts with those of others to increaseand improve the means for the suitable education of allclasses of the insane I venture to make this call upon themchiefly for two reasons, first, because I believe that educationaids the medical treatment and due care of the insane, orsupplements what may be wanting in the latter for theirimprovement; and, secondly, because there appear to me to1876.] by JOSEPH LALOR, M.D. 419be unmistakable signs that public opinion is becoming alive,not doubtfully or slowly, to the necessity that full State provision should be made for supplying suitable education tothe educatable insane of the poorer classes. 1 believe thatthe action of this Association might greatly influence the determination of the question whether this education will beconducted in the County Lunatic Asylums or elsewere. Ihave a strong opinion that the position of District LunaticAsylums would be considerably elevated if, by the addition orincrease of educational appliances, they came to supply allthe requirements of the insane poor.Our institutions would receive sources of increased stabilityand strength which have become needful from their too rapidgrowth, and would be advanced towards their full normal development, if they were placed on a satisfactory footing asregards education .If they are not so placed I fear that they may fall fromthe high estimation in which they are now generally held .For the good of the insane and of the public, it would bebetter, in my mind, to provide whatever is wanted for theeducation of the mentally afflicted of the poorer classes bygrafting it on the parent stock than by trying to rear up anew plant partly with the nutriment heretofore suppliedaltogether to the old. I fear that by this latter process thepublic would have two ill - fed weaklings far inferior in fruitfulness to one such vigorous, mature, and wide-branchingtree as might be expected from giving existing establishmentsadditional and undivided nourishment.In relation with the foregoing remarks, I think furtherconsideration is desirable as to a conclusion which appears tobe held by the Committee, viz. , that the education of suchclasses as the blind, the deaf, and dumb, and sane orphanchildren of the poorer classes should be disconnected altogether from that for the insane.For a long time I have been led to regret (on abstract andspeculative grounds) the complete dissociation which exists,according to their specific objects, between establishments forthe cure of the poorer classes.The wants of these classes, whether on account of infirmity of mind or body, or destitution , have, and ever musthave, much in common. A common humanity forms acommon bond of sympathy and union between them, andeven the helpless of one class (if not at all times, yet atleast occasionally) may contribute something towards the aid420 Some Remarks as to Educating the Insane. [Oct. ,"of others suffering from the same or some different form ofhelplessness. In helping others they may also help themselves; for instance, the musical and vocal capabilities of theblind might be made available for the amusem*nt and improvement of the mentally or otherwise afflicted . The acquirements of the sane, blind, deaf, and dumb, as well as ofthose without any bodily defect ( supported in public institutions, such as industrial and reformatory schools, orphanages,and workhouses) might be better utilised. They might, forexample, be used so as to contribute to the better and moreeconomical working of institutions for the insane poor andother classes, maintained at the public cost by supplyingwants which some of those classes may not, from differentcauses, be able to supply to themselves or to others.The moral example of the well-conducted (that powerfullever for influencing the nature of man to good ends) mightbe brought to bear on the treatment of the insane. So, also,the sane poor; whilst they were made by judicious association to assist the feeble in mind and body, might get thelesson ( so much needed by many) , of more thoughtful consideration for the afflicted. In like manner the narrowingand deteriorating effects of constant association with onlyone phase of human nature might be more or less counteracted.Again, if the public provision for the wants of the poorerclasses were to be supervised by governing bodies havingknowledge and control not of one only, but of all the departments receiving public aid, greater breadth of view and harmony offeeling would be promoted, and financial advantagesmight also be expected to result; such, as I am told, haveresulted from the occasional association of Railway Boardsof Directors. In fine, that co-ordination of purpose and ofpower which is at present a great desideratum would be thussupplied.In visiting, some years ago, the admirable institutions atLeavesden-one for harmless lunatics and the other for theeducation of poor children-the speculative opinions just setforth appeared to be supported and illustrated by what I sawthere. I could not avoid thinking that advantages were lostto those establishments by an administrative and socialseparation, much as if an unbridged river and not merely anordinary road intervened between them.1876.]421The Relations of Drink and Insanity: Letters by Dr. Peddie and DR. BUCKNILL.The following letter has been written by Dr. Peddie, inreply to Dr. Bucknill's letter published in the last number ofthis Journal (July, p. 265): —DEAR DR. BUCKNILL , -I was much surprised, on reading your letters to Dr. Clouston,published in the July number of the " Journal of Mental Science,"under heading of " Occasional Notes of the Quarter, " to find that youhave greatly mis-stated my opinions in regard to " The Relations ofDrink and Insanity. "You ask Dr. Clouston (p. 270) to " read Peddie's and Bodington'spapers on the subject ( read last August before the British MedicalAssociation, at Edinburgh) , and you will, I think, see that I wasjustified in my statement," which statement is, " I am afraid that justnow members of my profession are taking hold of the stick by thewrong end, and considering drunkenness not as a cause of disease,but as a disease in itself, which to my mind is a great mistake. Ifdrunkenness was a disease, it was not a vice, and could not be dealtwith by education, and repression and attempts to reform, but mustbe dealt with-as indeed many of his profession proposed to dealwith it-by establishing hospitals for what they called the unfortunatedrunkard," p. 266. This, too, you aver to be, without any qualification or reservation, the opinions and practice of certain physicians in America. But I leave them to fight their own battle, and I alsoleave Dr. Bodington to answer for himself, which I have no doubt he is able to do. As for myself, I cannot believe that you have read asentence of the paper referred to, or seen my first paper on " Dipsomania," published in 1858, or my second one in 1860, in the " Transactions of the Society for the Promotion of Social Science, " or my evidence before the House of Commons in 1872 , which is fully reportedin the Blue-book of that session, otherwise you could never have somuch misrepresented my views.You take credit to yourself for what you say against Dr. Bodingtonand myself in the following, not very complimentary, sentences: -" AllI have said and written on this subject has been aimed at the mischiefwhich I thought likely to arise from this unqualified opinion (namely,that drunkenness is a disease in itself). I never supposed that you(Dr. Clouston) , or indeed any man able to bring a practised habit ofthoughtful consideration upon a large observation of vice and mentaldisease, could adopt such an opinion without wide reserves and exceptions; but such a man with his quantitative and qualitative truth isnot likely to appear as an agitator for a great change of law of doubtful wisdom upon a platform of disputed fact. " You then422 The Relations of Drink and Insanity. [ Oct. ,agree with Dr. Clouston, saying, "I think there is very little difference of opinion between us, if any. I fully recognize the cases youmention the men who are facile, sensual, irresolute liars, devoid ofthe rudiments of conscience, self- control, or true affection , ' andhabitual drunkards withal, as ' diseased drunkards. ' ” "But, " you goon to say, "these are not by any means the kind of men I have metwith in Inebriate Asylums, nor the kind of men on behalf of whomDr. Peddie and Dr. Bodington advocate an important change in the law of the land."Now what I have to say to this is simply that my sentiments haveever been such as appear to accord with those you have quoted asDr. Clouston's, and consequently that we are all three, in truth,agreed as to the persons who may be styled Dipsomaniacs! Yourposition, therefore, is the very serious and responsible one of aiming,from the supposed vantage ground of lunacy experience, to raise acloud of psychological dust to defeat or discourage a highly philanthropic and long- wished- for movement among thousands of medicalmen and others, for the reformation-it may be, the cure -of thosewho, if left alone, cannot help themselves, and in consequence notmerely suffer personally the inevitable consequences which vice, ordisease, or both together-acting and reacting on each other-occasion, but entail on families, perhaps through generations, and onsociety many and deplorable evils . The mischief which might thusarise may be infinitely greater than from a too wide or loose interpretation of habitual drunkenness, even although in some instancesthere may be circ*mscription of the liberty, or rather, it should becalled the license , of the subject, from a course of vicious drinking,which renders him a disgrace to his friends and a pest to society.Thus the line, although not quite correctly drawn at times, may notin itself be a very great evil or social grievance; but with the characters of dipsomania or insane drink- craving which I have drawn in thepaper you have treated so ignoringly, and what has been more fullydelineated by me formerly . I do not think the distinction betweensuch cases and the vice of intemperance, is one of difficult diagnosis.But it is rather too much for you to assume that in this questionit is only men engaged in the speciality of the care of the in- sane who should be listened to as authorities. From the fact thatit is illegal compulsorily to control in asylums cases of drink- craving,unless associated with some other marked feature of mental unsoundness which can be made prominent in a lunacy certificate, specialistsin lunacy cannot come in contact with many instances of genuinedipsomania. They can see only a fraction of such cases as comeunder the notice of physicians in ordinary practice; and the latterconsequently are better able to understand how much in each case isdue to physical and mental malady, how much to moral delinquency,and to say when there might be a reasonable prospect of benefit fromstrictly enforced and prolonged control, were that obtainable. Evennon-professional common sense is not in this matter to be entirely1876. ] The Relations of Drink and Insanity.423overweighted by any amount of psychological acumen and hairsplitting distinctions. And here let it not be supposed that Iadvocate for the cure of dipsomaniacs any connection with lunacyarrangements. For reasons now admitted by all, lunatic asylumsare not adapted for the reformatory treatment required in such cases;and, on the other hand, the presence of dipsomaniacs has been foundvery detrimental to the comfortable working of such establishments.""However, I shall not at present go further into these matters, butaddress myself to the felt injustice of having my opinion ignored onthe true nature of dipsomania from being only a physician, and not "able to bring a practised habit of thoughtful consideration to bearon the subject! All that I will say is that I have given muchthoughtful consideration to this matter-more, perhaps, than anyother man in the profession, and probably before you began to thinkat all on it, so that if I am wrong in my opinions now, it is not fromwant of consideration. The heading of my paper might have shownyou at once that I was not addressing an audience of doctors regarding the mere ordinary drunkard, but on " Insane Drinkers;" and hadyou read to the foot of the second column you could not have failedto perceive for which of the numerous classes of drinkers or drunkardsI was proposing special legislation, however feebly or obscurely I may have done so. But it is not enough to ask you to read a fewparagraphs of my paper to be convinced that I speak in it (as I havedone publicly for eighteen years ) of the same type of individuals whom you agree with Dr. Clouston in regarding as " diseaseddrunkards. " I must ask him, as one of the editors of the " Journalof Mental Science," to permit the insertion of a few quotations fromthe paper, so that numerous readers may be furnished with an antidote to the mischief which your assertions, uncontradicted, may doin obstructing one of the most philanthropic movements which ourprofession has ever thrown itself into-if not for the sake of thedipsomaniac himself, at least for the many tender and important interests connected with his condition.The paragraphs which I wish inserted are the following:-" That some legislative enactment is required to meet the case of alarge proportion of insane drinkers, psychologically termed dipsomaniacs or oinomaniacs-or, popularly, habitual drunkards-will bedoubted, I imagine, by few, if any, assembled on this occasion. AndI may further assume that little need be here said in considering whoare to be viewed as insane drinkers. They may be briefly described asthose-1 . Who inherit the propensity to intemperance; 2. Who evinceit as the principal manifestation of some form of cerebral disease;3. Who are affected with it as a result of an injury of the head, or severefevers, or other wasting bodily ailment, mental shock, heavy grief,reverse of fortune, and, indeed , from causes similar to those antecedingsome other insanities; 4. Those who acquire it through a course ofvicious indulgence in stimulants.XXII.28424 The Relations of Drink and Insanity. [Oct. ," In whichever way produced, or from whatever combination ofcauses, the distinguishing feature of this malady in its confirmedstate is total loss of self- respect and self-control under an overwhelming craving for alcoholic drinks, although with little or no palatalrelish for the same, which must be gratified at any cost, regardless of honour or truth, and, in fact, unaffected by appeals to reasonor self- interest, the tears of affection, or suggestions of duty either to God or man." I must also assume that it is not necessary at this meeting to pointout particularly in what respects dipsomania differs from the maniaà potu, or, as also called, the delirium ebriosum, or acute mania fromalcoholic excess; or how it is distinguished from delirium tremens,the toxic mania of alcoholic accumulation, or from the hydra-headed forms of the vice of drunkenness. Of the latter, we haveabundant examples everywhere around us, in which we have themost marked types of constant tippling without entire unfitness forthe business of life in persons drinking from facileness of disposition, from conviviality, and from the love of drink or the love ofintoxication, but who have more or less power to abstain when they choose to do so." That the phase of intemperance which so utterly annihilates selfrespect and the power of self- regulation is indicative of affection ofthe brain-plasm primarily or from exoteric influence through alcoholicaction-in other words, an abnormal cerebral condition, occasioningunsoundness of mind-cannot be reasonably questioned; and, as inorigin it thus resembles other insanities, it presents also similaritiesand variety in its course, manifestations, and terminations. Thus, inthis malady, the irresistible craving may spring up suddenly, often insuccessive attacks of singular periodicity, or from the mere taste ofanything alcoholic quickly bringing the system under the full sway ofalcoholic poisoning; or it may pass through a slow, stealthy, insidious course ere the action, if not the nutrition , of cerebral matter becomes changed."It is developed in all classes and conditions of society; in the menof refinement and high mental culture as well as in the coarseminded and ignorant; in the lady of rank and in the tradesman'swife; in all periods of life, in old age, in the adult, and even inearly youth; in different constitutions and temperaments, manifesting various eccentricities of deportment and habits, wastefulness,destructiveness, perverted moral feelings and impulses, revenge, theft,viclence, and invariably mendacity. It is occasionally cut short for atime by delirium tremens or acute mania, or goes on to drivellingdementia, chronic alcoholism, or some other form of insanity, iflife be not brought to a close by accident or some superinduced disease.66 Besides, while this alcoholic diathesis, as it may be called , is transmitted from generation to generation, idiocy, epilepsy, paralysis ,1876. ] The Relations of Drink and Insanity. 425and other forms of cerebro - spinal disease are the frequent legacy ofdrunken parents to their children ." It is a remarkable fact, too, that, if there be any peculiar proclivity, any black spot in a man's moral nature, it is brought outunder the weakening and perverting influence of alcohol. Hence,among the criminal class of dipsomaniacs, we have a variety ofresults, and often a most remarkable uniformity in crime committedbythe same individual under successive states of inebriety. Thus oneindividual will invariably be guilty of assault, another of wantondestructiveness, such as smashing windows, another of theft, and notonly so, but of stealing very frequently the same sort of articles.Did the limit allowed for this paper permit, it would be easy for me totreat of in greater detail, and to illustrate and verify with cases thevarious points now indicated ." The mass of cases arising out ofintemperance-purely the vicecarry with them their own pains, penalties, and checks, and must bejudged of by the peculiarities of each individual case, and left tovaried physical, moral, and religious teachings. But there is a linkwhich connects, and a boundary line which separates, intemperancethe disease from intemperance the vice. Here it is that legislative interference of any kind becomes, and very properly so, most delicate;and it is here that at first sight most formidable obstacles aresupposed to exist against our present proposal. For the very worstcases of dipsomania, in which there is a manifest concrete of themalady, of irresistible desire for stimulants, with some other form ofmental disease independent of alcoholism, the present law of lunacyclearly provides. The acute mania of drink is also, we would say, afit disease for asylum treatment, if there be not convenience inprivate or in the strong room of a hospital; to which cases ofdelirium tremens also may be taken, when safe and judicious management cannot be carried out in private. But cases of well- markeddipsomania, which are so serious to the unfortunate individuals themselves, and so perplexing and injurious to friends and society, arewithout help or hope, either in private or from the law of the land;there is nothing in the future but certain degradation and ruin tothemselves, often to those closely connected with them, and injury tothe community."No doubt the voluntary clause of the last Lunacy Amendment Actwas thought likely to meet to some extent the case of the dipsomaniac; but while there has of late been a gradual increase of voluntary admissions of the general insane, there has not been such ofinsane drinkers, and there are strong objections to the admission of such into lunatic asylums. It is not at all desirable that suchshould mingle with other lunatics in public or private asylums, or thata malady requiring special treatment should be brought under lunacylaw arrangements. It is most undesirable also that asylums shouldbe embarassed and annoyed by the care of dipsomaniacs, for it is a426 The Relations of Drink and Insanity. [Oct. ,necessity that an inebriate retreat should be a purely temperance institution which a general asylum cannot be, and consequently in suchinsane drinkers find opportunities, through other inmates, to obtainthe supplies they crave; and so, by schemings and untruthfulness,produce endless misery and inconvenience to these establishments.That the habitual drunkard of this class, therefore, absolutely requiresspecial care, is clear; but, as in cases of legislation a definition mustgenerally precede the proposed legislative provisions, he may bebriefly defined as a person of unsound mind whom the habit of intemperance is such as to render, notwithstanding the plainest considerations of interest and duty, unable to control himself, and incapable ofmanaging his own affairs, or such as to render him in any waydangerous to himself or others.Such"From the nature of the malady, it is evident that, unless there beseparation from the persons through whom, and places where, themorbid craving can be gratified , and well- regulated restraint placed onthe habits, little can be expected in the way of treatment.separation is necessary in most cases of insanity; but still more is itrequired in the case of insane drinkers, who, although unfit for attention to the proper duties of life , are full of devices (often most ingenious and clever) to obtain their desire (with them the one objectof their life); and so cunning and deceitful are they in schemingfor it , that they outwit the most vigilant attendants (women being inthis respect even more talented than men); so that at best any goodarising from ordinary restraint is extremely temporary. "I agree with every word which Dr. Clouston has said in his admirablereply to your Rugby speech. Every practicable general measureeducational, moral, religious , punitive-for the repression andreform of the extensively prevailing and deeply- rooted drunkenness inthe country must be employed; " but when," in certain cases -asDr. Clouston well says "the germs have grown, is there not room, isthere not necessity, then for the disease theory and the disease treatment?" And such legislative facilities as are wished to enable us todeal with the morbid branch grown out of, or grafted on, the evilhabit of intemperance, will not interfere with what you say you—aswe all more or less -rely on, namely, the treatment of drunkennessas a great social question by the Legislature, dealing with it " uponthe lines of their educational system. " Drunkards of the worstkind, therefore, whose brain and nervous system have become soaffected as to be entirely destitute of the power of self- control, wewould place under treatment in special establishments well fitted inevery respect for their care, and, if possible, their cure.This wedesire to do just as we place in asylums the insane who requirecontrol and treatment on account of the effects of mental disturbancefrom the excitement, say of commercial speculation , gambling, orsexual excess, in all of which instances much might have been expectedfrom education, and other means for the prevention of such vicious1876.] The Relations of Drink and Insanity.427and dangerous practices and results . In such sad cases as these,however, when the brain plasm has suffered, we surely cannot butpity the individuals and call them " unfortunate. " And so we may- [think-under similar circ*mstances, speak of dipsomaniacs; and inthe spirit of humanity do what we can in the hope of benefitingthem while we are protecting the various important interests , privateand public, which are involved in their conditions.You lay great stress on the alleged failures of certain American Institutions for the Cure of Inebriates; but that is no reason toprevent us-warned in some things by such tentative experiences— from trying what we can do with our dipsomaniacs. With this viewwe would require to obtain sufficient legal powers to enable us to place under control in licensed institutions those who would not submit to itvoluntarily; and to prolong detention for such length of time asappeared necessary for successful treatment. These institutions, too,would require to be well suited in all internal and external arrangements for the peculiar nature of the charge undertaken-not situatedin populous districts or in the vicinity of places where alcoholicliquors could easily be obtained; and especially would they requireto be under most intelligent and trustworthy superintendents and attendants. But on these matters and on various aspects of thequestion suggested by your speech and correspondence, I shall not further remark. It is enough at present to put before yourself myviews as to the persons who should be regarded as insane drinkers, andto leave the readers of the Journal to decide whether you have dealtwith the present discussion in a fair and right spirit.I am, dear Dr. Bucknill,Edinburgh, 15, Rutland Street,21st July, 1876.Yours faithfully,A. PEDDIE.We have received from Dr. Bucknill the following comments upon the foregoing letter:-TO THE EDITORS OF THE " JOURNAL OF MENTAL SCIENCE."SIRS,-Yesterday I received a printed letter from Dr. Peddie, addressed tome, purporting to be for publication in your Journal, and I naturallythought that I owed the sight of this letter, before actual publication, to his courtesy; but this morning I learn from the printer thatthis letter was sent to me in error. It can, therefore, scarcely surpriseDr. Peddie that, under these circ*mstances, I prefer to reply to hisattack in a letter to yourselves.In the friendly discussion which I have recently had with one of youon "The Relations of Drink and Insanity, " I said-" If you will readPeddie's and Bodington's papers on the subject [ read last Augustbefore the British Medical Association at Edinburgh] you will, I428 Dr. Bucknill on Drunkards [Oct., .think, see that I was justified in my statement." That is to say in thestatement that " members of our profession were considering drunkenness, not as a cause of disease, but as a disease in itself. " Little didI expect that this reference would have brought upon my head the accusations from Dr. Peddie: -First. That I have mis-stated and mis-represented his opinionsabout insane drinkers;Secondly. That I have ignored them;Thirdly. That I have not read them; accusations inconsistent witheach other, and reminding one of theold pleadings which are now happilyabolished, even in the casuistry of the law. It would help me if Iknew which count of the indictment contained the real offence, becausethen, perchance, I might be able to remove or atone for it. To agentleman who, according to his own statement, has given morethoughtful consideration to these matters " than any other man in theprofession," the felt injustice of having his opinions ignored"might possibly be capable of wounding his self-esteem. Let mehope that the opportunity which he has seized of placing one side ofhis opinions before your readers in lengthy quotations from his writings, and the further publication of the other side of his opinions whichI must ask you to permit me to quote, will induce him to condone thispart of my offence, which, I can further assure him, was committedmost unwittingly. But if I have ignored his " sentiments" about dipsomaniacs , how can I have mis- stated them? That is a thing whichno man can understand, unless his " brain-plasm" can unravel amystery.To the third count I must distinctly plead not guilty. Dr. Peddiesays " I cannot believe that you have read a sentence of the paperreferred to;" but the real truth is that, before I wrote my letter toyou, I had read his paper through several times, in the earnest effortto understand it.Dr. Bodington-with whose wrath I am also threatened, but ofwhich I am not much afraid, seeing that he leaves one in no doubtabout what he means, and, if we differ, as we certainly do, the battlewe shall have to fight will be about facts and their interpretation , andnot about " sentiments "-Dr. Bodington says " The confusionbetween drunkenness as a disease, and drunkenness as a vice, must becleared up. For my part, I look upon habitual drunkenness as adisease, and I would boldly call it dipsomania. It is in its characteras a disease that we physicians are entitled to deal with it. I wouldsink the notion of its being a mere vicious propensity. When fullydeveloped there are not two kinds of habitual drunkenness . Thecases are, one and all, cases of dipsomania, of irresistible, uncontrollable, morbid impulse to drink stimulants."That, without doubt, is a sentence entirely devoid of " hairsplitting distinctions. " No two sides ofthe same shield there painteddifferent colours; or dark cloud with a silver lining .1876.] Dr. Buckmill on Drunkards. 429Dr. Peddie has quoted a large portion of his paper ( though it wasalready accessible enough in the pages of the " British MedicalJournal") to prove that " my [ his ] sentiments have ever been such asappear to accord with those you have quoted as Dr. Clouston's, and,consequently, that we are all three in truth agreed as to the persons who may be styled dipsomaniacs! " But, if so, where is the need fordispute?In point of fact we are by no means agreed, for the real gist andpurpose of Dr. Peddie's paper turns upon his 4th class, namely,those who acquire " the propensity to intemperance " through a course of vicious indulgence in stimulants. About maniacal and deliriouscases he admits that there can be no doubt; they are proper subjectsfor a hospital or an asylum, but it is for the " unfortunate individualswho are so perplexing to themselves and to society," and who cannotbe placed in hospitals and asylums because they manifest no symptomsof disease of mind or body beyond the propensity to intemperance, itis for them that he advocates a change of the law under which theycan be profitably kept in a new kind of sponging-house, or private gaolfor drunkards instead of for debtors . When Dr. Peddie gave evidencebefore Dalrymple's Select Committee some of the members tormentedhim into a precise statement of his sentiments, and here they are: -Question 1016. Dr. Playfair-You say that you would take a man and put him into forced detention; under what condition would you dothat?-When a man could no longer control himself from the habitof intemperance, I would then consider him in a condition of unsoundmind and requiring to be cared for.1017. Even if he was only injurious to himself, and not immediatelyinjurious to the public?-Yes, I think that we should do somethingmore than provide against injury to the public; I think we have aduty as citizens and fellow- creatures to one who will not take care of himself.1059. Mr. W. H. Gladstone-Do you not foresee great difficultyin determining when a man may be said to have lost his power ofself-control?—No, I should not feel any difficulty; I think that it isa matter of medical diagnosis. There is not more difficulty in regardto the habitual drunkard than there is difficulty in regard to insanityof other forms; medical men have constantly cases of insanitybrought before them, and the question in each case is whether or notsuch an individual is a proper subject for control in an asylum for curative treatment.1060. Then do you think that a man who, when sober , is in complete possession of all his faculties, may still be said to have lost allself-control?-We know very well that we should be able to distinguish in that case his danger by the supposition that if drink wasplaced in his way the next day, or that very evening, he could notresist it, and that if he once tasted it he would go on from bad toworse; a craving would be set up of which there has been a frequent430 Dr. Buckmill on Drunkards. [Oct. ,opportunity of judging before, and that he would go deeper anddeeper into the mire.1061. Do you think that the impulse to drink, in a case like that,is different from other vicious impulses, such as, for instance, an impulse for gambling? —Yes, I think that the impulse is quite different.1062. It partakes more of the nature of an external disease , likefever, which comes upon a person?-I consider it greatly in thenature of an internal disease; there is also alcoholic influence andsome kind of change upon the state of the brain thus affecting itsoperations.1063. But it is analogous to an ordinary disease? —It is analogous to an ordinary disease.Surely I have a somewhat better right than Dr. Peddie to complainthat my opinions about insane drunkards have been misrepresentedwhen they are declared to be in complete agreement with those of awriter who maintains that a man may be an insane drunkard " whowhen sober is in complete possession of his faculties."Dr. Peddie " would not feel any difficulty in determining when aman has lost his self- control ." " It is a matter of medical diagnosis.There is not more difficulty in regard to the habitual drunkard thanthere is in insanity of other forms. "But is it not somewhat inconsistent with this avowal that Dr.Peddie should now insist that this diagnosis cannot be adequatelymade by men who have the greatest knowledge of insanity of otherforms, because " specialists in lunacy cannot come in contact withmany cases of genuine dipsomania? They can only see a fraction ofsuch cases as come under the notice of physicians in ordinarypractise. "As specialists in lunacy know so little about these genuine cases ofinsane drunkenness, it is not altogether unreasonable that they shouldbe warned off this domain of the physician in general practice. Consequently "the cure of dipsomaniacs" must not have " any connectionwith lunacy arrangements." " Lunatic Asylums are not adapted forthe reformatory treatment in such cases. "If these are the cases which when sober are in complete possessionof their faculties, specialists in lunacy will not perhaps act unwisely ifthey resign the honour of their treatment to those who understand itso much better; but Dalrymple's Committee had other views as tothe knowledge of such specialists in lunacy, or they would not havecalled before them as witnesses such men as Drs. Crichton Browne,Skae, Mitchell, Nugent, Boyd, and Mould, who contributed fortheir information many important elements of diagnosis which wedo not find in Dr. Peddie's writings, notwithstanding that he hasthoughtfully considered this matter for such a very long time. I amsure that these eminent specialists in giving their evidence desired nomore to give a specialist colour to the facts garnered by their vast1876. ]Dr. Buckmill on Drunkards. 431""experience, than in writing my letter to you I wished " to raise a cloudof psychological dust to defeat or discourage a highly philanthropic movement. " The movement may be highly philanthropic, but thereis another kind of dust, namely, gold dust, which seems to have someinfluence in urging it on, for to quote Dr. Peddie once more: -" In order to call into existence houses or institutions such as would"be suitable for the upper and middle classes of society, a law to em-' power restraint and detention is manifestly essential. A few such"institutions on a small scale have existed in Scotland, but have"laboured under most discouraging difficulties from want of authority" to receive and retain a sufficient number of inmates, and for a suffi-"cient length of time, to become remunerative. This has stood in"the way of liberal investment for suitable premises, ground furnish-"ings, staff of service, etc. Thus the important essentials for efficient"treatment have been necessarily defective; and the result is, that"the care of a very small fraction only of insane drinkers has been" undertaken, and cure somewhat rare. "" The inmates, with partially restored sanity from enforced depriva-"tion of stimulants, become restless , and knowing that they cannot be" detained legally, demand liberty, and take leave, or else work on the"minds of friends or guardians by entreaties or threats, and get it. If,"however, the State will sanction, under proper checks, both voluntary"admissions and compulsory commitments, in cases of genuine dipso-"mania, permitting prolonged detentions, until real benefit is derived, a" sufficient number of homes or retreats, or by whatever name they may"be called, for the cure of persons in the upper and middle classes ,"would certainly spring up, both through private enterprise and the"efforts of companies or associations, formed for the purpose, some-"what similar, indeed, to many existing and thriving lunatic retreats" and asylums, affording accommodation and means of treatment very"different in efficiency from those inebriate institutions which have, in"times past, struggled under cramping difficulties. Now, into such"houses as these, many unfortunate persons would enter voluntarily,as they do in some of the American inebriate institutions, knowing" that, if they did not thus surrender themselves for treatment, they"would be compulsorily committed; and then, when they are under"control, the law, as I have already hinted, could prolong it for sucha time as might be deemed necessary to accomplish the humane ends " in view."6666Alas! alas! that it should all come this! This highly philanthropic movement! These humane ends in view!When I think, sir, of what the evil of strong drink really is amongthe lower classes in some parts of your country and of mine; when Ithink of what I saw in company with Sheriff Dickson in the drinkhaunts of Glasgow, on the night of Saturday the 27th of May last;when I think of the crowds of men and women, many of them infantladen, whom I there saw steeped in the bestial*ty of drink, it makes432 Dr. [Oct. ,Bucknill on Drunkards.me right angry with these philanthropic fribbles, who, with eyesaverted from the drunken and debased populace, fondle the subject ofthe casual rich man's drunkenness, with dainty considerations of howhe is to be placed in a golden cage, " pleasing his palate in the wayof good culinary arrangements, " and his captivity made profitable.Let Dr. Peddie carefully examine the wynds of Glasgow, theirdrink- shops, lodging- houses, and police- cells , on a Saturday night, andhe will afterwards perhaps not think it so easy to perfume hell withrose water.As I said in the speech which has led to this discussion , some members of our profession are misdirecting the attention of the public inthis matter. By the noise of their philanthropic drum, they wouldlead us, by false alarms, from the real field of battle . They dallywith the tarnished fringe of drunken society, while its broad expanseis a funereal pall to myriads of lowly victims; and Dalrymple's Committee, with its foregone conclusion, unwittingly established the dreadful fact of alcoholic eremacausis in our swarming cities, and concluded by recommending a most dangerous and unconstitutionalchange in the law for the supposed benefit of those classes of societyin which a drunkard is becoming a somewhat rare specimen of a decaying and dishonored vice. They made out the charge fully againstthe common folk, at least in certain localities , and they directed themain force of their proposed remedy against the stragglers and backsliders of the sober classes . They would scarify the field with a chainharrow when it stands in urgent need of deep draining and subsoiling.Dr. Peddie, to give him his just due, has not altogetherpassed on the other side from the drunken crowd, for in hisevidence before the Committee he proposed the establishment for thewhole of Scotland of four public inebriate asylums, each to containforty patients of the working classes. They were to be model institutions. He admitted that all four would not contain the habitualdrunkards of Edinburgh alone, and, indeed, he may any day findnearly twice as many of the gentle sex in Queensberry House. But itwas honourable to him, considering the example of some of his coagitators, that he allowed his mind to dwell for a moment upon thetreatment of drunkards who cannot pay. Public provision for thetreatment of 160 working- class drunkards for the whole of Scotland,and for the idle class drunkards as many private houses of detentionas the law of profitable investment, aided by that of " compulsory arrest," may develope, reminds one of the proportions of Falstaff's breadand sack, in the relative regard for the class which represents the staffof life , and that which drinks the wine of its wealth and luxury.99 Dr. Peddie also suggests [ see Appendix of " Report on Drunkards,p. 187 , ] that " the pauper class of drunkards should be taken care of"in the separate wards of a poor- house," and that " the criminal"drunkard class should be accommodated in wards or separate houses"connected with our chief prisons." By these arrangements," he 661876.]Dr. Buckmill on Drunkards. 433thinks, "the unhappy individuals would have more chance of benefit"from a distinct and more attractive system of treatment. "In these separate wards, to be called Reformatories, work is " to be"made both agreeable and profitable by a system of rewards and bene- " fits." For the rich drunkard the loss of liberty is to be sweetenedby manifold attractions, of which " not the least would be perfection"in the culinary department" and " such new and relishable enjoymentsas might counteract or take the place of craving for alcoholic " stimulants. "66 All this, indeed, is philanthropy and not science , not even socialscience. Perhaps it is not even non-professional common sense,"for we should all wish to be Inebriates that we might enjoy ourselvesunder the protection of Dr. Peddie's wing, and he might become theonly sober man left in the land. What a position, Sanus, Solus,Sobrius, Rex ebriorum! Only there would be no bread-winners andrate-payers left to support the drunkards-I beg their pardon-theInebriates . But even this bit of a difficulty might possibly be avertedby Dr. Peddie's ingenious suggestion that Inebriates may be allowedto carry on their work or business, their wages or profits being takenaway from them, and " so leaving them free to earn but not free tospend;" a suggestion which indicates a knowledge of human naturemore profound than even " non-professional common- sense" can fairly reach.I am extremely sorry to have caused Dr. Peddie " the felt injustice of having his opinions ignored. " The truth is, that when Iwrote to you on The Relations of Drink and Insanity, I was entirelypre-occupied by the consideration of the question, and had no thought,purpose, or notion ofgiving Dr. Peddie the slightest offence . Shouldthis letter also not please him, I must insist that it is no fault ofmine, seeing that I have been constrained by him to introduce, mostunwillingly, into the discussion of a scientific question, matters whichmay seem to have a somewhat personal bearing. But, when a man ofDr. Peddie's eminence asserts that in such a discussion you are unjust if you ignore my opinions, one is compelled, as it were, to standand deliver one's opinions upon his opinions whatever they may be.I very much wish that mine could have been more in agreement withthem.I am your obedient servant,JOHN CHARLES BUCKNILL.39, Wimpole Street, August 24th, 1876.434 [Oct.,CLINICAL NOTES AND CASES.The Therapeutic Action of Hyoscyamine.Dr. Lawson, of the West Riding Asylum , contributes tothe " Practitioner " of July last his experience of the actionof this drug. In sufficient quantities it produces a subduedform of mania accompanied by almost complete paralysis ofthe voluntary muscles, and ending in quiet and refreshingsleep. Having regard to these effects, he thought it probable that it might be useful in certain forms of violentsthenic mania, which, notwithstanding the virtues of ergotof rye, do appear to be met with in the West Riding Asylum,and be useful in this way-by substituting for the extremeforms of excitement a quieter form of mania, which, on disappearing in its turn, might leave the patient quiet. Experience seems to have established the correctness of this surmise.First, in illustration of the treatment of recurrent mania, I shallquote a typical case. J. B., a male patient, aged 50, was admitted4th October, 1875. This was the patient's third attack, and he wasadmitted on transfer from a private asylum where he had been for twoyears. During the two previous attacks he was under treatment atthe West Riding Asylum for four and six months respectively. Atthe commencement of the first attack he attempted to shear off hisgenitals, and when admitted the cicatrix was fresh and raw.His excitement was extreme, and notwithstanding the vigilance of a specialattendant, he succeeded in dragging his right testicl* from the scrotum . It was replaced, however, and the wound healed readilyunder antiseptic treatment, without having produced any bad constitutional effects . Previous to this second attempt at mutilation he hadbeen ordered to have half a grain of hydrochlorate of morphia everyfour hours. The effect was good, but for some time the patient continued more or less excited, and made numerous attempts at self- mutilation. In three days the medicine was discontinued, and abouta fortnight afterwards he become much better and made a rapidrecovery. The second attack was of a similar character.When, after two years ' treatment elsewhere, he was admitted thethird time, he was exceedingly excited. His actions were grotesqueand his language obscene and incoherent. His words were mutteredthrough his teeth, were accompanied by a leering look, and followedby an apparently voluntary twitching of the whole of the muscles ofthe face. He had no marked delusions, but was quite incapable of1876.]Clinical Notes and Cases.435giving a rational answer to any question, though he appeared to understand clearly what was said to him. If he commenced toanswer, his remarks were quickly interrupted by the comical introduction of some obscene observation at which he himself laughed heartily. He remained in this condition for about a month. At theend of that time he had 14 grs. of hyoscyamine. The time ofadministration was 3.53 P. M. The pupils at that time were in. indiameter and the pulse 87. At 4 P.M. he was still talking incoherently and incessantly, but the pupils had become somewhatdilated . He was constantly winking, making grotesque movements,and directing passes over the medical officer " to put things straight in him." At 4.15 the pulse was reduced to 72. He could read aswell as before, and his motion was unimpaired, but he was not sotalkative. At 4.20 he commenced to rub his eyes, as if they werethe seat of some sensation; and when asked to read and write,penned some ribald verses, which were apparently original. Thepulse was now 88, and the pupils fully dilated . He could not read, onaccount of the development of hypermetropia. When attempting towalk he staggered as if drunk. At 4.30 the pulse was 106. He wasvery quiet, and did not speak unless to mutter an occasional piece ofobscenity. He was now almost completely affected constitutionally.The tongue was dry, and had a triangular- shaped red band round themiddle, and white edges. When asked to put his tongue out he didso, but fell fast asleep without retracting it. When awakened andrequested to pick his cap off the floor he endeavoured to do so, butgrasped at the floor on the proximal side of it. At 4:47 the pulsewas 144, weak but regular. He was very drowsy, slept heavily, andwhen wakened immediately went to sleep again after the irritation hadbeen removed. He never spoke unless when spoken to, and so indistinctly as not to be understood. At 450 he was sleeping soundly,unless when loss of balance on his chair wakened him. He madeuncertain movements with his hands, like the pickings manifested in low fever delirium. At this period he was sent to bed. At 5.30 hispulse was 114, and he was fast asleep , his skin being dry and pupilsfully dilated . The respirations were 18, heavy and snoring.At midnight the pulse was 87 , and he had taken food.Next morning he was very subdued, and did not manifest the sameamount of buffoonery. When asked how he was , he answered that hehad met several friends (two other patients treated at the same time)yesterday, and that they had indulged in a social glass of physic,which he believed had done him a deal of good. His recovery progressed daily from this time. He soon came to occupy himself in thestore, showed a reserve which contrasted strongly with his previousvagaries, and after a period of complete sanity was discharged fromthe Asylum, January 27, 1876. Only one dose of hyoscyamine hadbeen administered . He had no other medicine whatever; the attackhad lasted two years before the administration of the drug, and con-436 Clinical Notes and Cases [Oct., .valescence was traceable to the day after the establishment of the physiological action of the medicine.The record of another case of recurrent mania may be sufficient toestablish the value of the drug in such cases. J. H. F. , malepatient, aged 41 , was re - admitted 29th December, 1875.This washis third attack. The first had occurred several years before, and hadbeen characterised by delusions, hallucinations , and excitement. Forthe second seizure he was brought to this Asylum in March, 1875 .After the removal of the excitement which characterised the secondattack, he was detained for a considerable time. Notwithstandingthis precaution, no sooner was he discharged than symptoms of maniaagain set in. Almost daily he made road journeys to the Asylum,inquired in an excited manner after his associates, and made irrationalsuggestions regarding the management of the labour of the institution. After an absence of about six weeks he was again certified andbrought back in a state of intense excitement. He was in a conditionof furious mania, giving vent to delusions of a somewhat optimisticcharacter; smashing shutters and bed- stocks, refusing food, andthreatening violence to all around him. One grain of hyoscyaminewas administered after he had passed a sleepless night and persistentlyrefused food . After the administration of the drug he slept soundlyfor about twelve hours, and on wakening took a good breakfastand was free from every trace of excitement. He threw aside his delusions and employed himself usefully. The quiescence continued till ,after the expiry of a month from the date of his admission, his wife came to see him. The visit produced an outburst more severe eventhan the first. Hyoscyamine was tried, but with little effect. Thisresult, however, was explicable by the discovery that the hyoscyamineemployed bad been kept for some time over a stove in an imperfectlystoppered bottle. When a new bottle of Mirk's alkaloid was openedand dispensed, one grain produced the same effect as before, and in avery short time the patient was again restored to, and still retains,the proper use of his reason.After remarking upon the potency and permanency ofaction of single doses, in which respects it is not equalledby any other drug, he goes on to point out a class of cases inwhich it is particularly useful.In the refractory wards of an asylum outbursts of excitement areconstantly manifested which present more of the features of voluntary abandonment to angry passions than of pure insanity. Suchpatients are very aggressive, very loud in their denunciations , andvery destructive of clothes and furniture. To such a patient a graindose of hyoscyamine is a very ready and serviceable means of treat- ment. The violence and the alarming manifestations of muscularforce which precede the administration of the medicine stand in verystrong contrast with the helplessness , the absolute and conscious im-1876.]Clinical Notes and Cases. 437potence, which follow shortly upon its exhibition . The vigorous rupture of rugs is succeeded by involuntary pickings of a superlativelyfeeble character; the mind directed from the stimulation of surrounding excitants, is fooled by delusions and hallucinations which thelimbs are too weak to take action on, and a period of oblivious sleepis followed by a tendency not to waste energy to the annoyanceof others, but to court the most absolute retirement and inaction .The sensations produced by the immediate action and after effects ofthe drug are such as to lead the recalcitrant lunatic to exercisea certain amount of self- control in order to avoid the employment ofwhat such patients speak of as " the silly medicine. " Many circum- stances render such cases the most suitable ones for the use of thedrug. Such patients are usually in robust health, have been eatingwell, and are not likely to suffer much from a temporary derangementof digestion, and none feel more keenly the inconvenience of beingreduced to a state of helplessness . With patients suffering fromacute or furious mania, however, the case is different. These not unfrequently are, when admitted, reduced to the last degree by the prolongation of extreme excitement, the loss of sleep, and the refusal offood. Their tongues and throats are generally dry, and the tubealmost always requires to be resorted to for feeding purposes. Nowin such cases, though hyoscyamine will produce a most certain andrefreshing sleep, it will also by its physiological action increase thedryness of the throat, and thus both impede artificial feeding, and addto the constitutional disturbance which, even in a moist state of thethroat, the passing of the tube is apt to induce. But I could adducenumerous instances in which the use of hyoscyamine in outbursts ofmaniacal excitement has been productive, not only of great temporarybenefit, but of highly satisfactory cures . A few illustrative caseswill be sufficient to confirm this statement.S. J. , male patient, aged 25, was admitted on the 21st of August,1875. He was certified as being subject to attacks of maniacal excitement and irritability, in which he violently assaulted those about him and appeared to lose all control over his actions. He had beendischarged from the army as incorrigible, and when brought to theAsylum had just completed a term of two months' imprisonment foran aggravated assault. While in prison he made repeated assaults onthe warders, who accused him of acting the " balmy stick," or, inplain English, feigning madness. When examined on admission hewas rational, but very talkative, and occasionally pugnacious. Heaffirmed that his principle was to " act in Rome as the Romans do,"and adapt himself to all classes of society. On October 5th he hada severe attack of excitement, smashed an iron ventilator, andattempted to perpetrate a violent assault on an attendant. He wasordered -Pot. bromid. ziv, tinct. cannab. Ind. Zi. , aq. ad. Zviij . Sig.3i. ter. in die. This treatment was continued for ten days, but hisexcitement remained unabated. On the 17th he had grs. 1 of byos-438 [Oct.,Clinical Notes and Cases.cyamine. All the day he was prostrate with the drug, and when theimmediate effects had passed off was very much subdued. Duringthe next month, however, he had numerous outbursts of temper, andthough he was a young fellow of slender build, was continuallythreatening and challenging much more formidable and equallypugnacious men. Medicine according to the formula already mentioned, and also digitalis and opium, were administered to him without effect, and on the 21st December he again had one grain of hyoscyamine. The usual primary effects of sleep, motor paralysis, andprostration were manifested in about ten minutes; but the aftereffects were much more enduring than on the previous occasion.about a week he owned himself overcome by the " silly medicine, "and went to work in the tailors ' shop. There he employed himselfwith great industry. His reserved manner and great self- control contrasted strongly with the former aggressive impulsiveness, and afterserving a satisfactory period of probation he was discharged recoveredon the 12th day of January, 1876.InIn epileptic excitement also the drug is productive of marked benefit.E. H , male patient, aged 30, epileptic from birth, suicidal, destructive, and exceedingly dangerous, was admitted on the 17th September,1875. When received into the asylum he was labouring under stupor,resulting from a succession of fits. Subsequently he emerged fromhis stupor, and his condition with regard to dementia, andhis appearanceand manner were found to be in all respects those of a confirmed epileptic . Seven days after admission he had a severe attack of excitement, in which he made a furious onslaught on several attendants.He was ordered half- drachm doses of bromide of potassium in combination with three-drachm doses of liquid extract of ergot. Thismixture was administered for nearly a month, but during that time violent excitement was almost constantly manifested by him. He hadgr. 1 of hyoscyamine, and after a refreshing sleep began to take thefood which during his excitement had to be administered forcibly.The bromide and ergot mixture was discontinued . For a month hewas comparatively quiet, but on December 27th he again became veryviolent. During the night he wrenched a fixed bedstock from thefloor of one of the strongest rooms in the asylum, and barricaded him- self in such a manner that four men were unable to obtain admissionwithout mechanical appliances. At the same time he maintained adogged silence, so as to lead to the fear that he had again manifestedthe suicidal tendency which was certified as one of his symptoms.When admission was obtained he had gr. 1 of hyoscyamine by themouth, and in fifteen or twenty minutes was fast asleep . He has notsince then manifested a trace of excitement, has been a cheerful anduseful ward- helper, and has improved very much in physical condition .Similar good results have also been obtained in the analogous orcollateral condition of epileptic status, inasmuch as the number of1876.]Clinical Notes and Cases. 439convulsive attacks has been diminished with as much certainty as bythe administration of chloral hydrate.In referring to the treatment by hyoscyamine of acute, furious, ordelirious mania, I can do little more than record at present that thedrug possesses both great advantages and great disadvantages in suchforms of derangement. The advantages are the certainty of producing repose if a sufficiently large dose is administered and the permanency of the effect produced, which is more marked after the employment of a single dose of hyoscyamine than after the isolated useof any other drug. The disadvantages are, that the dose required tocombat extreme excitement may also be sufficient to produce such aphysiological action on the heart and the respiratory system as tocause danger to a frame wasted (as generally occurs in such cases) byprolonged fury, starvation and loss of sleep. Also, as I have alreadysaid, the dryness of the throat following upon the use of the drugmay interfere considerably with the success of forcible feeding, which forms so essential an element in the treatment of such cases. Combination with the tinctura pyrethri or some other equally powerfulsialogogue may to some extent obviate this last disqualification , andI am about to institute observations on this point. It is not probable,however, that I shall have to alter the opinion already formed, thatin cases of furious mania hyoscyamine is inadmissible unless in rareinstances where violent raving is accompanied by the survival of suchan amount of bodily vigour as may be sufficient to withstand theaction of a large dose of an exceedingly active drug.Recurrence of the same Erotic and other Delusions in aPatient, after being Twenty Years Dormant.A. G., æt. 38, male. Admitted into the asylum on 22ndJanuary, 1849. Carpenter by trade. Resides at Ratho.Patient was a respectable, well- conducted, hard-working man untilabout two years ago, when, after a false accusation regarding the performance of some parochial duties, he became changed in his waysand manners, and his friends remarked that he was not like the man he used to be. Six months ago he began to exhibit mild symptomsof the same nature as he now labours under, and in consequence ofwhich he was placed in the asylum. There is no hereditary history ofinsanity.On admission he was maniacal and excited, had delusions of an extravagant nature, great incoherence of ideas, and dressed in a gay and extravagant way. Had marked erotic tendencies, believed everywoman was his wife -wished to have connection with her, no matterwhere he met her- fancied men were women, and used most disgustinglanguage. He stated he was connected with the Royal Family, thatXXII. 29440 [Oct.,Clinical Notes and Cases.he owned several palaces, and that he was Pope Pius IX., and that hehad raised the most wonderful and powerful race on earth. If crossedin any way he at once became violent, and struck the person whohe imagined was insulting him.Patient remained in this excited state, labouring under the samedelusions, until 1855 , when a great improvement in his mental statetook place. The excitement disappeared and he gave no expression tohis delusions; he was somewhat enfeebled, but was able to work athis trade, make himself generally useful , and, in short, became morelike what he had been previous to his illness, being the most trustedand privileged patient in the asylum. He remained a somewhatirritable and demented, but extremely useful, inmate of the asylum tillthis year, when the following was his condition. He had got weak inbody, old- looking, bent, and suffered from paralysis agitans.April 1st, 1876. -For the last few days patient has been flushedabout the head and face, rambling in his conversation , dressing a littleabsurdly, laughing more than usual, talkative, and generally changed in his behaviour.April 3rd. -Is more excited, very restless , wandering about thegrounds; talks quite incoherently, laughs loudly to himself, and isalso very irritable if in any way crossed .He April 5th.-To- day patient, besides being excited, exhibits delusions of much the same nature as is recorded in his case on admission.is very erotic, and wished to have connection with several of the femalepatients is preparing his room for that purpose in a style of what hecalls great grandeur. Thinks men are women, calls the same attendant, John W., just as he had twenty- seven years before, " Fanny;"says he has raised a most wonderful and powerful offspring, that he also owns the place, and is going to sell all the books in it to realisean enormous sum of money, &c .—April 22nd. Is getting more excited, has the same delusions ,dresses gayly, is very erotic and disgusting in his language.May 30th. The patient has remained in the same excited statesince last date of entry, has the same extravagant delusions, and the erotic tendencies exist as strongly as ever.The above case affords an illustration of a relapse takingplace in a patient who had been free from maniacal symptoms for upwards of twenty years, and the marked resemblance these symptoms bore to those of the first attack. Ina patient of 65 years of age, we would more naturally haveexpected a class of symptoms such as occur in senile mania,and especially would not have looked for erotic symptoms.We find, however, the alteration in the patient's general behaviour, the excitement, the delusions, and the erotism wereexactly of the character, and presented features precisely thesame as they did on the first attack, with this slight differ-1876.]Clinical Notes and Cases. 441ence, that they followed each other and became pronouncedin more rapid succession. The delusions were the same forwhich the patient had been placed in the asylum twentyseven years before, and it becomes an interesting questionhow far the patient was free from the delusions during thetwenty years he remained unexcited.OCCASIONAL NOTES OF THE QUARTER.Dr. Buckmill on American Alienists.*At the Third General Meeting of the British MedicalAssociation, held at Sheffield, on the 3rd of August last, Dr.Bucknill, by permission of the Council of the Association,made a further statement on the subject of the accusationsmade in " The Lancet " against the superintendents ofAmerican asylums, and especially against Dr. Nichols, of theWashington Asylum. Dr. Buckhill said: -This was an age of international reciprocity in regard to manymatters, and he thought it should be no less an age for reciprocityamong the members of the scientific and medical professions underany circ*mstances in which an expression of sympathy might bedeemed advisable (hear, hear). He wished on the present occasion toask the kindly feeling of his medical brethren in this country onbehalf of one of their own tongue and race who was now practising on the other side of the Atlantic. We were prepared to criticiseAmerican medical men honestly and fairly, and to invite a similarmeed of criticism in return. But there was one point to which hewished to call their particular attention-they must be extremelycautious of the accuracy of what they read of their American professional brethren in the American press. The licence of the Americanpolitical press was not generally known in this country in its attackson private and professional characters. In America, when a man wassaid to be " too bad to live " and " too wicked to die," it generallymeant that he voted with the opposite political party to that represented bythe newspaper which said so ( laughter) . And if a medical manwho had charge of a public institute in any way got into trouble whichbecame the subject of enquiry, either before a civil or a criminalcourt, the newspapers of America were not prevented by any of theusages of the country from making the most severe comments uponthe defendant during the trial, and not only upon him, but upon thejudge, the jury, and the witnesses. They wrote such things habitually

• See " British Medical Journal," August 12, 1876.

442 Occasional Notes of the Quarter. [Oct.,as would subject the editors of newspapers in this country to be citedto appear before the court, and probably punished either by fine orimprisonment. A man might be abused in the American press -andsuch attacks were constantly made-who might be a most honourableman, and highly esteemed by all who knew him. Therefore, if thecomments made by the American press were copied into the journalsof this country, they were apt to mislead their readers very much,and ought to be received with due caution. In this country, if amedical man connected with or having charge of a public institutionwas charged with malpractice and extreme misconduct in carryingout his official duties , it was tolerably fair to presume that there wassome basis for the charges made, because, if such were not the case,the proprietor of the newspaper could be quickly proceeded againstunder the law of libel. Recently, an injustice such as he had alludedto had occurred in America, the subject of the attack being Dr.Nicholls, the Superintendent of the Government Asylum for theInsane at Washington, and an old friend of his (the speaker's) . Dr.Nicholls had been the subject of a political persecution in the shape of a secret committee of inquiry of the Congress. Some of theincidents of that inquiry leaked out during its progress, and werepublished in the " New York World," and from thence quoted in thecolumns of some of the journals * published in this country. Now, ifthose charges had been to some extent proved, yet the mode ofproceeding adopted would have been altogether unjust to theirAmerican brother; but, when he told them upon the authority of Dr.Marion Sims, with whom he had had an opportunity of conversingupon this matter, that the investigation had resulted in the fullacquittal of Dr. Nicholls, the committee finding that the chargesmade against him were entirely unfounded, he thought they wouldagree with him, that this was a case in point, which demonstrated thenecessity of English journals being extremely cautious before quotingand circulating charges made against professional gentlemen practising in America (hear, hear). He felt certain that their Americanbrother would in this matter, so far as he had been in any wayunjustly accused, have the entire sympathy of the members of the Association with him (hear, and applause).Intemperance and Insanity.The causes that have produced the insanity in the 310persons admitted are of great interest, socially and medically.We have a difficulty at the outset in finding out any cause ofthe disease in some cases, and in others to settle which is thereal cause out of a number of events that all may havetended to produce the malady. When a man with a strong66 + Erratum; for some of the journals," read " a journal."1876.] Occasional Notes of the Quarter.443family tendency towards insanity, who has drunk hard previously, is thrown out of employment, and has not thereforesufficient food, and then becomes insane, it is very difficult totabulate the exact cause of his disease. It is necessary,therefore, to divide the causes into predisposing and exciting,or remote and near; and then, for the sake of a systematicdivision, into physical and mental. The causes of insanityoften influence its whole course and symptoms, so that a particular cause produces a special form of the disease. It is ofmuch importance, therefore, that the Physicians to an institution like ours should be able to find out the causes of thedisease as accurately as possible; and I am most anxious inthe case of the rate-supported patients, who are usuallybrought to us by the Assistant Inspectors of Poor, that relatives who know something about the patients should alsocome along with them. The necessity for this will be apparent, when I say, that in 53, or 17 per cent. of the admissionslast year, no sort of information on this point could beobtained at all.Glancing over the summary of assigned causes (Table XI. ) ,it is at once seen that intemperance stands out as by far themost frequent. It alone caused 48 of the 257, or about20 per cent. of those in which the cause was known; andalong with other allied excesses for which the patients hadbeen themselves responsible it accounts for 72, or 28 per cent.of the cases. Much is properly said about the prevention ofdisease now-a-days. Most unquestionably the sum-total ofthe mental disease in our city might have been lessened bythat amount, if the laws of nature had been better obeyed.Fifty of the cases thus resulting from drinking and excessesbeing paupers, each costing £27 a year to the public rates,over £1,300 will have been paid for one year's production oflunacy from very preventible causes; and, of course, this takes no account of the cost of the old incurable casesalready in the Asylum from the same cause. I have nodoubt that both the number of cases and the cost will seemsmall to some persons, and will seem large to others whohave not had their attention directed to it. I am quite surethat intemperance was the remote cause of the disease inmore of the cases; but even allowing for these, we cannotput this down as accounting in any way for more than onein four of all cases of insanity. Medical statistics seemdefinite on this point.The forms of mental disease caused by intemperance are444 Occasional Notes of the Quarter. [Oct.,of two types-one being of a more transient and curablenature, the other incurable, and being accompanied byorganic diseases of the brain. Of the former class we hadabout thirty cases, of the latter about twenty. It is interesting to compare the prevalence of those types of disease herewith other places. Such coal and iron mining counties asDurham and Glamorgan produce the most marked and fatalof all the brain diseases caused by excesses (General Paralysis) in twice the proportion ( 16 and 13 per. cent. ) we do(7 per cent. ); while, on the other hand, we stand at twicethe amount of the agricultural counties (3.6 per cent. ) onthis head.When the number of pauper patients whose disease wascaused by intemperate habits is compared with that of theprivate patients from the same cause, I find that there wereabout 3 per cent. more of the latter than the former.A better social position, more means of rational amusem*nt,a better education , and the stronger public opinion of theirclass, do not seem to have saved any larger proportion of thebetter classes than of the poorer. In this respect ourstatistics for this year are in accordance with those of formeryears.In assigning intemperance as the cause of insanity in anumber of cases, two things must not be forgotten. Thefirst is, that the taking to stimulants may not be a cause atall, but merely a symptom of the brain disorder, and, as amatter of fact, it is often one of the early symptoms in manycases; the second thing to be kept in mind is, that there aremany cases in which it is the real cause of the mental disorder, but the mental balance had always been so unstable,and the brain working so easily overset, that a very littlealcohol indeed will bring on an attack of insanity in thesepersons, just as in those same people a fright or a little over- excitement will upset their sanity. This is the class ofpersons who, in my experience, get upset by religious revivals. The resisting and recuperative power that is reallyan essential part of a healthy nervous system, whereby theeffects of not too long continued over- eating or over- drinking,over-feeling or over-work, are at once recovered from, iswanting in these people. Nature provides that short excesses don't do much harm to healthy people. It is a poorsort of boiler that bursts whenever the exact pressure neededfor its daily work is exceeded .And, before I leave this subject, I may mention, that I1876.] Occasional Notes of the Quarter.445have not reckoned in any way the mere drink-craving, or theinability to resist it, as constituting insanity. I believe thismay or may not be a real insanity in different cases, but itwas from developed and unmistakeable mental alienation that my patients suffered.Taking all the cases in which any direct cause for thedisease was assigned or known, 63 per cent. were physicalcauses, such as intemperance, injuries to the head, epilepticfits, starvation, or childbirth, &c.; while 37 per cent. weremental, such as grief, domestic or business anxieties, disappointments, religious excitement or fright. A comparisonof our statistics here in regard to this point with those ofother districts of the country exhibit very curious differences.Most people fancy that such mental causes as I have mentioned are far more frequent producers of insanity thanmere physical conditions, and will be surprised at the frequency of the latter in our table of causes; but when Iexamined the reports of the Asylums for such mining andmanufacturing counties as Durham, Glamorgan, and Staffordfor five years, I find that physical causes are put down asproducing the insanity in four cases for every one that is put down to mental causes. Mental causes, in short, onlyoperate there with half the frequency they do with us. Thereports of the Asylums for such agricultural counties asWilts, Worcester, Somerset, and Salop, for the same period,show that in them the physical stand to the mental as threeto one; and in the town populations of Newcastle, Liverpool, Birmingham, and Bristol, as two to one. Those arestill below our statistics in regard to the frequency of mentalcauses; but the difference is explained, I find, by the fact,that this is a mixed Asylum for all classes, while all theAsylums for the counties and towns I have mentioned take inonly pauper patients . When the causes of the insanity inour eighty-eight private patients are compared with those ofthe 222 paupers, the difference is most striking, and entirelybears out the general law already indicated . Of thoseeighty-eight private patients, mental causes produced thedisease in about as many as physical, while in the paupersthey were only as one to three. These facts tend strongly toshow, that the higher in the social scale we go, the morestrongly do purely mental and moral shocks act in upsettinga healthy mental balance, and that those causes operatemore powerfully on the lower classes of a town populationthan on an agricultural. They also point to the fact, that our446 Occasional Notes of the Quarter. [Oct. ,workers in coal, iron , and the potteries, expose themselves,above all other people, to the physical causes which produceinsanity. -Report of Royal Edinburgh Asylum for 1875.An Imposing Female.Among the patients who come here in a year, there arealways many with the saddest of histories, and usually a fewwhose doings before admission were of a very striking character. In one case, a woman who, up to about a twelvemonth of her admission, had lived a quiet but honest anduneventful life, had then struck out a highly sensational course for herself. By a series of the most extraordinarymisrepresentations and cleverly carried out impostures, sheraised large sums of money on no security whatever, andspent them as recklessly; imposed on jewellers, so thattheytrusted her with goods worth many hundreds of pounds;furnished grand houses entirely at the expense of trustingupholsterers; introduced herself by sheer impudence to onegreat nobleman after another, and then introduced her dupes,who, on the faith of those distinguished social connections,at once disgorged more money. To one person she was agreat literary character; to another, of royal descent; toanother, she had immense expectations; to another, she wasa stern religionist. At last all this lying, cheating, scheming,and imposture developed into marked insanity and braindisease, of which she soon died; and it was seen that allthese people had been the dupes of a lunatic, whose veryboldness, cunning, and mendacity, had been the direct resultof her insanity. -Report of Royal Edinburgh Asylumfor 1875.Good Effects on the Poorer Classes of the Insane ofFrequentVisits by Relatives.We are in this peculiar and almost unique position inScotland, that while our number of yearly admissions increase, our numbers left at the end of the year have diminished for the past three years. There are severalcauses for this. Our recoveries are very numerous, and alarge number of unrecovered but quiet cases are removed, atmy advice, by their friends. Our proximity to town, and theextraordinarily ready access provided by the tramways, are circ*mstances which most people, and among them manyhigh authorities in lunacy matters, would consider great disadvantages. Their effect is to bring the relatives of our poorerpatients out to the Asylum to visit them to an extent quite11876.] Occasional Notes of the Quarter. 447unknown in country Asylums. In this way an interest inthem is kept up, and very few of them indeed are forgottenand neglected by their kith and kin . This is an influencewhich often saves them from falling into incurable insanity,it gives many of them unbounded pleasure, it keeps alivehome feelings and associations, and it brings a direct publicopinion of the most unsleeping and critical kind to bear onthe officers and attendants of the institution-all matters ofincalculable importance, and much difficulty of attainment.When the relatives of patients see that the acute symptomshave passed off, they are often disposed to take them out fora day to see how they get on. If this succeeds, they trythem at their usual employment, and if they do well, areoften anxious to have them home altogether. It is by thismost natural of all means that any undue accumulation ofthe incurably insane has been avoided for the past threeyears, and the problem of how to provide for such, which isso urgent in many parts of the kingdom, has been solved forus at no cost to the rates whatever. I find from the Reportof the Commissioners in Lunacy, that Edinburgh is the onlycounty in Scotland, the majority of whose population isurban, where the numbers of the registered insane, whetherin Asylums or not, have absolutely diminished for the lastthree years. -Report of Royal Edinburgh Asylum for 1875.Insanity and Crime.We have been prevented, by great pressure on our space,from recording at the time, as we had intended to have done,some instructive trials of insane persons for murder. It istrue that they serve only to illustrate an often- told tale, butit is perhaps well that the moral of the tale should be enforcedby constant repetition, until it sinks into the hearts of thosewho may care enough for the progress ofjust doctrine to wishto see it prevail, and who may have influence enough to getit embodied in the legislative enactments of the country.We quote from the " Times " newspaper, of July 24th,1875, the report of a trial for murder in which Mr. JusticeBrett asserted himself almost as aggressively as on theoccasion when he passed the sentence upon the recalcitrantgas- stokers, which led to the quick abolition of the law underwhich such a sentence was possible . Pity that a similarresult did not follow his charge on this occasion!What asad pass things are coming to when the scientific observations448 Occasional Notes of the Quarter. [Oct.,ofdoctors and the common sense of jurymen dare to repudiatethe law declared by the Judges of England many yearsago!" Happy the country whose judges have discoveredby intuition and proclaimed with confidence, many yearsago, a criterion of responsibility which shall be a lampunto the paths of generations and nations for all time tocome! If Blampied knew that he was killing Catt bysmashing his skull with the adze, and that killing wasmurder, what more was necessary to entitle him to the privilege of being hanged for the luxury in which he indulged?" Uncontrollable" is by interpretation " uncontrolled. " Havenot the mouths of the Judges of England spoken it manyyears ago?Blampied was tried at the Maidstone Assizes for themurder of Catt, by whose side he was working. He hadkilled him suddenly, and without the least apparent motive,by striking him on the head with an adze.The two men had been for some time employed in the masthouse atthe dockyard, Chatham. A few months before the shocking occurrence they had had an altercation; but since they had been apparentlyon good terms. On the day mentioned they were at work together onthe same mast, about 6ft. from each other, and the prisoner was using an adze. Just before the act of homicide the prisoner went twice tothe foreman for directions as to his work, and seemed quite cool andsensible. Suddenly those who were near the two men heard the soundas of a blow, and heard the deceased man cry out, " Oh! oh!" Oneof the workmen ran to the spot and found Catt lying down and theprisoner standing close to him with the adze in his hand; and anotherwitness who came up saw the prisoner move from the deceased. Thiswitness cried out, " He has killed Jemmy." On which the prisonersaid , " No, he has killed himself; " and afterwards he added that Catthad taken up his adze and killed himself. But, from the nature ofthe wounds inflicted, it appeared that this was impossible, the woundsbeing at the back of the head, and one of them of such depth that ithad actually cleft the skull. The prisoner was quite cool and collected, and helped to remove the poor man to the surgery, where,however, he died in a few minutes. The prisoner went to the policeoffice and said he had to report that Catt had taken his adze and hadstruck himself with it severely. He was then charged with havingkilled the man, and said he was innocent. There was no doubt thathe had committed the act. The defence set up on his behalf was insanity, and he had certainly been in a lunatic asylum for some time,but he had been three years ago discharged as cured, and had been inthe service of the Government in the dockyard at Chatham, to allappearance perfectly in the possession of his senses.1876.] Occasional 449 Notes of the Quarter.The prisoner, when called upon to plead, pleaded " Not guilty,"with every appearance of sanity.A shipwright, who was working with two others not far off in thesame masthouse, stated that he had known the prisoner 14 or 15years, but more intimately for the eight or nine months previous tothe fatal occurrence. The prisoner, he said, had come to him fordirections as to his work about half-past two, and there was nothingthen in his aspect or demeanour at all unusual. The two men, hesaid, had worked together eight or nine months, and, so far as was known, were on good terms. At the time of the dreadful occurrencethe witness and two other men were from 30ft. to 60ft. from the prisoner and the deceased, and on hearing the sound of the blow andgoing up to the spot he saw the prisoner standing with his adze inhis hand. Witness was frightened and went back to get assistance,and on his returning to the spot the prisoner, who had then put theadze down, said that Catt had taken his (the prisoner's) adze andkilled himself with it. The two men at the time were working within6ft. of each other, and as the adze is 2ft . or 3ft. long the prisonerwould only have to take a step in advance with his arm extended tobring it down on the head of the deceased. The prisoner just after theact was quite calm and collected , and there was nothing, the witnessessaid, at all unusual in his appearance.The inspector of police stated that the prisoner came to him and said he had something to report, and went on to say, I have beenemployed in the masthouse, and when I turned round James Catt,who was employed with me, took hold of my adze and struck himselfon the head with it, seriously injuring himself." The inspector said,"He's dead then?" To which the prisoner replied, " No; I don'tknow about that." "Where is he?" asked the inspector. "At thesurgery," said the prisoner, adding, " He was a good mate, a goodworkman, and a good fellow." The inspector proceeded to write downthe man's statement, and read it over to him, and he said it was correct. The prisoner was soon afterwards charged with murder, andsaid, " I didn't do it; he did it himself."The surgeon who attends the dockyard stated that in April, 1874,the prisoner had been under his care for a few days for swimming ofthe head, and again for a few days in October suffering from melancholia. But this witness said he knew nothing of insanity, and hadnot studied the subject.The surgeon of the police at Chatham, who saw the prisoner in custody the day after the occurrence and conversed with him, stated thathe asked him, " Do you know what you are here for?" and he said hehad " knocked his mate on the head, and the stupid fellow fell down dead." " Then you killed him?" said the surgeon, to which the manreplied, " I knocked him on the head, and he fell down dead. " Thiswitness stated that in December, 1868, he had signed the certificatefor the removal of the prisoner to Barming Lunatic Asylum as a450 Occasional Notes of the Quarter. [Oct.,lunatic, where he remained until December, 1872, when he was discharged as cured. The witness said he agreed with Dr. Taylor thatimpulsive mania might come on and go off suddenly, and leave theperson quite cool just afterwards.The learned Judge observed that every impulse, of course, was sudden, or it would not be an impulse.The witness went on to say that " swimming" in the head mightbe the effect of the impulse, and that if the man had been suffering from melancholia the swimming in the head might be a symptom ofan attack.Mr. Joy, the medical attendant of the gaol, stated that since theprisoner had been there he had had frequent opportunities of seeinghim, and had conversed with him constantly, and was of opinion thathe was of unsound mind , being, he said, mad on the subject of religion.In cross- examination , he said the man has expressed strange opinionson the subject of religion; and, in answer to the learned Judge, saidhe considered him of unsound mind on these subjects. He thought,he said, that it was a sudden act-an act committed from a suddenimpulse.The learned Judge-Do you think that he knew, when he struckthat blow with the adze, that it was likely to kill the man?The doctor said no doubt he knew that; but he believed the actwas uncontrollable.The learned Judge said that would not do.The prisoner's counsel said it was laid down on high authority thatit was so, referring to Dr. Taylor's work on " Medical Jurisprudence; "butThe learned Judge said though Dr. Taylor was a high medicalauthority, he was not a lawyer, and was no legal authority at all.The medical witness said he believed the impulse to do the act was"uncontrollable."66 The learned Judge-What do you mean by that? Supposing aperson takes it into his head to steal something, is that an uncontrollable impulse?"The Witness- No!The learned Judge-Why? In fact, he has not controlled himself,and in that sense the impulse was uncontrollable.The witness said the man had been previously in a lunatic asylum,butThe learned Judge observed that he did not see how this affectedthe question. The man, he said, may be mad. I assume that he isso in the medical sense of the term, but the question here is, whetherhe is so mad as to be absolved from the consequences of what hehas done. He is not so absolved, though he is mad, if he was not somad as not to know what he was doing or not to know that he wasdoing wrong.The medical attendant of the Lunatic Asylum at Barming, from1876.] Occasional Notes 451 of the Quarter.which the prisoner was discharged in 1872, stated that his grandfatherwas insane and also one of his sisters, and that when he was receivedthere in 1868 he was suffering from melancholia, caused by religiousdelusions. But he was discharged as cured, and was believed to becured.The learned Judge, in summing up the case to the jury, said theprisoner's counsel had done his duty, and now they had to do theirs.They were not entitled to follow their own opinions, and say whatought to be the law, but simply to answer the questions proposed tothem. The first question put to them was, whether the prisoner struckthe blow; and if so, he told them, as matter of law, that he wasprima facie guilty of murder. If this were so, then it was for theprisoner to satisfy them not that it was doubtful whether he was mal,not even that he was mad, but that he was so mad as not to know thenature of the act he committed—that is , that he did not know whathe did, or that he did not know that it was wrong. As to themedical evidence, he declared advisedly that it was not enough to show that a man was mad, or had what medical men called an uncontrollable impulse," for, even assuming this , the law did not absolvehim from the consequences of his act. If he knew what he was doing,and if he knew that it was wrong, then he was responsible for it. Thathad been declared to the House of Lords by the Judges of Englandmany years ago, and by the law so declared Judges and juries wereequally bound.66Mr. Justice Brett then read to the jury the well- knownquestions put to the Judges by the House of Lords, and theiranswers, and proceeded as follows:-That is, the Judges laid down distinctly that, even although the actwas done under the influence of delusions, with the idea of doing apublic benefit, still if the person knew it was contrary to law, he wouldbe criminally responsible for the act he had committed. The jurymust be satisfied that at the time of the act the prisoner was undersuch delusion as not to know the nature of the act he was doing, ornot to know that it was wrong. Then, did the prisoner in this casekill the deceased, and did he know he was killing him, and did heknow that it was wrong or contrary to law to do it; if the prisonerdid the act knowing that he was killing the man, and knowing that itwas wrong to do so, then he was criminally responsible for his act. Ithad been urged that there was no motive, and that it was a suddenimpulse, as no doubt it was: but if that was sufficient to establish thedefence, then the less cause there was for a murder the more excuse there was for it. Again, it was urged that the man was cool just afterthe act, and that therefore he was mad, though that surely dependedon the state of his nerves; for if they were strong then he would becool and collected . If the defence was not fully established, then thejury were bound to reject it . It could not be seriously disputed that452 Occasional Notes of the Quarter. [Oct.,the prisoner struck the blow, and it could not be accidental, as themen were six feet apart. Nor was it possible that (as the prisonersuggested) the deceased could have done it himself, as it was at theback of the head, and broke the head almost to pieces. The othermen were from 30ft. to 60ft. off, and there was no one who could havedone the act but the prisoner, who was found with the adze in hishand. It was impossible, then, to doubt that the prisoner committedthe act, and then he was clearly guilty of murder, unless the defencewas established . But the defence required it to be shown that theman did not know the nature of the act he committed, or that he didnot know that it was wrong-i.e. , that he did not know he was killinga man, or that he did not know it was wrong to do so. No doubt theman was in a sense insane; that is, he was probably under the influence of delusion, and no doubt the act was sudden, and there was noapparent motive for it; but all this fell far short of the defence setup. He had been for two or three years working at his business, likeother men, and as to the " swimming in the head," why, it had nothingto do with insanity, and might have been merely a symptom of thestomach being out of order. The man had been for two or three yearspractically sane, and treated as sane, and even though he were underthe influence of religious delusions, that was far from showing suchinsanity as was required to establish the defence. It was said therewas no motive- i.e. , no known cause-and that was true; but, intruth, there never could be an adequate cause for a murder. Then,as to the circ*mstances of the act. There were none which indicatedinsanity in the sense which was necessary. When he found the mencoming up to him he put the adze down and said, " He has taken my adze and killed himself. " Did that show that he was not conscious ofthe nature of the act, or that he was not conscious that it was wrong?Did it not rather show that he was quite conscious of it, and soughtto avoid his liability for it? Then the prisoner went and made a statement to the inspector, which was quite coherent: but was it true?Was it not the sort of account which a man would give who sought toavoid the consequences of his act, rather than the incoherent accountwhich would be given of it by a man who did not know what he hadbeen doing? Was there evidence of insanity in the sense which hadbeen explained to the jury? No doubt the man had been insane,and might have been so at this time, and it would be better to assume that at this time he was of unsound mind. But the question was notwhether he was of unsound mind, but whether he was so insane as notto know the nature of the act he committed—that is, that he did notknow that he was killing a man, or that he did not know he was doingwrong in killing a man. If the jury were satisfied of this, then theywould acquit the prisoner on the ground of insanity; otherwise theywere bound to find him guilty of murder. Their responsibility , hereminded them, was limited to the true and faithful discharge oftheir own duty, which was to answer truly as to the facts. The ulti-1876.] Occasional Notes of the Quarter.453mate responsibility as to the fate of the man would rest with others ,who would, no doubt, discharge their duty as faithfully as the jurydischarged theirs. But their duty was clear and simple; and it wassimply to find their verdict with reference to the truth of the case and the effect of the evidence.The jury retired to consider their verdict, and after being absent forabout a quarter of an hour, they returned into Court with a verdict of" Guilty, but not accountable for his acts."The Clerk of Assize: That is, you acquit him on the ground ofinsanity?The jury: Yes.The learned Judge: Insanity in the sense I have explained toyou?The jury: Yes.The prisoner was then ordered to be detained during Her Majesty'spleasure.A few days after this trial, the same Judge tried at theCroydon Assizes a man who was indicted for the murder ofhis wife and child, but who was alleged to be insane. Medicalevidence of his unsoundness of mind was given at the trial .The case was very imperfectly reported in the "Times, ” andwe give, therefore, the result:-Mr. Justice Brett, in summing up the case to the jury,directed them as to the law on the subject of insanity, inaccordance with the law he had laid down in the Maidstonecase, that it was not sufficient to show that the prisoner wasinsane, unless it was also shown that he did not know thenature of the act he was committing, or did not know that itwas wrong. He told them that they must disabuse theirminds of the medical notions as to insanity, for the reasonthat these medical men had not met the Court upon theground which they desired them to do, and that their opinionswere founded on their own ideas as to what the law ofinsanityought to be. He further said that even at the risk of appearing to sum up against the prisoner he must tell them that itwas not enough for them to be satisfied that the prisoner wasinsane, but that he was so insane as not to know what he wasdoing, or if he did that he did not know he was doing awrong thing, or that he did not know he was doing a thingcontraryto law.The jury, however, without any hesitation, found theprisoner Not Guilty on the ground of insanity, and the usual order was made as to his custody.454 Occasional Notes of the Quarter. [Oct. ,Insane or Not?We extract the following interesting letter from the"Meteor," a small journal published at the Alabama Insane Hospital, Tukoloosa, and having the apt motto, Lucusa non lucendo: -EDITOR OF THE METEOR,-I know you would do any service in yourpower to a fellow- sufferer. I have therefore determined to ask you tomake room for a statement of some particulars of my own case. Myobject is to convince that I am not insane, though recognizing, asactualities of my daily life, circ*mstances which are so strange as notto have secured recognition , so far as I know, by the authors of ourmost advanced works on Physiology and Psychology. The only publication I have met with of similar experiences is in Mrs. Mowatt's" Autobiography of an Actress," and some late newspaper accounts ofexhibitions of the power of mind-reading . Of the last the editordeclared, that though remarkable they were vastly inferior to many others achieved by private performers.I have been an inmate of several Insane Hospitals, and it was notuntil I had staid some time in the second one that the phenomena to which I wish to call attention made their appearance. I was sent, thefirst and second time, to a hospital not because I was thought insane,but at my own request, in consequence of a grievous melancholywhich had long oppressed me, and which grew, partly out of impairedphysical health, partly out of some circ*mstances of my past life. Itwas not until I had been about two years in the second hospital-twoand a half in the two-that I became aware of my mind being opento the inspection of others; and for some time thereafter, say forthree years, though habitually amazed at the inexplicable anticipationof my words, acts and designs, I did not propose any consistent ex- planation of the matter. I could conceive of none except miraculouspower, and to this I was fain to resort, now and then, when sorelypuzzled by it. In the course of the third year, after my attention wascalled to the mind- reading, I noticed another and equally strange phenomenon―various unusual sensations in different parts of my body.Some of these were pleasurable, some very painful, and after a hugemass of testimony of daily experiences, I was convinced that theywere neither effects of the tonic medicine I was taking, nor of substances mixed with my food, nor of vapours thrown into my roomall of which theories I had entertained at different times. About thistime I found in the library Mrs. Mowatt's " Autobiography of anActress," and in that book an explanation of the circ*mstance of mythoughts being known to those about me. For an explanation ofthepleasurable and painful feelings that afflicted me by day and by night,I at length adopted the theory of a force projected in some way bythenervous system of others upon my own. Mesmerism I termed it, but1876.] Occasional Notes of the Quarter.455there was not in its effects the slightest symptom of the comatosestate usually implied by that word . I therefore became quite anxiousto leave the establishment, that I might abandon the vicinity of thosewho possessed such fearful control of my nervous system.After some years I was suffered to go, but all the way to NewYork, and thence to Memphis, I found myself still under the influ- ence of mind- readers and nerve-vexers. The extent of mysufferingsfor a year or more it would be difficult to pourtray. For hours onmany consecutive days, I would writhe in the agonies of unnaturalchill, fever or headache. Returning to Alabama, I was, after thelapse of ten or twelve days, sent to this Hospital as a dangerous person, I having, when utterly exhausted of patience with the artificialpains, made demonstrations alarming to those about me. I staid heretwo years and a half, and was never supposed to be insane except uponmind- reading and nerve-fretting. Mytime was very usefully employed in reviewing my Latin, Greek and Mathematics. I also read muchgeneral literature, and wrote hundreds of pages of essays, tales ,dramas and verses, much of which, without the change of a word,was published in popular periodicals, and highly commended.during all this time not a day went by without evidence of the proximity of mind-readers and nerve- vexers.YetReleased in the middle of the third year, I went north to visitmy only child, then about fifteen years old, and though I travelled asfar east as Baltimore, as far west as Kansas City, and as far south asNew Orleans, I nowhere escaped inflictions of the interest taken in my affairs by mind- readers and nerve-vexers. After eleven months Ireturned to Alabama on business, and was advised by my relatives toreturn to this Hospital and remain, as a mere boarder, until they shouldcollect some money from notes left with them. But Dr. Bryce refusedon my arrival to suffer me to remain except as a patient, and I havebeen here ever since. For some months I pretended to have given upa belief in the remarkable facts detailed here, but my detention continuing, I learned that I was kept, not for the strange beliefs, but forfear that I might base upon them courses of conduct detrimental to others.I have turned over the pages of many a medical book for attestations of the reality of my supposed facts, and am to - day surprised thatsuch important matters should not have been mentioned in the latesteditions of our most advanced works on Physiology, Psychology, andeven practical Medicine. If, as I believe , its most secret conceptionscan be wrenched by another from the inmost recesses of the brain;if the direst pains may be inflicted by the mere act of another's will ,all ought to know it. The vast import of such truths is obvious. Itmay be that not all brains are as open to inspection as mine; that notall nervous systems respond as readily to the force of another's will.My chief object in this letter is to gain some clues toward the acquisition of the arts of mind-reading and nerve-vexing. Dozens ofXXII.30456 Occasional Notes of the Quarter. [Oct.,persons, some of them quite insane, can read my mind while theirs issealed to me. My nervous system daily responds to the force of others'will, while I cannot make any one sick at the stomach except withipecac, &c . , nor give them pain in the head unless with a hickory stickor some of its relations.Brown Sequard's idea, that the nerve force cannot travel beyondthe nerve filaments may be correct. Then the phenomena may resulteither from all mind being, like all matter, in perpetual and instantcommunication, or from the vibrations of a universal medium communicating the acts of one mind to another. In proof that it wasnot due to prepossession or dominant ideas -- Carpenter's devicefor getting rid of facts which he cannot explain-I adopted severalexplanations of the sensations before settling upon what I am now convinced is the true one.I have written this letter to call the attention of the public, andespecially Superintendents of Insane Hospitals, to the subject, and toask for information of similar experiences. I would also be greatlyobliged if some one would send me a book, or the title of one, inwhich such matters are fairly discussed . * A PATIENT.Marriages between First Cousins.Mr. George H. Darwin, M.A., has undertaken a series oflaborious and painstaking enquiries into the proportion offirst cousin marriages to all marriages in the population, andinto the effects of such marriages on the health of the progeny. The method which he pursued in his enquiry, and theresults which he obtained, will be found described in anelaborate paper in the " Journal of the Statistical Society"for June, 1875.To sum upthe results of the whole investigation: It seems probable that in England, among the aristocracy and gentry, about 4 percent. of all marriages are between first cousins; in the country andsmaller towns between 2 and 3 per cent; and in London perhaps asfew as 1 per cent. Probably 3 per cent. is a superior limit for thewhole population. Turning to lunatic and idiot asylums, probablybetween 3 and 4 per cent. of the patients are offspring of first cousins.Taking into account the uncertainty of my methods of finding theproportion of such marriages in the general population, the percentageof such offspring in asylums is not greater than that in the generalpopulation to such an extent as to enable one to say, positively, thatthe marriage of first cousins has any effect in the production of insanity or idiocy, although it might still be shown, by more accurate"

• Answers to this communication, addressed to the care of Editor of the

' Meteor, " will be promptly delivered to our bewildered friend.1876.] Occasional Notes of the Quarter.457methods of research, that it is so. With respect to deaf-mutes, theproportion of offspring of first cousin marriages is precisely the sameas the proportion of such marriages for the large towns and thecountry, and therefore there is to evidence whatever of any ill resultsaccruing to the offspring in consequence of the cousinship of their parents.The results of Mr. Darwin's applications to the Superintendents of Lunatic Asylums were not satisfactory. Althoughthose to whom he applied for information responded in themost obliging manner, yet most of them felt it necessary tocaution him against placing reliance upon the statistics whichthey were able to send him. The difference of opinion regarding the effects of intermarriages showed at any rate that the statistics had not led to any uniform results. Dr.Crichton Browne thinks " that the great danger attendingsuch intermarriages consists in the intensification of the morbid constitutional tendencies which they favour.Hereditary diseases and cachexia are much more likely to beshared by cousins than by persons who are in no way relatedare transmitted with more than double intensitywhen they are common to both parents. Theyseemto be the square or cube of the combined volumeeven healthy temperaments, when common to both parents,often come out as decided cachexia in the children." Dr.Howden, of Montrose, says " As regards insanity, my ownimpression is, that unless there exists a hereditary predisposition the marriage of cousins has no effect in producing it.Neither in insanity nor in any other abnormal propensity do two plus two produce four; there is always anotherfactor at work neutralising intensification and bringing things back to the normal. "·Dr. Howe, in his Report of the Massachusetts Asylum forthe Blind, asserts that the intermarriage of near relatives,like all other violations of natural laws, is followed by somepunishment. This may, perhaps, hardly be remarked for along time, but close observation throughout succeedinggenerations proves the truth of it. "Conversing once withone of our eminent physicians upon the matter of bloodrelatives, I said " Why, Doctor, your parents were full cousinsthey left seven or eight children, and yet where are thepeculiarities in them? " "You don't see them, perhaps,"said he, quickly, " but I tell you every one of us has a ' hair lick' in the brain."

458 [Oct. ,PART II .-REVIEWS.The West Riding Lunatic Asylum Medical Reports. Edited byJ. CRICHTON BROWNE, M.D., F.R.C.S.E. Vol. V., 1875.This volume is the largest and, on the whole, the best thathas appeared. There is much painstaking work recorded,and if the results are in some cases merely negative, this isno more than has happened to scientific, and especially medical investigators before. There is one point of resemblancein nearly all the contributions which it would be well in futureto avoid, and that is a tendency to introduce each essay witha flourish of trumpets, that leads one to expect more than isfulfilled, and then to abound in learned-looking references toother writers , as if the author had exhausted all sources ofprevious knowledge. This is not true art, it takes up muchspace, and it fatigues a busy reader.Dr. Merson leads off with a paper on 66 The Influence ofDiet in Epilepsy." He puts a number of epileptics first onnitrogenous and then on farinaceous diet, and the followingis his conclusion:-On a review of the whole evidence furnished by these observations,I think, after making due allowance for all circ*mstances likely to tellin the opposite direction, that there are fair grounds for the conclusionthat a farinaceous diet is likely to be more useful in the treatment ofepilepsy than a nitrogenous.Dr. Ferrier follows with an interesting paper on Menière'sDisease, or Disease of the Semicircular Canals, with a peculiarform of Vertigo and Sickness . He saysShould the above observations be confirmed, they will serve to showthat the semicircular canals are, as regards hearing, specially concernedin the reception and transmission of skull vibrations in contradistinction to aërial vibrations.Dr. Lawson's very elaborate experiments on " The Physiological Action of Hyoscyamine, " led him to the following conclusions:-1. The smallest active doses of hyoscyamine, when administered toanimals, cause numerical depression of the pulse, and increased arterialtension, reduce the temperature, dilate the pupil, and have little effecton the respirations.2. Small doses cause reduction of the pulse, with increase of arterialpressure, followed by quickening, which after a greater or less persist-1876.]Reviews.459ence, somewhat suddenly subsides, and sinks towards the normal point.During the action of the medicine there is restlessness , followed bymotor paralysis, diminution of respiration, and reduction of temperature, about 4° . The drug in all cases produces dilatation of the pupil,and dryness of the mouth and throat.3. Large doses elevate the pulse without previous depression, andthis quickening is maintained for six or eight hours. Great fall oftemperature, diminution of the respirations, loss of motor power, delirious excitement, and sometimes prolonged but interrupted sleepsucceed, and are in their turn followed by sudden reduction of thepulse towards the initial point, and sometimes below it. This fallprecedes complete recovery from the operation of the drug.4. Lethal doses cause death either by syncope during extreme vascular excitement, or by coma following upon non- elimination of thedrug by the urine, and imperfect aeration of the blood through impair- ment of respiration.5. The drag generally produces increased urinary and diminished alvine secretion .6. To rabbits, pigeons, and others of the lower animals, hyoscya .mine is almost, if not altogether, as active a poison as to man; but inbirds no dilatation of the pupil is produced by it, and no dryness ofthe mouth and throat.7. Long-continued administration of the drug causes loss of weight,quickening of the pulsation, with increase of arterial pressure, quickening also of respiration and increase of temperature. Subsequentlythere is restoration of weight, but persistence of heightened pulsation, respiration, and temperature. Individual doses administered toan animal constitutionally affected with hyoscyamine cause not reduction, but elevation of animal heat.8. The intra - thoracic changes, and the decline of temperature, arephysiologically produced by stimulation of the sympathetic system,and depression of the cardiac and pulmonary distribution of thepneumogastrics. The elevation of temperature caused by individualdoses administered to animals, persistently under the influence of thedrug, is probably due to a tolerance of the substance by the pneumogastrics, while the sympathetic still remains affected by it.9. The pupil is dilated by hyoscyamine through simultaneous stimulation of the sympathetic and depression of the third pair as distributed to the iris.10. Local application causes dilatation of the pupil, commencing infrom three to four minutes, increasing for fifteen minutes, persistentfor about three and a half hours, gradually passing off and returningto the normal state in three days. After the internal use of moderatedoses, the pupil begins to dilate in from two to three minutes, andreaches the widest diameter in twenty minutes. The maximum dilatation persists more than twenty- four hours, and the pupil does notreturn to its normal size for six days.460 [Oct., Reviews.11. In man the cerebral symptoms are more marked than in thelower animals, and the motor, cardiac, respiratory, and thermal symp- toms less so. With small doses the pulse is first slightly reduced, andat the commencement of the cerebral and motor excitement is elevatedabout twenty beats above the initial index. The pupil is dilated, andthe vision becomes imperfect. During the hypnotic stage the pulsefalls towards the starting-point. During the whole period the temperature falls 0· 7°, and after the cessation of interrupted sleep somecerebral confusion remains, as is manifested by occasional incoherenceand a liability to trifling delusions.12. Larger doses cause direct elevation of the pulse and slightreduction of oral temperature. Dilatation of the pupil is followed byparalysis of ocular accommodation . Motor power is impaired, andinterrupted sleep alternates with, and is followed by, delirium. Delusions and hallucinations, associated with rapid and imperfect ideation,are succeeded in six or seven hours by a renewed tendency to sleep,which is disturbed by dreams and by intervals of wakefulness, withhallucinations.Mr. Bevan Lewis examined the great sciatic nerve in generalparalysis, and found1. Funiculi greatly diminished in size .2. A peculiar fasciculate atrophy of nerve tubuli, involving bothmedullary sheath and axis- cylinder.3. Non-susceptibility of the axis-cylinder to normal, deep stainingby carmine .4. Increased vascularisation .5. Hyperplasia of the intra-funicular connective element.In regard to the effects of senile atrophy, or the effects onnerve-trunks of disuse, he thinks they are the following:-The conditions therefore dependent upon this diminution of nervousactivity may be summed up as follows:-1. Degeneration of connective tissue.2. Funiculi greatly lessened in size, and receding from their neu- rilemmal investments.3. General diffused atrophy of nerve tubuli.4. Proliferation of connective tissue within the funiculus with sclerosis of the arterioles and capillaries.5. General fatty disintegration.Mr. Bevan would have found that this subject had been fullyinvestigated, had he looked at Bonnet and Poincare's book onthe " Pathology of General Paralysis. " Voisin also treats ofthe subject.Dr. Hughlings Jackson discourses on the ever new subjectof Epilepsy, and the temporary mental disorders that follow it1876.]Reviews. 461

""in some cases. He re-asserts his views as to the disease beingin reality a wider one than the definitions would include. Hegives many cases of the highest medical and medico- legalinterest. He says, " Every one of the cases I have to relateis an illustration of Layco*ck's doctrine of Reflex CerebralAction in fact, I hope the cases will show that this hypothesis of Layco*ck, nearly forty years old, is one of inestimablevalue, both for scientific and practical purposes. ' Dr. Jackson scarcely believes in the occurrence of sudden mental outbursts coming instead of an epileptic fit, but rather that aslight paroxysm has occurred in these cases, " strong enoughto put out of use for a time more or less of the higher nervouscentres," the " mental automatism" thus resulting from uncontrolled ones-action of the lower nervous centres. Hence,if the patient is already doing anything, e.g., playing thepiano, eating, &c. , he goes on, but doing it in an absurd anduncontrolled way. We regret that our limited space does notallow us to quote more largely from Dr. Jackson's paper.Dr. Arbuckle, after trying nicotine, atropine, aconitine,hydrate of chloral, nitrite of amyl, prussic acid, strychnine,hyoscyamine, morphia, nitrite of amyl and atropine, eachwith picrotoxine, comes to the following conclusions:--Summary. Not the slightest visible alteration took place in thedisc, retina, or choroid, during the powerful action of the several drugsadministered.I have, therefore, come to believe that the appearances of the disc,retina, and choroid are unreliable guides to the condition of the brain;that the condition, as regards heat and flushing of the face, ears, andconjunctiiva, and the state of the pulse, are infinitely more to be depended on as aids in diagnosis, while they are patent to, and can be observed by, every one.""Mr. Lennox Browne gives six good illustrations of " Othæmatoma or the insane ear, and comes to the following conclusions:-1. That prior to the occurrence of an othæmatoma, the tissues ofthe auricle undergo a softening process (Virchow), or chondromaticdegeneration ( L. Meyer). These changes are synonymous with the 66 vegetative disturbances" of Fischer and Nicol. No evidence hasbeen adduced of the pre- existence of atheromatous disease of thevessels, as is believed by Gruber and others.2. That the general nutritive derangement to which all othæmatomatous patients are subject, and the conspicuous absence of thesetumours in the persons of patients suffering from monomania—a mental disease which involves only a portion of the cerebral machinery, or462 [Oct.,Reviews.in which, as in melancholia, the lesion is of the most airily materialnature ( Nicol) -induce a belief that the aural tumour is, in a largemeasure, the result of a general , and not of a purely local , con- dition.3. That intense general excitement is an important and almost universal factor in the causation of these tumours, leading, as it does, toconsiderable vaso-motor disturbance, and that the intimate connectionof the cervical and intracranial sympathetic ganglia with the vesselsof the auricle strongly predisposes to vascular extravasation in thisneighbourhood. Dr. Robertson's case, already mentioned, bearing onthis point is of great interest.4. That the vascular distribution of the part, receiving, as it does,branches from the terminal arteries of the external carotid , all freelycommunicating with each other, and anastomosing with vessels supplying the brain- structure itself, is sufficient to account for the preferenceof the auricle as the point for effusion . The helix being the thinnestportion of the external ear, is that part which is first attacked.Lastly, that the left ear is most frequently affected, or where thehæmatoma is bilateral, is the first in which a tumour is developed. Myown explanation of this fact is the nearer position of the left commoncarotid to the heart, and the more direct and less impeded arterialsupply to the left than to the right side of the head.It may just be noted that arachnoid cysts, so frequent in that form of mental disease in which othæmatomata may be expected , are morecommonly found on the left than on the right hemisphere of the brain.Dr. Major gives, as usual, the results of careful and reliable histological work, in his paper on " The Morbid Histologyof the Brain in the Lower Animals." His beautiful platesshould enable one clearly to realize why our old dogs andhorses get stiff and stupid when their brain-cells become thus shrivelled and fibreless.Dr. Milner Fothergill's paper is on Cerebral Hyperæmia,and Mr. Hankey describes a process of preparing sections ofbrain and dying them with anilene blue-black. It strikesone as being a most troublesome process, and to possess noadvantages over those in use. He gives two lithographs,which are far " too good to be true.'Mr. Newcombe comes to the following conclusions as toepileptiform seizures in general paralysis:-1. That there does not exist such a relationship between the age ofa patient when attacked by general paralysis and his liability to epileptiform seizures as to indicate that the greater his age when attackedthe greater his chance of having a seizure. In other words, that theliability of a general paralytic to epileptiform seizures is not proportionate to his age when attacked by general paralysis.1876.]Reviews. 4632. That the total duration of general paralysis is not shortened toany great extent by the occurrence of epileptiform seizures.3. That in patients who have epileptiform seizures the disease islikely to be of longer duration in the younger than in the older.4. The conclusion to be derived from this table is similar to , butbetter based, than that drawn from Table II. , for while the totalduration of the disease is calculated by the addition of the time duringwhich the disease is conjectured by patients' friends (whose conjectureson this point are, for reasons already referred to, most unreliable) tohave existed to the time of residence in the asylum, there can be nopossible doubt as to the accuracy of the entries from which the lengthof asylum residence was in each case drawn out.5 and 6. That although epileptiform seizures occur most frequentlytowards the close of the disease, they may also occasionally happenwithin a short time after the commencement of the disease. Griesingerstates that epileptiform seizures never occur until the disease is far advanced.7. That patients attacked by general paralysis at an early age arenot likely to suffer from seizures so soon as those advanced in years atthe commencement of the attack.Dr. Crichton Browne's first paper is on the " Functions ofthe Thalami Optici," his conclusion that they are sensory ganglia being founded on the facts observed in the caseswhich he relates. He is unable to explain the diminution ofreflex excitability which is seen in lesions of the thalamioptici.Dr. Wallis tries to make out a case for the use of chloral inepileptic convulsions. We fear he does not succeed. Hesays drachm doses are " quite safe." We predict that he willchange his opinion if he gives many such doses.Mr. Lennox Browne examined into the state of the larynxin general paralysis, and foundFirst. That in general paralysis of the insane the power of utterance is impaired proportionately to the advance of the disease, beinggood in the first and early part of the second stage and very bad in the third stage.Secondly. That the voice becomes thick and coarse at a very earlyperiod, and that it is not unfrequently hoarse.Thirdly. That the power of protrusion of the tongue is diminishedfrom the commencement of the disease, and becomes gradually moreand more impaired as it progresses.Fourthly. That the reflex excitability of the pharynx is markedlydiminished from the beginning of the disease.Fifthly. That there is generally relaxation of the velum, and of themucous folds and muscles of the larynx, with hyperemia of the pharynx throughout the whole course of the disease.464 Reviews. [Oct. ,Sixthly. That there is impairment of tension and of coördinateaction in the vocal cords, unaccompanied by any distress of respiration. This last fact, coupled with the absence of reflex activity, suggests that it is the superior laryngeal nerve, rather than the inferior,which is affected .PART III -PSYCHOLOGICAL RETROSPECT.1. German Retrospect.By W. W. IRELAND, M.D., Ed. , Larbert Institution , Stirlingshire.The German Retrospect has been made from the following periodicals and papers which I have received:-Archiv für Psychiatrie und Nervenkrankheiten, Berlin, iv. Band,3 Heft.; v. Band, 1 Heft. , 2 Heft. , 3 Heft.Allgemeine Zeitschrift für Psychiatrie, Berlin, 1874 , xxxi. Band, 2 ,3, 4, 5 , und 6 Heft. 1875, xxxii. Band, 1 , 2, 3, 4, 5 Heft.Medicinische Jahrbücher herausgegeben von der K. K. Gesellschaft der Aerzte, redigirt von. S. Stricker, Jahrgang, 1875, 1 , 2, und 3 Heft.Psychiatrisches Centralblatt, Vienna, numbers from January, 1874,to December, 1875.Correspondenz - Blatt der Deutschen Gesellschaft für Psychiatrieund Gerichtliche Psychologie, numbers from December, 1873, to October, 1875.Der Irrenfreund, Coblenz, from number 7, 1873, to number 8,1875.Klinische Abhandlungen über Psychische Krankheiten von Dr.Carl Kahlbaum, 1 Heft. Die Katatonie, Berlin 1874.Untersuchungen über das Gehirn (Neue Folge) von Dr. EduardHitzig, Besonderer Abdruck aus Reichert's und du Bois Reymond'sArchiv, Jahrgang, 1874. Heft 4, Berlin, 1874.Die Heil und Pflegenanstalten für Psychisch Kranke in Deutschlandder Schweiz und den benachbarten deutschen Ländern von Dr.Heinrich Laehr, Berlin, 1875 .Fluid in the Sac of the Dura Mater.-Many anatomists, amongstothers Henle and Virchow, held that the sac of the dura mater (thearachnoid sac of Bichat) is empty during life, and that the cerebralfluid is contained by the pia mater. Dr. Hitzig, in his observationson dogs, has arrived at the conclusion that during life a considerablequantity of fluid exists in the sac of the dura, but that it is absorbedby the mass of the brain shortly after death.-" Zeitschrift," xxxi.Band, 6 Heft.Influence of Electricity upon the Nervous and Muscular System.—In these experiments Dr. Tigges has used the constant current, and1876. ] Psychological Retrospect.465has tried to measure the amount of electricity directly with agalvanometer. He found, leaving the spinal cord out of consideration, that the greatest excitability of the nerves and muscles is metwith in mania. The excitability in melancholia, in general paralysis,and in dementia is less than in ordinary health, and occurs in theorder stated. " Zeitschrift, " xxxi. Band, 2 Heft.Hitzig's Vivisections. - The intention of Dr. Hitzig's new experi- ments on the brain is to find out whether the existence of the so -calledmotor centres, as indicated by Dr. Fritsch and himself through theapplication of the galvanic current, can be confirmed by cutting away pieces of the brain and watching the results . His vivisections wereprincipally performed upon dogs, and the gyri or portions of gyri cut away are marked out on engravings of brains. This makes theirsituation very clear to the eye; only without a reproduction of theseengravings it is impossible to give an accurate report of the contents of Dr. Hitzig's pamphlet.In those parts of the dog's brain where no motor centres were foundto lie, or which did not respond with muscular movements to the electric stimulus, it was found that no loss of muscular sense ormuscular power followed on their removal; and this may be receivedas an indirect confirmation of previous experiments with the galvaniccurrent which are sketched in our German Retrospect of January,1875.Unfortunately, on cutting away the gyri whence defined muscularmovements can be excited by electricity, the results are not verydefinite. On removing a portion of convolution in which the " motorcentre" of the fore leg was believed to lie, he found that the dog putand kept one paw in inconvenient positions, but it did not lose thepower of the limb, and in active movements made use of it, though in an awkward manner. It sometimes put the back instead of the soleof the foot to the ground, and turned the limb inwards and sometimesoutwards in a manner that it did not do on the other side.In some cases the animal allowed its paw to be put in any positionwithout resistance, though on being set free the limb returned withmechanical certainty to the position in which it was before.Dr. Hitzig noticed that if the animal were turned upon its back, itheld its limbs in a different manner from what it did when they rested onthe ground. He calls the two conditions observed " loss of muscularconsciousness " and " loss of the energy of the will. " It is possiblethat we shall hear no more about motor centres in the grey matter ofthe hemispheres. Dr. Hitzig recalls a conjecture which he threwout in his previous work as more nearly explaining his new observations, that the part of the brain in which arises the volition to execute .a movement may be in another place, or in other places, from the socalled motor centres, which must thus be regarded as gathering .places whence intentional movements are propagated . Admitting thecorrectness of Dr. Hitzig's observations, it is clear from his own466 Psychological Retrospect. [Oct. ,admissions that there it much room for doubt of his interpretations.How can we explain the following? A dog, in which a portion ofbrain had been removed, suffered a great loss of muscular consciousness, but the power of vision was not affected; nevertheless he setthe paw blindly over the edge of the table, and would have tumbledover head foremost had he not been caught. Evidently the sense ofsight did not in this case assist him to repair the loss of muscularsensation . The author promises in a subsequent paper to attempt anexplanation of the facts which he has observed .The Motor Centres in the Hemispheres. - Dr. Eckhard has repeatedthe well-known experiments upon the effect of electricity on thecortex of the brain. His results tend to confirm the views of Hitzig,and to oppose the explanation of Schiff that the motions produced are the result of reflected action. Dr. Eckhard claims to havefollowed the course of the motor fibres for the anterior extremityfrom the surface of the brain to the outer edge of the corpus striatum." Zeitschrift, " xxxi. Band, 4 Heft.Electricity applied to Brain of New-born Animals. -Dr. OttoSoltmann has made a number of experiments upon the brain of newborn animals, of which the following are some of the results:-1. No muscular motions were excited by the application of electricity to the hemispheres in new-born animals.2. They were observed in the dog about the tenth day, and thefirst motions were in the opposite fore leg, then in the hind leg andthe motor muscles of the eyes. The extent of the motor centres is atfirst larger than it is at a later age; gradually they are isolated tothe situations pointed out by Hitzig.4. The extirpation of the grey matter of the frontal lobe does notlead, in new-born dogs, to any motor disturbance either immediately or later. The corresponding lobes of the opposite hemisphere seem to discharge the functions of the lost part. The extirpation of the grey matter of the frontal lobe causes in older animals aloss of muscular sense, which is the more decided the older the animalis. The extirpation of the grey matter of both frontal lobes causes lossof motor power neither at the time nor after; but in the full- growndog it causes incomplete ataxia on both sides.6. The corpus striatum is not motor in new- born dogs, only theapplication of electricity to the internal capsule between the corpusstriatum and optic thalamus produces contractions in the fore paw ofthe opposite side . In a dog of three months old, from which the leftlobus præfrontalis had been removed at birth, Soltmann producedmotions in both the fore paws by stimulating the right motor centre.-"Centralblatt, " Nos. 8 and 9, 1875 .Meynert's Views on the Basis and Tegmentum ofascending Peduncle.-Dr. Wernicke gave a demonstration at a meeting of the Psychiatrischer Verein at Breslau, in illustration of Meynert's views upon thenature of the basis of the ascending peduncle ( Hirnschenkelfuss).1876.]467 Psychological Retrospect.and of the tegmentum, (Hirnschenkelhaube) . These two tracts areseparated by the substantia nigra and by the fillet or Schleifenschiste .The basis is connected with the nucleus lenticularis and corpus striatum; the tegmentum with the optic thalamus and corpora quadrigemina. Descending towards the cord the basis of the peduncle answersto the anterior pyramids; the tegmentum to the posterior tracts .Meynert observed that the peduncle only approaches to the size ofthe tegmentum in man; in the lower animals the tegmentum is about seven times as large . After man the relative size of the basis is bestdeveloped in the harlequin monkey, out of 16 brains of animals examined by Meynert. In the fœtus of seven months the basis is onlyhalf the size of the tegmentum, and consists of grey matter, whereasthe tegmentum is fully developed. From this Meynert concludesthat the functions of the basis of the peduncle must be at theirhighest in man and not required for intrauterine life . In like mannerthe development of the basis of the ascending peduncle rises andfalls with the development of the brain as well as that of the nucleuslenticularis. This ganglion, otherwise called the corpus striatum externum, is situated in the motor tract, and is only in connection withfibres passing to or from the hemispheres; it has no connection withsensory nerves.Bearing in view its development, it would appear that the basis ofthe peduncle conducts the voluntary motor stimuli from the brain, whilethe sensory fibres that pass to it from the posterior pillars of the spinalcord conduct sensory impressions to the brain. The relations of thetegmentum are quite different by the corpora quadrigemina andoptic thalami it is directly connected with the optic tract.Adamük's experiments have shown that the corpora quadrigeminacontain several centres by which some of the combined motions of the eye are directed. Schiff has remarked that in sections of the opticthalamus the extensors of one extremity and the flexors of the opposite side come at once into action. This is analagous to the sideward movement of the eyes by which the external rectus of the oneeye and the internal rectus of the other work in common.Meynert has found that each optic thalamus has fibres going tothe muscles of both sides. The tegmentum seems then to be thetract by which impressions causing reflex motions are propagated tothe extremities, and it contains at the same time an anatomicalmechanism through which certain combinations of muscular activityare put in play. " Zeitschrift " xxxi. Band, 6 Heft.Function of the Optic Thalami. - From numerous experiments onrabbits, Nothnagel comes to the following conclusions on the functions.of the optic thalami. They have nothing to do with the innervationof voluntary motions, nor had any destruction of the sensibility of theskin been observed after their extirpation . On the other hand theyseem to stand in a certain relation to the muscular sense.--" Centralblatt " Nos. x. and xi.468 Psychological Retrospect. [Oct.,Function of Nuclei Lenticulares .-Nothnagel found that all voluntary motion was destroyed by extirpation of both nuclei lenticulares.The animal sits without stirring, as when the hemispheres are removed, till death comes; reflex movements are not impeded. Thiscondition can be induced without injury to the nuclei caudati.—“ Cen- tralblatt " No. ii . 1874.The Sense of Equilibrium. - Dr. Breuer has a paper of 70 pagesupon the static sense, the organ of equilibrium, which is believed tobe situated in the vestibular apparatus of the labyrinth of theear. It is impossible in the space at our disposal to give a detail ofthe delicate experiments and subtle interpretations of this ingeniousphysiologist. The author now considers it certain, in spite of the arguments of Dr. Mach, that through the terminations of the nerves ofthe ampulla changes in two directions are indicated to the mind.considers that a sensation of turning is caused by the pressure of theendolymph against the termination of the nerves of the ampulla. Theappearances caused by lesion of the semi- circular canals in animalsseem to be identical with those of giddiness induced by turning rapidlyround, which causes alteration in the pressure of the endolymph.-" Jahrbuch " 1875 , 1 Heft.HeDr. H. Curshmann has a long paper on the function of the semi- circular canals. He used pigeons in his experiments, because inthose birds the canals can be reached without injuring the brain.The results of his experiments are that the power of directing movements is so much injured by the destruction of these organs on bothsides, that the pigeons lost even the capacity of feeding themselves;but they were still able to maintain equilibrium in the standing posture, though on the smallest movement they fell helplessly to theground. The sense of hearing remained after complete destruction ofthe semicircular canals.-" Archiv v. Band, 2 Heft."9Motor Centres in the Cord.-Dr. Schroff thinks that the centrewhence convulsions can be propagated may extend lower down thanthe pons or medulla oblongata. Several recent observers have shownthat the nerve centre for the vessels stretches farther down than hadpreviously been supposed. The same remark holds good for the centresof respiration, while motor centres for erection, the emptying of thebladder, for the sphincter ani, the uterus, and for some movements oflegs have been found in the lower part of the spinal cord. Bearing thisin view, the opinion that epileptiform convulsions were only propagatedfrom the pons seems to demand further examination. He experimentedupon dogs in whom the spinal cord was divided. By keeping up artificial respiration and secluding the animals in a box at a temperatureof from 1.33° to 35° C. he found that they could be kept alive forabout 19 hours. His experiments made him suspect the existence ofnerve centres, for the vessels below the medulla oblongata and centres forrespiration below the calamus scriptorius. Dr. Schroff found thatgeneral convulsions could be excited when the cord was divided below1876.]469 Psychological Retrospect.the pons and the medulla oblongata. He noticed that after section of the spinal marrow rigor mortis came on very soon . In some casesit came on in one or other of the limbs before death. In one case itcame on in all four extremities, two hours and a half after the severing of the cord, while the animal was still alive.-" Jahrbuch " 1875 ,3 Heft.Meynert on Aphasia. - Dr. Schlangenhausen gave an account ofthree cases which illustrated Meynert's view about aphonia. His viewis that the first temporal convolution is the termination of theacoustic nerve, and the first frontal convolution is the centre for themotor nerves for the muscles of articulation. In the first case therewas a motor aphasia, and the patient understood what was said tohim. In the third case there was no paralysis, and the patient couldunderstand what was conveyed to him by signs, but the perceptionor recognition of word sounds was destroyed, though he could hear perfectly well and repeat tunes which were sung to him. Dr.Schlangenhausen considers this a case of sensorial aphasia, andbelieves that there must be a different centre for the perception ofmusical sounds from that of the perception of word sounds. " Centralblatt, " No. 4, 1875.Deficiency of Corpus Callosum. - The " Centralblatt" quotes fromthe Italian a remarkable case of deficiency of the corpus callosumobserved by Professor Malinverni Germano, of Turin . A subject wasbrought into the anatomical rooms for demonstration of the corpuscallosum, when it was found that the very organ in question waswanting. The gyrus fornicatus and the septum lucidum were also absent.HeThe convolutions of the brain were quite normal; but the anteriorcommissure was somewhat larger than usual . The man had servedeight years in the army, and afterwards lived by field labour.bore the character of an industrious, quiet, and tolerably intelligent man. No mental deficiency had been suspected during his life.There is mention of an idiot girl of eighteen years of age in whomthe corpus callosum was also wanting. In most cases of absence ofthe corpus callosum some other parts of the brain are also deficient ." Centralblatt, " No. 7 , 1874.There is a case reported by J. Sander where a woman of twentyone, who died of pericarditis , was found to have the corpus callosumentirely absent. She had no trace of mental unsoundness . " Zeitschrift," xxxi. Band, 3 Heft. Dr. Cramer showed to the Psychiatrischer Verein of the Rhine provinces the brain of a microcephalein whom the corpus callosum was completely absent, and the com- missures deficient. The right hemisphere was shortened; the cerebellum was normal.Deficiency ofthe Cerebellum. -Dr. A. Otto gives an account of acase of small development of the cerebellum found in a man calledJoseph Degler. He was weak-minded from childhood, but grew up470 Psychological Retrospect. [Oct. ,to be strong and active, and dexterous in the use of his hands . Hehad very little sense of morality, stole, and repeatedly attempted arson and homicide. He had a decided inclination for the other sex,and was addicted to onanism and paederasty.On dissection the cerebellum was found to be very small, weighingwith pons varolii and medulla only 20 grammes.The author gives a short analysis of three cases of deficiency of the cerebellum, and compares them with his own. The first case is thewell known one of Combette. The cerebellum was found entirelywanting in a girl of eleven years of age ( Alexandrine Labrosse) . Shewas ofdeficient intelligence, and had a slight disorder in the movementof the legs. She was addicted to masturbation . In the second case,reported by Fiedler, there was an atrophy of the cerebellum and pons.The patient was unsteady upon his legs, and often fell backwards.He showed no sexual propensities. The third case was described byMeynert. There was atrophy of the cerebellum and pons , and greatdisturbance of the movements of the legs, other functions beingnormal. Dr. Otto thus sums up the fourth case ( Degler's) -weakintelligence, want of normal sense, obedience to low instincts , impulsive character of the movements, and powerful sexual desires . Theresults in these four cases are somewhat contradictory; hence, Dr.Otto tries to analyse the different symptoms, and separate what isessential to the deficiency of the cerebellum . He puts down the wantofmotor power as owing to the small size of the pons, and regards thedeficient intelligence, in cases one and four, as the result of cerebraldisease or defect. He thinks three symptoms are common to allIncrease of the sexual propensity, of the instinctive (only observed in two cases) in the sphere of the will , and of the impulsive inthe sphere of the motive activity. Where the cerebellum is ofnormal size one may expect that the reverse of this should holdgood.He comes to the conclusion that the cerebellum has the power ofchecking or restraining the desires, and in a wider sense of regulating the will.Granular Cells. Since the observations of Jastrowitz that granular cells occur in the normal development of the embryo, there hasbeen much doubt about their pathological signification when found inthe spinal cord. Dr. Adler has made some researches to find outwhere the cells most abound. He found that the vessels on enteringthe cord from the pia mater are accompanied by connective tissuewhich forms septa that lose themselves in the neuroglia. Dr. Adlercomes to the conclusion that the granular cells found in the spinal cordof insane patients are most frequent in the connective tissue of thesepta, and follow their radiations among the nervous substance. Thegranular cells are found diffused from around these septa after thedivision of the vessels, which the septa accompany both in a horizontal and a vertical direction.- " Archiv." v. Band, 1 Heft.1876.]471 ·Psychological Retrospect.Hydrocephalic Idiocy.-Dr. Ludwig Meyer has made a carefulstudy of a hydrocephalic idiot named Carl Fuge. The most notice- able observation is that the difference of length between the upper arm and the forearm is much less than usual . * The difference in anEuropean is 88 m.m.; in the negro, 90 m.m.; and in the Gorilla,70 m.m. The difference in the leg, above and below the knee standsrespectively 101 m.m., 70 m.m., and 75 m.m. The difference betweenthe humerus and forearm in Carl Fuge was 4 m.m; in anotheridiot only 30 m.m., and 50 and 30 m.m. respectively for the difference between the leg above and below the knee. The limbs were found tobe shorter in proportion to the body, as was also the case with the Egyptian mummy measured by Granvil,Dr. Meyer points out that in the foetal condition the humerus andfemur are shorter than the other bones of the arm and leg; about thefiftieth day their length becomes equal. He finds in the hand thesame excess of the carpus and metacarpus, but has to acknowledge that foetal conditions will not account for the small size of thethumb.Microcephaly.-Dr. Stark has a study of a case of microcephaly in a woman who died under his care. She could speak and do easywork. She was subject to epileptic fits . When ten years old she hadhemiplegia of the left side, with a cessation of growth in the left armand leg, which the author attributes to spinal disease. The right hemisphere, however, was much smaller than the left. Dr. Starkfound traces of myelitis of the anterior grey horn, especially on theleft side, and traces of chronic encephalitis with amyloid degeneration. The capacity of the skull, 785 c.c. , was less than that of achild of one year old , which he gives at 850 c.c. It is clear thatthis is a somewhat complicated case, and the author raises thequestion that many examples of microcephaly are not the consequenceof a simple lack of development, but of diseases of the cerebral tissuein intra-uterine life . He thinks that some of the cases describedby Vogt were of this character, and urges that a microscopic studyof the brain should, in these cases, always be made. " Zeitschrift,xxx. Band, 5 Heft.Surface versus Thickness of Cortex.-Dr. Zensen has some verycareful researches, illustrated with plates, upon the connection betweenthe condition of the brain and insanity, made upon six brains ofpatients who were all of unsound mind. The principal conclusion atwhich Dr. Zensen arrived is , that in taking into consideration the extentof surface of a brain and its relation to intellectual power we oughtalso to estimate the thickness of the cortical substance; and he is

• On comparing Dr. Meyer's figures several of the remainders have been found misprinted or wrong, and have been corrected. I have repeated his measurements on some idiots in the Larbert Institution, but have failed to get proof that a diminished difference between the length of the upper arm and forearm is characteristic of idiots . -W. W. I.

XXII.31472 Psychological Retrospect. [Oct. ,disposed to think that smallness of surface may be compensated forby increased thickness of the grey matter. Should this be true, it isuseless trying to find a relation between the internal capacity of theskull and the weight of the brain.-" Archiv. ," v. Band, 3 Heft.Morbid Lesions in General Paralysis. -Dr. Ludwig Meyer givesthe result of his examinations of thirty selected cases of generalparalysis. The changes which he finds after death are turgescence ofthe brain which makes the dura mater appear tighter, the convolutions broader, and the sulci generally, though not always, narrower.The grey matter is redder and has a glancing look, and in sections itsbreadth was found to be increased; its consistence is generally softer,though sometimes the reverse holds good.The histological examinations have been carefully made. The firstchanges are believed to occur in the vessels. There is a proliferation of cells around the wall of the vessels. These are full of formed cells,and not degenerated nuclei as Dr. Meyer once believed; and theyoccur in patches, often leaving healthy spaces between. Sometimesthey bulge into the vessels, or cause the lumen of the vessels entirelyto disappear.These degenerations are found not only in the hemispheres, but alsoin all the cerebral ganglia down to the medulla oblongata.The author then describes the progress of fatty and calcareousdegeneration of the vessels, the widening of their calibre, and theformation of minute aneurisms often of the dissecting variety. Inthis way the circulation is stopped, retarded , or altered in course, and small extravasations of blood take place. These are restrained frombecoming greater by the elastic masses of the neoplasms which lie round the outer walls of the vessels.Meningeal hæmorrhages of considerable extent have been found tooccur in ten cases out of 168 necroscopies of general paralysis, andif we consider the existence of congestion and the weakened state ofthe vessels, this proportion cannot appear large. Adhesions, thickening, and other alterations of the pia mater are very common, but thischronic meningitis is not found in all cases . Dr. Meyer could notfind in the early stages of general paralysis any alterations in the nerve cells . In the later stages the signs of shrinking and atrophyare observed. He is unable to connect the pathological lesions withthe rapid variations of mental power and motor capability observed in this disease.Lesions in Brain of Insane. -Dr. Adler gives as the result ofhis investigations on the pathological alterations in the brain of theinsane that the vessels are first affected , and then the connectivesheaths, which, passing from the pia mater, accompany the vessels.At this stage the vascular tube itself may be still quite intact. Thenext process in order is a hyperplastic one in the vascular sheathitself, which may be accompanied by hypertrophy of the fibrillar radiations of the connective tissue. The alterations of the nerve cells1876.]473 Psychological Retrospect.are to be viewed only as secondary, they follow in many cases, whilein others they do not, without our being able to tell the cause.—"Archiv.," v. Band, 2 Heft.Blindness from Chronic Hydrocephalus. -Dr. Geissler gives thedetails of a case of sudden blindness in chronic hydrocephalus. Itwas found to be dependent upon softening of the corpora quadrigemina. Only the anterior pair of ganglia were recognisable; theposterior pair and the crura cerebelli were reduced to a reddishpaste.Hydrocephalus Congenitus et Acquisitus. -Dr. Meynert gives somerules for distinguishing congenital from acquired hydrocephalus in post-mortem examinations. Hydrocephalus congenitus extends thelateral ventricles in their long diameter, and pushes back the posteriorhorn, so that it sometimes comes within a few lines of the surface;while hydrocephalus acquisitus increases the ventricles in theirvertical and cross diameter. Sometimes the enlarged hollow in theposterior horn becomes filled up by the union of the lining of theventricle on each side, leaving behind it a cavity containing serum andcysts. The medullary matter forming the walls of the ventricles ishard and tough in congenital hydrocephalus.to find Wormian bones in the lambdoid and sutures. " Centralblatt."One may also expectunder parts of sagittalDr. M. Bernhardt gives a number of cases from his own observation and reading in which he sees confirmation of the recent experi- ments of the function of the superficial parts of the brain. Suchobservations are of great value, if they are not merely selections ofresults chiming in with the vivisections and experiments of physiologists; but, as Dr. M. Bernhardt himself observes, clinical observations are rendered uncertain by the admission of Hitzig and Nothnagel, that the extirpation of the motor centres does not necessarilylead to the permanent destruction of the functions over which theyare believed to preside, other parts of the brain being supposedvicariously to take up the functions of the destroyed centres.—" Archiv.," iv. Band, 3 Heft.Hyperemia of Lungs after Injuries of Brain.-Dr. Heitler hasshown in a series of experiments that wounds of the encephaloncause hyperæmia of the lungs and effusions of blood under the pleuraand in the substance of the lungs. These hæmorrhages were observedafter injury to the hemisphere and optic thalami, crus cerebri, vermiform process, and the medulla oblongata. Injuries to the corporaquadrigemina were only occasionally followed by hyperemia of thelung. " Jahrbuch, " 1875, 1 Heft.Pernicious Anæmias.-Dr. Schüle gives some studies which he has made upon what he calls pernicious anæmias. He believes thathyperemia of the meninges and parts of the brain may be a cause ofpoverty of the blood, dropsies, and subsequent degeneration of thevessels and tissues. He cites the observation of Goltz that the tone474 Psychological Retrospect. [Oct. ,of the vessels, as well as the absorption of the food, is dependent upon the functional activity of the nerve centres. His views are illustratedby several clinical reports of cases in which anæmia occurred in connection with diseases of the nervous centres. " Zeitschrift, ” xxxii.Band, 1 Heft.Katatony. Dr. Kahlbaum thinks he has discovered a new type ofdisease, or made a new generalisation of insanity, to which he givesthe name of Katatonie. Like general paralysis, it has a mixture ofmental and nervous symptoms. The essential symptom is convulsions, as paralysis is the central symptom in dementia paralytica. The mental disturbance may vary.Katatonic generally commences with melancholia, along with convulsions, tonic or clonic. We may then have mania, stupor, extremeloquacity, a disposition to repeat words or rhyming sounds, obstinatetaciturnity, confusion of thought, and finally dementia; or one orother of these forms of derangement may be wanting.Dr. Kahlbaum has found, in the last stages of katatonie, somecontraction in the size of the brain, a diminished quantity of bloodwithin the cranium, and what he lays most stress upon, opacity, exudation or alteration of the arachnoid at the base of the brain, especially where this membrane stretches over the space between the pons and commissure of the optic nerve. The arachnoid over the upperpart of the hemispheres is free from disease. The prognosis is muchmore favourable than in general paralysis, speedy recovery being notunfrequent.Movements in Hemiplegia.-Dr. Westphal has a paper upon thissubject, in which he gives two cases who were hemiplegic from childhood, but when certain movements were made in the sound limb wereaccompanied by movements of the same muscles in the paralysed.Dr. Westphal accounts for this by supposing that in hemiplegia aportion of the opposite hemisphere is destroyed, but the commissuresremaining intact, through their means the great ganglia at the footof the brain become connected with the motor centres of the healthyhemisphere, and act in obedience to its stimuli.-" Centralblatt. "Perversion ofWill.-Dr. Meschede, at a meeting at Breslau, gavean account of a patient who found himself in the singular conditionthat when he wanted to do a thing, either from his own desire, orfrom the directions of others, he, or rather his muscles, did the veryopposite. If he wanted to look to the right, his eyes were turned tothe left; and this anomaly extended to all his other motions. It wasthus a simple misdirection of movement without any mental derangement, and differed from involuntary motions in this, that he did notmove unless he wanted, but when he did move, he did the very opposite of what he wanted.-" Correspondenz Blatt, " No. ii, 1874.Insanity in Children. -Dr. Rinecker remarks that insanity is veryrare in children, and gives two cases. The first was a girl of 11years old. She had suddenly become solitary in her habits, and lost1876.] Psychological Retrospect.475her appetite and her blooming complexion. She became more andmore unquiet, and several times attempted to escape from her mother'shouse, on which account she was sent to the lunatic department of theJulius Hospital, at Würtzburg. Here her unhappy condition onlybecame worse, and she was seized with epileptiform convulsions,accompanied by high temperature and quick pulse. The child died after about five weeks' illness . Tubercular meningitis was a probablediagnosis, as there were convulsions, fever, and occasional remissions;but this was not confirmed by examination. The brain was apparently healthy, and there was catarrhal pneumonia with bronchiectasis in both lungs.of age.The second case was a boy, who became insane when thirteen yearsHe became very restless and suicidal. The insanity lastedtwo years. Great benefit was derived from the use of Indian hemp,but he left the hospital without being quite cured .Dr. Rinecker considers that insanity in children is generally accompanied by disturbance of the motor system, frequently in the form of chorea. " Zeitschrift, " xxxii Band, 5 Heft.Hallucinations in Hearing.─Dr . Frederick Jolly has made observations upon five cases. In four of these, accompanied by hallucinations of hearing, there was an increased irritability of the acousticnerve to the electric stimulus, and there was paradoxal reaction . Thishe defines as hyperesthesia, in which the closing with the anode andopening with the kathode lead to sounds heard, not on the side wherethe galvanic stream is applied, but " rather " upon the opposite side.On the applied side the normal reaction is at the same time heard atthe opening with the anode and closing with the kathode . In general,paradoxal reaction requires a higher degree of electricity.TheThe effects of electricity were felt in both ears, which the authorconsiders must be owing to the diffusion of the electric current through the brain to the nerve on the other side . In three of the cases thehearing was affected . In one, however, it was quite normal, though there were marks of chronic inflammation in the outer meatus.anatomical alterations were as various as the degree of sensibility tosound, the only thing common being hyperesthesia to the electricstimulus . This agrees with the observations of Brenner, who foundthe hyperesthesia associated with no fixed anatomical changes; but,owing to the difficulty of the investigation, it is possible that structural alterations might be overlooked. Dr. Jolly upholds the view thathallucinations of hearing are really the result ofdisease ofthe nervousauditory apparatus, whether through alterations in the structure of theear, or through functional disease of the auditory nerve. In severalof his cases there were also ballucinations of vision.In the fifth of his cases, with chronic catarrh of the middle chamberwithout deafness , the auditory nerve was evidently less sensible thanusual to electric stimulus, which Dr. Jolly would fain account for, bysupposing that, owing to the unusual thinness of the petrous bone,476 Psychological Retrospect. [Oct.,the current had taken a new direction. In this case, however, underthe influence of the electric stream, not only was there a simple sound,but hallucinations of hearing. This the authorthought not to be dueto a direct influence on the auditory nerve, but to a reflex effect fromthe stimulus of the trifacial. Dr. Jolly was unable to find any curativeeffect from the application of electricity applied to the ear, though, inall the five cases, the sensibility of the auditory nerve was increasedby the prolonged use of electricity. " Archiv. " iv Band, 3 Heft.Stupor from Anesthesia of the Skin.-Dr. Arndt reported a case ofa woman of twenty years of age, who, on recovering from typhus,remained in a state of extreme listlessness, accompanied with anæsthesia. She was insensible to pricking, tickling, or pinching in anypart of the body, except the face. She swallowed her food , but laycontinually in bed with half- closed eyes . Faradisation was tried, witha large Stöhrer's apparatus, and in nine days the patient came to herself, answered questions, fed and dressed herself. The faradisationwas given up, and in twelve days she had fallen into her old condition .The electricity was resumed, and in ten days more her lethargy hadagain disappeared, and as the recovery seemed this time to be permanent, she was dismissed as cured. " Centralblatt, " Nos. 4 & 5, 1874,and " Zeitschrift," xxx Band, 6 Heft.Use of Galvanism in Aphonia.- Dr. H. Emminghaus has succeeded,in several cases of aphonia, in bringing back the voice by passing galvanic currents through the brain. He used a Stöhrer's battery, andapplied the kathode upon the mastoid process, and the anode upon the glabella, or, at other times passing the current from one mastoid process to the other. The current was strong enough to produce giddiness. During the application the voice perceptibly gained in strength.In peripheral or catarrhal aphonia, no benefit was derived from thismethod of treatment, but in one of these cases faradisation did good.The author is unable to say whether the favourable effects were owingto the direct physical effects of the current upon the brain or roots ofthe nerves, or by increasing the mental energy.—“ Archiv. ,” iv Band,3 Heft.Bromide of Potassium in Epilepsy. -Dr. Stark, in a series of careful observations upon the action of bromide of potassium, found animprovement from 61 to 64 per cent of those treated for epilepsy.These were all lunatics, and some of them quite chronic cases ofepilepsy, but in no instance does he seem to have obtained a cure.In most cases the fits returned with the same frequency as before. Innone of his patients was there any improvement in the mental symptoms. Many epileptics become maniacal ifthe intervals between thefits are prolonged, and this excitement appears when the fits are keptaway under the influence of bromide of potassium. In such cases hethinks it best that no attempts should be made to suppress the fits .In 40 per cent. of his cases, there were symptoms of an intense nervous intoxication when the bromide was given in large doses. These1876.] Psychological Retrospect 477 .doses were rarely under 10 grammes a day. From some observationswhich Dr. Stark made on the bromide of potassium and chlorateof potash, he is inclined to think that the bromine is the active agent.-"Zeitschrift, " xxxi Band, 3 Heft.Dr. A. Otto gives a report of thirty-one cases of epilepsywhich he has treated with bromide of potassium, and has foundbenefit in all. He claims cures in 75 per cent. , and 25 per cent.in which there was improvement, though the fits returned in morethan half his cases on the medicine being discontinued. This successwas obtained through using high doses continued for months. Thedoses varied from 120 grains to 180 grains a day. He considersthat the bromide acts by diminishing the excitability of the centralganglia, as well as that of the periphery ofthe nervous system, andin opposition to several observers, he holds that the bromide, and notthe potassium, is the active curative agent. In the brain of almostall the epileptics which he examined he found sclerosis and atrophyof one or more cornua ammonis. Dr. Otto has got a low opinion ofatropine, digitalis, and nitrate of silver as remedies against epilepsy,and has tried inhalation of nitrite of amyl thrice a day without anyeffect. Even in those cases where the amyl had been inhaled afterthe aura, he finds that it is at best very uncertain in its action.-" Archiv. , " 1 Heft, v. Band.Nitrite of Amyle. -Dr. Otto has tried nitrite of amyl in nine casesof epilepsy, but without success. He used it in one case of religiousmelancholy. The patient inhaled five drops every two hours, and ineight days was very much improved , and she is now almost recovered.Dr. Höstermann, in Vienna, used the amyl in eight cases of melancholia; in four of these there was permanent improvement. In threethere was a temporary improvement, and in one case the patient got worse. " Zeitschrift, " xxxi. Band, 4 Heft.Dr. Adolf Schramm has made some researches upon nitrite ofamyl upon melancholia, and in some cases found an improvement,especially where anæmia of the brain appeared to be present, thoughamelioration was also noticed where lesion and congestion of the headwere believed to exist. If amelioration does not at once appear theremedy need not be persevered in. At best it is only palliative, andeven, as such, it was found inferior to opium.-" Archiv.," v Band,2 Heft.Ergotin in Mania.—Dr. A. H. van Andel has found ergotin very useful in some cases of acute mania. He used it in the form of subcutaneous injection , prepared with a little glycerine and rectifiedspirit. The dose is about 100 milligrammes of ergotin. He cites the observations of Brown- Sequard, who saw the vessels of themembrane of the brain contract under the influence of thisdrug. Dr. van Andel has used it in epileptic insanity, and to combat hyperæmias of the nerve centres. The common effectwas diminution of the excitement; the ravings and shriekings478 Psychological Retrospect. [Oct.,gradually ceased, and, though the patient might remain distracted , he was, at least, more ready to listen to what was said to him. Sometimes the injection of ergotin was followed by a refreshing sleep . Dr.van Andel gives a very striking case of the master of a ship whopassed into a condition of furious mania, so that it required four men to hold him. His fits of irritability were found to be subdued bysubcutaneous injection of ergotin . Fifteen of these were used infourteen days. In his case the injection was followed by smallabscesses which were not long of healing. Considering the dreadful nature ofthe disease and the benefit derived, this could not be held as acontra-indication . In the other cases the irritation following theinjection was of a slighter character. " Zeitschrift," xxxii. Band,2 Heft.Census of Insane in the Tyrol. -From the census in the Tyrol it was found that the number of the insane stood as follows:-MALES. FEMALES .• 627 542229 Insane, including several paralyticsFatuous, including idiots and dements 236Cretins · 307 270The population is 779,072, thus making one inhabitant out of every 352 to be affected in mind. This seems to prove mental derangement to be very common in the Tyrol; but it must be remembered that all the statistics of small states show a similarly highaverage, because false returns are easily detected . " Centralblatt,"Nos. 8 and 9, 1875.Agricultural Colony ofInsane.-At a meeting of the Psychiatrischat Hanover, Dr. Snell gave an account of the Agricultural Colony atEinum, which was begun on the 1st of April, 1864. This experiment was connected with the Asylum at Hildesheim, which nowcontains about 400 male patients. It was found that about 11 percent. of these lunatics could be suitably sent to Einum. The numberof patients employed there was now 45. The great majority wascomposed of patients who had passed the stages of excitement, andwere willing and able to work. Those who shewed an anxiety toescape, or had bad habits, were excluded . During the ten years 31cases had been returned to the asylum on account of attempts toescape, recurring mental excitement, or bad health. Ten of the colonists had been sent back to their families, but some of them wereagain returned , having relapsed. The staff consisted of a director,7 male and 3 female attendants. In ordinary circ*mstances one visitin the week from an asylum doctor was thought sufficient . The farmconsisted of 78 morgen of arable land, and 10 morgen occupied bygardens and courts. The land was cultivated by spade husbandry.They had 15 milch cows, 3 horses, 2 asses, with pigs and poultry.The expenditure had at first been greater than the profits, but duringthe last year there was £221 17s. clear profit. The patients in the1876.]479 Psychological Retrospect.Colony live in full freedom, the door is never shut. They go freely in and out. Some go to the town alone to transact business. Theeffect of the daily work upon the minds of the patients is said to bevery happy. But Dr. Snell confesses that about the same percentageof patients are left at Hildesheim who do work within the asylumgrounds, and he assures us that the population of a German asylum isdifferent from that of an English, Dutch, or even French establish- ment of a similar character. Apparently the German Asylumcontains a larger proportion of manageable patients. Would thesepatients then be at liberty in Great Britain , Holland , or France?—"Zeitschrift," xxxi. Band, 6 Heft.Those who in travelling through Germany wish to visit its asylums will find full information about them in the little book of Dr. Heinrich Laehr. It gives an account of each asylum , the number ofpatients and attendants, and the names of the Superintendents. Itis illustrated by a map, with the different asylums and hospitals for the insane indicated by lines drawn below the places. I mustconfess that I never knew before looking at it how many institutionsof this kind I had passed by when travelling through Germany.2. English Retrospect.-Asylum Reports for 1875.Such of these Reports as have as yet come to hand are of averageinterest. There has not been anything particularly stirring in asylums,and the Reports share in the general placidity. We are gratified tonotice that there is year by year a more general tone imparted to themedical portion of them, and that they are in some quarters becomingwhat they ought to be, namely, the expression of the sentimentsderived from another year's experience in the management of the insane. We have never yet been able to see what good purpose wasserved by expending the rates in paying for the printing of a longstory about incidents in the life of the asylum during the past year,addressed to the Committee who know all about them already. Ifthere has been anything important in the alterations , improvements,and so on, the proper people to say so are the Committee themselves;and the Superintendent discharges his functions far better by puttinghis statistics into a readable shape, and pointing the moral of anythingparticular in them. Important questions of management and treatment will undoubtedly often arise out of structural changes, but theyshould be treated from a medical, not from a stone and lime point of view.FIFTH REPORT OF THE BERKS, NEWBURY AND READING COUNTYAND BOROUGH ASYLUM. -The Entry by the Commissioners in Lunacyin the Visitors' Book of this Asylum is not published, an omissionwhich is to be regretted in most cases, but especially so when theSuperintendent devotes a paragraph to the flattering remarks which480 Psychological Retrospect. [Oct.,it is said to contain. There was a slight out- break of Erysipelas inthe spring, but it subsided in May, and only one death resulted from it. The death rate is 10.2.TWENTY- NINTH REPORT OF THE KENT COUNTY ASYLUM, ATMAIDSTONE. This should in propriety of speech be styled theMEDICAL REPORT of this Asylum, for the Committee of Visitorsdo not publish theirs, neither is the Entry by the Commissionersprinted. The Report itself is written by Mr. Davies, then thesenior assistant Medical Officer, and the chief subject of interest itcontains is the announcement of the resignation of Dr. Kirkman, theSuperintendent. Another resignation is that of " Richard Crowhurst,the Foul Laundryman," who has been granted a pension of £20, andwhom we beg leave to congratulate, trusting at the same time that hissuccessor in office has been accorded a less dubious title. The percentage of deaths on the average number resident is 11.18.TWENTY- THIRD REPORT OF THE LINCOLN COUNTY ASYLUM.-Unless there is a mis-print , we are in this Report presented with theEntry by the Commissioners made in 1876. The documents publishedin an Annual Report should refer only to its own year, not to the following year. Dr. Palmer does not date his Report, but the presumption is that it was written on the 1st of January, and yet healludes to an Entry made on the 29th of the February following. Thedeath rate is 15.3, but there was no epidemic.FIFTH REPORT OF THE CHESHIRE ASYLUM, AT MACCLESFIELD.—There is no want of matter in this Report, that of the Committeeoccupying 7 pages, that of the Commissioners 9 pages, and that ofMr. Deas, the Medical Superintendent, upward of 27 pages. Asmight be expected, the result is a good deal of repetition , but it isonly fair to add that Mr. Deas' report contains some valuable observations, particularly on the subject of Escapes, of which he seems tohave an unusual experience; and he repeats in substance the wellknown truth that escapes are often of the utmost benefit to thedelinquent himself. We observe in connexion with the MedicalTables of this Report, that the average of recoveries is calculated on the admissions after the subtraction of " 79 chronictransfers and 2 not insane. " However justifiable this may be intheory, it is obvious that it is not capable of universal application,and therefore, its partial adoption, in tables which are designed foruniversal reference, must lead to the greatest confusion . If the recovery table is to be calculated on the principle of excluding what eachSuperintendent deems chronic transfers, on the same principle thedeath rate ought to be calculated after deducting such cases as wereadmitted in what he considered a dying condition , and all the elementof certainty which the tables contain at present will be virtually destroyed. The death rate is 14 .FIRST REPORT OF THE ASYLUM FOR THE COUNTY OF NOTTINGHAM. -This is the first year of the existence of this Asylum as a1876.] Psychological Retrospect.481purely County Asylum, it having for upwards of sixty years previously existed for the advantage of the Borough, as well as theCounty. It appears that the County has agreed to buy out the interest of the Borough, and to receive the Borough patients at thesame rate as that charged for those of the County, until the end of1876, after which an extra shilling per head per week will be charged.The total value of the property is estimated at £43,169, and of thatsum the Borough is entitled to receive one-third from the County.On the whole, unless the Borough be compelled to build, it hasthe best of it, for the interest of the third will probably more thanpay the shilling a week. Mr. Phillimore, the Medical Superintendent,seems to have had a very unfavourable class of cases to deal with.Speaking of the Admissions, he says, " 18 were of ages varying from60 to 81 years; 11 were epileptic, 13 were suffering from generalparalysis, three from hemiplegia, and 38 from diseases of the heart orthe lungs. Two women were pregnant, another had cut-throat, and athird was nearly moribund from voluntary starvation . One manwas blind, three persons were found after their reception to be affectedwith typhoid fever, one of whom died within twenty-four hours, and asecond within nine days." The death rate is 11:01 per cent.THIRTY-FIRST REPORT OF THE ASLYUM FOR THE COUNTIES OFSALOP AND MONTGOMERY. -There was a serious outbreak ofErysipelas in this Asylum in 1874, due, in the opinion of the Commissioners, to over-crowding and bad drainage, and what they say is probably correct, for when the Committee relieved the over- crowdingand put the drains in order, the disease disappeared. Dr. Strange,like Mr. Phillimore, has the admission of hopelessly feeble cases to report, but it is easier to complain of this than to carry out a remedy.The death rate is 8.4.FIFTH REPORT OF THE IPSWICH BOROUGH ASYLUM.-With the exception of the appointment of an Assistant Medical Officer, there isnot much of particular interest noted in this Report. The death rate is 11.05 .REPORT OF THE ASYLUM FOR THE NORTH RIDING OF Yorkshire.-We observe in the Entry by the Commissioners in Lunacy that thecharge for private patients in this Asylum ranges from 15s. 2d. to42s. per week. If the provisions of the 43rd. section of the " LunaticAsylums Act, 1853," that all lunatics not being paupers " shall havethe same accommodation in all respects as the pauper lunatics" beduly attended to , those paying 42s . per week must be a source of considerable profit to the Asylum, where the average cost per head is10s. 3 d. per week, or about 12s. 5d. if the building rate be included .The percentage of deaths is 9.3.FIFTEENTH REPORT OF THE BRISTOL BOROUGH ASYLUM. -Thechief point of interest in this Report are the remarks on the watersupply to the Asylum. The continued recurrence of typhoid feverjust after the pumping of water from a certain well raised the suspicions of the Commissioners, and on enquiry they found that the482 Psychological Retrospect. [Oct. ,well in question is probably supplied by percolation from a neighbouring stream which receives some of the drainage of a Workhouse.Mr. Thompson, the Superintendent, had the water analysed, and aftera perusal of the analysis, we heartily endorse his by no means toostrongly worded opinion, that " it is expedient that a new source should be looked for. " The death rate is 14.9.FOURTH REPORT OF THE ASYLUM FOR THE EAST RIDING OF YORKSHIRE . -Dr. Mercer refers, like some of his brother Superintendents ,to the caution with which the alleged causes of Insanity in the admis- sions should be received. He very truly says, that on enquiry "itwill be found that an hereditary or constitutional taint exists in many cases where drink alone has been blamed." It is not necessary hereto prove the truth of this, but we would fain hope that some memberof the Association would really take up the case in earnest, andmake a thorough investigation into the causes of Insanity. We aresure that every other member with statistics at his disposal would bewilling to help him. The death rate is 16.44.MEDICAL REPORT OF THE ROYAL LUNATIC ASYLUM OF ABERdeen.-Speaking of the over- crowding of this Asylum, one of the Commissioners states that he is of opinion that further accommodation shouldbe sought in other directions. The present building cannot, hethinks, from its position so near to Aberdeen, command the purchaseof as much ground as is necessary for the occupation of nearly 500patients. The actual number of patients on the 31st of Decemberwas 477, but of these, 175 were private cases, and in the majority of them it is difficult to make much use of open air employment. Wehad always thought that the Scottish Board of Lunacy were pre- eminently in favour of everything which tends to the freedom of thelunatics in Asylums, and the following extract from the Entry has,under the circ*mstances, rather surprised us: -" During the day thehalls themselves are relieved by the free access which is given to theairing courts but this free access, although under the circ*mstancesexpedient, is not favourable to discipline and good order, and must tendto foster degraded habits. " Of course this really means that circ*mstances alter cases; but why cannot the Board candidly say so? Thedeath rate in this Asylum is 7.2.

TWENTY-THIRD REPORT OF THE ABERGAVENNY COUNTY ASYLUM.-There is nothing particularly worthy of remark in this Report,except a passage in the Entry by the Commissioners, where they say;" Three men and 12 women only appear to have been secluded; theformer on three occasions and for a total duration of eight hours, thelatter on 28 occasions and for 151 hours. It has not however been thepractice here to record as ' seclusion ' the locking ofpatients in their ownrooms by day, where the window shutters have not also been closed!" Itis not easy to see what the window shutter has to do with it, because" seclusion " in Asylums means putting a patient in compulsory isolation by day, and the fact of the shutter being unclosed has no moreconcern in the matter than the fact of the ventilator being open.1876.]483 Psychological Retrospect.Nothing is more desirable than that the Commissioners, having oncedefined " seclusion, " should see that the rules which follow on thedefinition are observed . Until they do so, those who act upon theirdefinition minutely are likely to be little encouraged in their resolutionto be honest in the matter. A few cases treated for two or three dayseach in this way, the one recorded as " seclusion " and the other not,make a great and most unfair difference in the number of hours at the end of the year. The death rate is 11.2.REPORT OF THE SLIGO AND LEITRIM HOSPITAL FOR THE INSANE.-The peculiar nature of the duties of a Medical Superintendentof an Irish Asylum obviously makes it impossible to compare hisreport with those of his brethren on this side of the Channel.They are so multifarious that his report necessarily alludes to matterswhich we should think quite improper in those of an English orScottish brother officer. By the English Statute it is expressly provided that the Superintendent shall not be either the Clerk or theTreasurer, the evident intention being that he shall hold office in aMedical Capacity only; and though the spirit of the law is too often.broken, and he is made responsible for a great deal with which he properly should not be troubled, still he has never yet, so far as we know,been called upon to certify to the accuracy of the Balance Sheet, asDr. McMunn has to do. Another thing we notice is that most IrishAsylums have a Visiting Physician at a large salary, and no Assistant Medical Officer. The Visiting Physician is the relic of an oldsystem which is now happily obsolete, and we would suggest as vitalto the well - being of the Irish Asylums, that the Visiting Physiciansand Apothecaries should be done away with, their places filled by anAssistant Medical Officer, and that the Superintendent should be relieved of the Clerk and Treasurer portion of his duties; his authorityover all the officers, male and female, being established as absolute.The death rate is 8.31.REPORT OF THE LONDONDERRY DISTRICT HOSPITAL FOR THE INSANE. In this Asylum the Visiting Physician gets £ 100 a-year andthe Apothecary £30, for which an Assistant Medical Officer mightbe paid and boarded, to the far more satisfactory working of the estab- lishment. The death rate is 8:45 .FIFTH REPORT OF THE AYR DISTRICT ASYLUM. - Both theentries by the Commissioners are to the effect that there is littleto be desired in the management of this Asylum. They as usualdirect attention to the necessity for devoting untiring energies to thedecorations of the wards with mirrors, &c. , and one of them mentions that the old- fashioned eight- day- clock can always be obtained ata reasonable price " through a Glasgow auctioneer. " The death rateis 13.25 .REPORT OF THE MONTROSE ROYAL ASYLUM. -Dr. Howden'sReport is never dull reading, and it generally furnishes matter for reflection . It is not possible that a Superintendent can find somethingnovel to say of treatment year after year; but there is a way of writ-484 Psychological Retrospect. [Oct. ,ing suggestively of familiar principles which is in no wise akin to theutterance of mere platitudes . His Report this year is quite up to hisaverage, and we have read it with benefit and gratification . The death rate is 8.32.TWENTY- FOURTH REPORT OF THE DERBY COUNTY ASYLUM.—Inthis Asylum there was an outbreak of 13 cases of Erysipelas, and one death ensued from this disease . It is said to have been due to theleak in a soil pipe, which certainly contaminated the air; and, if theAsylum is supplied by wells, it probably contaminated the water also .A bad smell is very disagreeable to those who have to live in it andshould be remedied, if possible, but it is far from proved that it hasso ill an effect on health as impure water, and it is likely that manyepidemics of fever which are charged to vitiated atmosphere are really due to other causes. The death rate is 14.4.TWELFTH REPORT OF THE ARGYLE AND BUTE DISTRICT ASYLUM.-This is said to be the Report for 1874, but the Commissioners'Entries are both dated in 1875; a confusion which is not dispelled bythe fact of the Report of the Committee being dated the 7th July1875, and referring to both of these entries, one of which was madeon the 25th and 26th August following . These entries, as might beexpected, speak in the customarily high terms of the system which issaid to prevail at this Asylum. One part of this system appears to bethe total abolition of night nursing, with the result of having an average of eight wet beds per diem, in a population which is said to be inan excellent sanitary condition. The disuse of supervision, as it isgenerally understood in Asylums, seems to have led to alarge numberof escapes, and the Commissioner expresses the opinion that they are"perhaps more numerous than they might be if the surveillance were more active. " The death rate is 6.1 .ELEVENTH REPORT OF THE INVERNESS DISTRICT ASYLUM.-Dr.Aitken gives a long and interesting Report of this Asylum. Theprevalence of Phthisis amongst the insane of that district has longbeen a subject of remark, and it appears to have been aggravated bythe serious deficiency in the supply of milk to the Asylum during the cold months of the year. The average quantity daily required is 270pints, and at one time it fell so low as 70. This in a population whosestaple of diet is, we presume, oatmeal porridge and milk cannot but beattended with grave consequences. We notice by the way that theScottish Reports do not as a rule give the Diet Tables in use in thedifferent districts; they ought to be given, because they are of greatimportance in connexion with other things, in comparing rates of death,maintenance, &c. The death rate is 6.7.REPORT OF THE DORSET COUNTY ASYLUM. -The Committee ofVisitors of this Asylum are not disposed to carry out the wishes ofthe Commissioners in Lunacy with reference to the continuous supervision of the Epileptic and Suicidal patients. The structural difficultiesin the way are considerable, but the Committee are in addition opposedto the alteration on the grounds of its general inexpediency. The1876.] Psychological Retrospect.485Commissioners are not easily beaten, however, and we suppose theywill return again and again to the subject until they win their point.There is nothing particular in the Report of Mr. Symes. The death rate is 6.58.REPORT OF THE ROXBURGH, BERWICK, AND SELKIRK DISTRICTASYLUM.-Mr. Grierson seems to have much difficulty in procuringand retaining the services of a proper class of attendants and nurses.The Commissioner reports 17 changes in about seven months, whichcannot fail to have a most serious and prejudicial influence on keepingup the routine of the Asylum. Mr. Grierson ascribes the evil in agreat measure to the difficulty the married men have in procuringaccommodation for their families near the Asylum; if such be thereason, it is one which demands the instant attention of the Committee. There is no falser economy in any condition of life than asystem of management under which servants are reasonably dissatis- fied. The death rate is 6.1 .REPORT OF THE ASYLUM FOR THE SOUTH RIDING OF YORKSHIRE. - Dr. Mitchell is of the opinion that Asylums should have"appliances for enforcing lazy patients to undergo that amount ofphysical exertion which is necessary for the maintenance of theirbodily health. " He does not say what " appliances " he alludes to;but there can be no doubt that the dread of appearing harsh with theInsane operates on many Superintendents as an absolute bar to the dueenforcing of industrial habits on a class of lunatics who stand greatly in need of them. The death rate is 15.2.REPORT OF THE BROADMOOR CRIMINAL LUNATIC ASYLUM. -Dr.Orange reports that the custom of sending to Broadmoor convictswho go insane whilst undergoing penal servitude is dying out, and wecongratulate him and the inmates of this Asylum on the fact of theAuthorities having at last taken a step in so excellent a direction.The association of unfortunate men who, having gone insane, commitcertain acts which they would regard with horror were they sane,with the basest dregs of the population, who wind up a career of infamy and disgrace by becoming insane, is so flaring an act of injustice,not to say of hardship, that we wonder it has been tolerated so long.Broadmoor was never intended for the reception of such cases, andwe trust that in his next Report Dr. Orange will be able to say that none such are now sent to him. The death rate is 2.78.SIXTY- SECOND REPORT OF THE GLASGOW ROYAL ASYLUM. -Dr.Yellowlees advances a point of doctrine which we think he has a littlemistaken. He says, talking of the restlessness of some of the Insane," The friends of patients are so apt to mistake the restless efforts ofexcitement for real strength, and are so imbued with the notion thatinsanity confers herculean power that from the best possible motivesthey withhold the necessary amount of support.

The popular impression that the insane possess a marvellous strengthwhich it is almost impossible to control or resist is to a large extent erroneous. It is in the will, rather than in the muscles, that the486 Psychological Retrospect. [Oct. ,insane strength lies, " &c. Dr. Yellowlees has here, to use an unpolished expression, got hold of the wrong end of the stick. All thestrength of will in the world would not console a man who had to tusslewith an infuriated Sampson. The truth is that it is in the musclesthat the strength of the insane, as of any one else, lies; they areneither stronger nor weaker than others, and the reason why theirefforts appear so terrible to the unskilled is because they are so utterlywithout method. A large fire in one's grate is a very pleasant thing,but the same amount of burning coals scattered about the floor wouldbe hardly so soothing. The death rate is 9.0.FIFTY- SIXTH REPORT OF THE DUNDEE ROYAL ASYLUM.—Dr.Rorie reports that he has begun to test the alleged virtues of the"Colour " system in the treatment of the more intensified forms ofinsanity. " Two rooms for the admission of red, the other of blue light. On two occasionsmarked diminution of excitement was found to result from placing apatient in the blue chamber, but as yet the cases submitted to treatment have been too few to warrant a more decided opinion being given.The benefit of placing certain patients in darkened rooms and thusremoving them from all sources of excitement and irritation has longbeen known. It is not improbable, therefore, that similar if not moremarked benefit will result from what may be regarded as a morehighly developed and more scientific application of this fact." Theremay be benefit to be derived from this form of treatment, but it should be borne in mind that it is only Seclusion under another name. Itbears the same relation to Seclusion indeed that " Packing " does to Restraint. The death rate was 7.47." he says, "haverecentlybeenfittedup, one

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ELEVENTH REPORT OF THE BOROUGH ASYLUM, NEWCASTLE- ONTYNE.-Mr. Wickham reports: " Of the admissions, a large proportion were in a very feeble state of health, and although thedeath-rate has been surprisingly low, it is feared that in spite of allcare it will rise considerably in 1876. The types of insanity havebeen much the same as usual, but the number of patients sufferingfrom general paralysis has increased, and the cases themselves were ina particularly advanced stage.The total amount of hoursin which seclusion was employed is large as compared with some otherAsylums; and in the Report of the Commissioners in Lunacy of theirstatutory visit special attention is directed to this subject. Some oftheir remarks refer to eleven months of 1874, and it must be borne inmind that their Report includes a period of exactly 18 months. Of thethree men to whom they particularly refer, one has been discharged recovered; another was a case of general paralysis in a large powerfullybuilt man, who was at the time passing through that intractablestage of mania to which so many of them are subject, and which is sonearly allied to epileptic mania; and the third was a man who, as wasreported last year, was removed to Fisherton House Asylum. Thiswas a case of determined homicidal insanity whose fixed intention itwas to murder the superior officers, and who, while the arrangements1876. ] Psychological Retrospect.487for his removal to Fisherton House were being made, was placed inseclusion. Every year or so we hear of savage and brutal assaultson, and not unfrequently of the murder of, asylum officers by desperatelunatics who retain only the outward form of a human being; and Iam quite at a loss to see how the cause of humanity, science, or anything else good is promoted by allowing such persons to be at largeeven in the asylum wards. They are objects of terror to the well -disposed patients, and the feelings of the quiet and orderly , who, be itremembered, do all the work that is done in asylums, should be considered when one is resolving to attempt the task of eradicating thedisease in such a case as the one under remark. When an accident happens in an asylum, and an officer or attendant is either severely woundedorkilled outright, what is generally reported is to the effect that the patientwas of a refractory class, but not considered actually dangerous . 'This is simply an admission that those in charge of him were ignorantof one of the most important symptoms of his malady; and I respectfully suggest that he who finds out such a symptom and, taking stepsto prevent evil consequences, so avoids the probable loss of one or morevaluable lives, is more deserving of credit than he who never finds itout at all until irreparable mischief has been done. It will be understood that these remarks are made in reference to a particular caseof which the old saying may be quoted, desperate diseases requiredesperate remedies. " Since the visit of the Commissioners in July,1875, I have, in deference to their very strongly expressed wishes , almost entirely relinquished the use of seclusion . It would be premature to speak of the results of this change, but although far fromthinking that there is anything wrong, inhumane, or retrograde inseclusion, I am quite willing to give the other system as prolonged atrial as I have already accorded to seclusion , provided, of course, thatthe cases continue to be suitable." The death rate was 4.7 .(To be continued.)PART IV. - NOTES AND NEWS.ANNUAL GENERAL MEETING OF THE MEDICO- PSYCHOLOGICAL ASSOCIATION.This was held in the Library of the Royal College of Physicians, London, at11 o'clock, on Friday, July 28th, 1876, when the following Associates were present:-Dr. Parsey, Dr. Duncan, Dr. Maudsley, Dr. Wood, Dr. Paul, Dr. Lalor, Dr.Petit, Dr. Courtenay, Dr. Clouston, Dr. Murray Lindsay, Dr. Lyle, Mr. Thompson,Dr. Hack Tuke, Dr. O. Woods, Dr. Fox, Dr. Grabham, Dr. M'Dowall, Mr. Denne,Mr. Mould, Dr. Davey, Dr. Harrington Tuke, Dr. Hayes Newington, Dr. Jepson,Dr. Sutherland, Dr. Green, Dr. Boyd, Mr. Bayly, Dr. Anderson, Mr. Gill, Dr.Ward, Dr. Sankey, Dr. Hewson, Mr. T. O. Wood, Dr. Manley, Dr. Wilkie Bur.man, Dr. Kirkman, Dr. James Stewart. Dr. J. Langdon Down, Dr. Staden, Dr.Bucknill, Dr. Blandford, Dr. Donald Mackintosh, Mr. E. H. Byas, Dr. Mickle,XXII. 32488 Notes and News [Oct.,.Dr. Daniel, Dr. Fletcher Beach, Dr. Gilland, Dr. George Mickley, Dr. G. L. Latour, Mr. G. Henry Pedler, Dr. Wm. P. Kirkman, Dr. Guy, Dr. LockhartRobertson, Dr. Crichton Browne, Mr. Hy. Manning, Dr. Boyd, Dr. S. Words- worth Poole, Dr. Rhys Williams.Dr. DUNCAN, the President, took the Chair, and the minutes of the lastAnnual General Meeting having been taken as read and confirmed, he said it was his pleasing task to vacate the chair, but he could not do so without thank- ing the members for their kindness in having placed him there, and the support which he had received from them. He regretted that he had not attended moreof the intermediate meetings of the Association . He then vacated the chair,which was taken byDr. PARSEY, who said he would at once take the opportunity of thanking theAssociates for the compliment they had paid him. Although his attendances at the meetings had not been very regular, he could assure them he had the interest of the Association at heart.Dr. MAUDSLEY then proposed, and Dr. MURRAY LINDSAY seconded, that the next meeting should be in London. -Carried.ELECTION OF OFFICERS.Dr. DUNCAN said he had great pleasure in proposing Dr. Blandford as the President - elect . He was a gentleman who stood very high in the profession,and besides was well acquainted with private asylums.Dr. MAUDSLEY, seconding, did not think they could get a better man, and the motion was carried unanimously.Mr. MOULD begged to propose that Dr. Rhys Williams should be re - elected Hon. General Secretary.Dr. Wood seconded, and the motion was carried unanimously.Dr. HACK TUKE proposed the re- election of Dr. Paul as Treasurer, remarking that he had provided them with a good balance, and he was sure they could not possibly have a better man.Dr. GRABHAM seconded , and the motion was carried unanimously.Dr. HACK TUKE next proposed that the present Editors of the Journal, Dr. Maudsley and Dr. Clouston, should be requested to continue their services. He was frequently brought into contact with them, and he could thus speak personally of their uniform courtesy and of the ability with which they conducted the Journal.Dr. LALORseconded the motion, which was carried unanimously.Dr. CLOUSTON proposed the election of Dr. Rutherford as Hon. Secretary forScotland. He was a gentleman well known in Scotland, where they had but asmall body of members, and could not afford to disagree . They were unanimously agreed that Dr. Rutherford, of the Lenzie Asylum, was the best man.He said the change was occasioned by the resignation of Dr. Frederick Skae,their late Secretary, who had asked him to place his resignation in the handsof the meeting, he having gone as Inspector of Lunatic Asylums for the Colony of New Zealand. He did not know whether this was the proper time to propose, or whether it was the proper thing to convey, the thanks of the meeting to Dr Skae who had served them well.Dr. MURRAY LINDSAY seconded, and the motion was carried .A vote of thanks to Dr. Skae was proposed and carried unanimously.Dr. RHYS WILLIAMS read a letter from Dr. Fredk. MacCabe, enclosing hisresignation as Honorary Secretary for Ireland, he having been appointed an Inspector under the Local Government Board for Ireland, and desiring him to assure the Association that he (Dr. MacCabe) had esteemed their selection ofhim for the post as one of the greatest honours that could have been conferred upon him, and that he resigned the office with regret, a regret all the keenerfrom the fact that their meeting last year in Dublin had brought him personallyin communication with so many distinguished members of the Association,1876.] Notes and News. 489some of whom he ventured to regard as friends. . He suggested that Dr. Maziere Courtenay, of the Limerick Asylum, should be appointed his successor.Dr. LALOR had great pleasure in proposing the election of Dr. Courtenay,and that the thanks of the Association should be awarded to Dr. MacCabe forhis thorough zeal and activity during his term of office as Hon. Sec. for Ireland.Dr. DUNCAN seconded, and the motion was carried unanimously.Dr. RHYS WILLIAMS said there were four members who retired from theCouncil, Dr. Campbell (Essex) , Dr. Monro, Dr. Howden and Dr. Courtenay, who had now become Hon. Sec. for Ireland.Dr. Lalor, Dr. Fraser, of Fife and Kinross Asylum, and Dr. Rogers, of Rain- hill Asylum, were duly elected members of the Council.Dr. MAUDSLEY said there was still one other Member of Council to be elected,and he was sure the name he should mention would commend itself to theapproval of every member present, if it was in accordance with the rules toelect him, and that was the name of Dr. Bucknill . Dr. Bucknill was anordinary member ofthe Association for manyyears, till he became Chancery Visitor, when he was elected an honorary member, but he had now resigned his honorary membership, and been elected again, at his own request, an ordinary member.Dr. HACK TUKE had great pleasure in seconding the motion, which was carried.On the motion of Dr. MAUDSLEY, seconded by Dr. LALOR, Dr. Hack Tuke was appointed Auditor.Dr. RHYS WILLIAMS said that by the direction of the Association last year he had written to the family of the late Dr. Robert Stewart , expressing the deep sympathy of the Association, and he had received a letter in reply, thanking the Association very much for their kind expression of sympathyHONORARY MEMBERS.Dr. J. Crichton Browne and Dr. John Gray were unanimously elected Honor- ary Members.NEW MEMBERS.The following were then elected-by ballot-Ordinary Members of the Association:-Baker, Robert, M.D.Edin. , The Friends' Retreat, York.Blackall, John Joseph, M.D. , Qu. Univ. , Irel. , Assistant Medical Officer, Rich.mond District Lunatic Asylum, Ireland.Day, Edward Joseph, M.R.C.S.Eng. , L.S.A. , Dorset County Asylum.Dickson, Francis Kennedy, F.R.C.P.Ed., Wye House Lunatic Asylum, Buxton,Derbyshire.Kebbell, William, L.R.C.P.Lond, M.R.C.S.Eng. , Assistant Medical Officer Three Counties Asylum, Stotfold, Baldock, Herts.Kenyon, John Kilshaw, M.R.C.S.Eng. , L.S.A., The Old Hall, Billingborough,Lincolnshire.King, William Louis, M.R.C.S.Eng. , Suffolk County Asylum, Melton, Wood- bridge.Kitchen, Walter, M.R.C.S.Eng. , Heworth, York.Newcombe, Charles Frederick, M.B. Aberd. , Assistant Medical Officer, CountyLunatic Asylum, Rainhill, Lancashire.Owen, Harold, M.R.C.S. Eng. , L.R.C.P.Ed., Resident Medical Proprietor,Tue-Brook Villa Asylum, Liverpool.Powell, Evan, M.R.C.Š.Eng. , L.S.A., Assistant Medical Officer, Kent County Asylum, Barming Heath.Rogers, Edward Coulton, M.R.C.S.Eng. , L.S.A., Senior Assistant MedicalOfficer, Three Counties Asylum, Stotfold, Baldock, Herts.Thomson, William A., F.R.C.S.I. (Exam. ), Assistant Medical Officer, KentLunatic Asylum, Chartham Down.Townsend, Charles Percy, M.R.C.S.Eng., Assist. Med. Officer, Barnwood House, Gloucester.490 Notes and News [Oct. , .Wade, Arthur Ian, B.A. , M.D.Dub. , Worcester County Asylum.Wallis, John A. , M.B. Aberd. , L.R.C.P.Ed. , Medical Superintendent, Boro❜Asylum, Kingston- upon- Hull.Williams, William, M.D., Qu. Univ. Irel. , M.R.C.P. , Lond. , 70, Rodney- street,Liverpool.STATEMENT OF ACCOUNTS.Dr. PAUL (the Treasurer) then made his Annual Statement, stating that there was a balance in the hands of the Treasurer amounting to £393 Os. 7d. -about £150 more than they had ever had at any period of their existence and he should be very happy to know what to do with the money. At the request of Dr. Thompson he read over the several items.(For Treasurer's Balance Sheet see opposite page.)The PRESIDENT did not suppose that the funds of the Society had ever been so satisfactory, and he was sure great praise was due to Dr. Paul for his energyand determination. But what must be most gratifying to all was the increased sale of the Journal. This must be most satisfactory to the Association, and forthat they had to thank most sincerely the Editors for the trouble they had taken in the matter. Had it not been for their zeal and ability, the Journal would never have been sold outside the Association.The Accounts were adopted.Dr. MAUDSLEY said he had been asked to make a statement by the Members ofthe Committee which was appointed last year at Dublin to consider the question of the best form of applying the surplus funds of the Association, so as to secure the advancement of science, and also promote the interests of the Association.The Committee had met, but they had not this yearagreed upon a report. They were of opinion, subject to the ruling of the meeting, that it would be desirable for them to continue in office another year, when they would report their conclu- sions. By the standing rules of the Association, it was ordained that any surplus funds should be applied to the maintenance and support of the Journal,but he did not suppose Dr. Paul would care to have an application of that kind made to him for his entire surplus. It had been suggested that the best plan would be to institute prizes for scientific essays, or for some similar object, but there were no such prizes needed on the present occasion, owing to the munifi.cent liberality of the Tuke family, who had offered a prize of one hundred guineas for the best Essay on Insanity or on subjects connected with insanity. Untilthat prize had been awarded, it did not seem necessary that the Association should institute another, and for that reason no harm could accrue by the delayof a year. The best way, he suggested, would be to re-appoint the Committee,and ask them to present to the meeting another year a full report of what they proposed to do.Mr. MOULD begged to move the re-appointment of the Committee. After the munificent hospitality they received at Dublin, he was not at all astonished to hear that they required another year to take the matter into consideration (laughter).The PRESIDENT thought it well that he should read the original motion, which was put last year:-"That a Committee of this Association be appointed totake into consideration the question of devoting a portion of the funds of the Association for the advancement of Medico- Psychology, and to report to thenext Annual Meeting ." The Members of the Committee named were, Mr. Duncan, Dr. Maudsley, Dr. Clouston, Dr. Lalor, Dr. Crichton Browne, Dr. Pauland Dr. Hack Tuke. It had now been proposed and seconded that this Com- mittee should continue to act for another year and make their report. Three was one member of the Committee who appeared to him would have, as a matterof course, to resign, having become an honorary member, and as the Committee should consist of ordinary members, this would give an opportunity for another gentleman to be elected.THE MEDICO -PSYCHOLOGICAL ASSOCIATION .Thereasurer's Annual Balance 1875-6 Sheet ,.RECEIPTS .Hand ToBalance Cash inreceived ToSubscriptionsIreland for Secretary ByScotland for Secretary ByChurchill Journal ,Messrs .BySale of... ... ... ... ...£s.d265 14 ByAnnual Meeting... ... ... ... ... 262 60 Editorial ByExpenses... ... ... ... 33120... ... 420 Journal of ... 105 80EXPENDITURE £s.d...... ... ... ...... ...660880 ...... 269 710 Printing ,publishing engraving advertising and postage Sundries -Advertisem*nts ... ... ... ... ... Printing Byexpenses and Quarterly Meetings of"}Treasurer By 800 Ireland for Secretary ByScotland for Secretary ByByGeneral Secretary... ... ... ...1031660140 ... ... ...... ... ... ... 910 440 ... ... ... ... ... Treasurer's hands Bylance in ...709 02£Examined found and correct ,JOSEPH LALOR .ROYAL CLLEGE OFPHYSICIANS ,LONDON July 28th 176 .J.H.PAUL ,Treasurer .393 07£709 02492 Notes and News. [Oct.,It was then decided that the Committee should continue in office for anotheryear, and, on the motion of Dr. DUNCAN, that they should have power to add to their number.THE BALLOT.Dr. DUNCAN said he had been very much struck at the absurd process of sending round the ballot-box with a whole list of names that could not be carried in the recollection. He thought it would meet the wishes of theAssociation and the members generally if they adopted some other system.He suggested that the names of candidates should be sent to the Secretary about a week or so before the annual meeting, so that they could be sent to members with details as to claims for admission, and with the mover andseconder. They would then have all the persons before them, and put yes or no opposite each individual name. This would give members an opportunity ofexpressing their individual opinion as to the fitness of every candidate.Mr. THOMPSON said there were several of the names that morning he had never heard before.Dr. HARRINGTON TUKE was of opinion that the names of the proposer and seconder should be a sufficient guarantee; and, besides, the names generally brought before them were those of men who had passed a considerable canvassin order to get their appointments. He objected to throwing the slightest possible difficulty in the way of those whom they should be always glad to hail amongst them. He only knew of one objection to a candidate during aperiod of eleven years.Dr. OSCAR WOODS had great pleasure in seconding the original resolution,believing that what was worth doing at all was worth doing well. Supposing he had wished to object to one of the names proposed, how could he have done so?Dr. HARRINGTON TUKE said the matter could be easily settled, if a candidatewere objected to, by a member calling for the ballot to be taken in rotation. In that case no name need be mentioned.Dr. LANGDON DOWN thought the example set by other associations-the Medico-Chirurgical and Pathological -the one best to follow, one vote against the mass causing them to be taken individually.Mr. THOMPSON proposed, as an amendment, that they should proceed tobusiness, and this course was adopted, Dr. DUNCAN remarking that he merely wished to know the feelings of the meeting.LUNACY STATISTICS.Dr. CLOUSTON-Mr. President: The motion I have to make is, I think, an important one. You are aware that many years ago this Association appointed a Statistical Committee, who drew up a number of very valuable tables,namely, the tables of the Medico- Psychological Association, which have ever since gradually come into use. They are now used in almost every asylum in Great Britain. I think we all agree that those tables are most valuablefor the information they contain, but this Committee seems to have died anatural death; at all events, they have not done anything for some years back. Now we know that though these ten tables are very important, yetstill there may be some additions that would be important in the future. Ithink that medical psychological science has advanced during the last 10 or 12 years, so that we could embody in a statistical form some important information now. We have all used these tables for 10 or 12 years, andmost of us have acquired ideas which we could embody in our reportswithout going into very troublesome matters. Now, not as a basis, but as showing what can be done, both in France and in Germany they have aseries of tables containing a great deal more information than our tables con- tain, and the consideration of these French and German tables might be onework of the revived Statistical Committee, to see if any of that information1876.]Notes and News.493would be useful for us to embody in our new tables. Since the committee lastmet, I have no doubt that pathological research has been much more carried on in asylums. There are a number of facts resulting from post- mortem examina- tions performed in asylums that could be embodied in statistical tables. There are many facts which have been brought out by Dr. Boyd, of Somerset Asylum,a most distinguished superintendent, which we might very well copy, and which the Committee might study. I am merely taking some illustrativethings such as this and heredity and causation of insanity generally. I have no doubt there are facts in regard to those matters that could be brought out and which would be extremely important. There are facts , too, on the result of treat- ment; but this is not the time or place to go into the labours of the Committee -we shall leave that to them. What I wish to propose is this: " That aStatistical Committee, for the purpose of taking into consideration the tables of the Medico- Psychological Association , be appointed. " This Committee would meet and would report at the Annual Meeting. I think that the extremelyvaluable labours of the former Committee, to whom we cannot but be thankful, should be the strongest argument for the appointment of a new Committee. It is true we have lost Dr. Thurnam, the venerable president of the former Committee, whose advice and assistance were so very valuable, but still I have no doubt there are many among us who will be able to suggest to us additional tables of great value.Dr. LALOR-I have very great pleasure in seconding Dr. Clouston's pro- posal, and I may at the same time mention what may appear to you acurious thing. I don't think there is a single asylum in Ireland which adoptsthe tables of the Medico- Psychological Statistical Committee, and I wish to explain the reason of that. It is not that we are insensible at all to thevalue and importance of those statistics, but we are obliged, by official authority,to make out such a number-amounting to 40-that though adopted in England and Scotland, we cannot adopt them in Ireland without adding them on in someway with our other tables. Perhaps the Statistical Committee, if it is re- appointed, may see their way to having us relieved in Ireland from such anenormous mass of statistical tables, amounting to 40, some of which we think completely valueless. Then I think we should be most happy-on the part ofmy Irish friends I say we should be most happy-to adopt a uniform set of tables. In a statistical table the great point is, that it should be uniform over all the districts it affects-that there should be uniform tables all through. Itmilitates against their usefulness if you have not similar tables in Ireland,because you have no means of making comparison on the different points in England, Scotland , and Ireland. I have great pleasure in seconding the pro- position, and I hope the Committee will see their way to include Ireland.The resolution was put to the meeting and carried, and, after some discus- sion, the following were appointed the Committee: -Dr. Lockhart Robertson,Dr. Major, Dr. Ashe, Dr. Boyd, Dr. Wilkie Burman, Dr. Hayes Newington, Dr.Clouston, Dr. Sibbald, and Dr. Murray Lindsay.AFTERNOON MEETING.The President resumed his seat at two o'clock.Dr. BLANDFORD-I have to thank you for the honour you have done me in electing me as President for the ensuing year. I have always considered it the greatest honour that could be conferred on anybody to be elected President of a Society by one's fellow workers. That honour you have conferred on me today, and I can only say I will endeavour to the utmost of my ability to fulfil the duties of that office after the examples set me by yourself and so manyillustrious gentlemen who have been your predecessors in that chair.Dr. WOOD-Perhaps you will now allow me to do what we ought to have done this morning, to offer a vote of thanks to the retiring President. It hasbeen usual, I believe, to propose such a vote at the morning meeting, but by some accident it was omitted. At all events, we are all agreed that we don't494 Notes and News. [Oct.,intend it simply as a compliment, but as heartfelt thanks for the way the late President has fulfilled his office.Dr. RAYS WILLIAMS-I have very great pleasure in seconding that resolution.I was present in Dublin last year, and the hospitality and courtesy we received from our Dublin friends has not been excelled anywhere.The PRESIDENT-I am sure this will be the unanimous vote of you all, and Ishall not think of putting it to you (applause) .Dr. DUNCAN-I can only say I did not anticipate this vote of thanks, for Ifeel I have had a full return for what I have done. I only regret that we in Ireland have done so little to advance the Association, but I do think that afrequent visit to that country may have the effect of stirring us up, and show- ing that there are some resources in the country which only require to be brought out.The PRESIDENT then gave his Address. (See Original Articles, p. 343.)DR. BUCKNILL. - Mr. President, I am sure we are very muchobliged to youfor your able and practical address. It deals with subjects which at the pre- sent time press for a solution, and it will, I am sure, aid us very much in ourjudgment as to how those important matters should be dealt with. I haverarely had the pleasure of hearing a more able and practical address, and I am sure that in the name of my colleagues and associates, I may say that we areall exceedingly pleased and obliged to you for it (hear, hear). I am personally most gratified to see you in that chair; I do not know that anyone has agreater right to be gratified than I have after the intimate knowledge I havehad of you for 30 years as a friend and fellow officer , and during that long period I have become more and more deeply impressed with your moral worth and intellectual force. I hope the production of this able paper will lead youto change in some respects that which has been the habit of your life, and thatwe may hope for some further literary efforts from your pen which, while we all knew you were so capable of using, from your having devoted your life tothe practical cares of the treatment of the insane, we have not had the benefit of until the present time. There is one point in your address in which I take more interest than any other, and I am happy to be allowed to refer to it as an opportunity for asking this association to follow your advice in their hearts and minds, and to reserve their judgments as to the accusations which have been made in this country against our psychological brethren in the United States.Some of those accusations have been quite recent, and of those I will speak first. They are contained in the Lancet of the 8th of this month, and they areof a peculiar nature, to which I wish to draw your attention. They are mere copies from American newspapers of accusations which have not been proved in evidence; one especially is copied from the World newspaper of New York, and professes to be the charges made against Dr. Nichols, of the WashingtonAsylum, before a Committee of Congress. Now I should like to read to you part of a letter which I have from a gentleman, whose name is never mentioned among alienists without respect, on that very subject. It is from Dr. Thomas Kirkbride, the venerable and venerated head of the Pennsylvania Hospital for the Insane, Philadelphia. He says: "Dr. Nichols is just now going through amost infamous persecution by what is called an ' investigating committee,'started by the Democratic majority in Congress, with the determination to blacken, if possible, the character of everybody connected with the Govern- ment. One would have thought that such a manand such an institution wouldhave escaped, but where the testimony of discharged employés, uncured patients, and personal enemies is eagerly sought after, in a secret investigation,there is little probability of even an approach to justice being done." Now Idwell upon the word " secret " there, not because I think such an investigationmight not very properly be secret, but because it will show to you that the charges which the Lancet has published have been obtained either on informa- tion which has been stolen or which has been betrayed . And I ask you to put1876.]Notes and News. 495it to your own minds, whether, if such charges made against any of the Superintendents of the English Asylums were liable to be published in themedical press as if they had been proved, any Superintendent could ever feel that his character was safe? Dr. Nichols is the President, and hasbeen for many years, of the American Association of Superintendents of Asylums, and he is a man who, until these accusations were made, was held inhigh and good repute. I am far from wishing to defend Dr. Nichols from any charges of wrong doing which can be proved against him, but I do think that this is a pointed example of the necessity of your wise counsel, that we should hold our judgment suspended. I remember a short time ago a pamphlet beingpublished in this country, purporting to have come from a Society of Supposed Lunatics, in which charges were made against many of us. They were nottaken up, because we all of us had sense enough to see that a clique of crazy women and their imbecile supporters were not worth powder and shot (laughter).But if the Lancet had transferred those charges to its pages, I think that Journal would very quickly have had to pay heavy damages for libel. Dr. Nichols, I suppose, stands as a foreigner in a different position to that we should have cccupied, and as he cannot defend himself, such attacks are the more inexcusable. I hope I shall not be wasting the time of the Association ifI refer to the commencement of this discussion, and very briefly tell you what was said by the Lancet in its leading article on November 13th last. It is avery consistent tissue of indiscriminate accusations against the "MadDoctors," as it calls them, of America. There is no mistake, it is all wool,there is no cotton in it; it is an accusation against them from the first to thelast line against these American " mad doctors. " It commences by dividing the treatment of insanity into three stages, the first is the barbaric, the second is the humane, the third the remedial, and it declares that the " mad doctors "of the United States have not made much progress out of the barbaric into the humane stage, but have remained for the most part in " that stage in whichthe lunatic is simply regarded as a wild and dangerous animal, from which society needed protection, and which might be kept in chains, tamed or destroyed, as convenience should dictate." That is the charge against the alienists of America. It then proceeds to make special accusationsagainst them, namely, that they " resort to contrivances of compulsion, they adhere to the old terrorism tempered by petty tyranny; that they use at least the hideous torture of the shower bath as a punishment in their asylums,although it has been eliminated from the discipline of their gaols, and worse than all, if the reports that reach us may be trusted, their medical superintendents leave the care of the patients practically to mere attendants while devoting their own energies principally to the beautifying of their colossal establishments." These are definite charges, and it gives the reason why they should do all these things on the broad principle that " there can be no question that the custom of slave holding and the brutalising regime from which it is inseparable have blinded and blunted the sensibilities of the people." Ido think the Lancet might have asked some little boy in the street about the brutalising regime, and the probability is that it would have been told that the regime of slave holding only extended to a portion of the States, and that itwas detested in the remainder. But with great consistency the Lancet applies that principle to the whole of the people, as it applies its other accusations to the whole of the " mad doctors." Now on reading this I felt that I should be ashamed to see the names of such men as Edward Jarvis, Thomas Kirkbride,John Gray, Isaac Ray, Pliny Earle and many others even in print, if it was left unanswered. I therefore did answer it in a letter in which I claimed justicefor those who were innocent, admitting at the same time that there were asylums in the States, and that I had seen them, which were disgraceful.In this matter I was not consistent, at least according to the opinions of the Lancet, whose consistency seemed like that of King David496 [Oct.,Notes and News.who said in his haste, " all men are liars " (laughter, and " hear, hear") , asthe consistency of the Lancet consisted in saying that all the people, and there- fore all the " mad doctors " of America, were under brutalizing influences.However, the Lancet invited me to make known what I had seen in America,saying that, " no information could be more important and trustworthy." Iaccepted this invitation, and sent my Notes. Now, I was under the appre- hension that, in writing those Notes, I had expressed my sense of the evils which I saw very unreservedly, and that I might, perhaps, have offended thosewhom I most earnestly wished to convert, and I think that those of my associates who have done me the honour of reading my remarks will agree with me that I did run a very considerable risk of doing so. But I attempted in what Iwrote to distinguish the good from the evil, to discriminate between those whowere justly accused and those who were not. Now, the Lancet-and I hope Iam not going into a matter which may be thought personal, for the manner in which I have been treated did not greatly surprise me, knowing, as I did, that those who play at bowls must put up with rubbers, and those who contradict editors must take the consequences; but I do think it a matter of extreme im- portance to our specialty to know how we may expect to be dealt with by ajournal which takes upon itself the censorship of the treatmentof the insane in this country and abroad.--I was proceeding to say that the Lancet, on the 8th of this very hot month, having " nursed its wrath to keep it warm" ever since last November, " sums up" the subject, as it says. First of all it calls attentionto my "extraordinary inconsistency;" accusing me of having confounded the good with the evil. That is exactly what the Lancet itself had done in the first instance, it confounded the good with the evil; it made indiscriminate andsweeping charges and accusations, which it has not substantiated; it says I have written in defence of restraint, and leaves it to be inferred that I have tried to prop up the tottering system of restraint. I can onlyappeal to you to know whether that is a fair inference to be drawn from what I have written. I don't myself think it is, but the very opposite.Then it censures me because, with reference to the Washington Asylum,where I saw restraint in use, I used these words:-" It must have beenimposed because it was thought the best mode of treatment." Now, gentlemen, did or could any of you think that , by my saying that, I meant to express my opinion that it was the best mode of treatment? Why, if I were to say that the Lancet perverts everything that an opponent writes, and that the Lancet thinks this a fair and candid way of conducting a discussion, none ofyou would believe that I thought myself it was an honest way of conducting adiscussion. Yet that is an exact parallel. I must beg, however, to tell youwhy I did not ask for any explanation why this restraint was used. I had been expressly told that any discussion on the subject would be unwelcome and dis- agreeable, and I think that after that warning it would have been bad manners and discourtesy on my part to have demanded such an explanation . The Lancet also censures me severely because I did not ask to be permitted to inspect theregister of injuries and accidents. Now, may I ask if any one of yon, in going unofficially round an asylum, have ever asked for the register of injuries and accidents? I should like to know if anybody has done so? If he has I should like to hear him say so. I pause for a reply. I suppose, then, no one has doneso. Perhaps the Lancet Commissioner might have done so, for his knowledge of lunacy appears to consist of the crusts and crumbs of information which he haspicked up in his raid upon us by unreserved questioning . But I venture to think that, as a stranger in a far country, it was right not to return impertinence forcourtesy; and that to do so is not the right way to obtain or impart informa- tion under such circ*mstances. The indiscriminate accusations of the Lancethave produced in America nothing but angry opposition, but I am happy to know that the descriptions which I have given in a more discriminating andtempered vein have done some good (hear, hear) . I have recently had a letter1876. ] Notes and News. 497from Dr. Edward Jarvis, saying that my descriptions of American Asylums are, he believes, quite true. That is something from such an authority. Then I have had letters from Dr. Landor, the Superintendent of the Ontario Asylum,who has made a tour of American Asylums since I left, and he tells me that my Notes have induced some of the Superintendents to make a trial of non- restraint. And farther, I have had other letters from America, assuring methat my Notes have awakened a desire among Superintendents to visit this country and examine our system, after the bustle of this Centenary year has passed. If books and pamphlets could have converted the Americans, they would have been abreast of us long ago, but in a matter of this kind seeing isbelieving; and I have faith that, when the American Superintendents do come to this country, and carefully and conscientiously examine for themselves intoour system of treatment, they will very generally adopt it. And when they docome, gentlemen, allow me to say that you will find them most friendly, kindlyand agreeable men, whom you will be happy to welcome into professional and domestic circles. In their own country they are most hospitable. In this country I am sure they will be welcomed as they deserve to be. I should wishthat this great association should, under these circ*mstances, say a kindly word to them, and while I entirely concur in the wisdom of that reserve which ourPresident has recommended, I shall ask of you to adopt a resolution which Ihave framed, and which I will put before you for discussion. I am not sure it is such as you will approve, therefore I submit it for alteration if you think fit.It is:-" That this Association, while reserving its opinion onthe general ques- tion of the treatment of the insane in America, and in matters which are underinquiry, desires to express its sympathy with the medical men engaged in the treatment of the insane in the United States who have been made the subjects of unfounded accusations or imputations either in the United States or in thiscountry " (hear, hear). I have now only to thank you for your indulgent attention (applause) .Dr. CLOUSTON-I have the greatest possible pleasure in seconding the reso- lution which Dr. Bucknill has so very ably proposed. I am sure what he has said many of you know to be quite true, and I think it will be taken as asympathetic act on our part that we should have sent this word of kindness tothem at a time when they are being so traduced.Dr. JAMES STEWART-AS I have had the good fortune to have receivedtheir hospitality, it would not be becoming in me to allow a resolution to be put from the chair on the subject without having said a few words. Iwent over to America to judge for myself, and to see wherein the truth lay with regard to the great many statements I have read. It was my good for- tune to be received hospitably, and from personal observations I can corroboratewhat Dr. Bucknill has said with regard to the unfair way in which various things are managed connected with the asylums. I know this by an incident that came under my observation during the time I was there. It may be a new thing to the members of this Association when I tell them that a number of theappointments that are held by the medical superintendents of the institutions corresponding with our county asylums, are held really as political appoint.ments. I have in my possession, and if I had known I would have brought it,a letter from a gentleman, which I received quite recently, and in which healludes to the fact that as the government of his province has changed he was not sure but what he would be turned out of his appointment very shortly.This gentleman is a fellow associate of my own, and I amsure we shall be very glad to give him a helping hand if his hour of trial comes. His hour of trial isnot at all unlikely to come. Dr. de Wolf, of Nova Scotia, recently wrote me aletter saying that the government having gone out, and as he was known not to have the same views politically as the government which had come in, it was quite "on the cards " that he would get his congé. I only mention thisfact in order that we may, as far as we can, realise the position that they498 [Oct., Notes and News.occupy, and that the hands of our medical brethren abroad maybe strengthened by our resolution. We require to look at these things from quite a different light to what we are accustomed. We are accustomed to be treated in a verydifferent way to what they are on the other side of the Atlantic, whose cause Dr. Bucknill has so nobly espoused.Dr. WOOD-I thought I would confer for a moment with my esteemed friend Dr. Bucknill. It strikes me that the resolution we are about to propose israther weak, and if we mean really to express the feelings we entertain for our brethren on the other side of the water, we should do it in somewhat warmer terms. It strikes me the resolution before the meeting seems to say, " Youhave got into hot water, and we hope you will get out of it." There ought to be some general expression of opinion as to our confidence in them and the esteem in which they are held as professional men. I find Dr. Bucknil wasunder the impression that if he made it too gushing it would not be unanimous.I think, if we do pass a resolution at all, it should be something to convey an expression of our feelings, and not something like that we are simply sorry for them.Dr. BUCKNILL- Allow me to say that when I drew up that resolution I did it with the object of so expressing the opinions of the Association that we could have no dissentients, and therefore I made it as pale as I could. I think as it stands there could be no dissentient. I could not before I came into this roomknow how far the sympathy of the Association would be unanimous, and allow me to say I should be very well satisfied to withdraw it in favour of a resolutionwhich expresses our feelings more warmly, if Dr. Wood or any other gentleman would have the kindness to draw up such a resolution.The PRESIDENT-I think it very likely a warmer and more cordial resolution could be put, but it ought to come from you.After some conversation, the following resolution was carried unanimously: -"That this Association, while reserving its opinion on the general question of thetreatment of the insane in America, and on matters which are under inquiry,desires to express its esteem for the medical men engaged in the treatment of the insane in the United States, and its sympathy with those who have beenmade the subjects of unfounded accusations and imputations either in the United States or in this country."Dr. BUCKNILL-Allow me, Mr. President, to propose, as a rider upon that,that a copy of the resolution be sent to Dr. Curwen, of Harrisburg, in the Stateof Philadelphia, he being secretary to the Association of Superintendents in America.Dr. DUNCAN-I beg leave to second that.The following resolution was then put, and carried unanimously: —“ That acopy of the foregoing resolution be forwarded by the Secretary of this Associa- tion to the Secretary of the Association of Medical Officers of Asylums and Hospitals for the Insane in America."Dr. BUCKNILL-I believe, sir, I began what I had to say with the intentionof proposing a vote of thanks to you for your paper, but it slipped out of my mind in consequence of the matter which intervened. I hope, however, youwill allow me to do so now, and I therefore propose a vote of thanks to you for your valuable, able, interesting, and practical paper.Dr. GRABHAM-I have very great pleasure in seconding that. I am sure we have all been very muchinterested in your paper. I myself have been especially interested in it, as one of a Committee which has originated from the Charity Organisation Society, who have been considering for some months past the expediency of separating the chronic lunatics and idiots. We would be veryglad to be relieved of a few idiots. I shall not take up your time beyond just stating that a number of resolutions have been passed by this Committee ( see p. 503), which have been referred to a sub-committee, and I think we shall soon see an attempt at legislation on the subject.1876.]Notes and News.499Dr. DUNCAN-I had intended to have proposed this resolution myself. Iwill, however, put it to the meeting. -Carried unanimously.The PRESIDENT It is a great gratification to me that anything I could have brought before you to-day should have elicited any commendation from you,because I did not profess to come here at all as a teacher-I came to learn ,and I generally carry away with me a certain amount of information. I havebeen merely a practical worker among the insane, and any observations whichI have brought before you are perhaps not those which should have been sub- mitted to you on an occasion like this, but it was a practical subject in which Itake some interest, and to which I have paid some attention, so I thought itwiser to refer to that, though tedious to you, than to attempt something upon which I could say very little at all. I shall be very glad indeed if anything Ihave said to- day can throw any light upon the subject of the treatment or the management of the insane, which are now rather blocking up our asylums and workhouses. I am afraid it is a step which will be the work of time. I have tothank youvery much indeed for your vote of thanks.ASYLUM ATTENDANTS.Dr. CLOUSTON then read a paper on the question of getting, training, and retaining the services of good asylum attendants. (See Part I.; p. 381.)The PRESIDENT-I should be sorry such an interesting paper should passwithout discussion. I do not propose going into details, but I may say my ownexperience has been that the difficulties are not really so great as some peopleimagine in getting a good class of attendants. The principle I have gone onhas been to endeavour always to keep what I may call a permanent staff. Iset very great value upon that staff, and endeavour to keep them with me foryears. Having that, I am very independent of my juniors. I don't care howoften I change them, providing I have the good fortune to retain those whoappear to me to be likely to be good attendants. I object to having attendantsfrom another asylum; although they may bring some good training, they generally bring a good sprinkling of bad habits. I may say for myself,I have attendants who have been with me very many years, my headattendants 15, 12, and 14 years, and my under attendants some perhaps a few months. With regard to inducements, I try different methods. Idon't think myself there is a very great deal in high pay, but there is Ithink in the pensions which may be offered to them. It has been my principle, when those pensions have become due, that they should be paid up tothe full. I have never had to recommend anybody for a pension, but that mycommittee has given them the whole value of the appointment. That hasacted as a great encouragement to the elder servants to retain their positions.We endeavour to give them every facility for amusem*nt, which they appreciate, but my own opinion is a great deal may be done by ourselves by identify- ing ourselves with them. With regard to my own case, though my establishment keeps on increasing, and the numbers are getting so large, I allow everyone of them to look up to myself, not as their head, but as their personal friend and adviser. If they want any advice, they come to me. By inducing thatfeeling throughout your staff, you have a greater chance of keeping them welltogether. That has been my experience, and I have not been, thus far, disappointed. I should be very glad to hear the experience of any other of thosegentlemen who have a large staff under their supervision.Dr. CLOUSTON-May I venture to ask you how many changes you probablyhave, whether you have about the number mentioned by the Scotch Commis- sioners?The PRESIDENT-Certainly not. My under attendants certainly do change often, but my upper attendants are of not less than four or five years' standing -they range from four to five to about fifteen, on the male side. I have justnow pensioned off one man of tolerably long service. The females I have from two to ten or twelve.500 Notes and News [Oct., .Mr. MOULD-I thoroughly believe in the humanizing influences that women have in the male wards. I do believe this, that nothing will help us so muchas the introduction of women into the male wards. They have an instinctive power of nursing which men do not possess -to men, as a rule, nursing is distasteful. We know this, that women have much less pay than men, but what is small pay to a man would be very large pay to a woman. I know severalasylums which have been infinitely improved by the introduction of women.In my own asylum it has quite changed the character of the wards, and I may say changed the character of the attendants, for bad language is rarely used in the presence of the women. The attendants and patients are not so depraved as to use bad language before women. I believe, if we introduced more women into the male wards, we should do better. We should give male attendantsbetter facilities for marriage, by providing them with good cottages and such like, for it is very rarely indeed that a good married attendant leaves you. Ifwe could only have the men Dr. Clouston has pictured to us, we should be living in Utopia, but we are not likely to be there yet. We cannot give such aclass of men wages sufficient to keep them amongst us, but we can give otheradvantages to a man which might happily induce him to be surrounded by awife. I believe nothing ties a man to a place so much as a woman (laughter).Certainly, my attention has been directed to getting able, conscientious, good women attendants , and I have found very great benefit from it. I had a mostdisagreeable, cantankerous fellow, who was always complaining, and not asingle male attendant could do anything with him. I placed with him a very good looking woman, in whom I had great moral confidence, and from that timethat man never made one single complaint so long as he remained with me.When one is ill , one knows how infinitely better it is for a woman to attend upon one than for a man to do so.Dr. W. P. KIRKMAN-I have had from eight to ten years' experience asmedical officer, and consequently I can speak with some experience. I think the causes of change are two- fold-general and special. The general cause is an increased desire to travel, and the unfaithfulness of characters given by masters and mistresses, as well as the ease with which they can get places without characters at all. As an instance of the unfaithfulness of charactersand I have suffered very severely from it myself-I had to all appearance avery eligible person apply to me for an attendant's place in my asylum; I re- ceived an excellent character with that young woman from the Mayor of the town, as well as from one of his colleagues, and I received also an excellent character from the Matron of the Infirmary of the town. After she had beenthree days in the asylum, my attendants came to me and said they would not hold their places if they were to associate with such a character. I immediately produced the character I had had of the girl. I read it to the servants who came to me, and I said I had an excellent character from those gentlemenwho had known her for many years; had been constantly in the habit of meet- ing her; that she had been in the Infirmary for so many months, and could be spoken of very highly. I immediately went to the town, and made special inquiries. The result was, I found that her characters had been given on the following knowledge of her: -The Matron knew her because she had been inthe Infirmary some eight months for syphilis, and the Mayor and his colleaguehad scen her pass their houses constantly when on her professional duties as street- walker. That was the only way in which those gentlemen had known her! There was a general desire amongst servants now to travel and a desirefor change. They have not the means of travelling the same as persons have in the upper classes, and the consequence is they change their places to become acquainted with the world. I think that as a rule the great thing is to makethem happy. I don't think that in some of the asylums they are thoroughly happy and comfortable. I think also interference is a rock upon which we have to split. The Superintendent is not high enough, and the Committee of some1876. ]Notes and News.501asylums do not take the broad principle of the meaning of the statute which provides that they should appoint the servants. Agreat drawback is the oftenvexations and petty appeals allowed to be made, even from the kitchenmaid, to the Committee. As regards the keeping of servants, the best thing is to culti.vate domesticity, and, as regards the class of servants, I have always found that those persons who know nothing about asylums generally turn out to bethe best. As regards soldiers, sailors and policemen, they always give me the most trouble. I think I can ratify what Dr. Clouston has said about chap- lains; they do an immense deal of good and an immense deal of harm, by theirgossip and interference. I may mention that in the Devon Asylum you could pick the eldest attendants of any in the kingdom, yet a year ago there was not a servant in Devonshire who had been there five years. As regards wages, myexperience is that it is not of much concern, but I think they ought to have good wages. There is one matter which is of very great importance, and that is thepension clause. My experience is this, that attendants and servants do not pay any attention to the pension until they have been there about ten years, and then they begin to ask howabout a pension. They havethe pension clause published, but as they find the pension clause not compulsory, they pay no atten- tion to it. If the pension clause was made compulsory, then it would be an inducement for them to stop.Dr. JOHN KIRKMAN-I have myself had 45 years' experience, and have had three attendants who have been with me 15 years. Ihave not had the slightest inconvenience by encouraging domesticity, and I have never heard a rude word spoken. I believe if attendants are treated with kindness, not in the " standoff " form, but with uniform kindness, they will invariably be found to do their duty well. I have always taken extreme interest in attendants, because I thinkthey are a class who have not received all that they ought to receive. I have had them 12, 15 , and 25 years, and never had any reason to be dissatisfied. The great objection is not giving the Superintendents paramount power. If Committees are to receive complaints and that sort of thing, the whole place goes to the wall , and there is no proper supervision because the attendant goes forthe higher appeal. I do think if there is a simple domesticity encouraged, and uniform kindness shown, attendants will do their duty.Dr. JAMES STEWART-There is one point I had hoped Dr. Clouston would have drawn attention to, inasmuch as he has been connected with establishments forprivate as well as pauper patients. In my small experience of private asylums, Ifind that the people of culture will often resent the way some attendants have ofexpressing their wishes, from no desire to be unkind, yet expressed in such a way as to be repulsive. They would say, "Who is Sarah, that she should tell me togo to such a place?" A practical point is, can we have anything in the shape of what is established in our hospitals generally? can we have Sisters of Mercy introduced into private asylums? This was hinted to me by a gentleman whothought it was a very strange thing it had not been attempted. I should thinksomething of an intermediate character might be tried. In these days of Lady Helps, it seems strange we don't have a suggestion of them in Asylums.Mr. BAYLEY-I may say, with reference to those remarks, that this system was tried some years ago in a hospital of which I am now Superintendent, andit was an utter failure. They had what was called a " Lady help," and she did a great deal of harm.Dr. MANLEY-Out of my seven servants I have five pensioners, and I cannotagree with Dr. Kirkman. In some cases their pension is absolutely as large as their pay; they are married , and with families, and I have no better attendants.One man has just left me now. He had a pension of £40 a year. I had afemale nurse come to me a short time ago; she stayed her month, and then went to another asylum. When she left, one of the old nurses told me she wasgetting her expenses paid from one asylum to the other, and she was so making a tour of England.502 [Oct.,Notes and News.Dr. BUCKNILL-I should like to say a few words, and it will be mainly to express my very full concurrence with Dr. Clouston's able and suggestivepaper. I hope he will carry it into some practical shape. I also wish to say how entirely I agree with what Mr. Mould says about women in male wards.The experiment was first tried by a very dear friend of mine, and a very great supporter of this Association, and that was Mr. Ley, of Littlemoor. He carried it out to a large extent, It was a hobby of his, and a very useful hobby it was.I am only surprised it has not come into more general use. If I had remained the superintendent of an asylum, I should certainly, after his experience, have tried to follow in his steps , but I have, in a small way, made some use of his expe- rience in the treatment of lunatics living in their own homes, and I have, onvarious occasions, when I have met with a troublesome, disagreeable, unmanageable lunatic, who never could get on with any attendant for him,suggested that a nurse should be placed instead of the keeper-as the male attendant used to be called -and with the happiest results. With regard to themateriel of attendants, I fully concur that we should have what the French call bon naturel, a quality which I don't think we have an English word totranslate fully. But if a man or woman has those high qualities, morally andphysically, which would make a good attendant, and if that man or woman is in a pretty good position of life, it is not likely that such qualities will be thrown away by his taking such a place as attendant in a lunatic asylum. If youfind them in a lower class of life, you can cultivate them, and make the very person you desire to have. The very first attendant I engaged will, I think,bear me out in what I say. The only knowledge I had of him was that hehad been an exceedingly good second horseman, and was a very decent, honest fellow, with plenty of good sense, and a man to be trusted . I engaged him,and I think Dr. Manley, Dr. Kirkman, Dr. Parsey, and others will remember John Bettry. I left him behind, and he was the best attendant I ever had in my life.Dr. CLOUSTON-I have only to say I am very much obliged to the membersfor the reception they have given my paper. The paper has done exactly what I wished it should do-created a discussion. I have now to suggest that a Committee of three members be appointed to report to the next annual meeting of this Association on the advisability of the formation of an association orregistry of attendants in connection with this Association and the best manner of carrying it into effect.The resolution was seconded and carried , the Committee to consist of Dr.Bayley, Dr. Clouston, and Dr. Mickle, with power to add to their number.THE EDUCATION OF THE INSANE.Dr. LALOR read a paper ( see Original Articles, p. 416) on the " Education of the Insane."Dr. HACK TUKE-I am very glad Dr. Lalor has brought forward this subject,and everyone who knows what he has done in his own asylum knows that no one is better qualified to bring such a subject under our attention. I think it is due to this Association that it should know the action now being taken by the Charity Organization Society, and I will just read the reference made by the Council to the Sub- committee appointed in April last on this subject. I think by that means you will be better put in possession of the facts: -"That the Council, recognising the expediency of placing institutions for idiots, imbeciles,and harmless lunatics on the most comprehensive and satisfactory footing,resolved that a Committee be formed to consider and report upon the wholesubject." That subject has been under consideration for about three months,and a Committee has been appointed to draw up a report. I do not agreemyself with the view Dr. Lalor takes, that it is undesirable to have a separate administration for idiots and imbeciles from lunatics; on the contrary, thereare many men well calculated to be superintendents of lunatic asylums who are not calculated to take charge of idiots and imbeciles. I believe there1876.]Notes and News. 503should be not only separation, but distinct superintendence and manage- ment. But although I differ from him on that subject, we both agreeentirely as to the propriety of some fresh action being taken, and some better legislation devised . The subject is such a very large one, that I don't at all intend to enter into the various points, and therefore I will venture to proposea resolution. I think I am in order in bringing this resolution forward uponthe paper which Dr. Lalor has read. I intended bringing the subject forward a year ago in Dublin, but until I knew the resolutions which the Committeeultimately adopted, I hardly felt justified in asking the Association to express even a general assent to the action taken by the Charity Organization Society.I think a very general resolution would strengthen the hands of that Society without at all asking you to give your adhesion to the details-" Thatthis Association, having had the proceedings of the Charity Organization Society in regard to idiots, imbeciles, and harmless lunatics brought under its notice, desires, without committing itself to the immediate line of action theabove Society might think proper to take, to express its satisfaction that it has taken up the subject of educational and custodial establishments for thisclass." I think there are probably many points of detail from which some of us would dissent, especially with regard to harmless lunatics, but I think ageneral resolution of this kind would leave us quite unshackled . When a Society outside ourselves has been considering a subject of this kind for so loug, Ithink it is about time we should appreciate their intentions, at any rate.The PRESIDENT-They have kept their proceedings rather quiet, but I shall have great pleasure in seconding the resolution.Dr. HACK TUKE-The Editors of the Journal are going to give the resolu- tions in their next number.The motion was then put and carried.Dr. LALOR said he would next propose a vote of thanks to the President andFellows of the Royal College of Physicians for the use of the room, not only on this, but on former occasions.Dr. CLOUSTON seconded, and the motion was carried.Dr. BUCKNILL then proposed, and Dr. HACK TUKE seconded , a vote of thanksto the President, which was unanimously carried and acknowledged .The proceedings then terminated.The members of the Association and their friends dined afterwards at Greenwich.IDIOTS AND IMBECILES.The following resolutions have been passed, after full discussion, by a SpecialCommittee of the Charity Organisation Society in regard to idiots and imbe- ciles and harmless lunatics:-In reference to the question, " How far capable of Improvement," the follow- ing resolution was agreed to:-"That a small proportion may be made self- supporting; that a further larger proportion may be trained to do some useful work; and that, as a general rule, the habits of the remainder can be improved so as to make their lives happier to themselves and less burdensome to others."The Committee then proceeded to consider the several heads of the secondSection, entitled, " General Principles of Treatment," and the following reso- lutions were come to, after discussion, in reference to the five first heads:-1st. " That idiots and imbeciles should be treated distinctively from other classes."2nd. " That they ought not to be associated with lunatics in asylums."XXII.33504 Notes and News, [Oct.,3rd. "That they ought not, unless in exceptional cases, to be associated with paupers in union houses. "23 4th. " That the distinctive treatment suited to idiots and imbeciles ought to be applied collectively, especially in the earlier stages of education; and5th. "That idiots and imbeciles cannot with advantage be placed in ordinary schools with other children. "A motion made by Sir Charles Trevelyan, that " Feeble-minded Children ought not to be associated with Adult Idiots," was discussed in detail, and on its being shown that, under certain circ*mstances, mutual aid might withadvantage be interchanged among those diversely afflicted, and the eldermight act as nurses and helpers to the younger, and having regard also to theimprovement likely to be effected by early training in the habits of this class,the motion was withdrawn.The Committee then proceeded to consider the remaining heads of the second Section of the agenda, entitled " General Principles of Treatment," and passed, after discussion, the following resolutions:-6th. " That the improvement of idiots and imbeciles would not be promotedby boarding them out, but in certain cases, boarding out, under proper super- vision, is not unsuitable to harmless lunatics."7th. "That the education of idiots and imbeciles should be based on physical considerations."8th. "That the education of idiots and imbeciles should commence at theearliest age at which they can dispense with a mother's care, and the sub.sequent stages should depend upon the capacity developed by them."9th. "That idiots and imbeciles should have a thorough industrial training,so as to enable them, as far as practicable, to support themselves, or at least tocontribute towards their support, when circ*mstances render it necessary; "and10th. "That idiots and imbeciles of all classes should, as far as may be prudently done, be also encouraged to cultivate any literary, scientific, artistic,or mechanical faculty they may happen to possess, or be otherwise furnished with employment, so as to promote their self-respect, and to make them feel that they are of some use in the world, or, at anyrate, to occupythem pleasantly."The Committee next considered the third section of the agenda, entitled "Treatment of Adults," and, after discussion, passed the following resolu- tions:-1st. " That the treatment of adult idiots and imbeciles must depend upon the degree in which the character and faculties have been developed by pre- vious education and training."2nd. " That a small proportion may be permanently improved, so as to take care of themselves, either at their own homes or elsewhere, and to earn their own living."3rd. " That a larger proportion may be improved so as to support themselves under proper safeguards."4th. "But that there is also a large proportion of cases which, having achieved a certain improvement, are unable to get beyond this, and are, indeed,liable to retrograde, and for these cases suitable institutions, or departments ofinstitutions, where suitable classification may be carried out, are indispensable."5th. "Not only can idiots and imbeciles in asylums be employed withadvantage to themselves, and the asylums be managed as industrial establishments for manufacturing or agricultural industry, but it is essential to the moral and mental well- being of the class that such a system should be adopted;and, under good management, it may be made advantageous to the institu- tion in a financial sense by diminishing the cost of maintenance."The Committee then considered the first five heads of the fourth section ofthe agenda, viz. , " Administrative Arrangements," and passed the following resolutions:-1876.]Notes and News.5051st. "Voluntary charity has directed attention to the claims of this neglected class, and made great progress towards the establishment of a model for generaladoption; but it has not proved equal to providing a remedial machinery co- extensive with the evil."2nd. " Assuming that the returns of the census of 1871 are within the mark,only about three per cent. of the idiots and imbeciles in England and Wales have been suitably provided for by voluntary charity."3rd. " Adequate provision for all the idiots and imbeciles in England and Wales of the poorer classes, whether juvenile or adult, cannot be made without the intervention of the State."Under the 6th head letters were read from Mr. Jonathan Pim and ProfessorHanco*ck, stating that the provision made in Ireland for idiots and imbeciles was simply that they might be confined in Lunatic Asylums as being insane,or in prisons as criminals, or in workhouses as paupers, excepting only the Stewart Asylum, established about eight years ago, in which there are at present 43 inmates; but that a report is being prepared by the Charity Organisation Committee of the Dublin Statistical and Social Inquiry Society,under the several heads of the agenda, so that the Committee may have uniforminformation for all parts of the United Kingdom, as a basis for an uniform law for the helpless classes .The existing arrangements for the education and care of idiots, imbeciles,and harmless lunatics in Scotland were then considered, under the sixth headof the fourth section of the agenda, and letters were read from Dr. Mitchell,member of the General Board of Commissioners in Lunacy for Scotland; Mr.Skelton, secretary to the Board of Supervision for the Relief of the Poor in Scotland; and Dr. Ireland.Under the seventh head of the fourth section it was determined to postponethe consideration of new legislation until it shall be seen what arrangementsmay be recommended to be made.Under the eighth and ninth heads it was resolved " That the arrangement which has been made for idiots , imbeciles, and harmless lunatics in the Metropolitan Asylum District is applicable, in its main principles, to the rest of England; viz., that idiots, imbeciles, and harmless lunatics should be removedfrom workhouses and county lunatic asylums, and that young persons of those classes should be suitably educated and trained."Under the tenth head it was resolved " That the education and care of idiots,imbeciles, and harmless lunatics should be conducted by governing bodiesspecially appointed and responsible for that purpose; that such governing bodies should be composed-"1. Of representatives of the local magistrates;2. Of representatives of the local guardians; and 3. Of persons appointed by the Crown."Under the eleventh head, "That such governing bodies should also becharged with the education and care of blind and deaf and dumb children of the poorer classes. "The Committee then had before them the fourteenth head of the fourth section of the agenda, " Administrative Arrangements," and after consideringa paper, prepared by Mr. Millard, on the number of idiots, imbeciles, and harmless lunatics, under and above 20 years of age, who had to be provided for, unanimously passed the following resolution: -"That the country should be divided into districts each sufficiently large tofill an asylum containing not more than 2,000 adults , and schools containing,at the utmost, 500 young people."And under the fourteenth head the Committee resolved, by 10 to 5— "That, besides the supervision of the Commissioners of Lunacy, theschools and asylums should be inspected and reported upon to the Local Government Board,"506 Notes and News.Appointments.BROWN, J. J., M.B., F.R.C.P.Ed., has been appointed Senior AssistantMedical Officer to the Royal Lunatic Asylum, Morningside, Edinburgh, vice Maclaren, appointed Medical Superintendent of the Stirling District Lunatic Asylum.CASSIDY, D. M., M.D., C.M., has been appointed Resident Medical Superintendent of the County Lunatic Asylum at Lancaster, vice Broadhurst, resigned.EAGER WILSON, L.R.C.P.Lond. , M.R.C.S.Eng. , has been appointed MedicalSuperintendent of the Suffolk County Asylum, vice Kirkman, resigned.HUTCHINGS, R. L., M.R.C.S.E., has been appointed an Assistant Medical Officer to the Lancashire Lunatic Asylum, Prestwich.JONES, R., L.R.C.P.Ed., L.F.P.S.G., has been appointed Junior AssistantMedical Officer to the Warwickshire Lunatic Asylum, Hatton, vice Seed,resigned.MAJOR, H. C., M.D., has been appointed Lecturer on Mental Diseases at the Leeds School of Medicine, vice Browne, appointed a Chancery Visitor of Lunatics.NICOLSON, D., M.B. , has been appointed Deputy Medical Superintendent of the Criminal Lunatic Asylum, Broadmoor, vice Cassidy, appointed Resident Medical Superintendent of the Lancashire Lunatic Asylum, Lancaster.THOMSON, J. , M.B., C.M., has been appointed an Assistant Medical Officer to the Southamptonshire Lunatic Asylum, Knowle, vice Levinge, resigned.TURNBULL, A. R., M.B., C.M., has been appointed Junior Assistant Medical Officer to the Royal Lunatic Asylum, Morningside, Edinburgh, vice Brown,promoted to Senior Assistant Medical Officer.Correspondence.To the Editor of THE JOURNAL OF MENTAL SCIENCE.DEAR SIR, -Allow me to correct a mistake that inadvertently, no doubt, wasmade by Dr. Langdon Down, when he ascribed to a Doctor Granville, of Paris, awork " On the Measurement of the Palate in Idiots and Imbeciles." There is noDr. Granville in Paris. The only work ever published in France on thissubject is the one of which I have the pleasure to send you a copy, togetherwith a copy of my " Recherches sur l'Epilepsie et l'Hysterie," which is just out.I am, yours sincerely,Paris, July 12th, 1876.BOURNEVILLE.ERRATA IN JULY No. OF THE JOURNAL.Page 213, line 12-For finny, read fenny." 338 " 21 -For Dr. Harrington Tuke, read Dr. Hack Tuke.THEMEDICO- PSYCHOLOGICAL ASSOCIATION.THE COUNCIL, 1876-77.PRESIDENT. -W. H. PARSEY, M.D.PRESIDENT ELECT. -G. FIELDING BLANDFORD, M.D.EX-PRESIDENT.-J. F. DUNCAN, M.D.TREASURER. JOHN H. PAUL, M.D.EDITORS OF JOURNAL. T. S. CLOUSTON, M.D. ( HENRY MAUDSLEY, M.D.AUDITORS. STD.. HARRINGTON HACK TUKE, M.D. TUKE, M.D.HON. SECRETARY FOR IRELAND. -E. M. COURTENAY, M.B.HON. SECRETARY FOR SCOTLAND. -J. RUTHERFORD, M.D.GENERAL SECRETARY. -W. RHYS WILLIAMS, M.D.W. WOOD, M.D. J. BATTY TUKE, M.D. E. S. WILLETT, M.D T. B. CHRISTIE, M.D. R. M'KINSTRY, M.D. W. H. GARNER, F.R.C.S.I.D. YELLOWLEES, M.D. H. RAYNER, M.D. J. LALOR, M.D. T. L. ROGERS, M.D. J. FRASER, M.B. J. C. BUCKNILL, M.D.Members ofthe Association.Adam, James, M.D. St. And. , Medical Superintendent , Metrop. Dist. Asylum,Caterham, Surrey.Adams, Josiah O. , M.R.C.S. Eng. , late Assistant Medical Officer, City of London Asylum, Dartford; Brooke House, Clapton , London.Adams, Richard, L.R.C.P., Edin. , M.R.C.S. Eng. , Medical Superintendent, County Asylum, Bodmin , Cornwall.Aitken, Thomas, M.D. Edin . , Medical Superintendent, District Asylum, Inverness.Aldridge, Charles, M.R.C.S., Plympton House, Plympton, Devon.Allen, T., M.D. , St. And. , M.R.C.S. , Medical Superintendent of the Lunatic Asylum, Jamaica.Anderson, Thomas, M.B. Edin. , M.R.C.P.E. Midlothian and Peebles District Asylum, Rosewell, Edinburgh.Ashe, Isaac, M.B. , Medical Superintendent, Central Criminal Asylum, Dundrum,Ireland.Atkins , Ringrose, M.A. , M.D. Queen's Univ. Ire. , Assist. Resident Med. Superin- tendent, District Lunatic Asylum , Cork.Bacon, G. Mackenzie, M.D. St. And. , M.R.C.S. Eng. , Medical Superintendent,County Asylum, Fulbourn, Cambridge.Baillarger, M., M.D. , Member of the Academy of Medicine, Visiting Physician to the Asylum La Salpêtrière; 7, Rue de l'Université, Paris. (Hon. Mem.)Baker, Robert, M.D., Edin . , The Friends' Retreat , York.Balfour, G. W., M.D. , St. And. , F.R.C.P. Edin . , 17, Walker Street, Edinburgh.Banks , Professor John T. , A.B. , M.D. Trin. Coll. , Dub. , F.K. and Q.C.P. , Ireland,Visiting Physician, Richmond District Asylum, 11 , Merrion Square East,Dublin.Bayley, J., M.R.C.S., Medical Superintendent, Lunatic Hospital, Northampton.Beach, Fletcher, M.B. Lond. , Medical Superintendent, Clapton Idiot Asylum,London.Belgrave , T. B. , M.D. Edin . , 149, Hyde Park, Sydney, N.S.W. , Australia.Bell, John H., M.D. Ed. , M.R.C.S. Eng. , Asst . Medl. Officer , General Lunatic Hospital, Northampton.Benbow, Edward , M.R.C.S. Eng. , Hayes Park, Uxbridge , Middlesex .Benham, William T. , M.D., C.M. Abdn. , M.R.C.S. Eng. , Med . Supt. Lunatic Asylum, Santiago, Chili.Biffi, M., M.D. , Editor of the Italian " Journal of Mental Science, " 16, Borgo di San Celso, Milan. (Honorary Member. )Bigland, Thomas, M.R.C.S. Eng., L.S.A. Lond. , Bigland Hall, Lancashire,and Medical Superintendent, The Priory, Roehampton.Bishop, Sidney O., M.R.C.S. Eng , Durham County Asylum, Sedgefield Ferry Hill.Black, Cornelius . M.D. Lond . , M.R.C.P , St. Mary's Gate , Chesterfield .Blackall, John Joseph, M.D. Qu. Univ. , Irel. , Assist. Med. Officer, Richmond District Lunatic Asylum, Ireland.Blake, John Aloysius, Esq., ex M.P., 12, Ely Place , Dublin. (Hon. Member.)ii.Members of the Association.Blandford, George Fielding , M.D. Oxon , F.R.C.P. Lond. , 71, Grosvenor Street, W. (PRESIDENT ELICT.)Blatherwick, T., M.R.C.S., Staff Surg. - Major, Royal Victoria Hospital , Netley,Southampton.Bodington, George Fowler, M.D. Giessen, M.R.C.P. Lond. , F.R.C.S. exam. , Eng. ,Ashwood House Asylum, Kingswinford, Dudley, Staffordshire.Boismont, M. Brierre de, M.D. , Member of the Academy of Medicine, 303, Rue du Faubourg St. Antoine, Paris. (Honorary Member.)Boyd, Robert, M.D. Edin., F.R.C.P. Lond. , 1, Bolton Row, Mayfair, W. (PRESI- DENT, 1870.)Braddon, Charles Hitchman, Esq. , M.R.C.S. Eng. , Surgeon, County Gaol, Salford,Manchester.Brodie, David , M.D. St. And. , L.R.C.S. Edin. , Superintendent, Private Home for Imbeciles , Columbia Lodge, Liberton, Edinburgh.Brown, Joseph John, M.B. Edin . , Asst. Physician, Royal Asylum, Morningside,Edinburgh.Brown, John Ansell, M R.C.S. Eng. , L.S.A.. Lond. , late Medical Staff, Indian Ármy, Peckham House, Peckham,Brown, William James, M.B. Assist . Med. Officer, Borough Asylum, Newcastle-on- Tyne.Browne, William A. F., F.R.S.E. , F.R.C.S.E. , late Commissioner in Lunacy for Scotland; Dumfries, N.B. (PRESIDENT, 1866. ) ( Honorary Member.)Browne, J. Crichton , M.D., Edin. , F.R.S., Ed. , late Medical Superintendent,County Asylum, Wakefield, Lord Chancellor's Visitor, 46, Lincoln's Inn Fields , W.C. ( Honorary Member.)Brushfield, Thomas Nadauld, M.D. St. And. , M.R.C.S. Eng. , Medical Superinten- dent, County Asylum, Brookwood, Woking, Surrey.Bucknill, John Charles, M.D. Lond. , F.R.C.P. Lond. , F.R.S. , J.P., late Lord Chan- cellor's Visitor; Hillmorton Hall, Rugby. Editor of Journal, 1852-62 .(PRESIDENT, 1860.) (Honorary Member, 1862-76.)Buck, John, M.R.C.S., Medical Superintendent, Leicestershire and Rutland County Asylum, Leicester.Bulckens, M., M.D., Gheel , near Brussels. (Honorary Member.)Burman, Wilkie, J., M.D. Edin. , Medical Superintendent, Wilts County Asylum,Devizes.Burrows, Sir George, Bart . , 18, Cavendish Square, London, W. (Honorary Member.)Butler, John, M.D. , the Retreat , Hartford, Connecticut, U.S. (Hon. Member.)Byas, Edward, M.R.C.S. Eng., Grove Hall , Bow.Cadell, Francis, M.D. Edin. , 20, Castle Street, Edinburgh.Cailleux, M. Girard de, M.D., Member of the Academy of Medicine, Inspector General of Asylums in the Prefecture of the Department of the Seine , Hôtel de Ville, Paris . (Honorary Member.)Campbell, John A. , M.D. Glas. , Medical Superintendent, Cumberland and West- moreland Asylum, Garlands, Carlisle.Campbell, Donald C. , M.D. Glas . , M.R.C.P. Lond. , F.R.C.P. Edin. , Medical Superintendent, County Asylum, Brentwood, Essex.Calmeil , M., M.D. , Member of the Academy of Medicine, Paris, Physician to the Asylum at Charenton, near Paris. (Honorary Member.)Cameron, John, M.B., C.M. Edin . , Medical Supt . Argyll and Bute Asylum,Lochgilphead.Cassidy, David M., L.R.C.P. Edin, F.R.C.S. Edin. , Med. Supt. County Asylum,Lancaster.Chapman, Thomas Algernon, M.D. Glas. , M.R.C.S. Edin . , Hereford Co. and City Asylum, Hereford .Christie, Thomas B. , M.D. St. And. , F.R.S.E., F.R.C.P. Lond. , F.R.C.P. Edin. ,Medical Superintendent, Royal India Lunatic Asylum, Ealing, W. (Hon.General Secretary, 1872.)Christison, Sir Robert, Bart . , M.D. Edin , D.C.L. Oxf. , Professor of Materia Medica in the University of Edinburgh; late Pres. R.S., Edin.; 40, Moray Place, Edinburgh. (Honorary Member. )Clapton, Edward, M.D. Lond. , F.R.C.P. Lond. , Physician , St. Thomas's Hospital,Visitor of Lunatics for Surrey; 4, St. Thomas Street, Borough.Clarke, Lockhart, M.D., F.R S., 64, Cavendish Square, W. (Honorary Member. )Cleaton, John D. , M.R.C.S. Eng. , Commissioner in Lunacy, 19, Whitehall Place. (Honorary Member.)Clouston , T. S., M.D. Edin. , F.R.C.P. Edin. , Physician Superintendent, Royal Asylum, Morningside, Edinburgh. (Editor of Journal.)Corley, Anthony H. , M.D. Queen's Univ. , Ire. , F.R.C S.I. , 30, Lower Bagot Street,Dublin.Coxe, Sir James, Knt. , M.D. Edin. , F.R.C.P. Edin. , Commissioner in Lunacy forScotland; Kinellan, near Edinburgh. (PRESIDENT 1872.) (Hon. Member.)Members of the Association.iii.Courtenay, E. Maziere, A.B., M.B., C.M.T.C.D., Resident Physician- Superinten- dent, District Hospital for the Insane, Limerick, Ireland. (Hon. Secretary for Ireland.)Daniel , W. C., M.D. Heidelb. , M.R.C.S. Engl. , Epsom, Surrey.Davey, James George, M.D. St. And . , M.R.C.P. Lond. , late Medical Superintendent of the County Asylums, Hanwell and Colney Hatch, Middlesex; 4, Redland Park Villas , Red and, Bristol.Davidson, Charles , F.R.C.S. Edin. , Cassland Road, South Hackney, London, E. Davidson, John H., M.D. Edin. , Medical Superintendent, County Asylum, Chester.Davies, Francis P. , M.B. Edin. , M.R.C.S. Eng. , Kent County Asylum, Barm- ing Heath, near Maidstone.Davis, Robert A., M.D. St. And. , L.R.C.P. Edin. , Medical Superintendent, CountyAsylum, Burntwood, Lichfield.Daxon, William, M.D., Queen's Univ. , Ireland, F.R.C.S. Ireland, Resident Physician, Ennis District Asylum.Day, Edward Joseph, M.R.C.S .. Eng., L.S.A, Dorset County Asylum.Deas, Peter Maury, M.B. & M.S. , Lond. , Medical Superintendent, New Cheshire Asylum, Macclesfield .Delany, Barry, M.D. Queen's Univ. , Ire . , Med . Superintendent, District Asylum,Kilkenny.Delasiauve, M., M.D., Memberof the Academy of Medicine, Physician to the Bicêtre, Paris , 35, Rue des Mathurins- Saint- Jacques , Paris . (Hon. Member.)Denholm, James, M.D., Dunse, N.B. Denne, T. Vincent de, Esq , M.R.C.S. , Eng. , Assistant Medical Superintendent Bristol Lunatic Asylum, Stapleton.Déspine, Prosper, M.D., Rue du Loizir, Marseilles. (Honorary Member.)Dewsnap, William , M R.C.S. Eng. , L S.A. , 1 , Theresa Terrace, Hammersmith, W. Diamond, Warren Hastings, Esq . , M.R.C.P. Edin. , M.R.C.S. Eng. , Dudley Villa,Effra Road, Brixton.Dickson, Francis Kennedy, F.R.C.P. Ed. , Wye House Lunatic Asylum, Buxton,Derbyshire.Dickson, Hanmer, M.B., Edin. , and C.M. , 26, Nelson Square, London, S E. Down, J. Langdon Haydon, M.D. Lond. , F.R.C.P. Lond. , Physician to the London Hospital; late Resident Physician, Asylum for Idiots, Earlswood; 39,Welbeck St., Cavendish Sq . , W. , and Norman's Field , Hampton Wick.Douglas, William, M.D. Edin. , County Asylum, Sedgefield, Durham.Dove, W. Watson, M.R.C.S. Eng. , Assistant Medical Officer, County Asylum,Wells, Somerset.Duckett, William Shaw, M.D. Glasgow, 44, Upper Mount Street, Dublin.Duncan, James Foulis, M.D. Trin. Col. , Dub. , F.K. and Q.C.P. Ireland , Visiting Physician, Farnham House, Finglas; 8, Upper Merrion Street, Dublin.(PRESIDENT, 1875.)Duncan, Peter Martin, M.B. Lond. , F.R.S. , M.R.C.S. Eng. , late Med. Super. Essex Hall Asylum; 8, Belmont, Church Lane, Lee, Kent .Dyer, Thomas B., M.D. Aberd. , M.R.C.S. Eng. , L.S.A. , Asst. Medical Officer,County Asylum, Colney Hatch, Middlesex.Eager, Reginald, M.D. Lond , M.R.C.S. Eng. , Northwoods, near Bristol.Eager, Wilson, L.R.C.P. Lond. , M.R.C.S. Eng. , Assist. Med. Officer, County Asylum, Prestwich, Manchester.Eames, James A., M.D. St. And. , F.R.C.S.I. , Medical Superintendent, District Asylum, Cork.Eastwood, J. William , M.D. Edin. , M.R.C.P. Lond. , Dinsdale Park, Darlington.Edmundson, Joseph, M.D. St. And. , L.K. and Q.C.P. Ire. , M.R.C.S. Eng. ,District Asylum, Enniscorthy, Wexford, Ireland.Elliot, G. Stanley, M.R.C.P. Ed. , L, R.C.S. Ed. , Assistant Medical Officer, County Asylum, Colney Hatch, Middlesex.Eustace , John, M.D. Trin. Col. , Dub. , L.R.C.S. Ireland; Highfield, Drumcondra,Dublin.Eustace, Marcus, F.K.Q.C.P. Ire. , Highfield , Drumcondra, Ireland.Fairless, William Dean, M.D. St. And. , M.R.C.S. Eng. , late Medical Superinten- dent, Old Royal Asylum, Montrose; Kirklands , Bothwell , Lanarkshire, N.B. Falret, Jules , M.D., 114, Rue du Bac, Paris . (Honorary Member.)Farr, William, M.D., Registrar General's Office, Somerset House. (Hon. Member.)Finch, W. Corbin, M.R.C.S. Eng., Fisherton House, Salisbury.Finch, John E. M., M.B. , Medical Superintendent, Borough Asylum, Leicester.Fitzpatrick, Thomas, M.D. Ed. , F.K. and Q.C.P. , Ireland, 31 , Lower Baggot Street,Dublin.Flemming, C. F. , M.D., Editor of the " Zeitschrift fur Psychiatrie," late of the Sachsenberg State Asylum, Schwerin, Mecklenburgh. (Honorary Member.)Fletcher, Robert V., Esq. , L.R.C.S.I., L.R.C.P. and L.R.C.S. Ed. , Medical Superin- tendent, District Asylum, Ballinasloe, Ireland.Foville, Achille, M.D., Rouen, France. (Honorary Member.)iv.Members of the Association.Fox, Francis Ker, M.D. Cantab, Brislington House, Bristol.Fox, Charles H., M.D. St. And , M.R.C.S. Eng. , Brislington House, Bristol.Fraser, John. , M.B. , C.M., Medical Superintendent, Fife and Kinross District Asylum, Cupar, Fifeshire.Gairdner, W. T. , M.D. Edin. , Professor of Practic of Physic, 225, St. Vincent St.,Glasgow.Gardiner, Gideon G. , M.D. St. And. , M.R.C.S. Eng. , Upper Clapton, N.E. Garner, W. H., Esq. , F.R.C.S.I., A.B.T.C.D. , Medical Superintendent, Clonmel District Asylum.Gasquet, J. R., M.B. Lond. , St. George's Retreat, Burgess Hill, and 127, Eastern Road, Brighton.Gelston, R. P., Esq. , L.K. and Q.C.P.I., L.R.C.S.I., Assistant Medical Officer,Clonmel District Hospital for the Insane.Gibson, Charles H., Esq. , L.R.C.P. Ed. , M.R.C.S. Eng. , Senior Assistant Medical Officer, County Asylum, Hatton, Warwickshire.Gilchrist, James, M.D. Edin . , Resident Physician, Crichton Royal Institution,Dumfries.Gill, H. Clifford, M.R.C.S. Eng. , L.S.A., Medical Supt. , The Asylum, Bootham,York.Gilland, Robert B., M.D. Glas . , L.F.P.S. Glas. , M.R.C.S. Eng., L.S.A., Medical Superintendent, Berks County Asylum, Moulsford , Wallingford.Grabham, George W. , M.D. Lond. , Res. Physician, Earlswood Asylum, Redhill,Surrey.Gray, John P., M.D , LL.D , Medical Superintendent, State Lunatic Asylum,Utica, New York. (Honorary Member. )Green, Thomas, M.R.C.S. Eng. , Medical Superintendent, Borough Asylum,Birmingham.Greene, Richard , L.R.C.P. Edin. , Assistant Medical Officer, County Asylum,Haywards Heath, Sussex.Grierson, S. , M.R.C.S., Medical Superintendent, Roxburgh District Asylum,Melrose, N.B.Griffin, L. T., Esq . , L.R.C.S.I. , Ext. L.R.C.P. Lond. , Visiting Physician, Killarney District Hospital for the Insane, Ireland.Guy, W. A., M.B. Cantab, late Professor of Hygiene, King's College, London.(Honorary Member); 12 , Gordon Street, W.C. Haigh, Henry, W., F.R.C.P.E., The Crescent, Scarborough.Hall, Edward Thomas, M.R.C.S. Eng., Blacklands House Asylum, Chelsea.Harbinson, Alexander, M.D. Ire. , M.R.C.S. Eng. , Assist. Med. Officer, County Asylum, Lancaster.Harmer, W. Milsted , Esq. , M.P.C.P. E., North Grove House Asylum, Hawkhurst,Kent.Harper, Henry Lewis, M.D. St. And . , M.R.C.S. Eng. , late Medical Superin- tendent, County Asylum, Chester; 19, Addison Road, Kensington.Hatchell, George W. , M.D. Glas. , L.K. and Q.C.P. Ireland , Inspector and Commis- sioner of Control of Asylums, Ireland, 16, Elgin Road, Dublin. (Hon. Mem.)Hatchell, Joseph H., L.K.Q.C.P. Ire. , Resident Med. Superintendent, District Lunatic Asylum, Maryborough, Ireland.Haughton, S. ( clerk) , School of Physic, Trinity Coll. , Dublin, M.D., T.C.D.,D.C L., Oxon, F.R.S. (Hon. Member).Haynes, Stanley, M.D. Edin. , Eastnor House , Malvern, Worcestershire.Hearder, George J. , M.D. St. And. , L.R C.S. Edin. , Medical Superintendent,County Asylum, Carmarthen.Hemming, John Lamond, Esq. , L.R.C.P. Lond. , Munster House, Fulham, S.W. Hewson, John Dale, Esq. , Ext. L.R.C.P. Eng., Medical Superintendent, Coton Hill Asylum, Stafford .Hill, Robert Gardiner, Esq. , L.R.C.P. Edin. , M.R.C.S. Eng. , late Medical Superin .tendent, Lunatic Hospital, Lincoln; Earl's Court House, Brompton.Hills , William Charles, M.D. Áber. , M.R.C.S. Eng. , Medical Superintendent ,County Asylum, Norfolk.Hingston, J. Tregelles, Esq. , M.R.C.S. , Eng. , Medical Superintendent, North Riding Asylum, Clifton, York.Hitchco*ck, Charles, L.R.C.P. Edin . , M.R.C.S. Eng. , Fiddington House,, Market Lavington, Wilts.Hitchman, John , M.D. St. And. , F.R.C.P. Lond. , F.R.C.S. Eng., late Medical Superintendent, County Asylum, Derby; The Laurels, Fairford. ( President,1856. )Holland, Joseph, F.R.C.S. Eng. , L.S.A. , Medical Superintendent, County Asylum,Whittingham, Preston.Howden, James C. , M.D. Edin . , Medical Superintendent, Montrose Royal Lunatic Asylum, Sunnyside , Montrose.Howden, Thomas, M.D. Edin. , Medical Superintendent, District Asylum, Had- dington.Members of the Association.Howe, S. G., M.D. , Boston, United States. (Honorary Member.)Hullah, Robert , M.R.C.S., Surg. Supt. Eastern Prov. Lun. Asyl. , Graham's Town,Cape of Good Hope.Humphry, John, M.R.C.S. Eng. , Medical Superintendent, County Asylum,Aylesbury, Bucks.Iles , Daniel , M.R.C.S. Eng. , Resident Medical Officer, Fairford House Retreat,Gloucestershire.Ingels, Dr. , Hospice Guislain à Ghent, Belgium .Inglis, Thomas, L.R.C.P. Edin. , Assistant Physician, Royal Asylum, Morningside,Edinburgh.Ireland, W. W., M.D. Edin. , Medical Superintendent, Larbert Institution, Stirling- shire .Jackson, J. Hughlings, M.D. St. And. , F.R C.P. Lond. , Physician to the Hospital for Epilepsy and Paralysis, &c .; 3 , Manchester Square, London, W. Jackson, John J., M.R.C.S , Eng. , Medical Superintendent, Lunatic Asylum,Jersey.Jamieson, Robert, M.D. Edin. , L.R.C.S. Edin. , Medical Superintendent , Royal Asylum, Aberdeen .Jarvis, Edward, M.D., Dorchester, Mass. , U.S. (Honorary Member.)Jepson, Octavius, M.D. St. And. , M.R.C.S. Eng. , late Medical Superintendent, St. Luke's Hospital; Medical Superintendent, City of London Asylum, Dartford.Johnson, John, M.D. Edin . , Belmont, Church-road , Tunbridge Wells.Jones, Evan, M.R.C.S. Eng. , Dare Villa, Aberdare.Kebbell, William, L.R.C.P. , Lond. , M.R.C.S., Eng. , Assistant Medical Officer ,Three Counties Asylum, Stotfold, Baldock, Herts.Kenyon, John Kilshaw, M.R.C.S., Eng. , L.S.A. , The Old Hall, Billingborough,Lincolnshire.King, William Louis, M.R.C.S. Eng. , Eastbourne.King, T. Radford, M.D., Edin. , Marlborough House, Slough.Kirkbride, T. S. , M.D., Physician in Chief and Superintendent, Pennsylvania Hos- pital for the Insane, Philadelphia. (Honorary Member.)Kirkman, John, M.D. , 1 , Buckingham Road, Brighton . PRESIDENT, 1862.Kirkman, W. Phillips , M.D. St. And. , M.R.C.S. Eng. , L.S.A. , The Briars, St. Leonards - on-Sea.Kitching, Walter, MRC S. , Engl. Heworth, York.Krickenbeck, C.Á. , M.D. , Jaffna, Ceylon.Laehr, H., M.D. , Schweizer Hof, bei Berlin, Editor of the " Zeitschrift für Psychia- trie." (Honorary Member.)Lalor, Joseph, M.D. Glas. , L.R.C.S. Ireland, Resident Physician- Superintendent,Richmond District Asylum, Dublin . PRESIDENT, 1861 .Lawless, Edmund, Esq. , R.N., M.R.C.S. Eng. , L.A.H., Dub. , Medical Superin- tendent of St. Patrick's Hospital, Dublin.Lawrence, James, Dr. , County Asylum, Chester.Lasègue, M., M.D., Paris , Physician to the Neckar Hospital. (Honorary Member. )Layco*ck, Thomas, M.D. , Gottingen, F.R.C.P. Edin . , L.R.C.P. Lond. , Physician in ordinary to the Queen in Scotland, Professor of the Practice of Medicine and of Clinical and Psychological Medicine, Edinburgh University; 13,Walker Street, Edinburgh. (Honorary Member. ) (PRESIDENT, 1869.)Leeper, Wm. Waugh, M.D. Ed. , Loughall , Co. Armagh.Leidesdorf, M., M.D., Universität, Vienna. (Honorary Member.)Levinge, Edward G., M.B. Dub. , L.R.C S. Ire. , West Riding Asylum, Wakefield.Lewis, Henry, M.D. Bruss . , M.R.C.S. Eng. , LS.A. , late Assistant Medical Officer,County Asylum , Chester; West Terrace , Folkestone, Kent.Ley, H. Rooke, M.R.C.S. Eng. , Medical Superintendent, County Asylum,Prestwich, near Manchester.Lindsay, William Lander, M.D., F.R.S. Edin. , F.L.S. Lond. , Physician to the Murray Royal Institution, Perth; Gilgal, Perth.Lindsay, James Murray, M.D. St. And. , L.R.C.S. Edin , Medical Superintendent,County Asylum, Mickleover, Derbyshire.Lister, Edward, L.R.C.P. Edin. , M.R.C.S. Eng. , Haydock Lodge Retreat,Newton-le-Willows, Lancashire.Long, C. F. , M.R.C.S. Eng. , L.S.A., Medical Superintendent of Borough Asylum, Ipswich.Lovell, W. Day, L.R.C.P. Edin. , M.R.C S. Eng. , L.S.A. , 2, Cambridge Villas,Oakfield-road, Croydon, S E. Lowe, William H., M.D. Edin. , F.R.C.P. Edin. , Saughton Hall, Edinburgh.Lowry, Thomas Harvey, M.D. Edin. , M.R.C.S. Eng. , Malling Place , West Malling,Kent.Lush, John Alfred , M.P., F.R.C.P. Lond. M.D. St. And. , Fisherton House, Salisbury.Lyle, Thos . , M.D. Glas. , Assistant Physician, Parkside Asylum, Macclesfield,Cheshire.vi. Members of the Association.Maccabe, Frederick F. Xavier, Inspector Local Government Board, L.K. and Q.C.P. Ireland , M.R.C.S. Engl. (Hon. Secretary for Ireland, 1874-76.McDowall, T. W. , M.D. Edin., L.R.C.S.E , Medical Superintendent, Northumber- land County Asylum, Morpeth.Mackintosh, Donald, M.D., Durham and Glas. , L.F.P.S. Glas . , 10, Lancaster Road, Belsize Park, N.W. Mackintosh, Alexander, M.D. St. And. , L.F.P.S. Glas. , late Physician to Royal Asylum, Gartnavel, Glasgow, 26, Woodside Place , Glasgow.Maclaren, James, L.R.C.S.E., Stirling District Asylum, Larbert, N.B. Macleod, M. D. M.B. , Assistant Medical Superintendent, Cumberland and West- moreland Asylum, Garlands , Carlisle .Macleod , William, M.D. Edin. , Deputy Inspector- General, Naval Lunatic Hospital,Great Yarmouth.Maclintock, John Robert, M.D. Aber. , late Assistant Physician, Murray's Royal Institution, Perth; Church Stretton, Shropshire.Maconchy, John, M.B., T.C.D. F.R.C.S. Ireland, M.R.C.S. Engl. , Infirmary House, Downpatrick.Macmunn, John, M.D. Glas . , L.K. and Q.C.P. Ireland, L.F.P.S. Glas . , ResidentPhysician, District Hospital for the Insane, Sligo.Madden-Medlicott, Charles W. C. , M.D. Edin. , L.M. Edin . , Medical Superintendent,County Asylum, Wells, Somerset.Major, Herbert, M.D. Med. Director, County Asylum , Wakefield.Manley, John, M.D. Edin. , M.R.C.S. Eng. , Medical Superintendent, County Asylum, Knowle, Fareham, Hants.Manning, Frederick Norton, M.D. , St. And. , M.R.C.S. Eng. , Inspector of Asylums for New South Wales, Medical Superintendent, Hospital for the Insane,Gladesville, near Sydney.Manning, Harry, B.A. London, M.R.C.S., Laverstock House, Salisbury.Marsh, James Welford, M.R.C.S , Eng. , L.S.A., Assistant Medical Officer, County Asylum, Lincoln.Marsh, W. Joseph, M.R.C.S. Eng. , L.S.A. , Assistant Medical Officer, County Asylum, Littlemore.Marshall, William G. , M.R.C.S. , Medical Superintendent, County Asylum, Colney Hatch, Middlesex.Maudsley, Henry, M.D. Lond. , F.R.C.P. Lond. , Professor ofMedical Jurisprudence,University College, formerly Medical Superintendent, Royal Lunatic Hospital,Cheadle; 9, Hanover Square, London, W. (Editor of Journal. ) (PRESIDENT,1871.)McDonnell, Robert, M.D. , T.C.D. , F.R.C.S I. , M.R.I.A., 14, Lower Pembroke Street, Dublin.McDowall, M.B. Edin. , Assist. Med. Officer, South Yorkshire Asylum, Wadsley.M'Cullough, David M., M.D. Edin . , Medical Superintendent of Asylum for Mon- mouth, Hereford , Brecon , and Radnor; Abergavenny.M'Kinstry, Robert, M.D. Giess. , L.K. and Q.C.P. Ireland, and L.R.C.S. Ireland,formerly Physician, Trough Fever Hospital and Glasslough and Emyvale Dispensaries, Resident Physician , District Asylum, Armagh.Mercer, Niel Gray, M.D. Edin. , L.R.C.S. Edin., Resident Medical Supt. , E. Riding County Asylum, Beverley.Merrick, A. S. , M.D. Qu. Uni. Irel., L.R.C.S. Edin. , Medical Superintendent,District Asylum, Belfast , Ireland.Meyer, Ludwig, M.D. (Honorary Member. ) University of Göttingen.Mickle, Julius, M.D. , Medical Superintendent, Grove Hall Asylum, Bow.Mickley, George, M.A., M.B. Cantab. , Medical Superintendent, St. Luke's Hospital, Old Street, London, E.C. Millar, John, Esq. , L.R.C.P. Edin. , L.R.C.S. Edin. , Late Medical Superintendent ,County Asylum, Bucks; Bethnal House, Cambridge Heath, London.Millson, George LRCP. Lond. , M.R.C.S. Eng. , Northampton County Asylum,Berrywood, Northampton.Milne, Thomas , M.D. Aber. , C.M. Aber. , New Deer, Aberdeenshire:Minchin, Humphry, A.B. and M.B., T.C.D., F.R.C.S.I., Surgeon to the City of Dublin Prisons, 56, Dominick Street, Dublin .Mitchell, Arthur, M.D. Aberd. , Commissioner in Lunacy for Scotland; 34, Drum- mond Place, Edinburgh. (Honorary Member. )Mitchell, S., M.D. Edin. , Medical Superintendent, South Yorkshire Asylum,Wadsley, near Sheffield.Monro, Henry, M.D. Oxon, F.R.C.P. Lond. , Censor, 1861 , Visiting Physician , St. Luke's Hospital; 13, Cavendish Square, London, W. (PRESIDENT, 1864.)Mould, George W. , M.R.C.S. Eng. , Medical Superintendent, Royal Lunatic Hospital, Cheadle, Manchester.Mundy, Baron Jaromir, M.D. Würzburg, Professor of Military Hygiene, Uni- versität, Vienna. (Honorary Member.)Members of the Association. vii.Munro, Archibald C., M.B. Edin., Asst. Medical Officer, Crichton Royal Institution ,Dumfries.Nairne, Robert, M.D. Cantab. , F.R.C.P. Lond. , late Senior Physician to St. George's Hospital, Commissioner in Lunacy; 19, Whitehall Place , London.(Honorary Member.)Needham, Frederick, M.D. St. And. , M.R.C.P. Edin. , M.R.C.S. Eng. , late Medical Superintendent , Hospital for the Insane, Bootham, York; Barnwood House,Gloucester.Newcombe, Charles Frederick, M.B. Aberd. , Assistant Medical Officer, County Lunatic Asylum , Rainhill , Lancashire.Newington, Alexander, M.B Camb. , M.R C.S. Eng. , Ridgway, Ticehurst, Sussex.Newington, H. Hayes, M.R.C.S. , Ticehurst, Sussex.Newington, Samuel, M.A. Oxon. , M.R.C.P. Lond. , Ridgway, Ticehurst , Sussex.Nicholson, William Norris , Esq . , 45, Lincoln's- Inn- Fields , W.C. , Lord Chancellor's Visitor of Lunatics. (Honorary Member.)Nicolson, David, M.B. and C.M. Aber. , late Medical Officer, H. M. Convict Prison,Portsmouth. Deputy Superintendent, State Asylum, Broadmoor, Woking- ham , Berks.Niven, William, M.D. St. And., Medical Staff H M. Indian Army, late Superinten- dent of the Government Lunatic Asylum, Bombay, care of Thacker, Vining and Co. , Bombay.Noble, Daniel, M.D. St. And. , F.R.C.P. , 32, Ardwick Green , Manchester.North, S. W., Esq. , M.R.C.S. E., F.G.S. , Medical Attendant Dunnington House Asylum, Castlegate, York.Nugent, John, M.B. Trin. Col. , Dub. , L.R.C.S. Ireland, Senior Inspector and Commissioner of Control of Asylums, Ireland; 14, Rutland Square, Dublin.(Honorary Member.)Ogle , John W., M.D. Oxon. , F.R.C.P. Lond. , 30, Cavendish Square, London, W. Orange, William, M.D. Heidelberg , M.R.C.P. Lond., Medical Superintendent, State Asylum, Broadmoor, Wokingham.Owen, Harold, M.R.C.S., Eng. , L.R.C.P. Ed , Resident Medical Proprietor, Tue- Brook Villa Asylum, Liverpool.Paley, Edward, M.D., M.R.C.S. Eng. , late Res. Medical Officer, Camberwell House,Camberwell; Med. Superintendent , Yarra Bend Asy. , Melbourne , Victoria.Palmer, Edward, M.D. St. And. , M.R.C.P. Lond. , M.R.C.S. , Medical Superin- tendent, County Asylum , Lincoln.Parsey, William Henry, M.D. Lond. , M.A. Lond. , M.R.C.P. Lond. , Medical Superintendent, County Asylum, Hatton, Warwickshire. ( PRESIDENT.)Pater, W. Thompson, MR.C.S. Eng,, L.S.A., Medical Superintendent, County Lunatic Asylum , Stafford.Paterson , G. A. , M.D. Edin. , F.R.C.P. Edin. , Deputy Commissioner in Lunacy;51, Queen St. , Edinburgh.Patton, Alex. , M.B., Resident Medical Superintendent, Farnham House, Finglas,Co. Dublin.Paul, John Hayball, M.D. St. And . , M.R.C.P. Lond. , F.R.C.P. Edin.; Camber.well House, Camberwell. (Treasurer.)Peddie, Alexander, M.D. Edin. , 15, Rutland Street, Edinburgh.Pedler, George H., L.R.C.P. Lond. , M.R.C.S. Eng. , 6, Trevor Terrace, Knights- bridge, S.W. Perkins, Whitfield , M.R.C.S. Eng. , L.S.A. , Asst. Medical Officer, City of London Lunatic Asylum, Stone, Dartford, Kent.Petit, Joseph, L.R.C.S. Ire. , L.R.C.S I. , District Lunatic Asylum, Letterkenny.Philip, James, A., M.A., M.B. & C.M. Aberd . , Lincoln Lunatic Hospital.Philipson, George Hare, M.D, and M.A. Cantab. , F.R.C.P. Lond. , 7 , Eldon Square,Newcastle on- Tyne.Pim , F., Esq. , M.R.C.S. Eng. , L.K. and Q.C.P. Ireland, Medical Superintendent Lucan Institution for the Insane and for Idiots, Lucan, Ireland .Pitman, Henry A. , M.D. Cantab. , F.R.C.P. Lond. , 28, Gordon Square, W.C.,Registrar of Royal College of Physicians. (Honorary Member. )Powell , Evan, M.R.CS. Eng.. L.S.A. , Assistant Medical Officer, Kent County Asylum, Barming Heath.Prichard, Thomas, M.D. Glas. , M.R.C.P. Lond. , F.R.C.P. Edin. , late Medical Superintendent , Glas . Royal Asylum; Abington Abbey, Northampton.Pringle, Henry Turnbull , M.D. Glasg. , Medical Supt. County Asylum, Bridgend,Glamorgan Ray, Isaac, M.D. , late Physician to the Butler Hospital for the Insane, Providence,Rhode Island, U.S. (Honorary Member.)Rayner, Henry, M.D. Aber. , M.R.C.S. Eng. , L.S.A. , Medical Superintendent,County Asylum, Hanwell, Middlesex .Rice, Hon. W. Spring, late Secretary to the Commissioners in Lunacy. (HonoraryMember.)viii. Members of the Association.Richardson, B. W. , M.D. St. And. , F.R.S. , 12, Hinde Street , W. (Honorary Member.)Robertson , Alexander, M.D. , Medical Superintendent Ararat Asylum, Victoria,Australia.Robertson, Alexander , M.D. Edin . , Medical Superintendent, Town's Hospital and City Parochial Asylum, Glasgow.Robertson, Charles A. Lockhart, M.D. Cantab. , F.R.C.P. Lond. , F.R.C.P. Edin. ,Lord Chancellor's Visitor, 45, Lincoln- Inn- Fields, London . (General Secretary, 1855-62 .) Editor of Journal, 1862-70. (PRESIDENT, 1867.)(Honorary Member.)Robertson, John Charles G. , Esq. , L.R.C.P. Edin. , M.R.C.S. Eng. , L.S.A. Lond. ,late Assistant Medical Officer, County Asylum, Hanwell; Medical Superin- tendent, County Cavan District Asylum, Monaghan, Ireland.Rogers, Edward Coulton, M.R.C.S. , Eng. , L.S A. , Senior Assistant Medical Officer three Cos. Asylum, Stotfold, Baldock, Herts.Rogers, Thomas Lawes, M.D. St. And. , M.R.C.P. Lond. , M.R.C.S. Eng. , Medical Superintendent, County Asylum, Rainhill, Lancashire. (President, 1874.)Rorie, James, M.D. Edin . , L R.C.S. Edin . , Medical Superintendent, Royal Asylum,Dundee. (Late Honorary Secretary for Scotland. )Rutherford, Jas. , M.D. Edin. , F.R.C.P. Edin . , late Medical Superintendent Argyll and Bute District Asylum, Lochgilphead; Medical Superintendent Woodilee Asylum , Lenzie, near Glasgow. (Hon. Secretary for Scotland. )Sabben, James, M.D. Edin. , Northumberland House, Stoke Newington.Salomon, Ernst, M.D., Medical Superintendent, Malmö Asylum, Sweden.Sanderson, Alexander, F.R.C.S. Edin. , Bridge Street, Musselburgh.Sankey, Heurtley H., M.R.C.S. Eng. , Medical Superintendent, Oxford County Asylum, Littlemore, Oxford.Sankey, W. H. Octavius , M.D., F.R.C.P. Lond.; late Medical Superintendent,Hanwell, Middlesex; Sandywell Park, Cheltenham, and Almond's Hotel,Clifford Street, Bond Street. (PRESIDENT, 1868. )Du Saulle, M. Legrand , M.D. , Paris , 9, Boulevard de Sebastopol , Paris. (Honorary Member.)Saunders, George James S., M.B. Lond. , M.R.C.S. Eng . , Medical Superintendent,County Asylum, Exminster, Devon.Savage, George H. , M.D. Lond. , Assistant Medical Officer, Bethlem Royal Hospital,London.Schlager, L., M.D., Professorof Psychiatrie, 2, Universitäts Platz , Vienna.(Honorary Member.)Schofield, Frank, M.D. St. And. , M.R.C.S. , Camberwell House, Camberwell.Seaton, Joseph, M.D. St. And. , F.R.C.P. Edin . , Halliford House, Sunbury.Seymour, Francis, M.R.C.S. Eng. , L.S.A. , Assist. Med . Officer, Thorpe Asylum,Norwich.Shaw, Thomas C. , M.D. Lond. , M.R.C.P. Lond. , Medical Superintendent, Metro- politan Asylum , Leavesden.Sheaf, C. A. E., Esq . , L.R.C.S. and L.R.C.P. Edin. , late Assistant Physician , Royal Asylum, Edinburgh, Hartington Street, Barrow in Furness.Sheppard, Edgar, M.D. St. And. , M.R.C.P. Lond. , F.R.C.S. Eng. , Medical Su- perintendent, County Asylum, Colney Hatch, Middlesex.Sherlock, James, M.D. , Edin . , M.R.C.P. Lond. , F.R.C.S. Edin . , Medical Superin- tendent, County Asylum, Powick, Worcester.Sibbald , John, M.D. Edin . , M.R.C.S. Eng. , Deputy Commissioner for Scotland,Office, 51 , Queen St. Edinburgh, (Editor of Journal, 1871-72 .)Simpson, Alexander, M.D., Professor of Midwifery , University , Edinburgh.Skae, C. W., M.D. St. And. , Medical Superintendent, Ayrshire District Asylum,Ayrshire, Glengail, Ayr.Skae, Frederick W. A. , M.D. St. And. , L.R.C.S. Edin. , Medical Inspector of Asylums, New Zealand , Wellington , N.Z. (Hon. Secretary for Scotland,1872-76 . )Smart, Andrew, M.D. Edin . , F.R.C.P. Edin . , 24, Melville Street, Edinburgh.Smith, Patrick, M.A. Aberdeen, M.D. , Sydney, New South Wales , Resident Medical Officer, Lunatic Asylum, Yarra Bend, Melbourne, Victoria.Smith, Frederick Moore, M.D. St. And. , M.R.C.S. Eng. , late Assistant- Surgeon,4th Reg.; Hadham Palace, Ware, Herts.Smith, Robert, M.D. Aber. , L.R.C.S. Edin. , Medical Superintendent, County Asylum, Sedgefield , Durham.Smith, John, M.D. Edin. , F.R.C.P. Edin. , late Physician, City Lunatic Asylum;Visiting Physician to Saughton Hall; 20 , Charlotte Square, Edinburgh.Spence, James B. , M.D. Ire . , Assistant Med. Officer, Earlswood Asylum, Surrey.Spencer, Robert, M.R.C S. Eng. , Med. Superintendent, Kent County Asylum,Chartham, near Canterbury.Stabb, Henry, M.D., Medical Superintendent, The Asylum, St. John's, Newfound- land.Members of the Association. ix.Stanley, Hans Sloane, late Chairman of Visiting Magistrates, County Asylum,Hampshire; Paultons , Romsey. (Honorary Member.)Stevens, Henry, M.D. Lond. , M.R.C.P. Lond., M.R.C.S. Eng. , late Medical Superintendent, St. Luke's Hospital; Medical Department, Privy Council Office, Whitehall , S.W.Stephens , Henry Oxley, M.D. Aber. , M.R.C.P. Lond. , M.R.C.S. Eng. , 5, Hampton Terrace, Compton, Bristol.Stewart, Henry H., M.D. Edin. , F.R.C.S. Ireland, 75, Eccles St. , Dublin.Stewart, James, B.A. Queen's Univ. , L.R.C.P. Edin. , L.R.C.S. Ireland , late Assistant Medical Officer, Kent County Asylum, Maidstone, Mount Hope,Sneyd Park, Bristol.Stillwell Henry, M.D. Edin. , M.R.C.S. Eng. , Moorcroft House, Hillingdon,Middlesex.Stocker, Alonzo Henry, M.D. St.And. , M.R.C.P. Lond. , M.R C.S. Eng. , MedicalSuperintendent, Peckham House Asylum, Peckham.Strange, Arthur, M.D. Edin. , Medical Superintendent Salop and Montgomery Asylum, Bicton , near Shrewsbury.Sutherland, Henry, M.D. Oxon, M.R.Č.P. London, Blacklands House, Chelsea;and Otto House, Hammersmith.Sutton, H. G., M.D. Lond. , F.R.C.P., Assistant Physician to the London Hospital,9, Finsbury Square, E.C. Swain, Edward, Esq. , M.R.C.S. , Medical Superintendent, Three Counties' Asylum ,Stotfold Baldock.Tate, William Barney, M.D. Aber. , M.R.C.P. Lond. , M.R.C.S. Eng. , Medical Superintendent of the Lunatic Hospital, The Coppice , Nottingham.Terry, John, M.R.C.S. Eng. , Bailbrook House, Bath.Thompson, George, L.R.C.P., M.R.C, S. , Medical Superintendent Bristol Lunatic Asylum, Stapleton.Thomson, William A., F.R.C.S.I. ( Exam. ) , Assistant Medical Officer, Kent Lunatic Asylum, Chartham Down.Toller, Ebenezer, M.R.C.S. Eng. , late Medical Superintendent, St. Luke's Hospital; Medical Superintendent , County Asylum, Wotton, Gloucestershire.Tours, M. Moreau de M.D., Member of the Academy of Medicine, Senior Physician to the Saltpêtrière, Paris . (Honorary Member.)Townsend, Charles Percy, M.R.C.S. Eng. , Assist. Med. Officer, Barnwood House,Gloucester.Tuke, John Batty, M.D. Edin. , 20, Charlotte Square, Edinburgh. (Honorary Secretary for Scotland, 1869-72. )Tuke, Daniel Hack, M.D. Heidel. , L.R.C.P. Lond. , M.R.C.S. Eng., late Visiting Physician, the Retreat, York; Wood Lane, Falmouth, and 5, Charlotte street,Bedford square , London.Tuke, Thomas Harrington, M.D. St. And . , F.R.C.P. Lond. and Edin.,M.R.C.S. Eng. , Visiting Physician , Northumberland House, Stoke New.ington; 37, Albemarle Street, and The Manor House, Chiswick. (General Secretary, 1862-72. ) ( PRESIDENT, 1873.)Turner, Thomas, M.D., L.R.C.P. Edin. , M.R.C.S. Eng. , Assistant Physician,Northumberland House, Stoke Newington.Tweedie, Alexander, M.D. Edin. , F.R.C.P., London, F.R.S., late Examiner in Medicine, University of London , Visiting Physician Northumberland House, Stoke Newington, 119, Pall Mall, and Bute Lodge, Twickenham.(Honorary Member.)Tyner, George St. G., L.K. and Q.C.P. Ireland , L.R.C.S. Ireland, Resident Physician, Downpatrick District Hospital for the Insane.Wade, Arthur Law, B.A. , M.D. , Dub. , Worcester County Asylum.Walsh, Francis Delaval, M.R.C.S. Edin . , Medical Superintendent, Lunatic Hospital , Lincoln.Wallis, John A., M.B. Aberd. , L.R.C.P. Edin. , Medical Superintendent, Boro'Asylum, Kingston- upon-Hull.Ward, Frederic H., M.R.C.S. , Eng. , L.S.A., Assistant Medical Officer, County Asylum, Tooting, Surrey.Ward, J. Bywater, B.A., M.B. Cant. , M.R.C.S. Eng. , Medical Superintendent,Warneford Asylum, Oxford .Warwick, John, F.R.C.S. Eng. , 25, Woburn Square , W.C.Watson, Sir Thomas, Bart. , late President of the Royal College of Physicians , M.D. Cantab. , D.C.L. Oxon. , F.R.C.P. Lond. , F.R.S., Physician Extraordinary to the Queen, 16, Henrietta Street, Cavendish Square. (Honorary Member).West, Francis John, M.R C.S. Eng. , Medical Superintendent, District Asylum,Omagh, Tyrone.Westphal, C. Professor, 40, Mauerstrasse, Berlin. (Honorary Member.)Whitcombe, Edmund Banks, Esq. ,M.R.C, S., Borough Lunatic Asylum, Birmingham,X, Members of the Association.Wickham, R. H. B., F.R.C.S. , Edin. , Medical Superintendent, Borough Lunatic Asylum, Newcastle- on- Tyne.Wilkinson, Matthew Eason, M.D. Edin. , F.R.C.P. , Physician to the Manchester Royal Infirmary and Lunatic Hospital, 25, Gore St., Greenheys, Manchester.Wilks , Samuel, M.D. Lond. , F.R.C.P. Lond. , Physician to Guy's Hospital; 77,Grosvenor Street, Grosvenor Square.Wilkes, James, F.R.C.S. Eng. , Commissioner in Lunacy; 19, Whitehall Place , and 18 , Queen's Gardens , Hyde Park. (Honorary Member.)Willett, Edmund Sparshall, M.D. St. And. , M.R.C.P. Lond. , M.R.C.S. Eng. ,Wyke House, Sion Hill, Isleworth , Middlesex; and 7, Suffolk Place, Pall Mall.Williams, Llewellyn , M.D. Edin . , M.R.C.P. Lond. , L.R.C.S. Edin. , 9, Leonard Place, Kensington , W. Williams, S. W. Duckworth, M.D. St. And. , L.R.C.P. Lond. , Medical Superin- tendent, Sussex County Asylum, Haywards Heath.Williams, W. Rhys, M.D. St And. , M.R.C.P. Ed. , F.K. and Q.C.P. , Ire. ,Resident Physician , Bethlem Hospital , London. (Hon. General Secretary.)Williams, William, M.B. Lond. , Medical Superintendent, North Wales County Lunatic Asylum, Denbigh.Williams , William White, M.D. St. And. , F.R.C.P. Lond. , Consulting Physician,County Asylum, Gloucester; Hayes Lodge, Sydenham Road, Cheltenham .(Hon. General Secretary, 1847-1855. )Williams, William, M.D. , Qu. Univ. Irel. , M.R.C.P. Lond. , 70, Rodney street,Liverpool.Wilson, J. Grant, M.D., M.R.C.P. Lond . , 49, Redcliffe Gardens, London, S.W. Wilton, Francis , M.R.C.S. Eng. , late Medical Superintendent, Joint Counties Asylum, Carmarthen, Gloucester; Ridgway, Ticehurst, Sussex.Winn, James M.M.D. Glasg., M.R.C.P. Lond. , late resident Physician, Sussex House Asylum; 31 , Harley Street, Cavendish Square, W. Winslow, Henry Forbes, M.D. Lond . , M.R.C.P. Lond. , Sussex House, Hammer- smith, Middlesex.Winslow, Lyttleton S. , M.B. Camb. , M.R.C.P. Lond. , D.C.L. Oxon, 23 , Cavendish- square, London, W.Wolf, James de, M.D. Edin . , Medical Superintendent, Hospital for Insane, Halifax,Nova Scotia.Wood, William M.D. St. And. , F.R.C.P. Lond. , F.R.C.S. Eng. , Visiting Physician,St. Luke's Hospital, late Medical Officer, Bethlehem Hospital; 54, Upper Harley Street, and The Priory, Roehampton. (PRESIDENT, 1865.)Wood, Thomas Outterson, M.R.C.P. Edin. , F.R.C.S. Edin. , M.R.C.S. Engl. ,Medical Superintendent General Lunatic Asylum. Isle of Man.Wood, B. T., Esq . , M.P., Chairman of the North Riding Asylum, Conyngham Hall , Knaresboro. (Honorary Member.)Woods, Oscar T., B.A.M.B. Dub. , Medical Superintendent , Asylum, Killarney Wright, Francis J. , M.B. Aberd. , M.R.C.S., Eng. , Assistant Medical Officer,County Asylum, Prestwich, Manchester.Wright, John Fred , M.R.C.S. Eng. , L.S.A. , Asst. Medical Officer, County Asylum,Hanwell, Middlesex.Wright, Strethill , M.B. Edin. , late Medical Superintendent, Barnhill Parochial Asylum, Glasgow.Wyatt, William H., Esq. , J.P. , Chairman of Committee, County Asylum, Colney Hatch, 88, Regent's Park Road. (Honorary Member.)Yeats, William, M.D. Aberd. , Bankfoot, Perth, N.B.. Yellowlees, David, M.D. Edin . , F.F.P.S. Glas . , Physician Superintendent, Royal Asylum, Gartnavel, Glasgow.Younger, E. G., M.R.C.S. Eng. , Asst. Medical Officer, County Asylum, Hanwell,Middlesex.Notice of any alteration required in the above List to be sent to the Honorary Secretary,Bethlem Royal Hospital, London, S.E. , and in duplicate to the Printerof the Journal, Geo. P. Bacon, Lewes, Sussex,THE JOURNAL OF MENTAL SCIENCE.[Published by Authority ofthe Medico- Psychological Association. ]No. 100. NEW SERIES, No 64. JANUARY, 1877. VOL. XXII.PART 1.- ORIGINAL ARTICLES.Contribution to the statistics of insanity. By ARTHURMITCHELL, M.D., LL.D., Commissioner in Lunacy for Scotland.I. NATURE OF THE INQUIRY.1. In this inquiry all the asylums of Scotland are regarded asone asylum, and the different institutions merely as differentwards of the asylum. A patient transferred from one institution to another is thus regarded as never leaving theasylum, but merely as passing from one ward to another.The words-the asylum-therefore, in this paper, mean anasylum made up of all the asylums of Scotland.2. The inquiry does not deal with the whole population ofthe asylum. It deals only with the patients who were admitted into it during some single and remote year, and whohad never been under asylum treatment before-in otherwords, who were admitted during the year in question forthe first time.3. The history of each of these patients is followed fromyear to year down to a certain fixed period. No cognisanceis taken of the existence of any other patients . The wards.of the asylum might thus have been empty when thesepatients went into them, so far as concerns this research,and in like manner no fresh admissions need have occurredduring the time over which it extends. The inquiry is limited to the new cases which presented themselvesin one remote year; and, at a fixed and comparativelyrecent period, it is asked, what has become of thesepatients? how many of them are still in the asylum?how many of them have died there?-how many haveXXII.34508 Contribution to the Statistics of Insanity, [Jan.,gone out and returned to it?-how many are out of it inlife and sanity?-how many are out of it in life but in astate of insanity?-how many have died after leaving it,and what was their mental condition at the time of death?These and other such questions are asked, and as far aspossible answered.4. It is important to bear in mind that the whole historyof each patient has been separately tabulated.5. It is scarcely necessary to say that I am indebted to myofficial position for the means of making an inquiry of thiskind.II. GENERAL RESULTS.1. During the year 1858, there were 1297 patients admitted for the first time into the asylum, and in the year1870, or 12 years after, it is asked what has become of them.I am able to speak definitely regarding the condition of 1096,or about 11ths of the whole.2. It is found that 412 had died in the asylum, and that273 remained in it. We thus account for 685, or about 53per cent. There remain 612, or about 47 per cent, who haddisappeared from the asylum- neither having died in it, norbeing found in it at the end of the 12 years.3. The inquiry has gone further, and an effort has beenmade to find out the history of the 612 patients who haddisappeared from the asylum . With reference to them ithas been ascertained that, at the end of the year 1869,42 had died in a state of insanity,78 had died in a state of sanity,94 were living in a state of insanity,and 197 were living in a state of sanity.This accounts for 411 of the 612, leaving 201 , regardingwhose condition at the end of the 12 years no trustworthyinformation could be obtained. *

• From what became known to me while making this inquiry, and from knowledge otherwise acquired , I think we may safely assume that what was found to be true of the 411 would have been found to be substantially true also of the 201, had we succeeded in getting the information regarding them which

1877.]509 by ARTHUR MITCHELL, M.D.III. THE RESULTS CONSIDERED IN THEIR BEARINGS ONRECOVERIES, RELAPSES, AND DEATHS.1. The broader features of these results are given in thefollowing table:-Discharged. Remaining Mean Re-ad- at 31 Dec. number Year. Admitted Recovered.Notrecovered.mitted. of each Dead resident.year.1858 1297 3201859 2201860 751861 45881888510355 8036 56 6527 321862 39 10 331863 33 11 231864 20 11 141865 22 5 191866 28 4 131867 16 6 151868 20 5 111869 13 2 13ུ= 33 ལྷ་ རྒྱ ཤྩ ཧྨ ླ མ47 833 41691 569 701467 51850 413 44042 373 39334 340 35634 329 33420 303 31635 293 29829 285 28928 277 28124 273 275Totals. 851 260 412 499was desired. On this assumption, we should have the whole 612 thus accounted for:---62 as dead, being in a state of insanity at the time of death,117 as dead, being in a state of sanity at the time of death,139 as living, and in a state of insanity,and 294 as living, and in a state of sanity.If we combine these figures with the figures in paragraph 2, we find that the 1297 patients admitted for the first time into the asylum in 1858 are accountedfor in 1870, or 12 years after, in the following manner:-(1. ) As insane-(a.) Dead-while in the asylum 412,, -afterleaving the asylum 62 474(b.) Alive-in the asylum .......... 273"3 -out of the asylum ...... 139 412886(2.) As sane-(a.) Dead-after leaving the asylum (b.) Alive-out of the asylum......117 294 411Total ...... 1297510 Contribution to the Statistics ofInsanity, [Jan.,2. These figures, however, lose much of their interest, ifthey are not examined in connection with the statementwhich gives the whole history from year to year of eachpatient separately. In this inquiry, a patient, however oftenhe may be discharged either as recovered or as unrecovered,or however often he may be re-admitted, counts throughoutas one and the same patient. The effect of being able thusto deal individually with the 1297 patients will be apparent,when we discuss separately the discharges of the recoveredand the unrecovered, the re-admissions, and the deaths.(a. ) Recoveries.1. The table shows that the 1297 patients yielded duringthe 12 years 851 discharges of recovered patients, or 65-61.Giving the figures in percentages, we have the 1297 patients accounted for thus:-As dead in the asylum 31-7 p.c. As dead after leaving the asylum but insane at the time of death 49 p.c. 36.6 p.c.2.As still alive , and in theasylum 210 p.c. As still alive, but out of the asylum, and in a state ofinsanity 10.7 p.c.31.7 p.c. Yielding a total, for all those who had either died in a stateof insanity, or were still living in a state of insanity, of ......... 68.3 p.c.3.As having died out of the asylum, being in a state ofsanity at the time of death 9'0 p.c. As still alive, and in a state of sanity 22.7 p.c.31.7 p.c.100.0More briefly stated, these figures stand thus:-36.6 p.c. are found to have died, being in a state of insanity at the time of death,317 p.c. are found to be still alive and still insane,and 31· 7 p.c are found to be either still alive and sane, or to have died being in a state of sanity at the time of death.These calculations are given in a foot note, because they involve the assumption (which I believe to be a safe one) that the 201 patients, regarding whosecondition no trustworthy information was obtained , would present substantiallythe same results as the similarly situated patients regarding whom satisfactory information was secured. In no other part of the paper is anything introducedwhich involves any assumption.1877.] by ARTHUR MITCHELL, M.D. 511p. c. If we add the re-admissions (499) to the admissions( 1297) we have 1796, of which number the whole recoveries tabulated constitute 47.3 p. c.2. But these 851 discharges refer only to 538 patients, whoare 41.5 p. c. of the patients admitted, and 300 p. c. of thepatients admitted and re-admitted taken together.3. Of the 538 patients who were at any time during the12 years discharged as recovered it is found thatand67 were re-admitted and were found in the asylum at the end of the 12 years,33 were re-admitted and died in the asylum,9 were re-admitted and were ultimately dischargedas unrecovered.Total 109.Ifwe deduct these (109) from the whole number ofpatientsever discharged as recovered (538) , we have 429 as the numberof patients who permanently disappeared from the asylum asrecovered that is, 330 p. c. of the original number admitted, and 23.8 p. c. of the numbers both of the admitted and of the re-admitted taken together.4. A large proportion of the recoveries occurred in the caseof patients who had not been longer than from a year to a yearand a half in the asylum. Of the 538 patients, who were atany time during the 12 years discharged as recovered, 505,or about 94 p. c. , were so discharged during the first twoyears.5. The recoveries, which occurred during these first twoyears, appear to have been the most satisfactory of all therecoveries which took place. We have evidence of this in thefacts that 295, or 58.4 p. c. , of the 505 patients discharged asrecovered during these two years never entered the asylumagain, and that 263 of these 295 patients are included in thetotal number of patients (411) who appear to have beeneither alive and sane at the end of the 12 years, or to havedied in a state of sanity during those years.6. If we take the three first instead of the two first years,these results are still better marked. Thus: -Of the whole512 Contribution to the Statistics of Insanity, [Jan.,number of patients ever discharged as recovered (538) we have515, or about 96 p. c. , who were so discharged during thefirst three years, leaving only 23 to be for the first time discharged as recovered during the other 9 years, viz. , 7 in 1861 ,5 in 1862, 3 in 1863, 2 in 1864, 2 in 1865, and 1 in each ofthe 4 last years. Of this small group of 23 patients, whowere from 3 to 12 years continuously in the asylum beforebeing discharged as recovered, it happens that no fewer than15 are accounted for as being among the insane still at theend of the 12 years-some being alive and insane, and othershaving died in a state of insanity.7. In view of these statements it may be asked how therecan be 13 recoveries registered in the last of the 12 years.The explanation is simple:-11 of the 13 recoveries registeredin 1869 refer to patients re-admitted in 1868 or 1869. So itis with the recoveries in the other years towards the close ofthe duodecennial period: they are almost entirely recoveriesafter recent re-admission.(b. ) Re-admissions.1. The whole number of re-admissions is 499, but thenumber of patients in whose history re-admission appeared isonly 316.2. It follows, of course, that some patients must have beenoften discharged and often re-admitted . So true is this, thatit is found that 81 patients contributed 264, or more thanone half (52.9 p. c. ) of the whole re-admissions -45 patientsbeing re-admitted twice, 11 three times, 9 four times, 7 fivetimes, 3 six times, 3 seven times, 2 ten times, and 1 eleventimes.3. Re-admission presented itself somewhat more frequentlyin the history of patients discharged as recovered, than in thehistory of patients discharged as unrecovered-234 patientsdischarged as recovered giving 404 re-admissions, and 82patients discharged as unrecovered giving 95 re-admissions.(c.) Discharge of the unrecovered.1. The number of patients discharged as unrecovered is in1877.] by ARTHUR MITCHELL, M.D. 513In no the first year 21 p. c. of the mean number resident.other year is it above 8 p. c. In one year it is below 1 p. c.The average for the last 8 years is between 2 and 3 p. c.(d.) Deaths.1. Of the 1297 patients admitted, it is found that 412, or 31.7 p. C. had died in the asylum during the 12 years.2. Ofthese 412 patients who died in the asylum, it appearsthat 370, or about 90 per cent. , had died in it without everhaving left it after admission. In other words, of all thepatients who died in the asylum 90 p. c. had never been outof it after admission. Ofthose who thus entered the asylumto die there, 103 died during the first year after admission,76 during the second year, 51 during the third year, and soon-10 of the 13 who died during the twelfth year neverhaving been out of the asylum, and all of the 14 who diedin the seventh year having been 7 years in the asylum.3. The 499 patients, in whose history re-admission appeared, yielded only 41 of the 412 deaths.4. The rate of the mortality during the first 3 years was24-8, 11-4, and 10.8 per cent. of the mean number resident.During the next three years it fell to 7.3, 84, and 6.4 p. c .;and during the last 6 years it fell still further, and wasgenerally about 40 p. c. , only once rising to 6.0 p. c.5. The mean age of the whole number of patients admittedwas 39.6 years. The mean age of the 103 who died duringthe first year was 49.5 years. The mean age of the 24 whodied during the last two years was 55.8 years at the time oftheir death . The mean age of the 273 patients who werefound remaining in the asylum at the end of the 12 yearswas 47.9.6. The deaths of the first year thus occurred among theolder of the patients admitted-the mean age of those whodied being 10 years above the mean age of the admitted.Entering still further into details, it appears that of the 103patients who died during the first of the 12 years, 11 werebetween 70 and 80 years old, 17 between 60 and 70, 17514 [Jan., Contribution to the Statistics of Insanity,between 50 and 60, and 25 between 40 and 50. In other words,about 70 p. c . were above the mean age of the admitted.7. Many of the very aged are thus immediately and finallydisposed of, but there occurs coincidently a final disposal ofmany of the younger by permanent recovery, so that themean age of those who remain at the end of the first yeardoes not differ much from the mean age of the admitted.8. Those remaining at the end of the 12 years aremade up largely of the younger of the patients originally admitted. Their mean age at the end of the 12 years was47.9 years, so that their mean age at the time of admissionmust have been 35.9, or about 4 years below the mean age ofall admitted.9. The patients who died during the two last years had amean age of 55.6 years, and were older than those who diedduring the first year, whose mean age was only 49.5 years.Their age at the time of admission was also above thatof the mean. The range, however, between the ages of theoldest and youngest of those who died in the two last yearswas much lower than the range in the case of those whodied in the first two years.10. It thus appears that the lower death rate of the lateryears is not supplied by a younger but by an older population.IV. CONCLUDING REMARKS.1. All these things might possibly be found to be not evensubstantially true of a second group of patients who wereadmitted for the first time during some other year and whosehistory was examined in the same way. It happens however, that we possess evidence that the study of such asecond group would, in fact, yield results which wouldbe in very close accord with all that has been disclosedregarding the 1297 patients admitted for the first time in1858. This evidence is furnished by the following table,which I extract from the 18th Report of the Scotch Board ofLunacy (p. xx. ) . If it is compared with the table given inthis paper (p. 509) , the progressive history of the one groupof patients will be found to resemble that of the other in avery striking manner.1877.] by ARTHUR MITCHELL, M.D. 515Discharged.RemainingReadmitted Year. Admitted.Recovered.Not recovered.at 31 Dec. of each Dead.year.1868 1319 305 97 107 38 8481869 209 70 94 83 5581870 51 23 60 40 4641871 38 25 48 42 3951872 26 13 28 39 3671873 . 23 15 25 26 3301874 15 11 13 23 3141875 16 9 13 21 2972. I have confined myself as much as possible in this paperto a mere statement of the results of an inquiry, which, sofar as I know, has not previously been made, and which insome directions teaches new lessons, and in others givesprecision and certainty to opinions already entertained.On the Prevalence of the Causes of Insanity among theAncients. By D. HACK TUKE, M.D., F.R.C.P.(Concluded from p. 381.)Passing from the Egyptians to the Greeks and Romans,we proceed to pursue, in regard to these, the same line ofenquiry as that which we have already attempted in regardto other nations. Were their habits, their social life, thecharacter of their civilization, such as to lead us to expectthat there must have existed among them, in any wellmarked degree, the clearly recognised causes of insanity? Inthis investigation we must carefully distinguish between theirearly and heroic age and the period of their highest cultureand refinement, otherwise we shall fall into the error of comprising under the same term widely different conditions ofsociety, and in the endeavour to compare them with our own-that is to say, modern civilized life -shall draw a totallyfalse inference. The seeds of insanity may have been widelysown among the people of one age, and but sparsely amongthose of another. We have abundant evidence in theimmortal verse of Homer of the general character of the516 The Causes of Insanity among the Ancients, [Jan.,civilization of the Greeks at the period to which he refers-the legendary and heroic age of Greece; not as a state ofbarbarism, assuredly, but one which we feel differs widelyfrom our own. They were far removed, doubtless , from thesavage condition of certain early Greeks, described byThucydides, marked, as he represents it to have been, bypiracy-men falling upon towns which were unfortified andlike straggling villages, and rifling them without disgrace,but rather with glory. He adds that in many other respectsit might be shown that the Greeks, at the period of which heis speaking, lived in a manner similar to " the barbarians ofthe present age," implying by this that their food consistedof milk and what the chase afforded , uncooked, and that theywere clothed in undressed hides. To the people who were inthis rude condition the remarks we have already made onbarbarous tribes would apply; and we can have no doubtthat the causes of insanity were then prevalent in only alimited degree.Although, however, the Greeks of Homer were by nomeans savages, a robust simplicity marked their mode of life.They had no knowledge of coined money. There is not conclusive evidence that they were familiar with the art ofwriting, or that they had advanced in the arts of painting and sculpture. "All the varieties of Grecian music, poetry,and dancing arose later than the first Olympiad"-B. C. 776(Grote) . It must be admitted that, although we have spokenof simple manners, there were not wanting indications ofwealth. " The halls of Alcinoüs and Menelaüs glittered withgold. Copper and iron were stored up in the treasurechamberof Odysseus and other chiefs " (op. cit. ) . In illustration of the condition of Homeric society, it may be remembered that in the Iliad Paris constructs his own house. Hebrought together some skilful designers, or architects, but he"himself the mansion raised. " If it be objected that thisonly implies that he built himself a house in the generalsense in which we ourselves speak at the present day, wemay refer to the account of Ulysses, which is still more definite. He cements the stones, he roofs his dwelling, hehangs on the doors . Royalty in that age did not disdain,but gloried in manual occupations, while now-a-days an exPremier is thought to act rather strangely, and cannotescape a sly hit from " Punch," because he delights to takethe axe into his own hands and fell his trees.Ulysses boasts of his skilful mowing and ploughing, and1877.] by D. HACK Tuke, M.D. 517cares not for the toilsome length of the day. He proteststo Eurymachus that he would prove a match for him with hiswell-bent sickle in his hand, or with the plough- share, makinga straight furrow through the glebe.Women, even of noble family, concerned themselves in whatwould now be regarded as unbecomingly menial occupations.Irrespective of rank or freedom, they are constantly engagedin spinning and weaving. The dress of both men and womenwas homespun. In this occupation " Helen as well as Penelope is expert and assiduous . The daughters of Keloës atEleusis go to the well with basins for water, and Nausicaä,daughter of Alcinoüs, joins her female slaves in the businessof washing her garments in the river " (Grote) . But wemust not extend these references, our object being merelyto show that when regarded as a psychological study, thegeneral state of Greek society at this period must be clearlyrecognised. When, with the same object in view, we passfrom the more or less legendary to the truly historical periodof Greek history, and see the gradual advance made in thearts and in the mode of life, we are conscious that there arespringing up fresh elements of psychological importance, orat least a development of some already in existence, butcomparatively powerless. But it is when we come to thatperiod of Greek cultivation and refinement which culminatedin the era of Pericles that we recognise a degree of civilization which resembles in many respects that of the Europe ofto-day, and which without a doubt must have involvedmental loss as well as mental gain, and must have entailedno inconsiderable peril to mental health both on theside of luxury and on the opposite but ever accompanyingside of pinching poverty. In this connection one aspectof Greek life, before effeminate habits marked the declineof the nation, is important, namely, a brave and hardynational spirit. It is not necessary to show that a conditionof society in which hardihood and active habits are enjoinedand practised is more favourable to psychical health than one of great wealth and luxury. Hence Greek politiciansencouraged a willingness "to brave at all times personalhardship and discomfort; so that increase of wealth, onaccount of the habits of self- indulgence which it commonlyintroduces, was regarded by them with more or less of dis- favour " (Grote).Intemperance. To the question, was intemperance prevalent among the Greeks? the general reply must certainly518 The Causes of Insanity among the Ancients, [Jan. ,be that they were by no means strangers to the vice, but thatthey were, as a race, much more temperate than the nationsof Northern Europe.Women and children drink wine in the Iliad, but not toexcess. Achilles is described as " spitting out the wine infroward infancy " (Il. ix. 487) . Nausicaä and her companions take it (Od. vi) . Athenæus says the Greek womenwere ill thought of, on account of the liberty allowed themin this respect compared with other nations. Homer dilateson the good qualities of the earliest known wine-theMaronean-so strong that it required dilution with twentymeasures of water. But Agamemnon does not appear tohave favoured such aqueous dilutions, for he says to Idomeneus, " Though otherlong-haired Achæans drink by measure,thy cup stands always full, like my own, to drink when thedesire prompts thee " ( Il. iv. 263).Lycurgus only allowed wine for the purpose of satisfyingthirst, and ordered that those who were returning home froma feast should find their way without a light. The Lacedemonians recognised the custom of drinking healths as a frequent cause of drunkenness. Solon's laws made drunkenness in an archon a capital crime, and he found it necessaryto revive a former rule that wine drunk at feasts should bemixed with water. The Senate of Areopagus punished thosewho were given to drink and convivial company.Again, Dionysius, the Sicilian, offered at a feast a goldencrown to him who should first drink a cup containing a pint,and Xenocrates was the successful winner of the prize.Aristotle says that Dionysius was sometimes drunk for three months together. His sons were drunkards. Plato, in"the Laws, " says, " Shall we not lay down a law that boysshall not taste wine at all, until they are eighteen years old?thus exercising a caution about the mad-like habits ofyoung persons; but afterwards to taste indeed wine inmoderation until they are thirty years old; but that a youngman is to keep himself, by all means, from intoxication andmuch wine; but on reaching forty years to indulge freely inconvivial meetings, and to call upon the other gods, andespecially to invite Dionysus to the mystic rites and sportsof old men, in which he kindly bestowed wine upon man asa remedy against the austerity of old age, so that throughthis we might grow young again, and that by a forgetfulnessof heart- sinking , the habit of the soul might become from aharder state more soft," &c. (Bk. ii. , c. 9) . All which is very!1877.] by D. HACK TUKE, M.D. 519clear proof that the Greeks in Plato's day were so well awareof the evils resulting from intoxication that restrictive legislation seemed desirable in a model state.In Mitylene, where wine was very abundant, Pittacus, thelawgiver, instead of allowing drunkenness to be an excusefor a crime, directed that it should entail a double punish- ment.There is an anonymous address to Simonides,* which is of much interest in this inquiry. " To him who will drink letthem pour out without stint-it is not every night that weenjoy such luxury. But I-for I am moderate in honeysweet wine-will court soothing sleep when I have gonehome, and will show you how wine is most pleasant for man to drink. For neither am I too sober a man, nor am I veryintemperate. But whosoever exceeds a measure in drinkingis no longer master of his tongue or his mind, and talksrecklessly of things disgraceful to the sober, and is ashamedof nothing, though modest when he is sober. Now you, perceiving this, drink not to excess, but either retire before you are drunk . . . or else stay and do not drink. But you areever babbling that silly word, ' fill your glass,' and so yougetdrunk. For first comes the health of the guests, and thena second cup is left ready before you, and a third is for alibation to the gods, and so you know not how to refuse.'He ends with recommending good conversation around the bowl, and " so our feast will not want in refinement."""There is a great deal said in Greek writings about copious potations of wine, but it must be borne in mind that this wasoften diluted with water-probably three parts of water totwo of wine. Equal parts made people " mad," says a comicwriter. Some writers are at a loss to decide whether Greekwines were stronger or Greek heads were weaker than ours;but, whichever it may have been, it is quite clear that the winedrunk was capable of producing the evils which arise fromits abuse. Euenus says " that wine taken out of measure isthe cause of grief or weakness; " adding, " in company withthree (water) nymphs he is most suitable " (quoted byMahaffy) . When the Greeks drank wine without water theywere said to act like a Scythian.Diotimus the Athenian was nicknamed " the Funnel, "because, putting a funnel into his mouth, he would allow any

• The praise of wine by the contemporary of Simonides, Anacreon, is too well known to require proof. He was at once a sign and a cause of the free

use of the wine bottle, though he himself was reputed temperate.520 The Causes of Insanity among the Ancients, [Jan.,amount of wine to be poured into it. Xenarchus, an excessive drinker, was called " the nine gallon cask. " One of theDeipnosophists says that wine being the cause of madness,and all sorts of debauchery, might be called the " metropolis " of these evils. A quotation made by Athenæus fromAlexis clearly shows that the extent of intoxication, if comparatively limited, was quite sufficient to cause much misery,and some madness. "Is not, then, drunkenness," he asks," the greatest evil, and most injurious to the human race?"It has been given as a proof that the Greeks were at oneperiod at least addicted to drinking, that whenever anyone drank without taking his breath, the company applauded,saying long may you live, and that those who refused to drinkat entertainments were in most places obliged to leave theroom, by that celebrated law of good fellowship, Drink orbegone! In fact, many examples of intemperance among theGreeks are given by Athenæus, in whose work (" The Deipnosophists") is an epitaph on Arcadion, written by his sons,which leaves no room for doubt as to the dipsomaniac habits of their father:-This is the monument of that great drinker ArcadionAnd know, travellers, the man did die From drinking strong wine in too large a cup.Greek women have been frequently charged with drunkenness, but we are satisfied that although not necessarily teetotalers, they did not imbibe to anything like the sameextent as the women of England. Indeed, the Milesian ladiesare said to have only drunk water.* The number of wineflasks left daily in the waiting rooms of English RailwayStations by the ladies who frequent them is something extraordinary, and forms a striking proof of an amount of femaletippling which would have shocked the fair sex in Greece atany period of their existence.A story of psychological interest, and to our purpose, istold by Timæus of some young men who got drunk at Agrigentum, and were so mad that they thought they weresailing in a trireme, and were being tossed about in a storm,and so threw all the furniture out of the windows, fancyingthe captain had ordered them to lighten the ship. The" Of course ladies were never present except at strictly family dinners.The ladies who frequented men's society, though they too affected the samemodesty, were often led away to greater indulgences than were consistent with the purest attic salt " (Mahaffy, " Social Life in Greece," p. 317) .1877.]by D. HACK Tuke 521 , M.D.prætors next day found the young men lying " sea- sick," asthey said, and they replied to questions put to them that theyhad been in danger from a storm, and been compelled tothrow the cargo into the sea. The prætors were evidentlybewildered with the mental condition of the men-one ofwhom said, " I, O Tritons, was so frightened that I threw myself down under the benches and lay down as much out ofsight as I could "-and dismissed them with a reproof, and awarning not to indulge in future in too much wine. True totheir delusion, the young men replied that whenever theyarrived in port they would erect statues to them as their deliverers!The facts we have now given convey the impression of anessential sameness between the drinking customs of all butthe early Greeks and our own; and we are forced to concludethat with them as with us, insanity must have been not veryunfrequently induced by too copious potations of alcohol.There is, however, no evidence that even in the most corruptperiod of Grecian history there was the widespread tipplingwhich disgraces England; and we know that the masses didnot suffer like ours from the demoralization of innumerablegin palaces and beershops-in reference to which the"Times " says that " in other parts of the world maybe seen the frenzy of an African when excited by rum, thecontortions of an Arab under the influence of hashish,Malays furious from bang, Turks trembling from the effectsof opium, or a Chinaman strangely emaciated from inordinate use of the drug, but for a scene of horrid vice andlust and filth and frenzy, all drawn into one pit and therefermenting, a man might search the world all over, and notfind a rival to a thriving public- house in a low gin-drinkingneighbourhood. " We firmly believe he would not havefound it in Greece. And just as firmly do we believe thatthere was not so much drink-made madness in Greece as inEngland, in Athens as in London.The festivals in honour of Bacchus must have exerted abaneful mental influence upon the Greeks. It is impossibleto doubt that permanent insanity must have frequently resulted from the excessive excitement of the religious andalcoholic frenzy temporarily induced. In this connection ,also, some form of divination must have bordered closely oninsanity. The relation between the worship of Bacchus andprophetic frenzy is not a simple one, for it is difficult todecide how much was due to intoxication merely. Tiresias,522 The Causes of Insanity among the Ancients, [Jan.,the blind seer of Thebes, is represented by Euripides in theBaccha as saying of Bacchus, " This god is a prophet, -forBacchanal excitement and frenzy have much divination inthem. For when the god comes violent into the body, hemakes the frantic to foretell the future. " That this does notrefer to intoxication altogether, if mainly, would seem tofollow from the next passage in which he says that thefrenzy of Bacchus is also displayed in the terror whichsometimes flutters an army when under arms before they touch the spear. Pentheus tells Tiresias, when he sees himwith a thyrsus, that but for his hoary old age he would makehim a prisoner for introducing these wicked rites, “ for wherethe joy of the grape cluster is present at a feast of women, Ino longer say anything good of their mysteries." To punishthe opposition to the worship of Bacchus he has renderedAgave, the mother of Pentheus, a victim to the madness bywhich the Mænads were affected, and he has done the same toher sisters, Ino and Antonoë, who were also opposed toBacchus. Others have joined them in their frenzy, and they celebrate the rites of the god in the mountains. Pentheusthreatens to put a stop to this " ill-working revelry," byhunting these fanatics and binding them in iron fetters.The Bacchæ or Mænads are described by a messenger asdriven by madness; and no wonder, when we read of themdashing at everything they came across, one tearing asundera fat, lowing calf, another a cow, so that hoofs and ribs werethrown wildly about, while myriads of maiden hands assailedand threw down the fierce bulls, dragged children from theirhomes, and contended with armed men.Whatever form, then, the Bacchantic excesses assumedwhether a wild, contagious, violent and destructive excitement, or a form of divination-there was an amount of emotional disturbance which may well have actually unhingedsome of the minds of those engaged in them.Defective Nourishment, Poverty, &c., as shown in the Mode ofLife. The style of living in the Homeric and Hesiodic daysthe table of the chiefs or even the king-would have presented a very different appearance from that of a luxuriousage. The Greeks had then, it seems, only two meals a day.Homer, at least, never mentions more. They had a moderatebreakfast, soon after the sun rose; and ended the day with asupper, to which they, no doubt, did justice, and slept well,the active muscular exertion in the open air preventing anyill effects -dyspeptic or hypochondriacal-arising from "a1877.] by D. HACK TUKE, M.D. 523heavy supper."Menelaus makes a feast when Telemachusdines with him, and Homer certainly says ( Od. iv. , 65): —The table groaned beneath a chine of beef,With which the hungry heroes quell'd their grief.But he never, as Dioscorides points out, " put rissoles orforcemeat, or cheesecakes, or omelettes, before his princes,but meat such as was calculated to make them vigorous inbody and mind; and so, too, Agamemnon feasted Ajax, afterhis single combat with Hector, on a beefsteak; and in the same way he gives Nestor a roast sirloin of beef. AndAlcinous, when feasting the luxurious Phæacians, and whenentertaining Ulysses and displaying to him all the arrangements of his house and garden, and showing him the generaltenour of his life, gives him the same dinner. Homer neveronce represents either fish or game as being put on the tableto eat ("The Deipnosophists "-Bohn's edit. , vol. i . , pp.13-14, 41).In the heroic age, the relation borne by the poor to thewealthy would probably resemble that of the serfs to thebarons in the middle ages. Actual poverty, or destitution ofthe kind with which we are so familiar, would not be likelyto prevail, nor in subsequent times would the great slaveclass in Athens and other cities be what we should understand as a pauper class. That there did exist in Greece aconsiderable number of poor persons, however, and sufficientpoverty to constitute one cause of mental disease, I do notdoubt. The popularity of Solon arose in part from hiskindness to the poor; the freedmen finding it difficult tomake a livelihood in consequence of so much being done bythe slaves. In much later times, also, the poverty existingside by side with wealth and luxury is frequently referred toby Greek writers. Still, there is no proof that at any periodwere there so many squalid , half-starved, poverty- strickenmen and women in Greece as there are in England, inprocess of manufacture for our county asylums.Causes chiefly Moral.-It is certain that emotional excitement of various kinds must have exerted no inconsiderable influence upon the Greek brain. The excitementimmediately attending war cannot be reckoned amongthe potent causes of insanity. In a war-like age, atany rate, the effect would be much less than in an age accustomed to peace. This cause, therefore, except as аmeans of producing misery and scarcity, cannot be sup- XXII.35524 The Causes of Insanity among the Ancients, [Jan.,posed to have induced much mental disease. Political excitement may have unhinged some minds fired with patriotismor ambition. A circ*mstance meriting notice, as serving tocontrast the early period of Grecian history with modernsociety in England and English-speaking countries, is therelation subsisting between the people and the ruling powerin heroic Greece. The authority claimed and secured forthe king was of no limited character. The position taken inthe Iliad that " the rule of many is not a good thing, let ushave one ruler only, one king, to whom Zeus has given thesceptre and the tutelary sanctions, " is shown to be fully borneout by the history it contains, not only proving “ the passive,recipient, and listening character" of the general Assembly(the Agora) but exhibiting " a repulsive picture of the degradation of the mass of the people before the chiefs" (Grote,vol. i. , p. 464) . The treatment to which Thersites was subjected for daring to act an independent part, and venturingto express his own opinion in opposition to that of Agamemnon, so graphically described by Homer, illustrates the servility expected from this professedly popular gathering , inwhich his companions enjoyed, instead of resenting, the treatment to which he was subjected. The subjection to kinglyauthority in the assembly here depicted, indicates a conditionof society at that period which would not be likely to favourmuch individual freedom of action, or encourage unduepolitical excitement and mental perturbations. With thisrepressed and passive state of the people generally might becontrasted the oligarchies which subsequently arose in Greece.The condition of society of which it is an indication, andwhich it fosters, marks an advance to a form of civilizationand political life, which, by allowing of and encouragingindividual thought and action, more frequently accompaniesa loss of balance of the mental powers, than the oppositestate of passivity. Thus, as might be expected, we find thevery important and significant fact that political power hadlost, according to the historian of Greece, " its heavenappointed character," and consequently "the ground waslaid for those thousand questions which agitated so many ofthe Grecian cities during three centuries." He tells us thatthey elicited " much profound emotion, much bitter antipathy, and much energy and talent." In the days of Periclesthere may have occurred as much, or nearly as much, excitement in Athens, as there was in London at the time of theReform Bill, or in Paris in 1848. In the above description1877.] by D. HACK Tuke, M.D. 525we have unquestionably those elements of modern civilizedsociety which act so powerfully on the minds of men, excitesuch active thought, arouse such intense feeling, and which,while invaluable in counteracting dead- levelism, increase theliability to a loss of mental balance. We believe that theseinfluences were more limited than in France or England inthe present century, even when we have regard to the mostactive periods of Greek life, but it must be admitted that thepolitical intrigue and lust of power which existed not only inAthens, but in the small free towns, must have both stimulated the activity of thought, and excited the emotions;indeed, Mahaffy goes so far as to say that politics corrodedthe social life as well as the literature of Periclean Greece.The profound philosophical and religious questions whichstirred the thinking men of Athens in her palmy days mustnot be overlooked here; some minds, it may reasonably besupposed, went astray, -lost in the bewildering mazes ofspeculative thought.Among moral causes, the share played by licentiousnessamong the Greeks cannot be regarded as inconsiderable.We have touched upon it already in connection with Manadmadness. Insanity from this cause must have been far fromrare. The chivalry of the Greeks has been described by Mr.Symonds as a compound of military, amatory, and patrioticpassions, meeting in one enthusiastic habit of soul; onlydiffering in his view from medieval chivalry in its being"patriotic," where the latter was " religious," but as aSaturday Reviewer points out, this combination when it occurred was accidental with the Greeks, while with themediæval knights the object of their affection represented theentire sex to which that object belonged, and they becamethe protectors of innocence and weakness; but to place thefriendship of Greek men among the elements of chivalry isunfounded, and may be compared to planting the image of asatyr amid the shining synod of Olympus. "The introduction of the word amatory ' into the characteristics of theGreek ideal betrays the rotten spot, while it seeks to cover itwith a bold ambiguity."Thirlwall draws the inference from the character of thestories of their gods, that female purity was not very highlyvalued, and that the faithlessness ofthe wife was neither rarenor regarded with much disfavour, while Mahaffy points outthat the Homeric lady was the property ofthe stranger, so thatmuch delicate feeling vanished in practice, notwithstanding526 The Causes of Insanity among the Ancients,[Jan.,the ornamental outside. He criticises, however, those writerswho, in forgetfulness of the splendid characters which figurein the tragedies of Euripides and other dramatists, regardthe morality of the Athenian women with disgust, and fancythat the most refined civilization could have existed alongside with the worst possible demoralization of domesticrelationship.-Intellectual Strain. -Recurring to the doubtful practiceof the art of writing in the Homeric age-Grote maintaining that the Iliad was handed down orally for some two centuries , and that no reading class existed inGreece until the middle of the seventh century beforeChrist, the intellectual food of the nation consistingnot of true history or philosophy, but mythical tales -we need not hesitate to dismiss the idea of intellectualstrain as a cause of insanity at that period in Greece. Epicpoetry was the " solitary jewel " of the heroic age. Thepeople were, the above writer considers, poetical and religiousat that period-not reflective or philosophical, although, eventhen, displaying much mental vigour. In regard to mereschool education among the Greeks, this, of course, musthave varied at different periods, but, when it reached itshighest point, its range and amount must have been withinvery narrow limits indeed, compared with the extent of learning demanded in the present age. We have no reason tothink the brains of children were injured by early forcing,nor that an enfeebled nervous system often resulted from thecourse of study pursued, sending its possessor out into theworld less able to meet its cares and perplexities, unless thepassage from Aristophanes belowrefers to study. It has beenmaintained that, from a moral point of view, the Greekparent acted more carefully and wisely than we do, for that,instead of casting their sons into public schools, where theylose alike their simplicity and their innocence, they placedthem under the strict supervision of a slave tutor—in short,a male duenna ( Mahaffy) . This involves however a moralrather than an intellectual element. Obedience to parentswas implicit, and the scholar was very docile. Even in hisday, Aristophanes, in "The Clouds, " makes the " BetterCause " complain of the degeneracy of youth in these andother respects. In the good old days it was incumbent thatno one should hear a boy utter a syllable, still less contradicthis father, that he should march to the harp-master's schoolunprotected from the snow, though it fell as thick as meal,1877.] by D. HACK TUKE, M.D. 527that he should not sit cross - legged, and that he should be well thrashed if he made mistakes-a system, it is contended,which made the men who fought at Marathon. The " WorseCause" considers such a youth would be a booby. The" Better Cause " replies that, under the old system, he wouldhave a stout chest, a clear complexion, broad shoulders, anda little tongue; while " the youths of the present day " pursue a course likely to produce a narrow chest, a pallid complexion, small shoulders, and a big tongue; they have to becarefully wrapped up, they are not to be found blooming inthe gymnastic schools, but chattering in the market place, ordragged into court. The days have gone by when it was notallowed, if one was dining, for youth to snatch from their seniors dill or parsley, or to eat fish, or to giggle, or to keepthe legs crossed! " Happy," says the Chorus, " were thosewho lived in those days, in the times of former men!" The absence of any intellectual requirements on the part of thewomen has been pointed out by Mahaffy, who has shownthat ladies of rank at Athens, and in other cities, had notenough education to shine in conversation.Although, therefore, during the most brilliant period ofGreek literature there must have been much active culture ofthe mind, and while the study of philosophy must have taxedthe mental powers of a certain number, while I doubt notthere were some heads that ached from deep thought, andthat " much learning " may have made one "mad " here andthere, I do not think that over study, or rather the accompaniments of over study, can be credited with much influence as a cause of mental disorder in Greece.Glancing back now on the various causes of mental diseasein their relation to Greek life, it is unquestionable that theymust at certain periods have exerted a considerable in- fluence. Intemperance in general, Bacchanalian orgies,vicious habits, cannot fail to have induced attacks of lunacy.At the same time there is no proof of that chronic besotted drunkenness and the half-starved families associated with itwhich distinguish our pauper population, and, therefore,there is no doubt a difference in degree between the influence exerted by intoxication and mal-nutrition in Greece,at any period, and in England . Of other causes, those of amoral nature, and associated with excessive refinement, susceptibility, self- dissection , morbid religious feelings, theGreeks may well have experienced the effects to a certainextent; to what extent it is impossible to determine, but we528 The Causes of Insanity among the Ancients, [Jan.,do not think that moral causes of this nature were sopowerful as in the present day. It is also probable that thecauses of insanity exert a cumulative effect, and in thisway later generations of men are actually more susceptibleto influences of the same morbid intensity.We proceed now to consider Roman life in relation to thecauses of mental disease. Many of the observations wehave had occasion to make in reference to the Greeks applyto the Romans, not only because there are broad featurescommon to any two nations in their course attaining tocivilization, but because Roman culture and refinement werelargely drawn from Greek sources. In the latter nation asin the former, our inference from manner of living as to theprobability of the prevalence of insanity among the peoplemust be affected by the period of her history which we havein view, namely, whether the early and not highly cultivatedage, extending from the foundation of the city to the thirdcentury B.C. , or the later and ever increasingly luxurious agecomprising the two centuries before Christ and Imperial Rome. In the first period, an age of hardihood and simplemanners, we should not look for the development of subtlenervous affections born of luxury. These were " the bravedays of old," when the goodman mended his armour, and thegoodwife's shuttle went merrily flashing through the loom;before thedays of imperial extravagance, in which it may safelybe inferred that the same psychological evils were fostered andgrew as we deplore in modern forms of luxurious life.Plautus abounds with illustrations of Roman luxury. Inone of his comedies, " Aulularia," Megadorus complains of awife saying that as she brought a dowry much greater thanher husband's wealth, he must find her purple and gold,mules, lacqueys, pages to carry compliments, and carriages;but all this is light compared with what a wife asks for herallowance required for the embroiderer, goldsmith, dealers infigured skirts, dyers in flame- colour and violet, perfumers,sandal makers, boddice makers, &c. Three hundred dunsmake their appearance, and have to be paid.would think them got rid of by this," he says, " when dyersin saffron colours come sneaking along; or else there'salways some horrid plague or other which is demanding something." The tax gatherer appears on the scene; herhusband, however, by this time is in debt to the banker, andthe tax cannot be paid."You1877.]529 by D. HACK Tuke, M.D.Intoxication.-In the early days of Roman life drunkennesswas no doubt much less common than in the days of herluxury. Wine was not easily procured and was costly. Itsprincipal use was in pouring out libations to the gods and atsacrifices, on which occasions alone women were allowed todrink it, and young men under thirty years of age.refers to the relaxation of this rule in the reign of Tarquinius Superbus.OvidIn later periods of Roman history drunkenness was a wellknown vice. It is very difficult, however, to decide to whatextent it really prevailed. In high life there was a timewhen men gloried in intoxication and endeavoured toheighten its effects by adding to their ordinary winearomatic ingredients. If at feasts the proper and moreusual course of having a director was not adopted, it waspermitted to the guests to drink ad libitum. But even hereit was not thought right to indulge in excess. In regard tolow life, I do not know that there is any evidence to provethat drunkenness prevailed at the worst period of Romanhistory to the same extent as among the lower classes ofEngland. There were public-houses-thermopolia -nodoubt, where not only hot water but all kinds of liquor werevended. They appear to have been frequented in much thesame way, according to Adam, as our modern coffee- houses,and there were a considerable number of them even duringthe Republic. Their abuse, in the way of intoxication,might be argued from the restrictions put upon them, butthese partly arose from a dread of political clubbing.Among other proofs that the Romans were by no meansfree from this vice, reference may be made to the facts thatSeneca himself thought it allowable to get drunk to ease themind of any great and tormenting care, and that Cato ofUtica spent sometimes whole nights in drinking, that asregards the elder Cato, and Corvinus the Stoic, the formeroften enlivened and invigorated his virtue by wine, and thatthe latter, though tinged with Socratic principles, was by nomeans an enemy to the wine cask ( Vide Potter's " Antiquities ").Among the Romans, as with the Greeks, the influence ofBacchanalian rites must have exerted a prejudicial effectupon the mind. A Greek of mean condition, a priest ofsecret and nocturnal rites, imparted a knowledge of them togreat numbers, both men and women, according to Livy."To their religious performances," he says, " were added the530 The Causes of Insanity among the Ancients, [Jan.,pleasures of wine and feasting. " Debaucheries of every kindwere practised. The infection spread so far and so rapidlythat Livy compares it to " the contagion of disease." Tothink everything lawful was the grand principle of theirreligion. One passage in the description given by an informer is particularly significant. " The men, as if bereft ofreason, uttered predictions, with frantic contortions of theirbodies; the women, in the habit of Bacchantes, with theirhair dishevelled, and carrying blazing torches, ran down tothe Tiber, where, dipping their torches in water, they drewthem up again with the flame unextinguished, being composed of native sulphur and charcoal " (Bk. xxxix. , c. 7 andc. 14) . In the speech made by one of the Consuls to thepeople, he said that these orgies had existed for some time inevery country in Italy, and at that time in many parts ofRome; in proof of which he refers to the nightly noises andhorrid yells resounding through the whole city. He assertedthat there were many thousands-a great part of them beingwomen, the rest men-" night revellers driven frantic bywine; noise of instruments, and clamours. . . If youknew at what age the males are initiated, you would feel notonly pity but also shame for them. Romans! Shall these,contaminated with their own foul debaucheries and those ofothers, be champions for the chastity of your wives andchildren? Each of you ought to pray that his kindred mayhave behaved with wisdom and prudence; and if lust, or ifmadness, has dragged any of them into that abyss, to consider such a person as the relation of those with whom hehas conspired for every disgraceful and reckless act, and notas one of your own.' The decree of the Senate that allplaces where the Bacchanalians held their meetings shouldbe demolished throughout Italy, and that in future none oftheir rites should be celebrated (subject to certain overpowering religious scruples in regard to the omission of theworship of Bacchus! ) , shews the frightful excesses whichwere committed-excesses unquestionably calculated to causemadness. Many were put to death. Here we see, as inseveral parallel instances, that in antiquity, not only insavage life, but in the condition of society among theancients we call civilized , the violent termination of existencecontinually prevented the development of those morbidpsychological conditions which are constantly attaining afull growth among ourselves, because they are not cut short""1877.] by D. HACK TUKE, M.D. 531by death. We can show that the causes of insanity were certainly present in considerable force at some periods of thehistory of the nations of antiquity, but still it does not follow that these causes always produced their legitimatefruit; on the contrary, as a matter of fact, they must havebeen often checked in their course by events certain tohappen in certain conditions of society, and from whichmodern civilization is in great measure exempt. In close connection with this is the fact, capable of large amplification, that homicidal tendencies, which in modern societiesfrequently land their possessor in an asylum, would in ancientsocieties find an outlet in the constant opportunities affordedby war.Defective Nourishment, Poverty, &c. -The sure coincidenceof a certain amount of poverty and great wealth didnot escape the notice of the Roman poets, and therecan be no doubt that, during the most civilised periodof the history of Rome, there existed in strong reliefthe two extremes of riches and poverty-perhaps as markedas between Belgravia and the Seven Dials in our own dayand that mal- nutrition, unwholesome dwellings, and the like,exerted a very appreciable influence in causing unstablebrains, degeneration of nervous power, and actual idiocy.Merivale, when showing that the dignity of the Romantemples and palaces stood in marked contrast with theircabins, says, "The spacious avenues of Nero concealed,perhaps, more miserable habitations than might be seen inthe narrow streets of Augustus." He observes that up tothe time when symptoms of the decline of the Empireappeared (A. D. 180) , " we have no distinct murmurs ofpoverty among the populace." The causes, according to him, were already at work, which in the second or thirdgeneration reduced the people of the towns to pauperism,and made the public service an intolerable burden, namely,the decline of agriculture and commerce, the isolation of the towns, and the disappearance of the precious metals. Itappears that under the Flavian Emperors there was a suddenadoption of the policy of administering public aid to impoverished freemen. There is another point closely connected with poverty, and that is the heavy taxation to whichthe subjects of Rome were subjected-the system of farming out taxes leading to great abuse and extortion. Thehistorian already cited asserts, indeed, that at no period532 The Causes of Insanity among the Ancients, [Jan.,within the sphere of historic records was the Commonwealthof Rome anything but an oligarchy of warriors and slaveowners, who indemnified themselves for the restraint imposed on them by their equals in the forum by aggressionabroad and tyranny in their household. While Gaius Verresheld authority over Sicily, 59 per cent. of the farmers in themost fertile parts-and these for the most part Roman burgesses -ceased to cultivate their fields, and suffered privationon account of the oppression to which they were subjected.Oppression is said to drive wise men mad, and no doubtoppression and impoverished homes did drive not a few madamong the Romans.Causes chiefly Moral. -As regards these we find frequentcomplaints among the Roman writers that, with increasedcivilization and luxury, the habits and manners of the peoplechanged from what they in the main were during the earlyperiod of Roman history to which we have referred. Thereis the well-known contrast drawn by Horace between theyouth of his age and those of the days in which they repulsed Hannibal. How bad, how base, he considers hisown generation, though he did not think it had reached thelowest depth of degradation, for the downward current wasso strong that he contemplated the sons of that generation would be guilty of crimes unknown even to it. And half acentury later his expectation seems to have been fulfilled, forJuvenal asserted that posterity could not possibly add anything to the immorality then rampant:-Nothing is left; nothing for future times To add to the full catalogue of crimes.Vice has attained its zenith, &c.NeverOf the " golden age, " it may be emphatically said that allis not gold that glitters . It did not seem so, as ProfessorSeeley observes, except to the Court poets. " On the contrary, they said it was something worse than an iron age;there was no metal from which they could name it.did men live under such a crushing sense of degradation,never did they look back with more regret, never were thevices that spring out of despair so rife, never was sensualitycultivated more methodically; " and after remarking that ifmorality depended on laws, or real happiness on comfort,there never would have been a more glorious age; he adds,"It was, in fact, one of the meanest and foulest." It isscarcely necessary to seek for further evidence on this point,1877.]533 by D. HACK TUKE, M.D.so clear does it seem that there must have been a mode oflife at this time unfavourable to healthy mental action, andthat the " causes chiefly moral " of insanity must have beenin operation in very considerable force; but we cannot avoidadding the dire picture drawn by Quintilian of the moraltraining of his day. " Would that we ourselves, " heexclaims, " did not corrupt the morals of our children! Weenervate their very infancy with luxuries. That delicacy ofeducation which we call fondness weakens all the bodily andmental powers, What luxury will he not covet in his manhood who crawls about on purple! He cannot yet articulatehis first words when he already distinguishes scarlet andwants his purple. We form the palate of children before weform their pronunciation. They grow up in sedan chairs;if they touch the ground they hang by the hands of attendants, supporting them on each side. We are delighted ifthey utter anything immodest. Expressions which wouldnot be tolerated even from the effeminate youths of Alexandria we hear from them with a smile and a kiss . " Quintilian says that all this is not wonderful, for they themselveshad taught them; they had heard the language from theirparents. From the shameless practices they witnessed athome their habits and very nature were formed." The unfortunate children learn these vices before they know thatthey are vices; and hence, rendered effeminate and luxurious,they do not imbibe immorality from schools, but carry itthemselves into schools. " Such a training as this musthave surely sapped the mental constitution, and where it didnot act as a direct cause of insanity must have often indirectly led up to it in the enfeebled nervous system induced,little fitted to bear the shocks of life; and in the tendenciestransmitted to posterity.Take a later period of Roman history. A good illustrationof the state of society, in its bearing on the causation andevolution of mental disorder, at the latter end of the fourthcentury, occurs in the poetical books of Claudian againstRufinus, an avaricious and ambitious man, who died A.D. 375.Ample proof is afforded of a condition of mental life whichmay reasonably be supposed to have not unfrequently causedinsanity. The struggle between contending emotions musthave often been great. The poet speaks of the discordwhich is the nurse of war, of imperious famine, of fretfuldisease, of pale envy, lamentation, fear, of spendthrift534 The Causes of Insanity among the Ancients, [Jan.,luxury, and of the sad want which closely follows in itstrain, with shuffling pace:-And last of all, and dreariest of their race,Clasping their mother Greed's polluted breast,The endless swarm of cares that know no rest.This graphic description of their " cares" marks a state ofsociety too much like that of modern life to allow us todoubt that the people of that day were suffering from someof the same brain-distracting elements of highly wroughtcivilized life as ourselves, and that many men and womenbecame insane; far more than in the early age of Romanhistory. Well might Claudian assert that he whose lifeneeds the least is in truth the best, and that—Natura beatisOmnibus esse dedit , si quis cognoverit uti.Intellectual Strain.-An examination of the character ofschool learning among the Romans proves two things: first,that the area or range of learning was but limited, at best;and, secondly, that fears sometimes were expressed eventhen that ill effects might result from over study; nor wereschool boy sorrows altogether unknown.It would seem that little more was taught than reading,writing, and arithmetic, Greek and Latin grammar, and the recitation of their own poets. School must have sometimesbeen, indeed, what one meaning of the word indicated among the Greeks-leisure, if not idleness. Juvenal criticised theschooling of his day as consisting of little more than teaching who nursed Anchises, how long Acestes flourished, andthe like. Quintilian gives some questions asked at school,as-Why Venus among the Lacedemonians was representedarmed? Or, why Cupid was thought to be a boy, andwinged, and armed with arrows and a torch?Meagre, however, as was the school lore of that age,Quintilian found it necessary to reply to some in his day whofeared the pupils' minds were overstrained by too hard work.He derides the alleged danger of cramming youths withknowledge, observing that there are those who maintain thatthe mind must be confused and wearied by so many studiesof different tendencies, " for which neither the understandingnor the body nor time itself can suffice;" and replies " that

• From a MS. translation by Thomas Hodgkin, Esq. , kindly placed at my disposal .

1877.] by D. HACK TUKE, M.D. 535such do not understand how great the power of the mind is;that mind which is so busy and active, and which directs itsattention, so to speak, to every quarter, so that it cannoteven confine itself to do only one thing, but bestows its forceupon several, not merely in the same day, but at the samemoment;" and he further makes the interesting remark,"It is by no means to be apprehended that boys will beunable to bear the fatigue of many studies, for no agesuffers less from (mental) fatigue" (Bk. i . , chap. xii . )seems, however, that some ladies even in Juvenal's day,strove to cultivate their minds; not being content with theknowledge they could acquire at school. He was muchscandalized at their doing so, calls such women intolerable,and trusts his wife may never stuff her head with the subtleties of logic.Enough for me, if common things she know,And boast the little learning schools bestow.ItWe have said that the Roman scholar had his sorrows;there was a cane then as now which had no sugar in it. Atany rate, it was so at the period when the boy Augustinelived and schooled. He says he did not love study and hatedto be forced to do it. He disliked Greek, and thought thethree R's as great a punishment. " Homer was bitter to my boyish taste, and so I suppose Virgil would be to Grecianchildren, when forced to learn him, as I was Homer. I wasurged vehemently with cruel threats and punishments."Much more might be cited from his " Confessions, " which arefull of interest, but we must restrict ourselves to the following passage, bearing directly on our enquiry:-" I was put toschool to get learning, in which I (poor wretch) knew notwhat use there was; and yet if idle in learning, I wasbeaten. For this was judged right by our forefathers, andmany passing the same course before us framed for us wearypaths through which we were to pass; multiplying toil and grief upon the sons of Adam. ”In spite, however, of Augustine's plaints, and the misgivings ofthose to whom Quintilian refers, I think we cannotset down an over-taxed brain from prolonged study, sleeplessnights, dread of examination, and feverish emulation forprizes, or disappointment and chagrin at failure, as a probable serious cause of insanity among the Romans. Suicideswere frequent from trivial causes and to escape the sufferingsof incurable illness; but we should seek in vain for any536 The Causes of Insanity among the Ancients, [Jan.,passage in the Latin writers similar to one which appears aswe write, in a London paper commenting severely on theinjury done by modern examinations, on the occasion of the suicide of a University College student from this cause. Itis said to be the ninth in the Metropolis by students (someOrientals) during the present year.*In conclusion, if-after the necessarily imperfect sketchwe have drawn of the psychological bearings of ancienthistory, as to the prevalence of the main causes of insanity—we endeavour to draw a general conclusion, we appear to bewarranted in saying that mental disease was not likely to belargely developed among the primitive races, that the causesof mental disorder must have exerted a very considerableinfluence upon the four important nations referred to, lessin their earlier, much greater in their later and highlyorganised condition. Probably these causes were not so influential among the Egyptians and Jews as the Greeks andRomans, taking the period most unfavourable to mentalhealth in each nation, and probably less so among the Greeksthan the Romans.In favour of the nations of antiquity as compared, letus say, with England, may be enumerated less dram andbeer drinking, and fewer half-starved and diseased childrenreared. The class of paupers from our large towns and theagricultural districts which fill our county asylums werecertainly not to be found either in the primitive races or theearly stage of civilization in the above nations. Nor havewe been able to detect an exactly corresponding class-indegree at any rate-in the subsequent complex social stateof these nations, whether at the height or decline of theircivilization. The patients from this class are those whowould be regarded by Dr. Richardson as the victims of mentalstagnation, perhaps it would be more correct to say of theunfavourable moral surroundings and the injurious habits ofpersons of this description-conditions undoubtedly far moredeleterious, psychologically, than any amount of mere intel-

• The paper maintains that it behoves the authorities of the University of London to beware how they drive poor students to seek a place where examiners cease to trouble, and the weary student is at rest. "At present,

what with the multiplicity of subjects, the constant alterations in books, and the unending changes in examiners, it is no wonder if the poor fellows are sometimes in distraction. It has sometimes been said that we shall never getrid of railway accidents till a bishop is killed; and it suggests the question,how many students must commit suicide before the authorities introduce amore humane and rational system of examination."1877.] by D. HACK TUKE, M.D. 537lectual strain. Again (and this bears upon the production ofhigher and middle class lunacy) there was less intense competition and fewer great commercial speculations and failures,less struggle between the natural and the religious feelingsa very important difference-less morbid self-consciousnessand dissection-a less highly wrought nervous system, andless susceptibility, therefore, to impressions calculated toupset the mind. It is certain, however, there must havebeen a period when moral and physical influences were notonly highly unfavourable to the healthy action of the emotions, but in some respects even more so than in Englandnow, because not counterbalanced by the superior religiousinfluences at work in our own country. A nation steeped inmoral corruption, as, for instance, the Roman Empire was atit* worst, must be regarded as very liable to the production ofthose mental diseases which have an immoral aetiology. Onthe other hand, the very humanity and consideration which areligious nation like England displays towards the poor, andto those of feeble mind or who are becoming insane, insteadof allowing them to perish, favours alike the accumulation ofinsane persons and the propagation of the disease by suchbefore they are placed in restraint or after their recovery.Feeble mental constitutions perished by the way in Egypt;sons probably affected with moral insanity, as evidenced bydisobedience to parents, were stoned to death in Palestine;homicidal men killed and were killed in the wars of Greeceand Rome, and defective children were thrown down theTarpeian rock. There was not, therefore, so much feebleness, moral insanity, or homicidal impulse transmitted tothe next generation in the old heathen or Jewish, as compared with modern Christian populations. Indeed, the moreancient history in all its psychological bearings is examined,the more will it appear that the explanation of the factwhich we have no doubt would be established could we havebefore us the actual census of insane persons in theseancient countries, on the one side, and that of modernEurope on the other, viz, that the number of the latterwould far exceed that of the former-lies largely in the direction here indicated . In short, the rapid clearing off orstamping out of cases of mental deficiency or derangement,whether by neglect, capital punishment, or war, is a mostimportant fact supplementing all we have said as to theprimary question of the prevalence of the causes of insanityamong the nations of antiquity.538 [Jan.,Torquato Tasso."Peace to Torquato's injured shade."CHILDE HAROLD.(Concluded from page 406. )Canto IV, Stanza 39.About this time an attack was made by the Academydella Crusca in Florence on his " Jerusalem." To violentabuse of himself, of his poem, and of his father and hisfather's poems, Tasso replied more for his father's sakethan for his own, for his heart was filled with one desire,and his chief energies were constantly employed in appealing to everyone of influence or power, to obtain hisrelease from confinement. He wrote to Bergamo a touchingappeal, which it is said moved the Council to tears, andthey despatched an embassy to Alfonso, petitioning fortheir compatriot's release and sending Alfonso a presentof an inscription relating to the antiquity of the d'Estefamily, which he was very desirous of possessing. TheDuke promised before long to comply with their request,and declared that he only kept Tasso in confinement to tryto cure him of his disorder. Perhaps he was influenced too,in some degree, by a fear of Tasso's renewal of languageagainst him at other Courts in the event of his release. Atall events Serassi confesses " He would have granted theurgent prayers of so many noble patrons, and set him atliberty with pleasure, but reflecting that poets are naturally 'genus irritabile,' and fearing that Tasso once free wouldrevenge himself for his long confinement and his illtreatment in the Ferrarese Court with that formidableweapon, his pen, he could not bring himself to the resolutionof suffering him to escape from his States, without beingfirst assured that he would make no attempt on the honourand reverence due to so great a Prince." Two years morethus passed-Tasso in constant hopes of being free, able attimes to write sonnets gracefully and with his old power; attimes mixing more in the world, then apparently withdrawnagain from it; weak and suffering in body, and his terribleapparitions and images increasing upon him, his cell appearing full of them. Flames wreathed and twined themselves init; rats and other animals seemed to him to crawl across thevault of the room. His ears were filled with noises-ringings of bells, clocks striking; in his sleep and even whenwaking he thought himself engaged in strife with the1877.] Torquato Tasso. 539spectres around him, and asserted that when no person hadbeen in his prison his closets were broken open, his clothestaken from him, his books pulled down and flung abouthis room, his gloves or letters drawn out from locked boxesat night and scattered over the floor in the morning. In themidst of this distress both of body and mind he believedthat " there appeared in the air the form of the gloriousVirgin with her Son in her arms, in the centre of bright andglittering clouds. "Pope Sixtus the Fifth, moved by Tasso's earnest appeals to him, made interest for him with Cesare d'Este,who, strengthened by the co-operation of the GrandDuke of Tuscany, assisted also by the Duke of Mantuaand his son Vincenzo, interceded with Alfonso forhis release. Alfonso consented that he should beliberated on condition that he would remain under thecharge of the Duke of Mantua, and submit to what treatment should be necessary for him. But at this time Tassobecame too seriously ill to move, and the physicians called toattend him began to despair of his life. He trusted himselfto the Virgin's intercession, he says, and seems to have hada vision glorious and comforting to him. He recovered ina short time from this severe attack, and after much delayedhope and waiting, and after the condition of his release asto his remaining under strict surveillance at Mantua hadbeen reiterated, the longed-for day did at length arrive.Costantini and a gentleman of Vincenzo's arrived with anorder for his deliverance, and after more than seven years'confinement he departed with them. The conditions laiddown, further than his surveillance, were that Vincenzo andhis father were to be responsible for him; he was to engagenot to write against the Ferrarese Court, and was neveragain to appear in Ferrara.The stipulation that he should return no more toFerrara does not support the supposition that the increasedliberty given him soon after the death of the PrincessLeonora was influenced by that event; otherwise on thatground reasons for desiring his absence from Ferrara wouldhave ceased. It is more probable that his presence, when atlarge there, had become always exciting to himself, and asource of alarm and even danger to others.When the time came that he was indeed to go forth, thathis intense and protracted longing was about to be attained,Tasso, in a kind of reaction perhaps, seems to have sucXXII.36540 Torquato Tasso [Jan., .cumbed more completely for a time to bodily weakness, andto have realised all the change wrought in himself in thelong, suffering years through which he had passed . He hadfondly dreamt that with liberation his own former feelingswould return and that happiness and renown might againbe his. Alas! instead of this he found himself worn anddejected, with a restlessness and melancholy upon him not to be shaken off. He was still only forty-two years ofa*ge, but he went forth broken in spirit and health to re- commence something of the same precarious life of dependencethat had for so many years been his. But on his arrival inMantua he was most kindly received by the Duke, lodged inhis palace, and tended with every consideration and regard;and numerous friends of talent and distinction bestowedmuch attention upon him. Here he would seem to haveattained to a respite and rest, feeling it so himself inthe first instance. He devoted his care to the restoration ofhis health, earnestly requesting one of his medical friends tosupply him with some remedy for the failure of memory hefelt so strongly coming over him. The remedies they wouldhave enforced, such as purging and bleeding, he persistently refused to adopt. He also composed new works andcompleted old ones, showing that much vigour still remained,if memory was failing; he even wrote a letter treating of therespective merits and advantages of different forms ofgovernment, which the Duke of Mantua is said highly tohave valued. The Carnival came round, and he seems tohave regained some of his former spirit, and his love of andsusceptibility to female beauty. But when the season ofLent commenced he turned from such thoughts and gavehimself up to theological studies .His wishes had now been met thus far-he had obtainedhis release, was living in competence and ease, and wastreated with kindness and distinction. But soon thespirit within him could no longer let him rest; the olddesire for change came upon him. Milman attributesit to his feeling himself too near to Alfonso and toFerrara, but does not give his ground for the conjecture,nor suggest that any interference with Tasso had beenattempted. He speaks of his having been disappointed ofpaying a visit to Sassuolo, where he was to have metFerrante Gonzaga and other friends and patrons, but areturn of his illness prevented him from accomplishing thisvisit and increased his melancholy. It seems more probable1877.] Torquato Tasso.541that after an interval of much greater calmness hadfollowed for a time on his release from his long confinement, his restoration to society and all the beneficial influenceand refreshment of this change, a return of the old andterrible malady came upon him, renewing his deep melancholy, his fears and restlessness . The surveillance underwhich, however necessarily, he was placed must at timeshave been galling to him, and on the slightest increase ofhis illness would chafe and fret him still more, and renewthe old suspicions of danger. He was considerately andkindly treated, the Duke taking him to a villa calledMarmirolo, where he met a pleasant society; he was alsoto have accompanied the Duke to Florence, but this projectwas frustrated, the Duke being himself obliged to foregohis visit. He had a fresh cause of vexation in the publication by Licino of his " Discourses on the Art of Poetry,'with a collection of his letters, without his permission,and indeed unknown to him, and which he would have desiredto revise and correct himself before publication . He nextfixed his thoughts upon Rome, desiring to try his fortunesthere. When we read of this ever-recurring restlessnessand desire of change of residence from city to city, wefeel that blame can hardly be justly attributed to otherson account of the want to which Tasso was subsequently attimes reduced; for we see that when in safety and in ease ofcirc*mstances he could not long rest, and that no persuasions of his friends could induce him to tarry when oncethe fever of change had come upon him.The wish to try his fortune at Rome had now become sopredominant that although at this juncture an offer was madehim of the Ethical and Poetical Chair of the Academy ofthe Addormentati, at Genoa, with a promise of at leastfour hundred crowns a year, he was unwilling to acceptit; his friend Angelo Grillo had obtained him this offer,which was accompanied by a flattering letter from the President of the Academy. It is said that he wasuncertain of being allowed to accept it, and feared to askit, dreading that it might lead to further restriction of hisliberty. He was permitted to visit Bergamo, where hewas received with every possible honour by his fellowcitizens, but could not even then shake off his melancholy.His thoughts were still bent upon Rome. He apparentlywrote to many patrons and friends regarding it, receivingonly discouraging replies, excepting from Scipio Gonzaga,512 [Jan.,Torquato Tasso.who was now Patriarch of Jerusalem . Cardinal Albanoentreated him to continue in the service of the Prince ofMantua; "Cataneo represented to him that he mustfirst perfectly re-establish his reputation for wisdom andprudence before he could expect any profitable employ- ment." All this did not turn Tasso from his purpose,though it delayed the carrying of it out. Angelo Grilloagain wrote urging his acceptance of the offer from Genoa.Tasso sent this letter to the Duke of Mantua's Chancellor,requested permission to leave Mantua, and also asked forsome pecuniary help. Just at this time, however, DukeWilliam, the father of Vincenzo, died, and Tasso, puttingaside Genoa, hasted back to Mantua on the succession of Vincenzo, who had been so great a friend to him; but he wasdoomed again to disappointment, Vincenzo being now soabsorbed in affairs of State and other occupations that Tassofound himself almost excluded from his presence or thoughts.He had returned to Mantua with freshly raised hopes of attaining that glory and renown and distinction for which hehad craved throughout his life, and ever thought himselfentitled to claim. His pride deeply resented the neglectwhich he now met with in Mantua; all the more did he rebelagainst it as coming immediately on his return from hissojourn at Bergamo, where all these feelings had beenfostered by his reception.He then more determinedly still fixed upon Rome asthe goal where his desires would attain their fulfilment,and finally declined going to Genoa. He implored permission to depart from Mantua, requesting to be completelyset at liberty. The Duke rendered him no definiteanswer, and did not furnish him with money; butTasso, who was not to be deterred, contrived to raise asmall fund, chiefly among his relations at Bergamo, andstarted in the direction of Rome, taking with him only a fewbooks, a desk containing writings, and his valise of clothes.His first intention was to perform a pilgrimage to Loreto, towhich he had bound himself by vows. He would havefailed both in means and strength, however, to carry this outhad not Ferrante Gonzaga, travelling with a retinue in thesame direction, overtaken him and carried him on with him.At Loreto Tasso confessed and communicated repeatedly,entering on these religious observances withthe utmost devotion and penitence. Here he would have been reducedto the greatest destitution had not the Governor of the place1877.] Torquato Tasso. 543and Giulio Amici sought him out and succoured him. Hisdevotion to the Virgin, who had, as he believed, appeared tohim in prison in his time of despair, was so intense that hecould scarcely tear himself from her shrine; and the exaggerated character of his devotion was evidently quite consistent with the tone and state of his mind. Amici befriended Tasso further by providing him with the means ofpursuing his journey to Rome, where he arrived in safetyfour days after quitting Loreto. He entered Rome with highexpectations, and was received with kindness and courtesy.Praises and promises were bestowed upon him by thosehigh in name and power. Tasso thought that Rome must behis resting place, and was happy in his first reception, butwas anxious to obtain some position of independence; and thiswas no easy matter to attain . He was received with kindness by Gonzaga, whose guest he was; but Cardinal Albanoand his secretary Cataneo were displeased that Tasso hadcome to Rome against their advice. The Pope, to whom hewas desirous of being presented, was too much taken up withother matters to be regardful of him; Gonzaga's affection, too,would seem to have cooled towards him, and his failing hopesweighed down his spirit anew. We mayinfer that his hopeshad been raised too high, and that to do for him all he desiredwas impracticable, while the greatness of his expectationsmust have tried and disheartened those who most admiredand were desirous of aiding him.At this time the Duke of Ferrara, displeased that hisstipulations had been disregarded, conveyed remonstrancesto the Duke of Mantua on the subject. This alarmedTasso afresh; he feared to lose his hardly gained liberty,and, added to the disappointments he had again metwith in Rome, induced him to quit it and to go to Naples.He had obtained full permission to return to that city,and was advised to repair there and endeavour to recoverhis mother's dowry, to which he was entitled . Weak inhealth and almost destitute of means, we are told, he nowagain left Rome and started for Naples. He resorted to aBenedictine Convent, and amid the quiet around him and thegreat kindness he received found again some rest and refreshment, though little hope of the restoration of his healthwas given him by the physicians whom he consulted . Hewas unsuccessful in obtaining the recovery of his property,but passed four or five otherwise tranquil months at themonastery. Many flocked from Naples to see him, but his544 Torquato Tasso. [Jan.,abode enabled him to select his visitors, and to secure retirement when he desired it. He made and enjoyed thefriendship and had the companionship of Manso, Marquisdella Villa (the friend also of Milton in later times) .For a while Tasso was much benefitted by his sojournhere, gaining a calmer tone of mind, and, as ever at thecommencement of his abode in a fresh place, felt more safeand happy, and believed he had now found his resting-placeand home. He engaged himself in altering and partlyre-composing his " Jerusalem; " but the old feelings wouldnot let him long rest in peace and security. He began toentertain fears that his presence and melancholy were aburden to the monks, and his restlessness returned. He hadlikewise many pressing invitations from numerous friends,and was at length about to pay a visit to the young Count ofPaleno, who earnestly desired it; but the Count's fatherrefused his permission to the reception of Tasso. He thendetermined, actuated, it is thought, by a considerate feelingfor the young Count's difficulty, to leave Naples for a season,and was persuaded by Manso to visit him at his castleat Bisaccio, in the Abruzzi mountains. Here, when theweather was fine, he spent whole days on the mountainshunting the roe and the wild boar. Manso's castle was filledwith tenants and guests, including the improvisatore andimprovisatrice for which the province was famous, and withthem the evenings or days of wet weather were passed, or inthe still greater enjoyment of the companionship of Mansoalone. They would retire together, and hold discourse onliterary, poetical, or more serious topics; and then wouldTasso speak of the continual communings held by him witha spirit, affirming his conviction that it was not an evilspirit, as it conversed with him on religious subjects, andpersuaded him to devotion and piety. Long discussionsseem to have taken place between himself and Manso on thissubject of the voices which Tasso heard, he affirming thatthey could not be fruits of his imagination only, as theydeclared to him things that he had never read or heardbefore. Tasso, finding that his arguments left Manso stillunconvinced, declared to him that he would convince him byManso himself beholding the apparition, but, as might havebeen anticipated, it remained invisible. Tasso called tohim to behold it, while his own gaze was fixed in a wraptmanner upon the window. Manso, with all his efforts, couldbehold no unusual appearance, though Tasso was absorbed1877.] Torquato Tasso.545in the apparent contemplation, and presently appeared toenter into earnest discourse and argument, as he supposed,with other voices, his words being heard, now in proposition, now in reply. Although of course no other voice rejoined, yet Manso could trace from Tasso's words the replieshe must have supposed himself to be receiving. This continued for some time, and when Tasso implied that the spirithad departed, he appealed to Manso if he was not nowconvinced, and when the latter said that it was indeed farotherwise, saying that he had heard much that wasmarvellous, but seen nothing that Tasso had promised toshow him to clear up his doubts, Tasso smiled and said,"You have heard and seen much more of what, perhapsand then stopped. Muratori supposes that Tasso may havebeen so deeply imbued with the remembrance of Socrates'familiar spirit as to have imagined himself to be companioned in like manner; his biographer faintly suggeststhe effects of dyspepsia-after partaking of wine andchestnuts, and after a siesta; but another explanation willprobably be given to it by those who are perfectly familiarwith such forms of hallucination .""Soon after his return to Naples, Tasso resolved on revisiting Rome, and wrote again to the Duke of Mantua,entreating him to let his books be sent to him. He wasonly able to prosecute his journey to Rome through thekindness of a kinsman at Bergamo, who supplied him withthe necessary means; and even as it was, his portmanteauwas detained at the Dogana, he not having the four crownsneedful for obtaining its admission. Without it and inthis poverty he arrived at the palace of Scipio Gonzaga,now a cardinal, but was so ill received that he sent in hasteto the Paduan abbot of Mont Olivet, happily then in Rome.The kind abbot hastened to succour him, released his baggagefrom the Dogana, and carried Tasso at once with himto the Olivetan Monastery of Santa Maria Nuova at Rome.He seems to have been then oppressed with many fancies, andsuffered from a return of fever, but anxiously occupied himselfin endeavouring to collect his works, with the idea of himself bringing them out in a complete form. This hewas, however, never able to do, though even in this stateof discouragement and ill health he did succeed in bringingout a collection, in three volumes, of his minor poems;he likewise produced an oration in honour of the houseof Medici, and also composed two beautiful canzoni; but in.546 Torquato Tasso. [Jan.,order to publish them was obliged to solicit aid fromthose whom he considered unfriendly to him.. And now he was indeed in great suffering and poverty,wandering from one abode to another; for a time in Gonzaga'spalace again, then, on Gonzaga quitting Rome, illtreated bythe Cardinal's people, and driven from the palace. His friendCostantini had entered the service of the Duke of Mantua,and through him Tasso had presented to the Duke a canzoneto celebrate the birth of the Duke's third son. He poursout to Costantini his troubles and destitution , saying thathe fears he shall have to die in a hospital. The Duke sent tohim clothes and money, but it is said they never reachedhim, being sent through the hands of Alario, Gonzaga'ssecretary. The abbot insisted on his returning to themonastery, where he remained only for a short time;for he quitted it soon, and before long was so reduced asto be received out of charity in the hospital of theBergamaschi, of which his immediate relations had beenthe founders. His cousin Alexander here found him,and he was again removed to the monastery of Santa MariaNuova. He was promised and afforded some pecuniary help,and informed of the Duke of Mantua being desirous of hisreturn to his Court. Tasso excused himself from returning,pleading his ill health and the deep melancholy with whichhe was oppressed. Now also he received, more than once,presents in money from the Duke of Tuscany and invitationsto Florence and Mantua. Comforted by these tokens of loveand reconciliation, he needed, he said, for his perfect consolation but the favour of his ancient master, the Duke ofFerrara, but it does not appear that from him he ever againreceived any communication.Being after a time a little recovered he did resort to Florence; he lodged at the Olivetan Monastery there, and allthe literary and other world of Florence, including the GrandDuke himself and his family, flocked to behold him, to welcome him or simply to look upon him. Still he was sufferingand conscious of his state, saying that his disorders will notlet him rest in Mantua, in Rome, in Florence, in Naples. Hewandered from one to another of these cities, and when inthem restlessly removed from one abode to another. Fora time he was again at Naples the guest of Manso, andone would have imagined, to a man sick and weary in mindand body, in a haven of grateful and perfect earthly rest.Everything in the situation of Manso's abode was calculated1877.]Torquato Tasso.547to charm and soothe; he must have felt in perfect safety there; he had no anxieties as to the mere sustenanceof life; and above all he had the friendship, companionshipand sympathy of Manso. He here made great progresswith his " Jerusalem Conquered," and commenced, at therequest of the mother of Manso, an aged, learned anddevout lady, a sacred poem, entitled , " The Seven Days," or"The Universe Created," a poem descriptive of the Scriptural History of Creation. Here he, however, onlyrested temporarily, for on receiving a command from the Popehe resorted to Rome for a season. It was on his journeyat this time thither that detained with those who travelledwith him by fear of the then powerful brigands, headedby Marco Sciarra, this brigand chief, in deference andout of honour to Tasso, sent to him offering him a free passage and escort, but as Tasso would not accept this for himself only, Marco Sciarra announced that he would, to allowthem to proceed without conditions, withdraw himselfaltogether for a time, and did so .On Tasso's safe arrival in Rome, he attached himselfespecially to the service of Cintio, the son of the Pope'ssister, and subsequently a Cardinal. Tasso was assured thathe should be exempt from all attendance and enjoy fullleisure for philosophy and poetry: he occupied himself inbringing out his second " Jerusalem," which he himselfpreferred to the first, thinking it much superior to it.He was honoured and beloved by the two nephews of thePope, distinguished with favour by the Pope himself, anddwelt in security and peace; scholars and authors, we aretold, eagerly seeking the privilege of his society and conversation. When the summer months came round he returnedto Naples, to avoid the unhealthy season at Rome.While at Naples the Prince of Venosa, who was friendlyto him, and for whom he had composed some madrigals,was about to proceed to Ferrara to be married to the sisterof Cesare d'Este. By Tasso's suggestion he wrote toAlfonso proposing or asking to bring Tasso in hiscompany, who was sincerely desirous of kissing his handsand obtaining his forgiveness before he died; butAlfonso refused this request, and remained firm to theresolution he had made when Tasso last quitted Ferrara, ofnever beholding him or allowing him to re-visit Ferraramore. Tasso, calm in mind and spirit now, and knowing thatdeath was surely approaching near to him, doubtless reverted548 Torquato Tasso. [Jan.,in thought to the days of his earlier career, and seems anxiously to have desired some token that Alfonso accorded himpardon for aught in which he had offended in the past. He writes to Alfonso for the last time:-"If past events might be recalled, there is nothing whichwould so rejoice me as to have been always engaged in yourHighness' service. But since it is impossible to amendthepast, in that space of life yet left me, which is but a momentary interval, I will guard myself more carefully from offending your Highness than any other person. This has been myresolution for many years, though often interfered with, andbut ill carried into effect. Once more I implore yourHighness to have compassion upon me, and I pray Godmost devoutly to grant me His pardon, and that of yourHighness. "Alfonso would appear to have made no response, and wecannot feel much surprise if he was unable to believe in thepower of Tasso to keep effectually, in the future, resolutionsthat had so failed in the past; especially as he had never beheld him since the calmer spirit had come over him, and,health and life declining, the old feelings were dying out, andhis mind becoming healed and restored.As we draw near the close of Tasso's troubled career,it seems evident that in his decaying health and strength amuch calmer state of mind did become his. Although athis death he was only fifty years of age, his strength andenergies had failed, and the wild longing for undue exaltationhad quite died out. It is almost sad to find him now, whenhe had resorted to Naples, only for a time, to avoid the unhealthy season at Rome, seeming quite to have forgottenRome and all his ardent aspirations once connected with it,and all the hopes of preferment he had so earnestly entertained. He had when he left Rome, however, only quitted ittemporarily, and Cardinal Cintio was not willing that Tassoshould remain away permanently; to recal him and to ensure his return, it was decided to confer upon him theLaureate Crown which-though conferred afterwards onmany less worthy-had once been conferred on Petrarch.His friends at Naples, even including Manso, wished himnot to reject this offer. He himself was nowise elated by it,even shrunk from it, and though in compliance with the pressing entreaties sent from Rome, and the persuasions of thosearound him, he consented to repair to Rome, he declared toManso that though he went by his advice he was convinced1877.] Torquato Tasso.549the honour proposed for him would come too late, and tookleave of Manso as never expecting to see him more.He wasreceived at the gates of Rome by the household of the twoCardinals (nephews of the Pope) , and by a great part ofthe Pope's suite, besides many other persons of distinction, conducted in state to the Vatican Palace, and the following daysolemnly introduced to the Duke's presence, who formallyapprised him of the honour intended to be conferred upon him. All produced in Tasso no pride or exultation; thelonging for praise and exaltation seeming to be quite extinguished. Unfavourable weather and the winter seasondeferred the event taking place; meantime the city wasfull of preparations for it, and Rome was to be especiallyadorned for the occasion . Many were thronging thereto be present at the ceremony-Poems were indited tocelebrate it. Tasso alone remained unmoved, sad and calm.His kinsman Ercole Tasso having read to him a flatteringsonnet, his reply was Seneca's line, " Magnifica verba morsprope admota excutit."The prepared-for event was destined never to take place.Now, when honours were to be lavished upon him, he desired them no more; sick and weary, rest was thegreatest earthly boon to be given. His weakness andillness increased, and he requested earnestly permission toretire to the Convent of St. Onofrio-his former place ofshelter. In a farewell letter to Costantini, he expresseshimself as fully aware that his end was approaching verynear, and speaks of the ingratitude of the world in triumphing in bringing him a beggar to the grave. But had hislife now been prolonged, the Pope had assigned him aregular pension and others had proposed to add to it.Peace however seem to have come to his spirit immediatelyafter this, and from the time that his state was pronounced to him to be hopeless, " He spoke," Manso tells us,no more of anything relating to this life;" his thoughtsoccupied only with preparations for the future, he layengaged in prayer and spiritual communing. He partookof the last sacred rites of his church, and on the 25thof April he passed away chaunting the words, " In manustuas, Domine." Then came the griefs and lamentations andregrets that the bestowal of the Laureate Crown hadbeen procrastinated until too late to place it on his brow,while yet in life; but that it should still be borne by Tasso,66550 Torquato Tasso. [Jan.,it was resolved that it should even in death be his. Thebody was gorgeously arrayed, the laurel placed around hishead, and on a stately bier he was borne from St. Onofriothrough the Borgo and the Piazza of St. Peter and back tothe church of St. Onofrio, followed by a numerous procession. He had desired to be buried in the church ofSt. Onofrio, and there in the evening of the same day onwhich the procession had taken place he was quietly laid to rest. The Cardinal Cintio intended to have had a solemnand grand funeral celebration hereafter, but time passedon and nothing of this was done. Two years after, Mansovisiting bis burial place found no monument of anykind marking it, not even an inscription to commemorate hisname; he appealed earnestly to Cintio, but Cintio seemedunwilling that any one else but himself should do anything,yet himself still deferred. Manso induced the brethren of theMonastery in the meantime to erect some simple memorial,and a small marble slab was placed over the grave, with thefollowing short inscription upon it:-D. O. M.Torquato TassiOssaHic JacentHoc ne nesciusEsses HospesFres Hujus Eccl.P. P.M. D. C. L.Obiit Anno MDXCV.At the end of eight years Cardinal Cintio died, without anything more having been done. At length a monument waserected (on the left hand on entering the church) byCardinal Bonifazio Bevilacqua, of Ferrara, his parents havingbeen great friends of Tasso. So through Ferrara at last the honour paid to him was ordained to come. The monumenthad the portrait of Tasso in relief and bore also an inscription of some length. Many were the honours, however, subsequently paid to him; medals were struck, cameos cut, and acolossal statue was erected in the principal Piazza of Bergamo, the laurel crown upon his head. Another statue was erected in Padua by the students of the University. Portraits were painted of him by many painters, representinghim at various periods of his life . A cast had been taken of1877.]551 Torquato Tasso.him as he lay dead in the Convent of St. Onofrio, and we aretold that it is very striking in its aspect, seeming to depictboth the genius and the suffering that had been his.AIf his biographer has taken a mistaken view of thesource of these sufferings, it was an error on the nobleside, from such a point of view as his, strenuously to striveto rescue the memory of Tasso from an imputation of madness. It is but another instance of the still uneradicated feeling of a kind of disgrace attaching to it.source of far keener suffering than the malice of themost ingenious enemies could have inflicted upon himwould this malady be to him, but no disgrace. Sad as hissufferings were, we may trust that they were not in wrongand cruelty inflicted upon him, but that the inscrutable handof disease was upon him. That the anguish of his soulwas indeed great we may well believe; there was no needof earthly agents to aggravate the sufferings of such animagination when afflicted by this dread malady. Thenames of those who would seem to have loved and pitiedhim, to have tended and befriended him as long as it remainedpossible to do so, and who tried to save him from himself,have been held up in powerful language to obloquy, execration, and scorn, as the authors of his misery and wrongs,but we have seen how, again and again, honours, distinctionand prosperity might have been his; but again and againthis was frustrated by the irresistible spirit that tookpossession of him, by his fears and restlessness, his terribleapprehensions. It is indeed a sad and troublous career totrace, and calls forth the deepest pity. We marvel not thatwhen at length in his last illness his physician announcedto him that there was no hope of his recovery, " Tassoembraced him with a tranquil countenance and thanked himwith fervour for the announcement; and then immediatelyraising his eyes and keeping them fixed on Heaven, with yetgreater earnestness and affection, he gave humble thanks tothe merciful God who was pleased at last, after so manyand violent tempests, to bring him thus to the desired harbour. "A. C. M.552 [Jan.,Case of Homicide by an Insane Person . By FREDERICKNEEDHAM, M.D., Medical Superintendent, BarnwoodHouse, Gloucester.I venture to send to the Journal of Mental Science thefollowing report of a recent trial for Murder, because by amultiplication of such reports not only are we supplied withpsychological facts, which may be classified to form the basesof important principles bearing upon the relations of insanityand crime, but we are also furnished, in the rulings of theJudges, with materials for an oral law, which will probablyultimately find its way to the Statute Book, to the extinctionof that unreasoning interpretation which is opposed alike tothe teachings of science, to common sense, and to humanity.Elizabeth Cole, about 30 years of age, the wife of alabourer, was charged, at the Gloucester Summer Assizes,with the wilful murder of her infant child. She had beenmarried for six years, and had three children, of whom thedeceased, aged three months, was the youngest.Previously to her marriage she had suffered distinctattacks of melancholia, and, since her last confinement, hadbeen gradually relapsing into a melancholic condition . Somuch was this the case that when her husband left home togo to his daily work, it was his custom to engage a little girl,the daughter of a neighbour, to stay in the house for thepurpose of exercising supervision over her.On the day of the murder, the husband being away, theprisoner, on some pretence, got rid of her juvenile attendantand two elder children, and in their absence nearly decapitated the infant by means of a chopper, its body and almostsevered head being found on the top step of the stairs leading to the upper rooms. On being questioned she said, " Idid it; I could not help it; I felt I must do it."She gave the following account of herself and her crime atthe interviews which I had with her for the purposes of herdefence, but she was evidently intensely depressed, and couldonly be induced to speak at intervals, and under constantpressure,She said, " My husband had recently taken a larger house,and I thought it was more than we could manage, for I wasnot feeling well or able to exert myself much, and I wassleeping badly. I had felt thus, and depressed in spirits,ever since the birth of my baby, and I feared I should be1877.] Case of Homicide by an Insane Person.553be unable to attend to it properly, and that it would neglected and suffer. I loved it more than either of my otherchildren, and I could not bear that it should feel the want ofmy care. Gloomy thoughts kept coming into my mind, andat last I was tempted to take my own life, and free myself from the trouble which I believed to be coming upon me. Thistemptation returned again and again, but I struggled against it, for I felt that I could not bear to leave my baby. Thenthe thought occurred to me-Kill the baby, and take it from the trouble to come. I dwelt upon this idea until I haddecided that I would act upon it, and one morning I sent thetwo children and the little girl who looked after me into thegarden, and killed my baby on the stairs with a chopper. Iwas not vexed with it for anything. I loved it very dearly,and only wished to save it from suffering. "Such was the account of the crime and the motives for itscommission dragged from her little by little; evidently toldat all most unwillingly.It was interesting in several particulars. It shewed, as thehistories of so many crimes committed by insane persons doshow, that the direction of the homicidal act is often a mereaccident, the result of love, fear, or other passing or morepermanent emotion of the mind; suicide being frequentlysuggested, and abandoned for reasons which, in presenceof the crime itself, seem feeble and absurd, but to thediseased mind are, doubtless, valid and all sufficient. Thedesire is to kill one or two or more, and the rest is often amatter of opportunity or chance. It shewed, moreover, as somany of these histories do shew, how difficult it may beprima facie to assign motives for crimes committed under theinfluence of insane beliefs .At the trial, the Judge (Mr. Justice Grove) drew an important distinction in his ruling. After stating the well-knownunscientific legal definition of responsibility, he said- "aknowledge of right and wrong does not necessarily implysuch a knowledge as is possessed by persons of ordinary sanemind. An insane person may know that he is taking awayhuman life, and so committing a crime in the eye of thelaw, but to him it may seem a rightful, or, at least, not awrongful act, and, in this view, he would not be responsible."In this sense I could reconcile the dictum of the law andthe teachings of science, and aid the prisoner by affirmingthat, while I could not have said that she did not recognisethe abstract difference between right and wrong, or was not554 Case of Homicide by an Insane Person. [Jan.,aware when she committed murder that she was doing awrongful act as against the law, I was satisfied that the lawset up in her mind as the result of disease was to her ahigher law than any mere external code, however perfect,could possibly be.The prisoner was acquitted on the ground of insanity.The Importance of Uniformity in Microscopical Observations ofBrain Structure. By A. H. NEWTH, M.D.The importance of microscopical observation as an adjunctto the study of disease is so very obvious that few can possibly deny its value. The great advancement that has beenmade in pathology, by the aid of the microscope, during thelast few years, has almost completely changed most of theideas that were formerly held as to the nature, prognosis,diagnosis, and treatment of many diseases. Diseases whichwere formerly shrouded in obscurity as to their real nature,are now clearly defined; we are enabled to trace the fons etorigo of the causes which have been at work insidiously undermining the constitution, destroying graduallyand surely important organs. We are enabled to employ amore certain means of diagnosis by discriminating structuresfrom one another, which, to the unaided eye, seem alike—thus forming a more sure prognosis. Pathology has, in fact,become a new science by the aid ofthe microscope. And asmicroscopical observation becomes more complete, as bettermeans of differentiating structures are discovered, whilemicroscopic objectives are made of more perfect definition,so will the study of histology, and consequently pathology,rank higher and higher, till at last its place may almost, ifnot entirely, be raised to that of one of the exact sciences.The microscopist does not deal in hypothetical abstractions,but in demonstrable facts; truths which it is impossible todispute, except from errors of observation. These errorsare, however, in some cases formidable, for so many circ*mstances arise tending to obscure observation. Hence, thereis a great necessity for co-operation in the work of histologyand pathology, in order that these errors may be seen and understood, then grappled with and overcome. Observersmust be willing to work more in unison, to compare results,to submit their work to the severest criticism possible: untilthey do so the science of histology will only slowly progress1877.] Microscopical Observations ofBrain Structure. 555towards exactitude. More labourers, too, are needed; thefield is so vast, time is so short, that the few earnest ones atpresent at work are not sufficient.No doubt the difficulties that lie in the path of the microscopist are great, and the encouragements so few that manydo not care to pursue it, or give up the pursuit after a shorttime. This neglect of an important study, this turning backafter having put the hand to the plough, is not entirely dueto want of perseverance or pluck on the part of the intendingobserver. It is rather due to the want of co-operationamongst workers in histology. An organisation of workers inthis branch of study is urgently needed, not only to promoteand encourage work, not only for the purpose of comparingresults, but also for determining what each observer shouldstudy. If each were to have some definite kind of work,some restricted portion of a pathological organ to confine hisattention to, he would do more, and his results would be farmore reliable than if he had no such restrictions. Thegeneral results of the total organised observations would alsobe of immense value, for each observer's work would fit intothe whole with tolerable exactitude.If there is, then, a necessity for histologists in general toco-operate together for work, there is a far greater necessityfor those who are engaged in the study of the microscopicstructure of the brain to do so. The brain, it is needless toobserve, is the most complex of all the organs of the body;its functions are so multifarious, and its structure necessarilyso intricate, that it may be regarded as the most difficultstudy histologists can pursue. In comparison, it is easy toshow the minute anatomy of the kidneys, lungs, liver, etc.,for these have each only a definite function to perform, andthis function is the same almost throughout the structure: asmall portion of one of these organs is typical of the whole.It is not so with the brain: though there is a general arrangement of nerve cells and nerve-fibres which are somewhat alikethroughout, yet, as probably each convolution and nervouscentre has a certain distinct series of functions to perform, the anatomy of each must necessarily vary from theother. Each individual nerve- cell represents some actionor thought, and there is a necessity for co- operation in thework of endeavouring to trace the connection between thevarious cells and the motor centres, etc. , which give expression to these thoughts . These cells are so numerous, and aredistributed over so vast an area, that a few observers are quiteXXII.37556 Microscopical Observations of Brain Structure, [Jan.,unequal to this task. As many as can possibly do so shouldbe induced to join with others in preparing microscopicsections of brain substance, so as to obtain a large number ofobservations for comparison.So many difficulties meet the microscopist in this specialstudy, at the very commencement of his course, that manyare prevented entering on the work by reason of the difficulties alone. These might, to a very great extent, be overcomeby co-operation.There is first of all the difficulty of making good sections,which, to those who have tried it, is very great, and whichthose who look back on their early unaided efforts rememberpainfully.*The failure in this respect may be the result of unnoticedcauses of so slight a nature as to be readily overcome whenpointed out. Many a person has been deterred from following up this branch of histology fromwant of success throughsome simple cause, probably adulteration of his chemicals,believing himself incapacitated for the work from want ofaptitude.Microscopists can seldom be charged with wishing to keepsecret any process they may have been successful with; as arule, they are always most liberal in explaining matters to theenquirer, and in publishing the results of their observations.The beginner, however, is often very unwilling to confess hiswant of success in preparing brain substance for examination, even if he has the opportunity, which he frequently hasnot, of obtaining advice in this respect. He goes on tryingand trying, with more or less success, but never satisfactorily,till at last he gives up the work from sheer weariness. Hemay even have not been able to get good specimens to copy;and thus fails for want of a model. Perhaps he buys " shop"preparations in hopes of working up to them, but they disappoint him; there is not the definiteness of structure hewants, and he cannot be quite sure of the appearances,whether they are natural or not. Had he seen a good specimen prepared by an experienced histologist, he might havebeen induced to persevere, and science might have beenenriched by his labours.There is a great need for microscopists to agree amongstThat the difficulties are not insignificant is proved by the fact that some experienced microscopists of my acquaintance acknowledged their incapacity to get good sections of brain substance, while others, like the reviewer in last number, go so far as almost to doubt the possibility of getting them at all.1877.] by A. H. NEWTH, M.D. 557themselves as to the method of preparing sections. Whileone adopts one method, and another a different, and a thirdsome other plan, no reliance can possibly be placed on acomparison of the results of these various methods. It isimpossible to tell how far the appearances, which may havebeen considered normal or pathological, are due to thehardening process employed, or to the colouring agent. Itmay be said that the microscopist can compare his ownspecimens one with another, and with a healthy standardof his own preparing, but this is not entirely possible; hewould have in that case to prepare more specimens than histime would allow, and a great number of preparations arerequired of the same class to be able to form a positiveopinion as to the structure.A standard hardening process and a standard stainingprocess ought to be fixed, and all observers should work bythese standards. Of course this would not prevent thememploying their own method on other portions of brain. Infact it would be a vast assistance to them, as enabling themto compare their own preparations with the standard ones.Many interesting facts might be brought out thus.Besides the fixing of a method for preparing the brainsections, it is most important that the brain be removed forthe purpose of examination at such a period after death andin such a manner as may yield uniform results. There is allthe difference in the world between a fresh and a partiallydecomposed brain, as to microscopical appearance. Nervestructure, necessarily the most active during life, is consequently the most liable to decompose early; it is, therefore,quite useless to compare a specimen which has been obtainedwithin twenty-four hours with one that has not been takentill thirty- six or even forty hours after death.The state of the weather, the temperature of the room inwhich the body is kept, the warmth, moisture, and electricalstate ofthe atmosphere, have an important bearing on therapidity or slowness of decomposition; the mode and causeof death too influence post-mortem changes. These effectsare beyond the power ofthe microscopist to modify, but theyshould be carefully recorded and noted, in order that comparisons may be of value. It would be an interesting subjectfor consideration how to obviate these post- mortem changes,or how to get the brain as soon as possible after death. Onemethod has suggested itself to me, and that is to trephinethe skull over certain parts, remove the small portion of558 Microscopical Observations of Brain Structure, [Jan.,brain exposed, and place it at once in a preservative fluid.My friend, Mr. Ward, of the Surrey Asylum, has suggestedinjecting the cranial cavity with a weak solution of chromic 、acid or bichromate, immediately after death. If it is possibleto get the solution to act over the whole cerebral surface,this would be a very valuable process. It would reduce to aminimum all difficulties from post-mortem changes, and bypartially hardening the brain substance before removal,would prevent, to a great extent, injury of the structure.Thus we should be enabled to form a more conclusiveestimate as to the actual state of the brain at or near themoment of death. But it is, of course, absolutely necessarythat all the observers should use the same preservativefluid, and, to a certain extent, inject it in the same way.When observers have been induced to work according toa uniform system, and their preparations have been provedto tally one with another pretty exactly, then there isanother and a not less important uniformity to be enforced.This is, that each histologist should restrict himselfto certainportions of the brain, which portions are to be settled atsome meeting held for the purpose. In this manner, if thereare a sufficient number of workers, the whole brain might beexamined minutely in a comparatively short time, and theresult would be a much more extended understanding of thebrain as a whole. The result as to the knowledge of thephysiological and pathological nature and connection ofhealthy and diseased nervous element that would thus beobtained, is beyond the power of the most sanguine personto predict. That it would advance the study is most certain,whilst it is as certain that it will not be so advanced, or, atleast, onlyvery slowly, when depending only on the desultorylabours of a few unorganised workers.It may be argued that there is no need for microscopistsjoining together in this way for the purpose of helping one another to determine uniformity of work and to compareresults. The meetings ofthe Association are sufficient for thelatter purpose, and the instruction in the various schools,and especially in such institutions as Bethlem and Wakefield Asylums, initiate the student into all that is necessaryfor a knowledge of how to prepare brain sections.These are not sufficient, however: much more is needed.The hurried glancings at morbid specimens during anAssociation meeting, amidst the distracting elements ofconversation, etc., are not conducive to a proper understand-1877.] by A. H. NEWTH, M.D. 559ing of the appearances of a delicate structure: whilst theclinical instruction of the various schools is, at best, butelementary, and microscope work, in order to be valuable,requires years of practice. There are men, too, earnestmicroscopists, who have not the least opportunity of attending the meetings of the Association; for instance, the Assistant Medical Officers, who largely engage in this work,cannot leave whilst the Superintendents are absent. Many,too, live so far away from where the meetings are held , thatthey cannot spare the time.If, then, an association of microscopists could be formedfor correspondence on matters appertaining to the histologyof the brain, and other parts of the nervous system, the progress of science in this respect would no doubt be advanced. The association meetings would, of course, affordan opportunity for those who can be present to converseon the subject as well. But for work correspondence is best:the postal system affords every convenience for the safe,cheap, and rapid transmission of slides and preparations.The worker requires a certain slide under observation, forsome time before he can grasp the details, and he should,therefore, have the opportunity of examining it at his leisure,and of carefully comparing it with those of his own preparing.Histology may be compared with astronomy. This latterscience would not be advanced very greatly if astronomerswere only to meet together occasionally to have a peepthrough a telescope. They have need to unite togetherfor the purpose of making observations. Astronomy hasbecome an exact science: why should not histology?will, no doubt, become more exact eventually, but this canonly be when microscopists are more unanimous in theirwork, and are willing to make preparations that will bear comparison one with another.It is to be hoped that the advantages of this co- operationwill be seen by all microscopists , and that some one, withthe power of organisation, will take the matter in hand.560 [Jan.,A Short Account of the Transactions of the Mental DiseasesSection at the International Medical Congress held atPhiladelphia in 1876. By FLETCHER BEACH, M.B. Lond. ,Medical Superintendent of the Clapton Idiot Asylum.Having had the opportunity of attending the InternationalMedical Congress at Philadelphia in the capacity of a delegate, by the kind invitation of the Committee of theCongress, it has occurred to me that a short account of theproceedings in the Mental Diseases Section may perhaps beinteresting to members of this Association.The Congress was held in the University of Pennsylvania,the class rooms being devoted to the use of the varioussections. Papers of much interest were read. The following were the officers of the Section: -Chairman: John P.Gray, M.D., of Utica, New York. Vice-Chairmen: E. Grisson, M.D., North Carolina, and I. Ray, M.D. , Philadelphia.Secretary: Walter Kempster, M.D. , Wisconsin.The Section opened at three o'clock in the afternoon ofMonday, September 4th, with a paper on " The MicroscopicalStudy of the Brain," by Walter H. Kempster, M.D., Physician and Superintendent of the Northern Hospital for theInsane, Oshkosh, Wisconsin . He first gave a brief statement, outlining the progress made by recent investigators instudying the pathological histology of the brain in insanity,and the following subjects were introduced: -The importance of microscopic observations of the severalcerebral membranes, to determine their pathological condition, and the relations that the various pathological stateshold to the forms of mental aberration:The abnormalities in arterioles and capillaries, includingthe various deposits on the walls of the vessels; engorgement and its consequences; the several changes observedin the coats of the vessels; occlusion from minute thrombiand embolism; alterations in the course of the vessels, andthe effect these conditions have upon the surrounding braintissue:Miliary aneurisms and miliary hæmorrhages; the effectthey have in the production of brain disease:The perivascular sheath and perivascular canal, as they arefound in cases of insanity, considered in their relations toadjacent brain tissue:1877.] The Medical Congress at Philadelphia.561The various alterations of structure and form noted innerve cells and nerve fibres in the several forms of insanity.The abnormalities in the neuroglia, and the conditionscalled " miliary sclerosis " and " colloid degenerations " weredescribed, and the influence each condition has in impairingnormal cerebral action was discussed.The various pathological conditions found in the microscopic examination of the brain in a number of cases ofinsanity were illustrated by means of photo-micrographs andlantern views made from fresh and prepared specimens.The pathological states observed were considered withreference to the mental symptoms noticed during the courseof the various forms of insanity.On Tuesday, September 5th, a paper on the " Responsibility of the Insane for Criminal Acts " was read by IsaacRay, M.D., of Philadelphia, of which the following is asummary:-Great differences of opinion still exist among physicians,lawyers, and men of the world on the question how far insanity shall be admitted as an excuse for crime. LordHale's doctrine that partial insanity-that in which thepatient is reasonable and correct on many subjects -does notnecessarily exempt one from the penal consequences of crimestill shapes the decisions of English and American courts.Tests for determining what kind of partial insanity does andwhat does not excuse for crime are diverse, unsatisfactory,and none supported by correct scientific knowledge of insanity. Delusion has been decided to be a sufficient excuseonly when the criminal act committed under its influencewould have been legally justified had the delusion been true.Notwithstanding many of the insane think and act correctlyto some extent, yet it is impossible to say, with any nearapproach to certainty in any given case, where sanity endsand insanity begins. Two mistakes are made by lawyers inestimating the responsibility of the insane, viz . , they definethe scope of the influence of the mental disorder in an arbitrary manner, unsupported by the facts of psychologicalscience, and they regard the affective faculties as without anypart in the play of disease. The latter mistake pervades thetheories of the law and the judgments of those who pretend to no law. Wrong as our present mode of procedure is, nochange for the better seems very practicable, unless it may562 The Medical Congress at Philadelphia, [Jan.,be that which takes the question of insanity entirely fromthe court and gives it to the jury as one exclusively of fact.The Section adopted, by unanimous vote, the followingconclusions:-1. There is at present a manifest tendency to hold the insane responsible for criminal acts. 2. That thistendency is unjust, unphilosophical, and contrary to theteachings of pathology, which clearly points out that insanity is but the expression of disease.On Wednesday, September 6th, Dr. C. H. Hughes, of St.Louis, Missouri, read a paper on the " Simulation of Insanitybythe Insane. "The following is a brief summary of his remarks:-The feigning of insanity by the sane has been long recognised as a practical fact. The possibility of similar effortson the part of men really insane has been ignored or forgotten. The fact that the proof of simulation possesses noreal practical value in the case of a person already adjudgedto be insane, is probably one cause of the rareness of recorded cases. Advanced general dementia is incompatible withsimulation. Acute and general mania is also incapable ofcoexistence with feigning. In recovery from the latter condition, circ*mstances might easily give rise to simulation ofa state recently passed through. Experience and observationmight certainly help to an excellent imitation of a state solately endured.Simulation requires and implies some degree of rationality,and usually some motive. This is by no means incompatiblewith insanity. In the remissions of periodic mania, incertain cases of chronic general mania and certain forms ofhysterical mania, and especially in affective or moral insanity, without distinct intellectual impairment, simulationis perfectly possible and practicable. The existence of susceptibility to ordinary motives is recognised in the management of every insane asylum. Striking instances of successin the simulated abandonment of delusions, so common inalienistic literature, suggest an equal facility at inventionor pretence.The criminal classes of our great cities are born andtrained to deception. Simulation might very naturally be added to constitutional infirmity. Such cases probablyoccur oftener than is supposed. Many famous and historic cases might be most correctly characterised as compounds of simulation with active disease.1877.]563 by FLETCHER BEACH, M.B.Rarely does insanity affect all the faculties alike. Amongthe rational acts done by the insane man simulation mayhappen to occur. Especially probable is it that a manrecovering from mania might imitate the crazy acts recentlyprompted by disease, if adequate motive existed.Simulation is peculiarly practicable in those forms of insanity which involve the affective faculties, leaving theintellect comparatively untouched.The question of responsibility in cases where simulation is mingled with actual disease is a very difficult one. Theancient legal test, " knowledge of right and wrong," is herewholly inadequate.The motive for simulation in the insane of hystericaltendencies is often the craving for sympathy and attention .Occasionally, however, it seems to be wholly motiveless-amere freak of disease. We should beware of inferring,because of detected simulation, the non-existence of disease.The following was adopted as the conclusion of theSection:-It is not only not impossible for the insane to simulate insanity for a purpose in any but its greatest forms of profoundgeneral mental involvement, but they actually do simulateacts and forms of insanity for which there exists no pathological warrant that we can discover in the real diseaseaffecting them.On Thursday, September 7th, a paper on " The Best Provision for the Chronic Insane " was read by C. H. Nichols,M.D., Physician and Superintendent of the GovernmentHospital for the Insane, Washington.The reader of the paper was strongly of opinion that itwould be inadvisable to erect asylums for the chronic insane,partly because, to save expense, such an asylum ought to beplaced where patients could be sent from two or three States,and they would thereby be removed long distances from theirfriends; and partly because the medical officers attached tosuch an Institution would, in his opinion, become depressedand likely to become apathetic in their duties in consequenceof the little chance of improvement likely to take place inthe patients confided to their care.An animated discussion took place on the numbers whicha hospital for the insane should contain, so that it might beefficiently superintended, and the cases resident therein might be properly studied and treated . The older members con-564 The Medical Congress at Philadelphia, [Jan.,tended that the limit should be placed at 250, but themajority held that, provided a sufficient number of AssistantPhysicians were appointed, the number might be extendedto 600 or more.The Section adopted the following conclusions:-1. That provision for the chronic insane should be madeby constructing buildings in connection with the severalhospitals for the insane.2. That it is not desirable to construct institutions solelyfor the care of the chronic insane.On the morning of Friday, September 8th, a masterly" Address on Mental Hygiene " was delivered by John P.Gray, M.D., Superintendent and Physician to the New YorkState Lunatic Asylum, Utica, Hunter McGuire, M.D., ofVirginia, in the chair.In the afternoon Dr. Edward C. Spityka, of New York, reada paper "On the Methods of Examination which will reveala clear and decisive connection between the Symptoms ofInsanity and the Pathological Lesions on which theydepend."This closed the proceedings of the Section.CLINICAL NOTES AND CASES.Case of Insanity with concomitant paronychia . Recovery.(under the care of R. H. B. Wickham, F.R.C.S.Ed.) .By WILLIAM J. BROWN, M.B., Assistant Medical OfficerBorough Lunatic Asylum, Newcastle-upon Tyne.H. S. ( No. 809) was admitted to this asylum 26th February, 1876.The statement contained the following particulars: -Æt 77 years.Widow. Poor. A nurse. First attack, and had lasted for ten weeksbefore her admission. Cause, unknown. Not subject to epilepsynor suicidal. Said to have been violent, and used threats, but notconsidered dangerous to others. Medical certificate: -Refuses tospeak; makes vague and unmeaning motions with her hands; has avicious expression, and appears to watch an opportunity for doing violence. Her sister states that she is at times very violent , requiringconstant watching and occasional restraint, as she bites those abouther, and has threatened to cut her sister's throat. Mrs. G————— , withwhom she has resided for three years, states that for some weeks pastshe has been dangerous to others.On admission she was placed in the Infirmary Ward, and slept in1877.]Clinical Notes and Cases. 565the dormitory attached to it. Pulse 66, weak, and thready. Tongue readily protruded, covered with a white fur, and fissured . No headache, eruptions, bruises, nor fractures. First finger of right handulcerated in various places, swollen, and perforated by sinuses, fromwhich a brick- red ichorous fluid exuded, apparently due to necrosis ofthe two distal phalanges. The nail was partially separated from thefinger, which had a specific appearance. The tissues at the root of thefinger had a dark red congested appearance, the adjoining skin beingin a state of desquamation. There was a surgical incision over the secondphalanx. Gait feeble. Greatly emaciated. Bodily health veryweak. Unable to walk without assistance. Complained of painover the sacral region. Trembled slightly. Partial loss of powerin the lower extremities. Intelligence degenerated into merechildishness. Pupils equally contracted.- Gestures fantastic, and expressions incoherent. Unable to answer questions properly.Complained of pain when the diseased finger was handled.Threatened " to bite, scratch, and eat reporter's head off. " In avery dirty and neglected state. Not appearing to be inclined tosleep, some hours after being put to bed, she was ordered thefollowing draught: -RChloral Hydrat Dii . Aq ad zii . m. ft. Haust.27th February.- Slept until 6 a.m. Finger dressed with linseedmeal poultices, and carbolic oil ( 1 to 30).28th February.- Free incisions were made into the finger, layingopen the sinuses. The finger was then bathed in warm water, and apoultice applied. There was very little hæmorrhage from the incisions.29th February.-The sinuses having healed, the adhesions werebroken down with a probe. No necrosed bone was detected onprobing. Slept well last night. Has taken very little food since her admission. Was given two ounces of brandy after the examinationand ordered 2oz. whisky and one pint beef- tea (as extras) per diem.4th March. The finger is improved, as also are her bodily condition and appetite. Local application of poultices still continued.The whisky has been increased to 4oz. per diem. Is taking thefollowing mixture-RQuin Sulph gr x. Tinct Ferri Mur ziii . InfusCalumbæ ad viii . m. ft. mist. 3ß ter. hor.6th March. Finger looking much better.-- Sinuses healing.Poultices continued. Appetite better. Mental state slightly improved.7th March. Finger strapped with diachylon. Talks more rationally.Appears to appreciate any little kindness which is shown to her.10th March. -Strapping removed. Finger much reduced in size.Pus having formed in one of the sinuses, poultices were applied.12th March. Noisy during the night. Bodily health and mentalstate improved.13th March. Portions of necrosed bone removed from the finger.Lotio nigra, on lint, applied .566 [Jan.,Clinical Notes and Cases.15th March.- Strapping re-applied . RQuin Sulph Jii. Tinct Ferrimur zii. Æther Chlor 3. Aq ad 3viii . m. ft. mist. 3 ter die .17th March. -Strapping removed. Swelling greatly reduced .small poultice applied to the extremity of the finger.A22nd March. -Strapping renewed. Has sat up, part of each day,since the last entry was made. Seems to be much improved.23rd March. - Continues to improve. Half- pint porter to be substituted for 2oz. of whisky.24th March.-Finger improved. Bread poultice applied in lieu ofplaster.25th March. Finger still improving. Dressed with resin ointment.27th March. -Zinc ointment substituted for resin ointment.Quinine mixture continued.31st March.-Finger still improving, and the nail growing again.Mental state worse. Childish manner.8th April. The finger has healed, and all medicines and extrashave been discontinued. Mental state greatly improved.25th April. -Finger much reduced in size. A small collection ofmatter formed under the inner side of the finger, and was treated bymeans of bread poultices, followed by weak mercurial ointment, tocause the induration, which remained , to disappear. Zinc ointmentis now being applied. She appears to be, both physically and mentally improved, and does light fancy work, such as knitting, &c .It 6th May. -Liberated on trial, for six months, from the 26th April.The finger is quite healed up, and a new nail has grown on it.promises to be a very serviceable finger. Her mental state appears tohave improved " pari passu " with the finger.23rd October.- Discharged. Recovered.23rd November. -It was stated by her relatives and friends thather mental faculties were in perfect order until her finger becamediseased, but that soon afterwards the mental disorder became developed. They also stated that since she was discharged " she has been as well as ever she was in her life. "Notes of a Case of Tubercular Tumour of the Brain. By Dr.HOWDEN, Montrose.J. G., aged 28, unmarried, native of Lerwick, Shetland, was admitted to Montrose R. L. Asylum, on 7th May, 1873.Cause of insanity unknown. Has monomania of suspicion . Has everyappearance of having phthisis pulmonalis. Suffers from amennorrhoea.During her stay in the asylum no change in her mental conditionwas observed. Since beginning of 1876, she suffered from severecough and expectoration, and ultimately died of phthisis on 22ndSeptember, 1876. A week before her death it was noticed that theright pupil was dilated.1877.] Clinical Notes and Cases. 567Autopsy -Body much emaciated.Thorax.-Both lungs contain extensive tubercular deposit andsmall cavities . Heart normal.Abdomen.—Kidneys-left, normal. Right contains tubercle.Mesenteric glands much enlarged and cheesy.Intestines contain tubercular ulcers .Head.-Calvarium normal.Dura mater at vertex seemed normal, as also arachnoidand pia mater at same place.Brain. Convolutions of brain flattened . On attempting to remove the brain a tumour was found attached to the dura mater in theleft occipital fossa. The brain substance was in no way connected withthe tumour, but seemed pushed aside, and in part absorbed . Thegrey matter of the convolutions over the tumour could scarcely bedetected, and the white matter, into which the tumour projected, was soft and broken up. The membranes (visceral arachnoid and piamater) could not be traced at the seat of the tumour, but seemed to have been absorbed.Tumour. The tumour, which had a fungoid appearance, was about2 inches in diameter. It was firmly attached to the dura mater, thearachnoid covering of which it seemed to have pushed before it andruptured at various points, giving the tumour a knotted fungoidappearance, like a bad finger- and-toe turnip.The left temporal fossa was much more pronounced than the right,and crossed the mesial line, the ridge between the two fosse beingmore on the right side.The whole left side of the back part of the skull seemed largerthan the right, but, owing to the state of the brain, the respectivehemispheres could not be weighed . The tumour had no connectionwith the skull. Both sides of the body equal.The tumour was found on section to be of the same consistencethroughout, and did not contain any cavity. Consisted of a densecheesy matter.Microscopic Examination of Brain. -The white matter into whichthe tumour was pushed was completely broken up, and under the microscope exhibited great quantities of compound granular bodies.The grey matter seemed normal. The juice of a section of the tumour showed tubercle cells, blood corpuscles, &c.; few compound granular bodies.Remarks. Judging from the appearance of the tumour,the condition of the brain, and the altered shape of the skull,the growth must have been slow and of long duration;indeed, the distinct bulging of the skull over its seat pointsto the probability of its existence during adolescence.With the single exception of the dilatation of the pupil,which may have existed for long, though it was only noticed568 [Jan., Clinical Notes and Cases.shortly before death, there was nothing observed during lifeto indicate any unusual condition of the encephalon. Neitherthe motor nor sensory systems were affected, and there is noreason to suppose that the mental symptoms were dependenton the presence of the tumour. During the time she wasunder observation she was suffering from phthisis. Mentallyshe was weak, melancholic and suspicious. She imaginedshe was under some supernatural influence, and often refusedher food from the belief that it was poisoned. The specialsenses were not affected. As is the case with most encephalictumours, it did not involve the brain substance proper.OCCASIONAL NOTES OF THE QUARTER.American Asylums.We have received from Dr. Wilbur the copy of a paperon the " Governmental Supervision of the Insane," read byhim at the Annual Meeting of the American Social ScienceAssociation. In this paper he strongly advocates a systematic governmental supervision of the asylums of the UnitedStates, similar to that which is carried out by the Commissioners in Lunacy in this country. It appears thatdesultory efforts have been made in some States to establishsuch a supervision , but not very successfully, for theSuperintendents of Asylums have not yet seen the necessityof other inspection than self-inspection. This is what Dr. Wilbur saysThe only opposition that has been made to the project has comefrom parties directly connected with the management of insaneasylums. For years they have placed themselves in opposition to apublic need and a public want. Banded in an association, knownas the American Association of Superintendents of Insane Asylums,a close corporation that excludes from fellowship any assistantmedical officer of however large experience or faithful service , it notonly assumes to dictate to legislative bodies what laws are necessaryin the case of the insane, but claims for a small class of medicalspecialists the sole privilege of the intrepretation and application ofthose laws. In fact, it rules the judges out of the court, except togive authority and judicial voice to the opinions of the medicalexpert. It assumes the prerogative of framing " a code of principlesof management to secure the individual good of the insane and thehighest public interest." It claims authority in all questions " re-1877.] Occasional Notes of the Quarter.569·lating to proper location, water supply, general character of hospital;number to be treated, material for construction, arrangement ofbuilding for classification, dormitories, service rooms, lighting,drainage, heating and ventilation, and all other details necessary insuch institutions, " also " all questions relating to organization and government in all their details. " They have brought the wholeinfluence of this association to bear upon the legislatures of the different states to prevent any legislative action that should in anywise interfere with their exclusively individual control of the severalasylums with which they are connected, or be at variance with what,in their estimation, is the proper mode of management for the insane.We do not of course endorse this accusation, for we arenot in a position to do so; but we may take this occasionto say that the exclusion of assistant medical officers fromfellowship in the Association of Superintendents has alwaysseemed to us to be as unwarrantable as we are sure it isunwise. There can be no question that the Association isseriously the sufferer by the absence of young and energeticworkers who would bring into it enthusiasm of spirit andfreshness of views; and no question, moreover, that suchexclusion is contrary to the fundamental principle of a trulyscientific association . Science knows no difference betweenprincipal and subordinate; all workers are equal in itscourts; and it gladly welcomes light, from whatever quarter it comes. American Superintendents might do well to takea leaf out of our book. The Medico-Psychological Associationbegan in the union of a few medical officers of asylums, butit now includes among its members not only most of themedical officers of asylums, superintendents and assistants,but some laymen, and a considerable number of medicalmen who are not connected with asylums; and it has grownin usefulness, prosperity and vigour, in proportion as it has extended its roots. Exclusiveness means the deliberateshutting out of instruction , and can have but one resultlack of knowledge.But let us return to Dr. Wilbur's indictmentA law is passed for the establishment of a new insane hospital .A local board of Trustees is appointed; or at all events, a board ofTrustees, of which a local interest soon acquires a paramount control,and to these is entrusted the expenditure of the public money in thepurchase of land and the erection of buildings. And this very factof local selection makes men appointed to represent the state and itsinterests lose sight of the object of their appointment. From theirproximity to the institution, they become, de facto, identified with its570 Occasional Notes of the Quarter. [Jan.,interests and the champions of its policy and its existing administration; as of a party distinct from the state. * *With what results, the customs that prevail in our insane asylumswill show. At certain periods the trustees, or a small portion ofthem, make their visits; usually once in three months. In companywith the medical officer, they stroll through the wards or a part ofthe wards. Their coming is known; the wards are scrubbed; theventilating fans are set in motion on these occasions at least;the patients are in order and the attendants all on duty. It is adress parade, in which the trustees are the inspecting officers .The Superintendent, a man selected often through social orpolitical considerations or some species of favoritism, and not by anyform of competitive examination , as is the case abroad, is loadeddown with an accumulation of duties and responsibilities, beyond thecapacity of one man in a thousand.Besides these home duties, he is, unfortunately, a frequent witnessin the courts, and often has a large and lucrative consultationpractice through a wide territory; both of which matters divert histime and his thoughts from the special work, where he is needed and for which he was chosen.The evil consequences he traces in neglect and abuses onthe part of subordinates, unkind treatment of patients, thehushing up of scandals, no prosecution of wrong-doers,and extravagant expenditure. The Superintendents become timid and over cautious.They are afraid to run any risks, even small ones, and when thewelfare and comfort of their patients might possibly be much promoted thereby. Thus, they feel safer when the patients are, most of the time, under lock and key in the wards or airing - courts. Andso the patients are not allowed that degree of freedom that is foundpracticable in other lands. They are not trusted to labour in variousoccupations, which is the great feature and art of management of theinsane in European countries. There are patients, physically strongand well , in our asylums who are scarcely trusted out of doors fromone year's end to another; and, prevailingly, the patients of Americanasylums are very little in the open air. Dr. Bucknill, the EnglishCommissioner of Lunacy, who visited this country a year ago,noticed this fact and comments upon it in an account of his visit toAmerican asylums. *

• NOTE.-Dr. Gray, the Superintendent of the Asylum at Utica, and also editor of the " Journal of Insanity," has a note upon this criticism of Dr. Buck- nill, which reads thus: " Dr. Bucknill visited Utica on the 22d, 23d and 24th

of May. On Saturday, the 22d, the records of the asylum show that out of a population of 287 men patients, 233 were out of doors , and on Monday, the 24th, 252." This is hardly an ingenuous statement. The days referred towere exceptionally fine ones. They were in a sense parade days, for on the1877.] Occasional Notes of the Quarter. 571The advantages of independent inspection of lunaticasylums by authorities who are not concerned in theirmanagement are so obvious, its necessity so palpable, thatwe cannot conceive any real argument against it; and weheartily concur with Dr. Wilbur in his wish to establishsystematic government supervision, while leaving to himthe entire responsibility for his indictment of the management of American asylums.In the main hall of the asylum at Washington stands an electricclock, which Dr. Nichols is fond of showing to visitors . By ingenious devices of mechanism, it registers on a sheet of paper, forthe information of the officers , the precise movements of the nightwatchman as he makes his periodical rounds through the wards, thussecuring his fidelity.On its face Dr. N. has placed the old Latin motto, " Quis custodiet ipsos custodes?" -who shall keep the very keepers? Would it notbe well to emblazon this same motto on the door-posts of this andall other American asylums? Is it not wise for the state governments to act upon the principle thus quaintly stated, and establish a proper supervision of the very care- takers of all confined in suchinstitutions?A Priestly Exorcist.The "Times " of November 2nd contains the followingreport from its Barcelona correspondent, who wrote underdate October 21st:-" I will briefly describe what has just happened in this wealthycity. About the 14th or 15th of this present month of October itwas privately announced, chiefly to the faithful women of the congregation which regularly throngs the Church of the Holy Spirit in thestreet of San Francisco, that a young woman of 17 or 18 years of ageof the lower class, having long been afflicted with a hatred of holythings'-the poor girl probably was subject to epileptic fits, and cried outbecame convulsed when she heard the noise of the organ in church—the senior priest of the church above mentioned would cure her ofher disease, or, to use that gentleman's own language, Avaunt,"22nd the Association of Superintendents of Insane Asylums were making avisit to the Utica institution, and some of them, with Dr. Bucknill, remainedover the 24th. Out of deference to the visitors, perhaps, an unusual effort was made to get the patients out. Nevertheless, in spite of this note, the factis patent to all who have had the opportunity of comparing the customs of American with British institutions, that the former are much less in the openair than the latter. In Great Britain they not only get the patients out of doors, but keep them out,XXII.38572 Occasional Notes of the Quarter. [Jan.,physicians and mountebanks; see how the Church will cure this poorgirl, who is at present possessed with 400 devils. '"" Those who are acquainted with Barcelona know well the CalleSan Francisco, one of the well-to-do streets of the city, and itschurch, Espiritu Santo, not a poor man's, but a fashionable church.For eight days, the last day being the 17th inst. , a little stream ofpersons of all ranks and of either sex might have been seen at theunusual hour (for church- going) of 12 a.m. threading its waytowards the church. The principal door was kept closely shut, butthe faithful or credulous, the open scoffer, and the lover of signs andwonders found admittance by a side door to the exhibition which 1 amabout to describe. The church was dark, but a sickly light was shedby wax lights on the sable forms of some 80 or 100 persons whoclustered round the presbiterio , or sanctuary, in front of the altar.Within the little enclosure or sanctuary, separated from the crowd bya light railing, lay on a common bench, with a little pillow for herhead to recline upon, a poorly- clad girl , probably of the peasant orartisan class; her brother or husband stood at her feet to restrain her(at times) frantic kicking by holding her legs . The door of thevestry opened; the exhibitor-I mean the priest-came in. Thepoor girl, not without just reason , ' had an aversion to holy things, 'or at least the 400 devils within her distorted body had such anaversion; and in the confusion of the moment, thinking that thefather was a holy thing, ' she doubled up her legs, screamed out withtwitching mouth, her breast heaving, her whole body writhing, andthrew herself nearly off the bench. The male attendant seized herlegs, the women supported her head and swept out her dishevelledhair. The priest advanced, and mingling familiarly with the shuddering and horror-struck crowd, said, pointing at the suffering child ,now sobbing and twitching on the bench, Promise me, my children,that you will be prudent (prudentes), and of a truth, sons anddaughters mine, you shall see marvels.' The promise was given.The exhibitor went to procure stole and short surplice (estola yroquete), and returned in a moment, taking his stand at the side ofthe possessed with the devils, ' with his face towards the group ofstudents. The order of the day's proceedings was ( 1 ) a lecture to thebystanders, and ( 2) the operation of exorcising the devils. The priestcommenced his running commentary on, or explanation of, the strangephenomenon lying panting, foaming at the mouth, to the gaze of thestupid and shuddering crowd of her fellow men and women. Thepriest began by lamenting with tears that ' It is, unhappily, thefashion of people in this day and age to seek the aid of doctors,sleepwalkers or spiritualists, and quacks of all description ' —thewords he used were medicos, somnambulas, y curanderos - when theyhave hard at hand the aid of religion, and an aid and remedy secureand all-sufficient.' He continued his address by saying that themeans of which he should make use in the present case were not the61877.] Occasional Notes of the Quarter. 578-strongest in his power, for to use the strongest was not now allowed.He then said, This joven-i.e. , young girl -enjoys a most perfecttranquility and calmness so long as she does not catch a sight ofholy things, such as the holy water, the priest's dress, the altar, thechurch, or hear the sound of a bell, the roll of an organ's noteresounding through the aisle. You know,' continued the priest,' that so great is this girl's aversion to holy things, myself included,that she goes into convulsions, kicks, screams, and distorts her bodythe moment she arrives at the corner of the street, and her convulsivestruggles reach their climax when she enters the sacred house of the Most High.' He ended with the following words: This girl hasoften had the same infirmity in bygone years, and the devils havebeen constantly expelled; but, owing to the laxity of religion in these latter days, they return again to possess her body.' Act the firstfinished. Act the second, the exorcism , commenced. Turning to theprostrate, shuddering, most unhappy object of his attack, the priestcommenced, ' In the name of God, of the saints, of the blessed Host,of every holy sacrament of our church, I adjure thee, Rusbel, come out of her.' (N.B.- Rusbel ' is the name of a devil, the devilhaving 257 names in Catalonia. ) Thus adjured, the girl threwherself in an agony of convulsion, till her distorted face, foambespattered lips, and writhing limbs grew well- nigh stiff, at fulllength upon the floor, and, in language semi-obscene, semi-violent,screamed out, I don't choose to come out, you thieves, scamps,robbers. ' Fulfil your promise, Rusbel,' said the priest. You saidyesterday you would cast 100 more of your cursed spirits out of thismost hapless girl's body. Can't you speak?' ' Yes, I can, ' camefrom the poor girl's foaming lips , ' I can. ' ' Yes,' said the cura,' you are a devil of honour; you are a man of your word.' Out ofthe crowd stepped a plainly attired Spanish gentleman, and said,' But, father, how can you pray to and praise the devil? I have readsomewhere he is a liar and the father of lies. Does he keep hisword? ' ' Yes, ' said the priest, he is muy formal-i.e. , a man of his word. Fulfil your promise, Rusbel.' Never, ' shouted the devil, orthe girl, now lashed into an agony of frenzy. You shall,' said theholy father; and the suffering girl, like a bruised and wounded snake,her dress all disarranged, her bosom heaving, wormed and twisted intothe arms of the silly women who knelt and cried by her bench of torture. At last from the quivering lips of the girl came the words,' I will; ' but the devil added, with traditional perversity, ' I will castthe 100 out, but by the mouth of the girl .' The priest objected.The exit, he said, of 100 devils out of the small Spanish mouth ofthe woman would ' leave her suffocated.' Then the maddened girlsaid she must undress herself, for the devils to escape. This petitionthe holy father refused. ' Then I will come out through the rightfoot, but first ' the girl had on a hempen sandal, she was obviously of the poorest class you must take off her sandal. ' The sandal"6เ·574 Occasional Notes of the Quarter. [Jan.,was untied; the foot gave a convulsive plunge; the devil and hismyrmidons (so the cura said , looking round triumphantly) had goneto their own place. And, assured of this, the wretched dupe of agirl lay quite still. The exhibition was announced for 11 a.m. on thesucceeding day, and it commenced again. Up came a band of bluebloused artisans and claimed admittance to the church. The prieststoutly refused entrance to any but women. The men beat thechurch door; the police came; a scrimmage arose, and the priestretreated in haste; the sick girl was dragged to her lowly home; twomechanics now lie in Barcelona gaol for their share in a called-for, ifillegal, demonstration; the street was cleared by the police, and the affair was over. Next day the civil authorities of the town, men ofhigh feeling and great enlightenment, shocked at what they hadheard and read (for the whole affair is now in print, and can bebought in Barcelona for a half penny), stopped, by civil decree, thewhole affair. In conclusion, a few remarks are due in justice to theauthorities. First of all the Bishop, a man of enlightenment anderudition, was not cognizant, I believe, of this freak on the part ofthe clergy of the church in question . Secondly, the moment it cameto the ears of the civil authorities, the sharpest and promptest meanswere taken to admonish the priest and prevent a repetition of ascandal which had shamed and sickened the whole city of Barcelona. "The priest was only following in the footsteps of holy menof old. It is related that-"St. Apre, bishop and confessor, being one day at Chalons-surSaone, saw a young man who was possessed and from whose mouth,as from a furnace, rushed sulphurous flames. As soon as he saw thesaint afar off, he became furious, and tried to bite all who came nearhim. Everybody got out of his way, but the possessed ran towards the saint as if to seize him. But the holy man advanced without fearto the encounter with the cross in his hand, and ordered the possessedto stop. As the fiery vapour which escaped from his mouth touchedthe face of the saint, and as the possessed tried to bite him, thebishop made over the mouth of the afflicted man the sign of the cross ,and the demon no longer being able to escape in that way went outfrom the body of the man in the form of a diarrhoea."After all the good Barcelona priest granted the demon amore pleasant way of exit.Mr. Serjeant Cox and his Prophet.An acute and impudent American, named Slade, had forsome time driven a good trade in humouring simpletons tothe top of their bent by getting so-called spirit-messageswritten on slates in gratification of their gaping wonder,charging them a fee of one guinea each for the pleasure of1877.] Occasional Notes of the Quarter.575being gulled. His vulgar fraud proved, at any rate, that hehad made one discovery-namely, the infinite capacity ofstupidity. Having been detected by Professor Lankester inwriting the messages which he professed to receive from theother world, he was prosecuted at the Police Court as arogue and vagabond by that gentleman; and he was finallyconvicted and sentenced to three months' imprisonment,with hard labour. In aid of his defence before the magistrate, the following report from Mr. Serjeant Cox was read: -" Having undertaken to examine without prejudice or prepossession,and to report faithfully, without favour, in a purely judicial spirit, anyalleged psychological phenomena that might be submitted to me asPresident of the Psychological Society of Great Britain, I narrate,without comment, what I witnessed at a sitting with Dr. Slade thisafternoon. I sat alone with him, at three o'clock, in a room at3, Upper Bedford-place, Russell- square, into which the sun shonebrightly, at a table about 5ft. by 4ft. , having four legs, no ledgebelow, and no cloth upon it. Dr. Slade sat at one side of the table,sideways, so that his legs and feet were not under the table, but hiswhole body fully in my view as he faced me. I sat at the side, thecorner of the table being between us. As I sat I could see half- waybelow the table, and, by moving my head slightly, I could see thewhole space below, which was wholly exposed in full daylight. Anordinary drawing- room chair was about six inches from the table onthe opposite side, six feet from Dr. Slade. A heavy armchair was inthe corner of the room, about the same distance from him and fromthe table. A slate of the ordinary school size and a piece of slatepencil were upon the table. Instantly upon taking our seats veryloud rapping came upon the floor. This was followed by a successionof furious blows upon the table, jarring my hands as they were lyingupon it. These blows were repeated at any part of the table desired, bymerely touching that spot with the finger, while the blows, as forcible.as if given with a sledge hammer, were being made. Dr. Slade'shands were on the table on my hands, and his whole body to his feetwas fully before my eyes. I am certain that not a muscle moved.Then he took the slate, after I had carefully inspected it to beassured that no writing was upon it, and placing there a piece ofslate pencil, the size of a small grain of wheat, he pressed the slateslightly below but against the slab ofthe table. Presently I heard thesound as of writing on a slate. The slate was removed, and on it azigzag line was drawn from end to end. At this moment the chairthat I had described as standing by the table was lifted up to a levelwith the table, held in that position for several seconds, and thendropped to the floor. While the chair was so suspended in the air Icarefully noted Dr. Slade. It was far beyond his reach. But hishands were under my hands, and his feet were full in view near my576 Occasional Notes of the Quarter. [Jan.,own on the side of the table opposite to that on which the chair hadrisen. While I was taking note of his position at this moment, ahand rudely grasped my knee on the opposite side to where Dr.Slade was seated, and his hands were still in mine on the table.Blows of a more gentle kind upon the table, attended with aremarkable quivering of it, announced, as he said, that his wife waspresent, and desired the slate . After the slate had been carefullycleaned, it was laid on the top of the table, with a like piece ofpencil under it. Upon the slate he placed his right hand, and Iplaced my left hand, and with my other hand I held his left hand as itlay upon the table. As my hand lay upon the slate I could feel, anddid distinctly hear, something writing upon it. The communicationwas evidently a long one; but before I report the result I desire tonote a remarkable phenomenon, to my mind the most suggestive thatattended this experiment. It is necessary clearly to understand theposition of the parties; therefore I repeat it, Dr. Slade and myself .sat face to face. One hand of each of us was laid upon the slate.The side of the slate that was being written upon was pressed by us against the table. Our second hands were linked together and layupon the table. While this position was preserved the writingproceeded without pause. When Dr. Slade removed his hand frommine it ceased instantly, and as instantly was renewed when hishand and mine met. This experiment was repeated several times,and never failed . Here, then, was a chain or circle formed by myarms and body and Dr. Slade's arms and body, the slate beingbetween us, my hand at one end of it , his hand at the other end, andbetween our hands and upon the slate that connected them thewriting was. When the chain was broken, forthwith the writingceased. When the chain was reformed, the writing was at once resumed. The effect was instantaneous. In this curious fact wemust seek the clue to this psychological mystery. Some rapidrappings indicating that the writing was finished, the slate waslifted , and in a clear and perfectly distinct writing the following was read. It filled the whole side of the slate: Dear Serj . ,-You arenow investigating a subject that is worthy of all the time that you orany other man of mind can devote to its investigation . When mancan believe in this truth, it will, in most cases, make him a better man. This is our object in coming to earth-to make man andwoman better, wiser and purer. —I am, truly, A. W. SLADE. ' WhileI was reading this a hand grasped my knee furthest from Dr. Slade,whose hands were at that moment holding the slate that I might copythe writing. As I wrote, a hand, which I saw distinctly, came fromunder the table, seized my waistcoat, and pulled it violently. Seeingthis, I took the pencil with which I was copying the words and laidit at the edge of the table furthest from Dr. Slade, and far beyond hisreach, the end of the pencil projecting about two inches over the ledge. I asked if the hand would take the pencil, Forthwith a1877.]Occasional Notes of the Quarter.577to me.-hand came from under the table, seized the pencil, and threw it uponthe floor. I again asked that it would pick up the pencil and bring itIn a minute it was brought and put upon the table by myside. I saw the hand that brought it as distinctly as I could see my own. It was a small hand, seemingly that of a woman. Again theslate was cleaned and laid upon the table as before, my hand upon it.In a few seconds the following sentence was written. Considerablepower was used in this writing, and I could distinctly feel thepressure of the pencil upon the slate, and its motion as every word was written: - -I am Dr. John Forbes. I was the Queen's physician .God bless you.-J. FORBES.' While I was reading this, the handcame again from under the table and seized the sleeve of my coat andtried to pull my arm down, but I resisted and it disappeared. Thenit came up again, as if from my legs, and caught the eyeglass that washanging from my neck and opened it. During all these phenomenaDr. Slade's hands were before me on the table, and his feet full in myview upon the floor. The hand on each occasion came from the sideof the table opposite to where Dr. Slade was sitting. He was seated onmy left, and the hand came and seized me on my right leg, in aposition impossible to him. The hand I saw was not half the size ofDr. Slade's hand. It touched my hand three times, and I could feelthat it was warm, soft, and moist, and as solid and fleshly as my own.Again the slate was cleaned and held under the table tight againstthe wood, one-half of it projecting against the edge, so that I might be assured that it was tightly pressed against the wood; but the slatewas seized and with great force drawn away and rapidly raised aboveme, and placed upon my head. In this position the sound of writing upon it was distinctly heard by me. On removing it I found writtenupon it the following words: Man must not doubt any more whenwe can come in this way.-J. F., M.D.' Then the large arm chair rushed forward from the corner of the room in which it had beenplaced to the table. Again, the slate was placed under the table andprojecting from it . A hand twice seized and shook my leg, both of the hands of Dr. Slade being at the moment before me, and his wholeperson visible. Thus ended this experiment. All that I have reportedwas done, that is certain . How it was done and by what agency is aproblem for psychology to solve . For my own part I can only saythat I was in the full possession of my senses; that I was wide awake;that it was in broad daylight; that Dr. Slade was under my observation the whole time, and could not have moved hand or foot withoutbeing detected by me. That it was not a self- delusion is shown bythis that any person who chooses to go may see almost the samephenomena. I offer no opinion upon their causes, for I have formed.If they be genuine, it is impossible to exaggerate their interestand importance. If they be an imposture, it is eqally important thatthe trick should be exposed in the only way in which trickery can be explained, by doing the same thing and showing how it is done."none.578 Occasional Notes of the Quarter. [Jan.,Dr. Forbes, when alive, could write English, and speakthe truth . He seems to have deteriorated in intellect andmorality since he became a spirit, for he writes now like acharity school- boy, and tells a lie in saying that he wasPhysician to the Queen. Mr. Serjeant Cox is the DeputyChairman of the Court at the Middlesex Sessions, anddescribes himself as President of the Psychological Societyof Great Britain. A doubt naturally suggests itself whetherone who has such faculty of observation and such notionsof evidence as Serjeant Cox has displayed in his above quotedletter is in his proper place when engaged in the trial ofprisoners. And it may, perhaps, suggest itself to thosemembers ofthe Psychological Society who have self-respect ,that they could consult that best by relieving their Presidentforthwith of his onerous duties in attending séances, or bytheir retirement from a Society which imposes such tasks onsuch a worthy man. Serjeant Cox may be an amiable andgood man in all his private relations, but he is plainly, asDeputy Chairman at the Middlesex Sessions, giving to theservices of a petty Court talents which were intended notfor the correction of the criminal, but for the edification ofthe idiotic portion of mankind; and, as President of aSociety which assumes to be scientific, he seems to be doinghis best to make his Society ridiculous. At the meeting ofthis so-called Psychological Society, if we may trust a reportin the papers, he spoke of the prosecution of Slade as evidenceof a conspiracy of the materialists who wished to crushspiritualism. We hope that he has been mis-reported, forwe should be loth to think that Mr. Serjeant Cox thinksit decent to imply that a brother magistrate, in sentencing arogue and vagabond to imprisonment, has lent his authorityand office to promote the purposes of a nefarious conspiracy.Responsible Imbecility.We extract from the Scotsman of October 31st the following paragraph:-PECULIAR CASE OF THEFT.The case of the Lord Advocate against John M'Lean having beencalled, the Lord Justice- Clerk said this case was tried at the recentCircuit Court at Aberdeen. The prisoner was accused of theft bymeans of housebreaking, committed on the 21st or 22nd July, andthe jury found him guilty, but recommended him to the leniency of1877.]Occasional Notes of the Quarter.579the Court on the ground of his mental condition. In regard to thatmatter, the circ*mstances were peculiar. The prisoner had been aninmate of the Lunatic Asylum of Aberdeen for a considerable period,whither he had been transferred from the poor-house of his parish.He made his escape on the 1st of July, and three weeks afterwards hecommitted the offence of which he had been convicted. It appearedthat for a considerable time previous to his being taken to the asylum,which was in 1874, he had been of weak mind, and had been twoyears in the asylum before he made his escape. The medical men whowere examined, however, were of opinion that he was not of unsoundmind at the time they examined him. He had been three times previously convicted-once sent to a reformatory, once imprisoned for sixmonths, and once for 18 months. It occurred to his Lordship thatthis was a peculiar case, and required to be dealt with somewhat outof the ordinary course. Accordingly, he certified the case for sentenceto the High Court of Justiciary, and directed that a report beobtained from Dr. Mitchell, one of the Commissioners of Lunacy, onthe mental condition of the prisoner. Dr. Mitchell, it may be stated ,reported that the accused " is not insane in the sense of being freefrom responsibility to the law, but he is of very weak mind. " LordDeas, taking the prisoner's state of mind into account, was of opinionthat a much smaller sentence might satisfy the ends of justice than inordinary circ*mstances it would have been right to pronounce. HisLordship suggested six months' imprisonment. The other judges.concurred, and the Lord Justice- Clerk passed sentence accordingly,remarking that he thought the Court should add to it a direction tothe effect that the previous history of the prisoner and the report ofDr. Mitchell should be brought under the notice of the prisonauthorities. -Prisoner: Thank you, my Lord.The Court then rose.It strikes us very forcibly that in any similar case of thekind Dr. Mitchell would do well to leave the question oflegalresponsibility to those whom it concerns. Otherwise, he maydo his office as little credit as the English Commissioners inLunacy did their office in the Townley case. If a person " ofvery weak mind," who has just escaped from an asylum, is tobe punished as an ordinary criminal, though happily not toan extent not quite ordinary, it would be well that a Commissioner in Lunacy should have nothing to do with it. Wehope that Dr. Mitchell has been misreported, and that hereally did not give an opinion about legal responsibility; butif he only declared that the prisoner's weakness of mind didnot incapacitate him from knowing that theft was wrong, hewas bound to have added that it was a very weak-minded580 Occasional Notes of the Quarter. [Jan.,knowledge. If he is correctly reported, it seems to us that hemight feel himself called upon, as a Commissioner in Lunacy,to urge in season and out of season the instant dischargefrom asylums of all very insane or very weak-minded personswhom he may believe to be "not insane in the sense of beingfree from responsibility to the law." There will not then bemany insane persons left in Scotch asylums.PART II.-REVIEWS.The Lunacy Blue Books.1. Thirtieth Report of the Commissioners in Lunacy, 1876.2. Eighteenth Annual Report of the General Board of Commissioners in Lunacy for Scotland, 1876.3. Twenty-fifth Report on the District, Criminal and PrivateLunatic Asylums in Ireland.The past year was happy in leaving no eventful annals oflunacy behind it in Great Britain or Ireland. The lunatics,the doctors, and the Commissioners all seem to have enjoyeda period of comparative rest and calmness. No great questions in regard to the insane stirred the public mind, and noscandals or abuses roused the indignation or sympathy of thephilanthropic world. One or two of the weekly medicaljournals did admit a paragraph or two directed against theScotch Commissioners, but as these clearly emanated fromsome one who was paying off an old score, and only broughtcharges of doing too much statistical work, they fell veryflat. The Lancet, ever burning to be the pioneer of progress ,it is true, got up an inquiry of its own, dubbing a gentleman"Commissioner," and sending him on a tour round a few ofthe asylums near London. But when it was whispered thatthe real object of this proceeding was to educate one of ourfuture masters, and to train his prentice hand to rule withdignity, it was impossible to do other than laugh, with thenaughty, uncharitable people who get up such stories, at his"Reports," and to wish oneself a protegé of a journal witha taste for " Commissions. "The same journal taking its cue, as well as deriving itsinformation, from Dr. Bucknill, made a serious attack on1877.] Reviews. 581American asylums, their management, and their medicalsuperintendents, and, as usual in anonymous writing, went beyond the proved facts of the case. Dr. Bucknill was placedin a peculiar position. He had received even more than theusual American hospitality and personal kindness, and yethad in honesty to report many unfavourable things in manyof their institutions . Especially he pleaded for non-restraintmost earnestly but in the kindliest spirit. Then the Lancetstepped in with still more serious and sweeping charges,made in a spirit of great bitterness, and from the standpointof those whose own asylums came up to all that combined philanthropy and science could make them. The tu quoque replywas only too readily found in the record of shocking accidents and cruelties by individual attendants recorded in ourblue books, and was used at once by our exasperated cousinsin their journals. Dr. Bucknill made a gallant fight, and theMedico-Psychological Association backed him up: but arenot all these things written in the medical chronicles of theyear? The last contribution to the question has been madeby Dr. Wilbur, an abstract of whose paper will be found in another part of this journal. His chief objection to thepresent system in America is, that they have there no inspection of asylums by independent government officials corresponding to our Commissioners and Inspectors. On thispoint we believe Dr. Wilbur to be entirely sound in hisopinion, however much we disagree with the captiousness andsourness of his tone. For the sake of the patients, and forthe sake of the medical superintendents, such inspection bycompetent officials, of proved ability and high professionalstatus, is an absolute sine quâ non to the success as a policyof any lunacy system in any country.We would mostearnestly press our American brethren to re-consider theirviews on this question. Could they but know the weight ofresponsibility that would be taken off their shoulders, bothas regards the public and the relatives of their patients, bythe existence of an advising inspecting board, composed ofsuch men, they would be the first to seek its formation in the United States. Some of them labour under most erroneous opinions as to the powers of our Commissioners. Arethey aware that in Great Britain the Commissioners cannotin any way interfere with the ordinary management of anypublic asylum, but can merely make and publish a report?We can assure them that, so far from being able to interfere582 Reviews [Jan.,.with the proper independence and authority of a superintendent, there is not an asylum in the kingdom whose committee and physician have not neglected many of theirrecommendations, and gone in the teeth of their opinions.This, in fact, adds a zest to the carrying out of a man'sindependent views, and stimulates originality of conceptionin asylum management, in a way that nothing else could do.We confidently appeal to the facts, whether an able andcompetent asylum superintendent on this side of the wateris not as independent in his position in all respects as inAmerica. If such an official is not very able and not verycompetent, then, for the sake of humanity, let him be stimulated and guided.The total number of the insane, so far as they are known to theCommissioners, was 64,916 in England, and 8,225 in Scotland; in all, 73,141 .The new cases for 1875, for both countries, were 14,715, excludingtransfers from one establishment to another, but including re-admis- sions.5,129 patients died during the year in Great Britain; and 5,869 recovered from their malady.There was an increase of 1,123 in the total number in England, and156 in Scotland. The rate of increase was therefore very much thesame in each country for the year, and as compared with the past tenyears was lower in England than the average increase, while in Scot- land there was no decrease.There was an increase of 196 in the new cases in England, and of186 in the new cases in Scotland.•In England the rate of recovery in county and borough asylumswas 34.11 per cent. on the admissions (including transfers) , which wasat the rate of 1.5 lower than the average since 1859. In Scotlandthe rate was 44.4 per cent. on the admissions ( excluding transfers) ,being more than 4 per cent. above the average.The death- rate in those institutions in England was 8.7 per cent.of the total number under treatment, and 11.3 on the average numberresident. This was slightly over the average rates . In Scotland thedeath rate was 5.3 on the total number under treatment, and 6-6 onthe average number resident.Regarding the increase of insane patients at presentresident in asylums the following extracts are taken fromthe report of the English Commissioners: -It, however, seems probable that the pecuniary advantage to unionsarising out of the Parliamentary allowance of 4s. per head per week1877.]Reviews. 583for every pauper patient maintained in an asylum, has in some countiescontributed to increase the number in these institutions, by the removalthereto of many patients who, but for such inducements, would havebeen retained in Workhouses. It will be observed, by an examinationof Table ix. , in this Report, and by a comparison of Table xii. in theReports of this and of last year, that the increasing ratio of the totalnumber of pauper lunatics maintained in asylums has, during the lasttwo years, been accompanied, as a rule, by a decreasing proportionkept in Workhouses, and the percentage of out- door paupers, whoare boarded with their relatives or others , has continued to diminish.From Table xi. it will be observed that there has been in 22 out ofthe 54 counties an actual diminution in the total number of insanepaupers on the 1st of January last, as compared with the 1st ofJanuary, 1875; but owing to the fact that an increasing proportion ofthe total number appears to be located in asylums, there is no sensiblediminution in the demand for increased asylum accommodation.The value of the conclusions to be derived from the statistical information of the English Commissioners may beestimated from what is here quoted: -The statistical information given in our Annual Reports hasgradually increased in bulk and importance, and we have reason tobelieve that among those interested in the care and treatment of theinsane, and the question of insanity in its various aspects, this portionof our Report is considered to possess much value. At no time,however, have we considered it our duty to draw any but the mostplain and obvious deductions from the figures which the means at ourdisposal enable us to present; nor can we deem it advisable or justifiable to offer to your Lordship, or to the public, any speculations ortheories of our own based on these statistics . At present we do notthink that the recorded experience is sufficiently extensive to warrantmany very certain conclusions to be drawn from it, and the officialpublication of conjectures founded on confessedly imperfect data, andtherefore liable to be falsified by the event, would not, we submit, beattended by any public advantage.The following quotation from the English Commissioners'Report gives the percentage of recoveries and deaths during the year:-The reported recoveries of the year, as compared with the admissions, were on the proportion of 34.11 per cent.; the deaths, uponthe average daily number resident throughout the year, were at therate of 11.36 per cent. , and, calculated upon the total number undertreatment, the rate of mortality would be 8.70 per cent.It will be seen on an examination of Tables v. , vi. and vii . , that therecoveries have been nearly 4 per cent. lower than those of the pre-584 Reviews [Jan.,.vious year, and 1.5 per cent. below the average of the last 17 years.The mortality has also been somewhat unfavourable, having been about5 per cent. higher than that of the previous year, and than the averagemortality of the last 17 years.The larger proportion of chronic cases included among the admissions oflast year must be accepted as an explanation of the diminishedratio of the recoveries; whilst to the severe weather at the commencement of 1875, which carried off an unusual proportion of agedpatients, must be attributed the higher rate of mortality shown bythe figures of the year.With reference to the weekly cost of insane patients, theEnglish Commissioners make the following statement:-The weekly cost, per head, of maintenance, medicine, clothing,and care of patients in county asylums, averaged 9s. 97d. , and inborough asylums, 11s. 6d. , and in both taken together, 10s. 04d.The details of the averages of weekly cost are as follows: -Borough Asylums.£ s. d.4 104County Asylums.Provision (including malt liquor in ordinary £ d.Clothingdiet)Salaries and wagesNecessaries, e.g., fuel, light, washing, &c.Surgery and dispensaryWines, spirits, porter .Charged to MaintenanceAccount.Furniture and beddingMiscellaneous14021000000000000007 00 10 02 11 014 00 11/1/1251100 80 00113OI∞470 07Garden and farm .Less monies received for articles, goods, andproduce sold (exclusive of those consumedin the asylum )Total average weekly cost per head01/07/2003/0000000. 0 0 4 0 0 22• 0 9 9 0 11 637With reference to the visitors' books we make the following extract:-The whole of the entries made by us in the Visitors ' Books of thelunatic hospitals will be found printed in Appendix ( E) . For severalyears back they have been thus published, and a perusal of them issufficient to give a good idea of the general condition and progress of each institution.They indicate, moreover, the nature of the inspection formed byus with regard to suitability of the buildings, their condition andrepair, and the general arrangements for the care and treatment ofthe1877.]Reviews. 585patients. It should not, however, be supposed that these mattersform the only subject of inquiry at our visits, though they aloneappear recorded in the Visitors' Book. In fact, that portion of ourwork which involves most responsibility, and frequently occupies mosttime, is the examination into matters connected with individual cases .Special attention is always given to patients admitted since the previousvisit, or who at that visit were reported as exhibiting any signs ofimprovement. Full inquiry is made into complaints either of unduedetention, of rough usage, of insufficient diet, or of any other grievance, whether made orally by patients, or arising out of lettersaddressed to us, and referred to the Visiting Commissioners for examination.In every case where there is any show of reason for it, a privateinterview, often of considerable length, is granted to the patientdesiring it. This practice is, of course, universal, and irrespective ofthe legal character of the establishment visited . In County andBorough Asylums, from the nature of the case, the number of patientsas to the propriety of whose detention there can be any serious questionis extremely small, and the power of discharge is not vested in us,but in the Committee of Visitors . In Hospitals and Licensed Houses,however, the case is different, and the Legislature has here provideda book called the " Patients ' Book," for the purpose of recordingthe result of any special inquiries, and the observations on particularcases which may occur to ourselves, or to the Visitors or Committeeof Management.Generally speaking, the reports will be found favourable to themanagement of the Registered Hospitals during the past year.Of illegal detention of patients the English Commissionerssay:-Some few cases of the illegal detention of persons of unsound mindhave been brought under our notice, and we have inquired fully intothe particulars of each. When satisfied of the absence of neglect orill- treatment by those having the charge of such persons, and of theirhaving offended through ignorance of the law rather than with thewish of evading it , we have been satisfied by an expression of regretfor the offence, and by having the charge of the patient authorised bythe statutory order and certificates.The English Commission advocate strongly, and we thinkjustly, the change of residence for patients to the sea- sidedwellings, and their remarks on this topic is well worthy of attention.The system of removal of patients to the sea-side or elsewhere fora time, for the benefit of their health, as sanctioned by section 86 ofthe Act 8 and 9 Vict , c . 100 , and as extended by 25 and 26 Vict. , c. 3,s. 38, so as to authorise leave of absence on trial , for the purpose of586 [Jan., Reviews.testing the power of self-control and management, continues in fulloperation.In several ways it is a most valuable arrangement. To the convalescent the change thus afforded is often of great benefit inre-establishing the healthy tone of the mind, while the relief from themonotony of the asylum is keenly appreciated by a large proportionof the hopelessly insane. At present the law does not, as we areadvised, permit us to grant any consent to removal, on leave or otherwise, to any place beyond England and Wales, the limit of our ownjurisdiction; but we should be glad if, in any amendment of the law,power were given to extend the license, so as to admit of a trip toScotland, or elsewhere in the United Kingdom, without involving thelapse of certificates .We find that the medical proprietors of licensed houses, and othershaving charge of the insane, enter, as a rule, very readily into ourviews on this subject, though the arrangements for safely carryingout an annual excursion to the sea are attended with trouble, a certainamount of anxiety, and sometimes with expense to the proprietor.During the past year we find that we have issued consents for theremoval, for health or on trial , of 819 patients . In 1865 thecorresponding number was 492. These figures apply solely to the Metropolitan licensed houses and the single private patients throughout England.The distribution of pauper lunatics in Scotland is containedin the subjoined:-It appears from this table that the proportion of pauper lunacy topopulation is far from being the same in all the counties of Scotland .Certain counties steadily maintain a high, and others as steadily alow proportion. The difference becomes very striking if we contrastsuch counties as Renfrew, Lanark, and Linlithgow with Argyll,Perth, and Inverness. Thus, at the first of January, 1875, the proportion of pauper lunatics per 100,000 of the population wasIn LanarkIn RenfewIn Linlithgow .148 In Argyll126 In Perth149 In Inverness337275273These figures may be regarded as exhibiting the measure of thepersistent burden of pauper lunacy in the two sets of counties;but if, instead of dealing with the number of pauper lunatics chargeable on a particular day, we deal with the whole number relievedduring the year, we find the position of the two groups reversed.Thus, when we calculate for each of the six counties, the proportion ofthe number relieved during the year 1875 , to the number on the rollon the last day of the year, we have the following results:-For Lanark . 130 to 100For RenfrewFor Linlithgow .·129 to 100126 to 100For ArgyllFor Perth• · 115 to 100· 115 to 100For Inverness · 112 to 1001877. ]Reviews. 587In various former reports, but more particularly in our last (Seventeenth Report, pp. ix . , and 260-269) , we have endeavoured to explainthe nature and origin of these important differences, which maintainthemselves steadily from year to year.We give the following extract from the Scotch Commis- sioners' Report:-It is too apt to be forgotten that the statutory lunacy of a countryis far from being a thing which "human power cannot multiply andmodify." In our Fifteenth Report ( p. 285) we pointed out that "theexistence of lunacy, in so far as it is officially recognised or requiredto be dealt with by the State, is at present decided by the certificatesof two medical men; and indeed must always be determined in thator some similar manner. If there be persons who imagine that auniform standard of mental soundness is accepted by all medical men,or by any one medical man in all circ*mstances, they must have littleexperience to guide them. Such certificates are always signed after aconsideration of the social as well as the medical circ*mstances ofeach case. And it is scarcely open to doubt that in actual practicethe source from which the required expenditure is to be obtained ,is, rightly or wrongly, a commion element in this consideration .Speaking of the discharges of the recovered, the Scotch Commissioners say:-Of 100 patients discharged recovered during the ten years, 1866 to 1875 , 22 were private, and 78 pauper. The ratio of recoveries,therefore, among private and pauper patients, is in tolerably close ac- cordance with the ratio of admissions.The average ratio of recovery is highest in parochial asylums.This is probably explained by the fact that the patients received intothese institutions comprise a greater proportion of persons labouringunder the ephemeral forms of insanity, than those received into publicand private asylums.The average annual mortality is highest in the parochialasylums, and this the Commissioners think is due to theproportion of admissions, as is shown from the following tableand comment:-Taking the average of the ten years, 1866-75, we find asfollows:-Proportion of admissions percent. on number resident.Proportion of deaths per cent.?on number resident.Parochial Asylums.50.5 37.8Private Public and Lunatic Ward Asylums. Dist. Asylums. of Poorhouses.50.1 21.810.2 9.5 8.5 7.9Many things must influence the death-rate in particular asylums,XXII.39588 Reviews [Jan., .as well as that which is now under consideration; but it appears tobe satisfactorily established that the differences depend, in somemeasure, on the varying proportions of old- standing to recent casesin the populations of the different asylums.The Scotch Commissioners give us statistical informationregarding general paralysis of a most elaborate and accuratedescription. Such a numerical account of general paralysis,as occurring in a county, must not only prove of greatinterest, but also of lasting value to all interested in thisdisease, and we consider the only way of doing justice to thecompleteness of their remarks is to quote fully from theirReport.One of the diseases, whose occurrence as a cause of death is leastlikely to be inaccurately recorded, is that known as general paralysisof the insane; it may, therefore, be useful to present some of theresults of an inquiry into its statistics, as taken from the returnsreceived by us from all the asylums of Scotland.The character and course of this disease are so especially destructivethat, before its almost invariably fatal termination, it can fail in fewcases to be recognised. It is, therefore, probable that if the inquiry be limited to the cases in which the disease has run its fatal course,no error of great importance in the data will vitiate such general conclusions as might fairly be drawn from them.But, even with this limitation, it is to be feared that we cannotregard the facts as supplying a basis which is in all respects perfectly reliable. There is evidence in the details which we possess, thatsome medical men still apply the term general paralysis to conditionsin which the name is rather descriptive than nosological; and thatothers consider the process of cerebal disorganisation which frequentlyaccompanies senile dementia, as entitled to be considered a form ofthis disease. Such differences as may be caused by those diverseopinions and practices cannot perhaps be entirely prevented in anymedico-statistical inquiry; but it is probable that they will not benumerous in this particular instance, and that they will in most casesbe somewhat counterbalanced, either by their own manner of distribution, or by the occurrence of other errors of opposite and consequently neutralising tendency.During the ten years, 1865-74, 524 deaths from general paralysiswere reported to us. Of these, 90 referred to private patients, and434 to paupers.It is doubtful whether the statistics of the private patients canyield any useful result. The number is too small to afford a valid basis of calculation, and the information which we possess regardingthem is too imperfect to be of real value. According to the state- ments in the asylum documents, 65 of the private patients resided insome parts of Scotland previous to their admission; 14 were resident1877.]Reviews. 589in England; 10 in the Colonies and the United States of America;and in one case there is no information regarding the previous residence of the patient.If we take both pauper and private patients labouring under thisdisease, we find that they present an annual number of deathsamounting to 1.6 per 100,000 of the population, one-fifth being private and four-fifths pauper. The numbers for each of the tenyears is shown in the following statement. The series seems to showa tendency to an increased frequency of the disease; but the numbersare not large enough, and the progressive character of the increaseis not sufficiently steady, to justify our regarding the existence of the tendency as demonstrated.TABLE XI.ANNUAL NUMBER OF DEATHS FROM GENERAL PARALYSIS IN ALL THE ASYLUMS OF SCOTLAND.Private PatientsPauper Patients1865. 1866. 1867. 1868. 1869 1870. 1871. 1872. 1873. 1874. Total.MFM FMFM FMF M. FM FM FMF MF MF7 0 4 011 0 8 310 3 5 1 9 1 6 4 9 2 4 3 73 1723 8 36 5 30 638 733 845 734 1331 842 11 39 9 351 83 195TOTAL.............. 30 8 40 5 41 646 10 43 11 50 843 14 37 12 51 13 43 12 424 100General paralysis of the insane is regarded as being of mostfrequent occurrence among town populations, though no definitefacts have been hitherto brought forward to establish this opinion .We have classified the 434 pauper patients according to the parishesto which they were chargeable, and find the correctness of the opinionfully confirmed. The cases belonging to parishes connected with thelocalities called town- districts by the Registrar- General yield anannual death-rate of 1.9 per 100,000 of the population; while thosebelonging to the insular and mainland rural districts present only 8per 100,000, or less than half the town rate.If we adopt the other classification sometimes used by theRegistrar-General, and group the cases according as they belong to the Principal Towns, the Large Towns, or the Small Towns and Rural Districts, we find the relation to density of population presented in a more striking manner. For each 100,000 of population we find our annual death-rate from general paralysis in the Principal Towns, 21; in the Large Towns, 13; and in the Small Towns and Rural Districts , 7.It is necessary, in order to appreciate these differences at theirproper value, that we look at them in connection with the differences590 Reviews. [Jan.,which are presented in the statistics of other diseases with the sameclassification of localities. The following Table gives an opportunityof doing this in regard to the statistics for the ten years 1862-71 .The respective rates for general mortality, for death from diseases ofthe brain and nervous system, and from delirium tremens, have beenselected as presenting the most instructive figures.TABLE XII.Annual Rates of Mortality per 100,000 of General Population of Scotland for the Ten Years, 1862-71 .Localities.All Causes.Diseases of Brain and NervousSystem.Delirium General Tremens. Paralysis.Insular and Main- land- Rural 1841 21.1.2 .8Towns 2565 35.6 2.6 1.9All Scotland 2131 27. 1.8 1.6 91From this it appears that the higher mortality characteristic oftown populations manifests itself in a special manner when welook at the statistics of all nervous diseases, but still more remarkablyin regard to delirium tremens and general paralysis.This comes out still more distinctly if we consider the number ofdeaths in the towns from these several causes, proportionate to 100 deaths from each cause in the insular and mainland-rural districts.Calculated in this way, we find that for every 100 deaths from allcauses in the rest of the country, there are in proportion to population 139 deaths in the town. For every such 100 deaths from nervousdiseases there are 170 in the towns. For every 100 deaths fromdelirium tremens, there are 217 in the towns. And the corresponding proportion for general paralysis is 237. We have here a remarkableindication of the special prevalence in towns of diseases of thenervous system . This no doubt results partly from the greaterstrain which town life makes upon the nervous and mental energy, butprobably in a still greater degree from the injurious influences of imperfect sanitary arrangements and hurtful social practices; and it isinteresting to find the opinion that delirium tremens and generalparalysis are special products of the dissipation and feverish activityof town life so strikingly corroborated by the figures. We have thought it desirable to exhibit the relative proportions of delirium1877.]Reviews.591tremens and general paralysis, because general paralysis is believedby some authorities to be due to excessive indulgence in alcoholic andcognate stimuli, and the parellelism in the geographical distributionaffords some countenance to this view.The Registrar- General adopts for some purposes a division of thecountry into Principal Towns, Large Towns, Small Towns, and RuralDistricts; and if we classify the deaths from general paralysisaccording to these groups, we merely obtain an additional illustrationof the close relation which their number bears to the density ofpopulation. The following Table gives the classification, with thegeneral death-rate for the respective districts, and also the annualproduction of pauper lunacy. The tendencies of the three columnsare in the same direction, though the increase corresponding to thedensity of population is, as before, most marked in the case ofgeneral paralysis. In other words, while the death-rate from generalparalysis is three times as great in the Principal Towns as in theSmall Towns and Rural Districts , the death- rate from all causes isconsiderably less than twice as great.TABLE XIII.Per 100,000 of Population.Annual Death-rate.Annual Productionof Pauper Lunacy.General Paralysis. All Causes.Small Towns and +7 1915 Rural DistrictsLarge Towns 1.3 2524 41Principal Towns...... 2.1 2703❁ རྒུསྐྱ3562Scotland 1.3 222212545The recorded ages at death, and the numbers of each sex at each period, are given in the following statement. It corroborates broadlythe opinions generally received in regard to the respective frequency of the disease according to age and sex. There is reason to believe,however, that a considerable number of the cases of death at themore advanced periods of life have been what most physicians would have considered more accurately named as senile dementia. Any attempt, however, that we could have made to eliminate this errorwould have deprived the Table of its value.592 Reviews. [Jan.,TABLE XIV.Age and Sex of those who Died of General Paralysis in Scotch Asylums during the Ten years 1865-74.Sex. Ages.21 to 30 31 to 40 41 to 50 51 to 60 61 to 70 Over 70MalesFemales WAbsolute Numbers .TotalMalesFemalesTotalPercentage for each Decade .Total.2688899998164 13226 3138363 29 10 42415 15 5CT10034 190 1632878 44 15 5246833839 3126ཚཚ3123515 ས7 2 10015 15 5 100630 」「 81 」「15 8 3 100TABLE XV.Duration of Residence of those who died of General Paralysis in Scotch Asylums during the Ten Years, 1865-74.Under From From From From 5 to 1 year. 1 to 2 yrs. 2 to 3yrs. 3 to 5 yrs. 10 yrs .M. F. M. F. M. F. M.Private 36 10 22Pauper....... 160 37 104Over10 years.Total.F. M. F. M. F. M. F. M. F. M. F.

3 9 1 6 1 ... 122 47 13 29 6 8 www7 8 1...

1 73 173 5 351 833 6 424 100243 151 70 42 9 9 524Total......... 196 47 126 25 56 14 35coPercentage for each Period.Males.........Females.......9546 30 13 8 2 147 25 14 7 10000 100100Total 469529 13 8 2 2 1001877.]Reviews. 593The remarks made in regard to Table XIV. are applicable also toTable XV. , in which the duration of the residence of the patients inasylums is given. It has also to be observed here, that in those casesin which there may have been more than one period of asylum residence, it has only been possible to take account of the final period. In75 per cent. of the cases, the death appears to have taken place within two years of the admission of the patient to the asylum.The Report of the Inspectors of Irish Asylums for theyear 1875, late as its issue undoubtedly was, we find to havethis year appeared before the corresponding Blue Book of theScotch Commissioners. In their abstract of the copiousTables of Statistics accompanying their report, the Inspectors notice the gratifying fact that while 2,132 patientswere admitted to district asylums during the year, 939 weredischarged cured, a proportion of over 44 per cent. , a resultwhich will compare favourably with that obtained in similarinstitutions in either England or Scotland. In addition tothese, 236 were discharged improved, while 355 of the casesadmitted were relapsed cases, so that the proportion of curesto new cases admitted reached over 52 per cent. It is wellknown that a large number of these relapsed cases, indeedby far the greater proportion, consists of patients formerlydischarged, or, rather, almost invariably removed by theirfriends, before their recovery was complete, and generallyagainst the wishes and advice of the medical superintendent,the patients being usually brought back, after a short sojournat home, in a more hopeless state than at first, often becoming a permanent burden on the asylum. We would suggestthat a Table bringing out this fact in the full light of statistics might very advantageously be added to those atpresent given. The rapidly decreasing proportion of discharges among these relapsed cases is shewn in Table 14,where the numbers 242, 73, 27, 7, and 1 , are given as thoseof relapsed cases admitted after previously sojourning in theasylum once, twice, three times, four times, and five timesrespectively. The figures might of course be held to implythat patients had a smaller tendency to relapse the morefrequently they were discharged, but experience shows thatthis is not the case, and that our interpretation of the figuresis the true one, viz., the patients were not re- admitted,because they had not been discharged, i.e., they had becomepermanent inmates of the asylum. Of course, if a patientis removed he ought to be discharged, even though theremay be reasonable grounds for apprehending a relapse, and594 Reviews [Jan.,.such cases there always are, though, we maintain, they arefew in comparison with the numbers who relapse in consequence of too early removal by their friends. This is thepoint we should like to see brought out by a Statistical Table.On the important question of relationship or hereditarytendency Table 17 shows that more than 10 per cent. of theinmates of the District Asylums have, or have had, relations insane.Table 16 gives the deaths during the year as 742, out ofa total under-treatment of 9,717 , or less than 8 per cent. , afavourable result, when it is remembered how many patientsare brought in in a state of extreme exhaustion, whetherfrom refusal of food or from a general break down of thesystem in old age, of which insanity is only a prominentsymptom.Table No. 4, giving the ages of patients admitted, is , weobserve, classified in periods of ten years each from birth.This is, of course, the usual method, and for the mere numerical statistician is all that is wanted; but we would suggestthat for the purposes of the medical statistician a betterarrangement would be to classify together all patients underthe age of 15, than to give two periods of five years each,corresponding to the periods of the development of pubertyin the female and male sexes respectively; after this twoperiods of 10 years each would afford material for generalobservations, and would include the periods of greatestactivity of the sexual system in both sexes; and after thistwo periods of five years each would embrace the periods ofcomparative decline of these powers in the female and malesexes respectively, while two succeeding periods of 10 yearseach would bring up the observations to 75 years, and wouldafford material for examining the bearing of old age on thedevelopment of insanity. We think that to practical men thevalue of such a modification of the Tables relating to theage of patients will be at once manifest.We observe in Table 11 that the number of unmarriedinsane is 5,303, viz. , 3,038 males, and 2,245 females, against1,674 married persons, viz . , 813 males, and 861 females. Tothe former number may also be added 441 widowed persons,viz . , 118 males, and 323 females, and probably the majorityof the 323 returned as unknown, viz. , 153 males and 170females . When we remember that marriage is the almostuniversal condition among the peasantry of Ireland duringthe ages at which insanity is most prevalent, we cannot but1877.]Reviews.595be struck with the great preponderance of insanity among theunmarried. To give full point to the disproportion broughtout by this Table it would be necessary and highly desirablethat the numbers of single, married, and widowed persons inthe whole community for the ages during which insanity isprevalent, say from 15 years upwards in five year periods,should be correlated with the numbers of Table 11. Materialsfor this correlation could of course be readily obtained at theRegistrar General's office .Ön Table 15 we would observe that without abrogating thepresent classification, a valuable resume of it might be given by classifying patients as out-door workers and indoorworkers; also as labourers and artizans, meaning by the latterterm those who employ their brains to a marked degree inthe guidance of their manual labour; then the educatedclasses, or those who practically employ their brains only,might be grouped together. Any trades known to have aspecial tendency to produce insanity might be specially referred to, if such should be discovered; at present we arenot sure that any such exist, the popular prejudice againsthatters notwithstanding, for the insane population of Irelandis stated in this table to contain only four members of thismaligned class, while there are no fewer than 112 shoemakers.The absence of any employment would appear to have aremarkably serious effect, for we find 161 mendicants, though mendicancy has very much disappeared in Ireland of lateyears.We observe that the salaries and wages of officers andattendants alike still continue very much below those ofEnglish and Scotch Asylums, though the duties are no lessonerous; indeed, the Medical Superintendent in Ireland hasresponsibility in many matters of which his brother in GreatBritain knows nothing; while the requirement which obligeshim to serve for 40 years for a 2s. 3d. pension , as against 15years in England, still remains unamended, and the consequent injustice unredressed . Further, the absence of efficientmedical assistance absolutely prevents his devoting thatamount of attention to the purely medical consideration andstudy of insanity that his English and Scotch brethren canfind time and strength for; a great reform would, in our opinion, be effected by appointing one or more assistantofficers in every asylum, according to the number of itsinmates. At present only five asylums in Ireland have anassistant medical officer, and one of these, the Richmond,596 [Jan., Reviews.has over 1,000 inmates. The salary of the assistant wouldbe saved by making him discharge the present duties of theapothecary, and dispensing with the obsolete office of visitingphysician, which is unknown in England, and in Ireland wasformerly introduced only because the Governor was a lay official.Commenting on the slight increase in the mortality of1875 as compared with 1874, about 8 per cent. , the Inspectors remark, that it may be in part attributed to thenumber of hopeless or indeed moribund cases transmittedunder magisterial warrants as being dangerous or violent.This may no doubt be the case; but our experience goes toprove that this is the very class of cases on behalf of whichevery point ought to be strained, and every possible irregularity overlooked, in order to compass their immediate admission to an asylum. For, indeed, our experience is that thesepatients are almost invariably moribund, simply from want offood, their friends having been utterly unable to inducethem to take anything, and indeed ignorant of the kind offood, beef-tea, &c. , which ought to be administered, andunable to administer it. Many of these patients die, nodoubt, after admission, but a larger proportion are saved byimmediate artificial feeding; and more still would be savedwere it not for the delays, sometimes of two or three days,imposed by the necessity for first obtaining and afterwardsfilling up the necessary forms imposed by the law. To obtainthe form of application from the asylum involves in itself adelay of two days in country districts, and two days in suchcases simply means all the difference between life and death.The magistrates' warrant can no doubt be obtained from thenearest petty sessions clerk, but there is every difficulty in theway of filling it, unless the patient has committed overtviolence against others. That the patient's mania is dangerous to his own life ought to be, but is not, considered sufficient to bring him under the category of dangerous lunatics.The Act by which two governors can authorise immediate admission, in accordance with certain engagements, nevertheless involves the delay of obtaining the necessary forms.The Medical Superintendent, though authorised to admitcases as urgent, can only do so on the production of theseforms duly filled . The Scotch plan of a " medical certificateof emergency " might be advantageously adopted in Ireland,on which a patient could be detained for three days.The Inspectors remark that practical arrangements have1877.]Reviews.597not yet been effected for the removal of chronic and quietpatients to workhouses. We think that a great deal ofdiscretion will be necessary regarding the removal of thesepatients. Chronic and quiet patients are just those whor*nder most assistance in carrying on the daily routine ofhouse-cleaning and other work in the asylum; and if they areremoved it will be necessary in most cases to hire wardsmaidsof a class much below that of the ordinary asylum attendantor nurse to replace them. These poor creatures may ingeneral be considered fully to earn by their work the greatercomforts of asylum life as compared with that of the workhouse. Of course, if they are very infirm this argument willno longer hold, but, as the Inspectors remark, workhouseshave many drawbacks which make it a matter of doubt howfar they may be suitable for the accommodation of theseessentially sick inmates.The Inspectors comment strongly on the disposition manifested by some Boards of Governors to endeavour to reduceasylum expenditure to a level with that of workhouses, andthat notwithstanding the subsidy now granted by Government with the very reverse object. It is only to be regrettedthat the Inspectors have no further power than simply toembody such remarks in their report. We think that whenGovernors refuse to provide beds and bedsteads for theirincreasing numbers, and keep patients lying during a hardwinter on straw placed on the floor, as we have known themto do, notwithstanding the urgent and repeated remonstrances of the Medical Superintendent, the Inspectorsought to possess a definite power of interference. Butindeed we should be strongly inclined to suggest that theseinstitutions should be removed altogether from local control,and constituted essentially a State service, their expenditurebeing entirely provided for out of the Consolidated Fund, atleast until the surplus funds from the Church Disestablishment should be forthcoming. The relief from local taxationwould probably compensate country gentlemen for the disuseof their services as Governors. The audit might be effectedas hitherto, the control of expenditure being entrusted to theMedical Superintendent under the supervision of the inspectors. This system has been found satisfactory in Criminal orState Asylums, and has just been introduced into the Prisondepartment of Ireland by Sir M. H. Beach's recent Act, theseinstitutions having been thereby removed from local control,and placed entirely under that of a Central Board. We think598 [Jan.,Reviews.it would be highly desirable that a similar measure should beapplied to Asylums, the medical element being stronglyrepresented in the Central Controlling Body. This measurewould, we venture to think, be preferable to swamping theAsylum's office altogether in the Local Government Board,as at present talked of. Asylums are hospitals, and a centralbody governing them ought to be essentially medical; theLocal Government Board is essentially lay.The Functions of the Brain. By DAVID FERRIER, M.D.,F.R.S. Smith, Elder & Co. , London, 1876.This work may fairly be considered as representing thelatest additions to our knowledge of cerebral physiology.The opening chapter is devoted to a brief sketch of the structure of the brain and spinal cord. Then follows a descriptionof reflex action as observed in the lower animals and in man.A very ancient drawing of an ascidian, which here does duty,as it has done in other works for the past forty years, leadsone to enquire whether it is not possible to make a morefaithful illustration of this interesting creature. The function of the Medulla oblongata are fairly described, but inall these descriptions there is not much that strikes one asbeing fresh or worthy of special attention . Dr. Ferrier havingled the way up from the lowest nervous function to thehighest, proves not only by his own, but by the experimentsof others, that the cerebrum is the sole seat of volition. Forwhilst an animal may exist, if fed, and even perform combinedmovements without any cerebrum, that is, with only thebasal ganglia, it is incapable of originating active manifestations of any kind. Consciousness also has its seat, not inthe mesencephale, but in the higher nerve centres. Thenerve faculty of adaptation to circ*mstances, which an animalwithout any cerebrum may be capable of, is no proof of consciousness, and, therefore, though the lower nerve centresmay have this faculty of adaptation, they do not necessarilypossess consciousness, or even sensation. Under the impression that many erroneous ideas arise from confusion inrespect to these terms, Dr. Ferrier suggests the term asthesis,to signify a new physical impression on the centres of specialsense, and the term noesis to signify a conscious impression,but he does not use these terms much himself.Equilibration, the loss of which is so prominent a fea-1877. ]Reviews.599ture in many nervous diseases is a function of the mesencephalic and cerebellar centres. It may be overthrown bylesions of the afferent or efferent apparatus alone, or of theencephalic centres alone, or by conjoint lesions. The afferentapparatus consists of ( 1 ) Organs for the reception andtransmission of tactile impressions: (2) The organ for thereception and transmission of visual impressions: (3) The semicircular canals and their afferent nerves. The incoordination of Locomotor Ataxy does not depend on themuscular sense in particular, nor on the loss of cutaneoussensibility in general. Hence it would appear that theefficient excitant of the co-ordinating centres of equilibrationand locomotion is a special form of cutaneous impressiongenerated by contact.Visual impressions exert an important influence on equilibration, and may, in a measure, compensate for the loss oftactile impressions.Recent researches on the functions of the semicircularcanals of the inner ear have made it clear that these have avery important relation to the power of equilibrations. InMeniere's disease they are diseased, and cause sudden attacksofvertigo and sickness, which are generally preceded by, orare associated with, ringing or pain in the ears.Functions of the Optic Lobes or Corpora Quadrigemina.-The destruction of these centres causes blindness; irritationproduces dilatation of the pupils on the opposite side, andvarious other effects which tend to the belief that theseganglia are concerned, not only in visual sensation, but, also,that they are the centres specially connected with the reflexexpression of feeling or emotion.Functions ofthe Cerebellum . -This organ seems to be a complex arrangement of individually differentiated centres, which,in associated action, regulate the various muscular adjustments necessary to maintain equilibrium of the body: eachtendency to the displacement of the equilibrium round ahorizontal, vertical or intermediate axis acting as a stimulusto the special centre which calls into play the antagonisticor compensatory action. There seems to be a connectionbetween the semicircular canals and the cerebellum, from theremarkable similarity between the effects of lesion of theformer and injury or removal of certain parts of the latter.The irritation or removal of the cerebellum has no effecton the sexual organs or instinct.Functions of the Cerebrum. -Though the credit of having600 [Jan.,Reviews.first demonstrated the localisation of the cerebral functionsbelongs to Hitzig and Fritsch, yet their experiments havebeen elaborated and improved on by Dr. Ferrier. He hasbeen successful, not only in eliciting more definite results,but also in obtaining results from parts which they considerto be inexcitable. This success he attributes to the use ofthe induced, in preference to the continuous electric currentfor excitation; and also to increasing the current up to amuch higher state of intensity. He labours to prove, inanswer to objections brought against his experiments, thatthe effects of the excitations are not due to conductionto the basal ganglia; and the errors which might arisefrom diffusion to neighbouring centres have been carefully allowed for and eliminated by repeated experiments.The results from excitation are, in nearly all cases,checked by destruction of the parts, and are supplemented by careful post mortem examinations as to the extentof the lesions, etc.The fact that even after removal of the grey matter thesame effect may be produced by stimulation in the denudedspaces, is no argument that the motor effects are dependenton the corpora striata, etc. For the cortical centres actdownwards on the muscles necessarily through the basalganglia and motor tracts, and the application of theelectrodes to the medullary fibres is essentially equivalentto the stimulus caused by the functional activity of thecentre itself.It is difficult to summarise the results of Dr. Ferrier'sexperiments without reference to the illustrations with whichhis work abounds. The areas of electrical irritation are givenin circles which not only point out the seat, but also limit theextent of the regions for certain definite movements.The areas to which the electrodes were applied, and theeffects of stimulation on them, are as follows: --1. On the postero-parietal lobule. Advance of oppositehind leg as in walking.2. On the upperpart of the ascending parietal, and adjoiningpart of the ascending frontal convolutions. Complexmovements of thigh, leg and foot, as the animal wouldemploy in grasping, or in scratching itself.3. Close to the ascending frontal portion of above centre, andclose to a slight sulcus or depression at the upper part ofthe ascending frontal. Movements of the tail (pleasure)associated with some ofthe movements as in 2.1877. ]Reviews.6014. Situated behind (3) , and below (2) , and occupying adjoining margins of the ascending frontal and ascending parietal convolutions. Retraction with adduction ofopposite arm. Like swimming movements. In cats likestriking a ball with paw.5. On the ascending frontal convolution, at its junction withsuperior frontal. Extention forwards of the opposite hand and arm, as in reaching. Prehensile movements.In cats movements as in raising the pawto step forwards.6. In the ascending frontal convolution, at the bend of theantero-parietal sulcus. Supination and flexion of thefore arm, as in raising hand to mouth.7. On the ascending frontal convolution below (6) . Actionof the zygomatics.8. On the same convolution below (7) . Elevation of ala ofnose and upper lip.9-10. Areas situated at the inferior extremity of the ascending frontal lobe. Opening of the mouth with protrusionand retraction of the tongue. In dogs, barking orgrowling. In cats, mewing, spitting, and lashing of tailas if in a rage.11. Extending from (10) to the lower extremity of ascending frontal convolution. Retraction of opposite angleof mouth.12. On the posterior half of the superior and middlefrontalconvolutions. The eyes open widely, the pupils dilate,and the head and eyes turn towards the opposite side.In jackals the conjoint action of both sides would causethe appearance of an animal pointing at game.13. On the anterior and posterior limbs of the angulargyrus. -The eyes move towards the opposite side, pupilscontract, eyelids close..14. On the superior temporo-sphenoidal convolution. -Pricking of the opposite ear, head and eyes turn towards theopposite side, pupils dilate widely.15. Subiculum cornu ammonis. -Torsion of the lip andnostril on same side.No satisfactory effects resulted from stimulation of otherparts ofthe brain.The above results were obtained from the brains ofmonkeys, to a great extent the same spots produced corresponding effects in the brains of some other animals, butelectrisation failed to excite any analogous movements inpigeons, frogs, or fish.602 Reviews. [Jan.,Electrical Stimulation of the Basal Ganglia.-The results were very uniform in various animals. Irritation of thecorpora striata causes general muscular contraction onopposite sides of the body. Destructive lesions producehemiplegia on opposite side, sensation remaining unimpaired. These ganglia are the centres of automatic or subvoluntary integration of the various voluntary- motor centresdifferentiated in the hemispheres.Optic Thalami.-Excitation causes no motor manifestations. Destruction occasions blindness, and paralysis ofcutaneous sensibility on the opposite side. These gangliaplay the same subordinate rôle to the sensory centres asthe corpora striata play to the motor centres of the hemispheres.From the results of his experiments on the cerebrum Dr.Ferrier has deduced the following physiological facts: -SENSORY CENTRES.-The Angular Gyrus-- seems to be theseatofvisual sensation. Excitation occasions movements oftheeyeballs; destruction of one causes blindness on the oppositeside; of both, total blindness .The Superior Temporo- Sphenoidal Convolution is the centreof auditory sensation . Irritation being followed by suddenretraction or pricking of the opposite ear, wide opening ofthe eyes, dilatation of the pupils, and turning of the head and eyes to the opposite side. Destruction causesdeafness.The Hippocampal Region (the Hip. Maj . and uncinateconvol. ) .- Destruction abolishes tactile sensation on opposite side of body. Experimentation very difficult . Stimulation of course could give no reliable effects on dumb animals.The Subiculum Cornu Ammonis, and its neighbourhood.-This region appears to contain the centres both of smell andtaste. Irritation caused a peculiar torsion of lip, and partial closure of the nostril on the same side. Destruction causedloss of taste and smell. The cutaneous sensibility of thetongue was also abolished.Occipital lobes.-Excitation has always been negative, anddestruction also. There seems, however, from negativeevidence to be a causal relation between the removal ofthe occipital lobes and the annihilation of the appetite for food.Occipito-temporal Convolutions. Dr. Ferrier suggests,though he has been unable to experiment on them, that these1877.]Reviews. 603are the seat of the sensations forming the basis of the sexualappetite.MOTOR CENTRES. -The convolution bounding the fissure ofRolando. Destruction causes hemiplegia on opposite side,dissociated from sensory paralysis in any form. The corporastriata may be capable of spontaneous action and coordinated locomotion, under the influence of present orpast impressions, or of emotional states. Only such movements, however, will be excited as have been automaticallyorganised in the corpora striata. Such forms of activity asare not habitual, and have not become automatic, would berendered impossible. The seat of origination for motoractivity is the cerebrum.Electrisation of the anterior or motor part of the hemispheres is one of a special character. The head and eyes aredirected to the opposite side, and at the same time thepupils dilate widely. The attitude is one of excited attentionor surprise. This centre may, therefore, be considered asconcerned in those movements expressive of attention andintelligent observation.The Antero-frontal regions of the brain, including theisland of Reil, gave only negative results both on irritationand destruction. After the latter, there seemed, however, tobe apathy, dullness and sleepiness: in fact a loss of the facultyof attention and intelligence.Thus far the book gives us valuable data for further investigations; it contains much that we have had to pass overunnoticed, which is no less important. The experiments arewithout doubt important, for though they do not furnish thecomplete data for a positive mental science, they serve to aidin overthrowing the data of a false psychology, and to formthe foundation of a more perfect philosophy.A. H. N.System of Positive Polity. By AUGUSTE COMTE. ThirdVolume, containing Social Dynamics, or the GeneralTheory of Human Progress. London: Longmans, Green,and Co., 1876.The general reader will probably find this volume moreinteresting than the two volumes which appeared before it,but he will do well to read those volumes before he reads it,if he wishes to have a thorough understanding of what he isabout. The spirit of it is indicated in these remarks-" In XXII.40604 Reviews. [Jan.,fact, the anarchy of the West consists chiefly in the interruption of human continuity; first Catholicism cursingAntiquity; then Protestanism reprobating middle age; andlastly Deism denying filiation altogether. Nowhere is theremore call for the intervention of Positivism, to furnish theone satisfactory solution of this revolutionary state ofopinion, by overcoming doctrines, all more or less subversive,which stirred up the living to revolt against the whole massof the dead." This great principle of human continuity, thefiliation of doctrine, no one but Comte seems ever to haveproperly grasped. Here is another pregnant sentence, inthe development of which a whole chapter might be written"Man becomes more sympathetic in proportion as he ismore synthetic and more synergetic."The volume has seven chapters. The first establishesComte's fundamental theory as based on the systematicdemonstration of the three grand laws of sociology; in thesecond he gives an account of Fetichism, from which he passesnaturally in the third chapter to the study of Theocracy; thefourth, fifth, and sixth chapters treat of the transition from theocracy to the modern revolutionary movements,under the headings of the Greek Elaboration, the Roman Incorporation, and the Catholic-Feudal Initiation respectively;and the seventh and last chapter is devoted to the enunciationof a sound theory of the five centuries during which the revolution has been going on.In discussing the general laws of progress in the firstchapter, Comte makes some interesting remarks touching theattack of mental derangement under which he laboured atone time. It is well-known that he was confined in a privateasylum for some time, getting not the least good from thetreatment, and began to improve only after being removedfrom the asylum as an almost hopeless case.I will confine myself to recording here the valuable phenomenaI was able to observe in the case of my own cerebral malady in1826, mentioned in the preface to the last volume of my PositivePhilosophy. I have already made use of them in my publiclectures. My derangement having been protracted by empiricaltreatment through eight months, there was the better opportunityof observing my different states. The complete course of thisexceptional oscillation enabled me to verify twice over my thenrecently discovered Law of the Three Stages; for while I passedthrough these stages, first inversely, then directly, the order of their succession never varied.1877.]Reviews.605. During the three months in which the medical treatmentaggravated my malady, I descended gradually from positivism tofetichism , halting first at monotheism, and then longer at polytheism.In the following five months, in proportion as the efforts of nature,in spite of treatment, brought back the normal state , I re- ascendedslowly from fetichism to polytheism, whence I speedily returned tomy previous positivism. In thus furnishing me with a decisiveconfirmation of my fundamental law of the Three Stages, and causingme to feel more thoroughly the necessary relativity of all our conceptions, this terrible episode of my life enabled me thereafter toidentify myself more completely with any one of the human phasesin accordance with my own experience. The continual advantage Ihave derived from it in all my meditations on history allows me tohope that readers suitably prepared will also be able to utilise this briefaccount of a memorable anomaly. It only remains to say that theperfect continuity of my philosophical labours before my derangementwith those succeeding it proves clearly that, relatively to the wholecourse of my intellectual progress, this serious disturbance wassimply an oscillation, to which exceptional causes gave a more extendedsweep than is reached in dreams, or in states of passion.It is a pity that all persons who have the misfortune tosuffer from an attack of mental derangement cannot make asimilar philosophical use of the phenomena of their malady;but it may be doubted whether, if they did, the result wouldbe to establish the three stages of the positive philosophy, orthe stages of any other philosophy.In discussing Fetichism, and pointing out its theoreticalsuperiority to polytheism, in that while the formerspontaneously confines itself to the degree of subjectivitywhich is indispensable, to us the latter becomes much moresubjective than its theoretic purpose requires, indulging inexcess of fiction, Comte says, carrying the general comparisoninto pathology, " I do not doubt that insanity, especiallywhen chronic, is more frequent and more obstinate amongtheologists than among Fetichists, a surmise which I hopewill be verified by judicious travellers." We dare say this istrue, though the reason may not perhaps be the one assigned;but the question may fairly be raised whether, ifthe judicious traveller were to continue his enquiries among positivists,he would not also find insanity more frequent and moreobstinate among them than among Fetichists.Another service which he attributes to Fetichism willappear more unfounded at the present day.We must refer to Fetichism a notion of capital importance, thatof the permanence of natural species, which, though seriously606 [Jan., Reviews.impaired under Theologism, and insufficiently respected by scientificempiricism, furnishes the last preliminary step necessary for therise of Positivism . . . This immense service, without which weshould have wandered into endless divagations, was in danger ofbeing radically undone when Theologism transferred the superhumaninfluences to purely imaginary beings, under whose capricious powermatter was supposed to be entirely passive. . . Its importancelies in this -that all notion of the real order would necessarily fall topieces, if species , that is to say, substances could arbitrarily change.For since natural laws always relate to the constancy of the generalarrangements between simultaneous or successive phenomena, theywould become incompatible with an indefinite variation of the seatpeculiar to each phenomenon .It is strange that, while perceiving so clearly as he did thecontinuity of human development, he should have been soblind to the great law of evolution, of which human continuity is but an effect. That he could discover an immenseservice rendered by Fetichism in the upholding of thedoctrine of permanence of species is an apt illustration of theweakness of his philosophy, which discovers always in facts aconfirmation of its theories, and in which speculative imaginations often outrun all restraints of positive observation,and do duty for facts on which to base further speculations.The translation of this volume has been the conjoint workof Mr. Beesly, Mr. Samuel Lobb, Fanny Hertz, Dr. Bridges,Mr. Vernon Lushington, and Mr. Godfrey Lushington, andseems to be satisfactorily done. That we find it hard tokeep our attention fixed, when reading, and sometimes getvery weary, is not the fault of the translators, but the effectof Comte's diffuse, prolix and tedious style. The author ofa great system of philosophy had certainly no notion ofsystem in composition; and the wearisome way in which hegoes over the same ground continually, and tells us in themost elaborate way what he is going to tells us afterwards,frequently tempts the irreverent exclamation-" Leave thydamnable iteration and begin!"Revue Philosophique de la France et de l'Etranger, paraissanttous les mois, Dirigée par Тí. RIBOT. Paris: Baillièreet Cie.This philosophical Review, which is excellent of its kind,has appeared regularly once a month since the beginning of the year. It consists of original and critical articles, ofreviews of philosophical works and foreign periodicals,and of instructive analyses of the development of philosophy1877.]Reviews, 607in all countries. It is well edited by M. Theodore Ribot,whose name is known in this country for his valuable work onHeredity, which has been translated into English . Whenwe received the first number, and learned that the Reviewwas to appear once a month, we were inclined to think thatit could not go on long at that rate, but it has shown nosigns of failing strength so far, and it is very evident thatgreat pains and labour are bestowed upon it. M. Ribot'sanalyses of new books and his critical studies of the historyof philosophy are admirable, being clear, concise, completeand carefully done; and he shows himself quite as much athome in German philosophy as he does in old and recentEnglish philosophy. The object of the Review-namely tofurnish a complete and exact picture of the actual philosophical movement, without excluding any school-has beenwell fulfilled . M. Ribot has been struck, as others have been,with the fact that, while a physiologist would not venture toundertake the determination of a problem until he had madehimself familiar with the work of his predecessors; whilethe historian would be justly reproached if he did not firststudy the works of those who had been before him; inphilosophy, on the contrary, nothing is more common thana complete ignorance of what has been done or is being doneby others. Hence a good deal of supposed original thought,which is really useless repetition or perfectly sterile. M.Ribot's Review will " come to the aid of all those who thinkthat it is not sufficient, in order to make a discovery, to shutthemselves up within themselves, by furnishing them withthat which, before all, it requires from its contributorsfacts." We have no doubt that the reason why these philosophers do not know anything of their predecessors is theirintrospective method: they have really got no predecessors,for they are supremely happy to concern themselves with theinfallible data of their own consciousness, whether they haveput anything of value into their consciousness or not. Certainly no one else can have preceded them in exploring thatsource of knowledge.Mind, a Quarterly Review of Psychology and Philosophy.-Edited by GEORGE CROOM ROBERTSON. London: Williamsand Norgate.We have been prevented,, hitherto, from noticing andwelcoming the issue of this new quarterly journal, fournumbers of which have now appeared. It is intended to be608 Reviews.[Jan.,an organ for the publication of original researches, and acritical record of the progress made in psychology and philosophy. Though holding that psychology must draw itsfundamental data from subjective consciousness, it will givedue prominence to the physiological investigation of nervestructure, and will embrace within its scope language andall other natural expressions of mind, insanity and all otherabnormal mental states, and mind as exhibited in animals.It will take account of logic, asthetics, and ethics; be occupiedwith general philosophy; will not overlook the history ofphilosophy; and will give attention to the practical application of psychological theory to education. The editor doesnot think it surprising that no such English journal shouldhitherto have existed, for English enquiry concerning thethings of the mind has, till quite lately, been unprofessional.Few British thinkers have been public teachers withphilosophy for the business of their lives. Bacon, Hobbes,Locke, Berkeley, Hume, Hartley, the Mills, did their philosophical work at the beginning or at the end of their careers,or in the pauses of time otherwise active; if their work hadbeen academic, it would probably have been much more sustained, more comprehensive, and better carried out.Are we to regret then that these men lived active lives inthe world, dealing with men and things, and getting theexperience and practical sense which comes from such intercourse, instead of having been professors of moral philosophy,dogmatically expounding empty traditions and homebredtheories of psychology to wondering students from a chairraised high above the tempering influence of converse with facts. So far from agreeing that their philosophy wouldhave been bettered by such treatment, we are disposed tothink that it was a great good fortune to them that theywere not academic; and we believe that the reason why eachone of the authors enumerated has a wholesome tone ofreality, and is readable with profit now, is that his philosophical work is informed by a strong masculine spirit,nourished with the experience of good practical activity.Put on one side these names of men who are presumed to havefallen far short of what they might have been-and it is apresumption-and on the other side put the names of theacademic professors who are supposed to have profited bytheir happier circ*mstances-the Dugald Stewarts, Hamiltons, and the like-and the contrast will certainly afforda curious illustration of the advantages of academic work.1877.]609 Reviews.If Dugald Stewart and Hamilton were dropped cleanout of the history of philosophy, nothing, or next tonothing, would be lost; but there is not one of these whoare mentioned as sufferers from their conditions of life,except perhaps the Mills, whose loss would not makea break in the evolution of philosophy. A comprehensivesystem of philosophy would have meant then, as it meansnow, and must mean for some time to come, a more or lessingenious fabrication of words and theories, which it wouldbe a clever gymnastic intellectual achievement to construct,and a gymnastic exercise to study. Were we asked then togive advice as to the proper means to qualify an aspiringyouth to become a profitable teacher of so-called moralphilosophy, it is plain that we should not agree with theEditor of " Mind " in the counsel which we should be apt togive. For it would be something of this kind: Go and takeup your abode in a prison for a year or two, and make yourself intimately acquainted with the constitution, feelings,and ways of the criminal nature; after which you may spendthree months' holiday, or a longer period if you can affordit, in visiting some other country, taking good care to learneverything you can about all its sorts and conditions ofpeople and their ways in a practical manner-we don't forbidoccasional visits even to their Cremornes and other similarinstitutions of the country. Then you may come home andspend a year or two in a lunatic asylum, and gain a thoroughknowledge of the various forms of mental derangement;after which, having earned another holiday, you may spendit, if you like, in attending a course of academic lectures onmoral philosophy, in order to find out how much helpfultheory concerning human conduct you will, or will not, getto guide you in your dealings with men. Lastly, you woulddo well to set to work to get a living in activepetition with men, and having acquired a moderate competency-by which time we calculate you will be nearly fortyyears old-you may, if you have inherited a well-bred brain,think about your proposed lectures. We have not said anything about the desirability of spending a year or two in adissecting room, and in the study of physiology, becausethat might defile your subjective insight into mind by objective knowledge of its material organ, and your scholasticbusiness is to lecture on the abstract philosophy, not to makeit available to men for any kind of use. Well, having gonethrough the course of training which we have roughlycom-610 [Jan., Reviews.sketched out, you may not perhaps turn out to be a greatacademic philosopher, but at any rate you will be a man withsome knowledge ofconcrete manity; and when you begin toexamine the data of your consciousness, you will have somereal stores to draw from, and will not bring forth merelywind; and you may take this comfort to yourself, that you will not, on the whole, do very badly if you do aswell as such philosophers manqués as Bacon, Hobbes, and Hume.We are afraid that " Mind " will think these notionsfoolish, and that we are at irreconcilable antagonism withit with regard to method. For we notice in its last numbera short article placed first in the post of honour, and presumably, therefore, thought by the Editor to be of weightymeaning, which is entitled-" Psychology: a Science or aMethod?" and which reads to us very much like a meritoriousstudent's exercise after attending a course of lectures on moralphilosophy. The author defends the method of introductionand naively propounds as the " home-question" of philosophy,which objective psychologists have overlooked, the amusingbut somewhat stale and puerile question: "After all, do Ireally desire nothing for myself but happiness?" He goeson to tell us gravely that " thoughtful reference to one's ownexperience is indeed a rare quality now; hence our books arenot likely to live as classics. Mr. Sedgwick's Method ofEthics is an exception. Its attitude is eminently personaland reflective, and, for this reason, we venture to think thatit will live and take classical rank beside Locke and Hume!"We would not willingly diminish reference, which is alessening quality in these days, but we venture to think thatif " Mind runs upon this gentleman's level of philosophy,whom it has-we should hope in a moment of temporaryaberration- exalted to its post of honour, it will not onlynot fulfil its excellent programme, but will run a greatrisk of falling into a decline from lack of substantialnourishment.""In the four numbers which have been published there aresome interesting original articles, some of which appeared atthe same time in the above noticed Revue Philosophique.Mr. Bain has, in successive articles furnished, with conscientious care and industry, materials for a biographyofJames Mill,and has certainly done it in a way to prove how possible it is todivest a human life of any human interest. The critical notes and reports, and the notices of books, which are a1877.]Reviews. 611great feature of each number, will be found very useful. Weheartily wish the new Journal a career of vigour and usefulness .Nouveau Traité Elémentaire et Pratique des Maladies Mentalessuivi de Considerations pratiques sur l'Administration des Asiles d'Aliénés. Par H. DAGONET. Paris: Baillièreet Fils.M. Dagonet published, several years ago, a treatise onMental Diseases. It was reviewed in this journal at thetime, and in a manner which was, perhaps, more critical than necessary. However, M. Dagonet is himself quitesensible now of the imperfections of the book, and admitsthe justice of the strictures which his critics passed upon it.He has borne these criticisms in mind, he says, and has soremodelled his treatise that, as it appears now, it is almost anew work. No labour has been spared to make it a usefulwork; and many authors, French and foreign, are largelylaid under contribution . There are eight plates, which contain thirty-three excellent photographs, representing thedifferent types of insanity.In the first part of the book M. Dagonet treats generallyof the pathology, the symptomatology, the prognosis , andthe morbid anatomy of insanity; in the second part, afterglancing at the different classifications of mental diseaseswhich have been proposed, he deals succinctly with thehistories of the principal forms, and with the most commonlyobserved varieties; and the third part is devoted to a studyof the general and particular causes of insanity, and of therelations of special forms to particular causes. There is asummary also of the principles of asylum administration.We are afraid that we cannot give the book the praise wewould gladly give it, or acquit M. Dagonet of hardly excusableomissions. We have looked at the short chapter on Classification, and what do we find? No mention whatever ofSkae's practical system of classification, while the briefestpossible summary, occupying less than half a page, disposesof Morel's important attempt at an etiological classification .Indeed, this summary, as it stands, is so meagre as to bequite valueless, and looks very much as if it had been taken,not directly from Morel, but at second-hand from some bookor journal in which it had appeared. Then again, under thehead of treatment, we learn nothing of the virtues or of the612 Reviews. [Jan.,"bad qualities of chloral. Altogether, as we look throughthe pages of M. Dagonet's treatise, we feel a suspicionsteal upon us, and become stronger and stronger, thathe is running too much upon the old lines, taking too littleaccount of the most recent developments of knowledge,and repeating the faults which we felt it our duty to pointout in the first edition . As the first edition is not at hand,we are unable to compare it with this treatise, and to pointout what alterations have been made, but if we might ventureto trust to our memory of what we read ten years ago, weshould be inclined to say that the changes are not so manyand thorough as to justly entitle this edition to appear as anew work; that it is our old acquaintance with his appearance a little disguised .Behind the Veil: An Outline of Bible Metaphysics comparedwith Ancient and Modern Thought. By THOMAS GRIFFITH,A.M., Prebendary of St. Paul's. London: Longmans& Co. 1876.The second part of the title of this bookvery well expressesits character. It is a comparison of Bible metaphysics, or,at any rate, of what the author conceives as such, with theachievements and impotencies of ancient and modern thoughtin the metaphysical direction. One can't help thinking sometimes, perhaps, that the author has read into Biblical doctrinea good deal of modern thought, and has so discovered therewhat he himself introduced into it; but no fault whatever canbe found with the calm, temperate, and direct manner in whichhe has done his work. The great object of his book "is toremind its readers of the old but never antiquated truth, thatthe world of sense, by the very nature of its presentimentsas merely phenomenal, requires the admission of supersensuous Realities as the indispensable complement and baseof these phenomena. And further, that since the action ofsuch Realities is shown by their phenomena to be limited andconditioned, they must be regarded as subordinate to aSupreme Reality, from whom they spring , in whom theysubsist, and by whom they are organised towards a pre- conceived end." He discovers in ancient and modernthought the unconscious echoes of the secret voice of God"the variables of Truths for ever constant. "It is gratifying to see a prebendary of the Church place་1877.]Reviews. 613himself in this wise attitude towards scientific opinion,and strive to get the most he can out of it, instead of takingup a position of hostility, and so learning nothing from it.After all, theologians and scientific men have to deal withthe same great facts and experiences; they both find out inthe end that what they are and know is but a very little partof what is and they cannot know; and there is no good reasontherefore why they should quarrel furiously about what namesthey shall give to the impotencies of their understandingthe things which no mortal can understand-die allmächtigeZeit und das ewige Schicksal.Slavery in England: An account of the manner in whichPersons without Trial are condemned to Imprisonment forLife, with illustrative cases. By An Eye Witness.London: W. H. Guest. 1876.دوThe writer of this pamphlet says near the beginning thathe is " not an author by profession. " The warning waskindly intended, but it hardly prepared us for such asentence as the following:-" Next, the doctor states that thecertificates are sent to the Commissioners in Lunacy, but thisis a mere form, and although they are often returned, it issimply trifling inaccuracies ." Slavery in England is thetitle of a brochure against the Lunacy Laws of England andWales; and though these are capable of amendment, it iscertainly not by the hands of such beings as " An Eye Witness that reforms may be carried out. It is, of course,impossible to frame an Act which shall not contain a singleflaw, and, so long as human nature is what it is, there will beunscrupulous persons ready to take advantage of the flaw.The English lunacy system is on the whole an excellent one,and the very few isolated cases of injustice-if, indeed , there be any at all-only prove it to be so. Setting aside the veryinferior style of the " Eye Witness," his-or shall we sayher?-manner of reasoning and of illustration by cases is sofeeble, one sided , incoherent, and takes so much for granted,that we must be pardoned if we say that the pamphlet is onlyan argument that the law is not nearly strict enough, andthat certain persons are at large who ought not to be.614 [Jan.,PART III.-PSYCHOLOGICAL RETROSPECT,I. French Retrospect.By T. W. McDOWALL , M.D.ANNALES MÉDICO-PSYCHOLOGIQUES, 1875.On the Inconveniences of Artificial Teeth in the Insane.-It canbe easily understood how disagreeable symptoms will follow if falseteeth be left in the mouth of a lunatic who has not the sensenecessary to remove them at night, keep them clean, and so on. Itdoes appear, however, rather startling to suggest that the employment of artificial teeth can stand in etiological relation to generalparalysis. This Dr. Sizaret does, though in an apologetic manner.He says: " Besides the inconveniences which may be justlyattributed to the employment of false teeth in lunatics, it hasoccurred to me that there may be others less manifest but much more to be feared. This idea has been suggested to me by the cases ofgeneral paralysis which I have noticed, and in which I aminclined tosee an etiological relation to their use. If this supposition appearsfar- fetched and without foundation, I think it will find its excuse inthe gravity and frequence of the disease and in the necessity of notneglecting any information relating to it. "Reminiscences of 1871.-This short paper is introduced by interesting references to several great historical events which undoubtedlyaffected the type of insanity occurring among the people subjected to them. It cannot be doubted that the dreadful disasters of 1871 ledto the occurrence of numerous cases of melancholia of a peculiar type.This was to be expected of a people " nerveux et impressionnable, quinaguère se regardait comme le premier du monde! "The case related by Dr. Hospital is that of an officer who becameinsane after the war, having been disappointed in promotion , andhaving witnessed the suicide of one of his comrades. His symptomswere those of melancholia. After apparently recovering he resumedhis military duties. An application for leave having been refused, heleft for home. There he shot his brother without provocation, andwithout having previously excited any suspicions of danger. Havingcommitted the murder, he surrendered himself to the military authorities and gave up his weapon.Medico-Legal Case.- Racquin. -The report of this case, as givenby Dr. Danby, does not appear to my mind to support his conclusions. A man drinks hard for twenty years, during most of that timeis a curse to his family, who appear to have been far too kind to thescoundrel; at last he stabs his son, who had shown bim nothing butkindness, and he escapes the scaffold because he was certified by the1877.] 615 Psychological Retrospect.expert appointed by the court as suffering from " dypsomania, amental disease caused by alcoholic intoxication. In striking his sonhe obeyed a sudden impulse resulting from his disease. He consequently cannot be considered responsible for the act which he committed. A dypsomaniac having an irresistible tendency to drink,and every new excess being accompanied by the same dangers , werecommend that the accused be detained in a lunatic asylum .'66Space does not permit us to reproduce the history of the case;that is unnecessary, for thousands such exist. Dr. Danby's remarkson it, however, do call for special attention . They contain opinions with which it is probable that few will agree. His statement thatdypsomania is a mental disease caused by alcoholic intoxication "is altogether incorrect and misleading. The description he gives ofthe man's condition when in the asylum shows that he was labouringunder the dementia due to disease of the nerve centres induced byprolonged intoxication.The manner in which occasional drunkenness, chronic drunkenness,and dypsomania, especially the two latter, are confounded is astonishing. In discussing the aspects of the case it is said, " A prominentfact consists in the change which, by the action of alcohol, occurs in the habits and character of the individual. In this case this transformation presents itself with the special characters of dypsomania.Whilst the confirmed drunkard leaves at each libation his moralsense at the bottom of the glass, and gains from it a certain intellectual excitement, and is merry or depressed as the case may be,and becomes himself again in the interval, the dypsomaniac exhibitsa more radical change, which, although more marked during theattack, continues during the period of remission to such a degree asto cause him to be with difficulty recognised. Besides, the dypsomaniac obeys in his cravings a different impulse. It is not only asatisfaction which entices him, and the attraction of a pleasure whichdrags him along; he suffers from an irresistible tendency which is inhim, which constitutes the very essence of his disease, and in whichwill, become powerless, no longer has apart. The drunkard could not equal these libations( Hacquin's) without rolling under the table and presenting thespectacle of the most abject inertia. The alcoholisé ' alone possesses this tolerance , and amid so many disadvantages it is one of theprivileges of intoxication . If, after the investigation ofthe manifestations of the alcoholic intoxication presented by theintellectual and moral state of the accused, there could still remainany doubt in our mind, it could not resist the examination of the organic lesions produced by the toxic agent. These lesionsare so pronounced that we have the more pleasure in indicatingthem, because the physician, from the very nature of mental disease,too rarely has occasion to meet them in aiding him in his difficulttask. These pathological disorders affect all the great functions of616 Psychological Retrospect. [Jan.,animal life, and may extend from the most simple dynamic disturbanceto the most profound organic lesions. But a last question,assuredly the most delicate, is the following: -What is the nature ofthe morbid impulses which the accused obeyed in striking his son,and how are they related to the mental affection from which hesuffers? Let us say first of all that in a dypsomaniac the mentaldisorders may, according to the individual idiosyncrasy, and perhapsaccording to the nature of the liquids absorbed, assume various expressions. We cannot place the accused in the class of hallucinateddypsomaniacs, for in his case the form of the attacks, the nature ofthe delirium, and the manner in which he committed the crime, allshow that he must be classed as an alcoholisé with maniacal attacks. "And so on.The report of this case is worth reading, whether we accept theopinions of Dr. Danby or not.The Pedro II. Asylum and Lunatics in Brazil.—It would appearthat this asylum, the first at Rio Janeiro, was opened in 1852 , andthat since that time others have been built, taking it more or less asa model, in Bahia and elsewhere. From an English point of viewthere is little worth imitation in the Brazilian asylums and theirmanagement. But we quite agree with M. Rey that some continental cities might greatly improve their asylums by adopting some of the good points of l'Hospice Pedro II. Still the followingparagraph can be considered but very faint praise indeed: —“ Brazil has done much for its lunatics. Its capital possesses an asylumwhich, in spite of its imperfections, might be envied by many of thegreat cities in Europe. Many of the asylums in Italy, notably thoseof Milan, Florence, and Rome, cannot be compared to the Asylum of Pedro II."On Insanity among Criminals. -This contribution to this mostimportant subject is summarised in the following paragraphs by theauthor, Dr. Hurch, physician to the large prison at Gaillon. It maybe remarked that prisoners who became lunatics were not detained inthe gaol, but were transferred to the asylum at Evreux: —1. In the cases transferred during the last seven years the causesof insanity were chiefly inherent in the prisoners and independent ofthe imprisonment—at least, in ten of them.2. Among the causes which induced mental derangement wereage; mental prostration after sentence and vexation thereat;embarrassments and alcoholic excesses anterior to sentence; awretched and irregular life and the consequent privations; immorality and debauchery; finally , epilepsy.3. Two prisoners were affected by general paralysis on their admission to the prison.4. The proportion of undoubted lunatics transferred during a periodof seven years was two per 1,000 prisoners.1877.]617 Psychological Retrospect.5. Besides those transferred, there is in our prison- to use theexpression of Dr. Baillarger- "a certain number of persons ofpeculiar organisation which almost constitutes in itself a commencement of disease, and which predisposes in the highest degree to allderangements of the intelligence. "6. Wemust separate epileptics from the prisoners .7. As is usual, simulated insanity was rather frequent, and wasobserved generally in prisoners whose mental state left much to be desired, and who seemed predisposed to derangement.On Alcoholic Epilepsy. -The consideration of this subject is dividedby Dr. Drouet into the following heads: -Statistics. Rarity ofepilepsy in acute alcoholism . What are the causes of convulsiveattacks in acute alcoholism? Does the nature of the drinks consumedexercise a leading influence in the production of epilepsy? Epilepsyin chronic alcoholism. Pathological anatomy. Differential diagnosis,prognosis, treatment." This paper is based on the observation of 529 alcoholised "lunatics admitted to the Ville Evrard Asylum between February,1868 and July, 1872. Of these, 442 were men and only 87 women.Fifty-four of these patients, or a little more than a tenth, had attacksat one time or another of their disease, and Dr. Drouet convincedhimself that they were due only to acute or chronic intoxication .The proportion of epileptics was about the same in the two sexes.It is interesting to observe that the proportion of epileptics was only1 in 50 among the patients under 30, but 1 in 8 in those between 30 and 50.Epilepsy is exceedingly rare in acute alcoholism, but may occur incases where unusually large doses of alcohol have been swallowed.Convulsions are rarer still in cases of occasional drunkenness. Inthe immense majority of instances they do not appear as an initialsymptom, but rather as late symptoms of alcoholic poisoning. Thepatients are almost always habitual drunkards. Long before suffering from convulsions they have passed through the various phases symptomatic of chronic alcoholic intoxication. Their diseases haveassumed either the gastro- hepatic or the nervous form. Almost allhave had at one time or another difficulty in speech, musculartrembling, formication, cramps, partial hyperesthesia, or anesthesia.Now, though convulsions are rare in acute alcoholism, it is not byany means easy to determine the special cause of their occurrence in each case. It seems probable that they are chiefly due to theoriginal or acquired morbid predispositions which exist in themajority of men, if not in all, through which their organisms presentdifferent symptoms under the influence of the same modifying agent.However latent they may be, these varied morbid tendencies exist, andone must be blind to deny them. If an equal dose of any alcoholic fluidbe given to ten persons, the effects will vary in each person: in onegastric symptoms will predominate, in another cerebral, and so on.618 Psychological Retrospect. [Jan.,In spite of great research the question remains in great obscurity,whether or not the nature of the drinks swallowed exercises a primaryinfluence in the production of epilepsy. Dr. Drouet agrees withLancereaux, Moreau and others, in opposition to the well-knownviews of Dr. Magnan, that there is reason to think that the oils oressences contained in alcohols at most only increase the exciting properties of these agents and modify very little the symptoms andprognosis.As already stated, alcoholic convulsions occur chiefly in chronicdrunkards whose brains have undergone a special morbid change.The tendency to convulsions may exist in three degrees of intensity.In the first stage an epileptic attack may occur after an unusualexcess in drinking. Later, seizures occur, although the patientsdrink comparatively moderately and without ever becoming drunk.In the third stage the tendency to convulsions is increased. There isa pretty numerous class of patients who, though confined in asylumsand deprived of all stimulants, continue subject to epileptic attacks.When things have gone so far, we may say that the epilepsy is constitutional.The most various lesions are observed in those who have diedduring the course of chronic alcoholism . The principal areHæmorrhagic pachymeningitis; adhesive inflammation of the piamater and arachnoid, specially well marked on the superior surface ofthe hemispheres in the neighbourhood of the great fissure; dilatations of the meningeal vessels, the result of repeated congestions;excess of cerebro-spinal fluid; granulo-fatty degeneration of thecerebral vessels, frequently accompanied by hæmorrhages "entraînées " or " de petit* foyers; " abnormal proliferation of the interstitial connective tissue; fatty degeneration and atrophy of the nervecells or fibres; and circ*mscribed encephalitis.Medico-Legal Case. -Manguen.- With the greater part of Dr. Debondt's report most readers will agree. An abandoned womansuffocates her child, and attempts to escape punishment bysimulating insanity. However, her acting was so bad that she waseasily detected in her imposition, and was sentenced to five years' hardlabour, which she richly deserved . On two or three occasions she wasobserved to drink her urine, and in relation to this it is remarked thatthis trick is too well known for it to be tried , except by those whohave no other resource, and is an act not rarely observed except insome dements, general paralytics, and certain idiots and imbecilesdepraved in their most natural instincts. Perhaps Dr. Debondt'sexperience may be peculiar, but in England it is a fact that urinedrinking is frequently indulged in by acute and recurrent maniacs, andeven by melancholics who labour under no excitement. It is alsostated that " she complained frequently of indisposition, pains in theback, belly and stomach, of diarrhoea; which is again contrary to thehabits of lunatics, who never make the least complaint, even when1877.] Psychological Retrospect.619they are affected by most serious diseases." Unquestionably suchcases do occur, but they are not by any means the rule.Hysteria in a Man. -This case has been recorded by Dr. Fabre,because it has appeared interesting to him in more than one respect.It is a disease rarely observed in the male sex, and the cases alreadyrecorded have been as a rule so imperfectly described that theirauthenticity is open to doubt. It is also very unusual to find a caseof hysteria in a man passing into demoniacal possession, a combinationalmost entirely confined to women, and appearing in an epidemic form.The facts of the case are as follows: -Colin, Joseph, æt. 30, awood- turner, was born at Nancy of parents who both died of phthisis.He is the only survivor of four children; one died of hydrocephalus,the second from an accident, and the third, a girl , was the victim,according to the patient, of a spell which a woman of immoral lifethrew over her, so that she died bewitched . This allegation , whichgives at once a measure of the intellectual development of Colin, appears to have some relation to the delusions which the patient mani- fested. His state of mental debility did not permit of him learningmuch; he can no longer write, and reads with difficulty, although heattended school for seven years. His physical development leavesmuch to be desired . Of a stature below the average, pale and feebleof aspect, he presents undoubted symptoms of phthisis and anæmia,His feet and ears are deformed, his legs thin, and the tibia stronglycurved forward and very prominent, but the thighs are relativelylarge, the pelvis wide, the genital organs slightly developed, the chestenlarged at its base, and his breasts, overlaid with adipose tissue,appear more voluminous than usual. The whole appearance of thetrunk and thighs recalls the female figure; even the quality of hissoprano voice has something effeminate; the hair is scanty; his sexualappetite is but slightly developed; he admits having practised masturbation frequently, but he has had sexual intercourse only five or sixtimes. He has pretty often indulged to excess in brandy, and hadconsequently frequent derangements of digestion , for which he wastreated in various hospitals. During these attacks one of his symptoms was frequent spitting.Having been arrested as a vagabond he was at last sent to Vaucluse, where he presented nothing abnormal in his condition for a fewdays. On 3rd September he had his first nervous attack which lasted about ten minutes. On the 5th, two attacks, one in the morning andthe other at night, each of about forty- five minutes ' duration . On the 9th an attack of twenty-five minutes. On the 10th four attacks ofabout ten minutes. On the 16th , at the time of visit , Colin suddenlylost consciousness, and was attacked by convulsive movements, which began in the lower limbs, soon attacked the whole body, and increasedin intensity. The patient twisted about on his bed, his face was distorted, the pupils contracted. There was analgesia of the limbs.XXII. 41620 Psychological Retrospect. [Jan.,But above the pubis the least contact provoked cries like those of apig being killed . When the attack ended, the patient said he felt asif a ball had risen from the genitals to the throat. It was impossiblenot to recognise the hysterical character of the symptoms; bromideof potassium was given from the beginning, and the dose increased.Numerous attacks , varying considerably in detail, occurred till the3rd October, when the following note was made: Five attacks , ofwhich one occurred at visit; -the face was distorted, the mouth open,the tongue was moved about with the point turned up; at the end ofa minute the mouth was shut, then the patient clutched with his handsthe sides of his bed, and his legs were convulsed for more than aminute; for about the same time he champed with his teeth , and spatoften a small quantity of saliva at a time. Sensibility remained perfect. Convulsive movements reappeared after a short interval ofrepose, and began first in the legs, then in the arms, and lastly in thetrunk; the patient continually held fast to his bed, knelt on hismattress, alternately shook each side of his bed; he uttered a fewguttural sounds, complained of suffocation and pains in the neck,navel, &c.During the next few days, the attacks continuing, he complained of pains in the abdomen, and refused to eat or drink. On the 15thOctober Dr. Fabre noted the following particulars: -Colin is halfseated on his bed, his right hand as high as his face, the fingers inrapid movement; the first is his father, the second his mother, thethird his father, the fourth is his sister, the fifth God. His fingersspeak to him, he hears their voices; the devil has come to put him allright; he has lengthened him, he wished to make a giant of him; thereare the marks which he has left on him, and the patient points to theskin of the scrotum where the cuticle is rubbed off in some places;he has also reduced his hernia. (Colin alluded to a remarkableinduration of the abdominal muscles, which Dr. Fabre had observedmore particularly above their pubic insertion during the majority ofthe attacks of hysteria at which he was present. ) The devil speaksto him, threatens him, he has 18,000 men in his belly; his limbs andfeet are full of them; he has swallowed some and passes them in hisurine; he should be taken to the university.By the 29th the attack had passed off, and he was able to give thefollowing account of himself: -Until I was twenty years of age I hadno serious disease, except smallpox . During the last war, at Toulon,where I was in garrison, I was seriously ill; my legs were swelled;I had water in the belly; two years ago, at Meaux, I had violentpains in the stomach, I spat much, I slept almost none, I dreamedmuch, I saw frightful things, beasts, devils, black clouds. At thebeginning of my attacks I felt first a severe pain in the belly, andsoon in the whole body, but especially in the throat; I felt as ifchoking, I could not eat, my head ached very much, I still saw black clouds. When my belly was touched I felt a frightful pain. After-1877.] Psychological Retrospect.621wards I thought the devil was in my head, then in my hands andfeet. He spoke to me and I heard his voice, also that of God, andof my parents; I saw flashes, flames, I smelt the odour of sulphur,and I seemed to swallow it when I ate or drank.In his remarks on this interesting case Dr. Fabre refers frequentlyto the opinions of Briquet, which may be summarised as follows:-1. Increased impressionability of the affective element of thenervous system constitutes the basis of the predisposition to hysteria.2. Hysteria is almost peculiar to the female sex, because in it there exists a predominance of this affective element.3. Nevertheless, hysteria may exist in man, but conditionally totheir existing in him the same predominance.4. The reason of this special tendency in woman is not to be foundin her sexual apparatus, but in the form of sensibility peculiar to her.5. The passions and melancholic mental conditions are the onlypredisposing causes of hysteria.As to the relations of insanity and hysteria the author concludes:1. During the convulsive attack the patients often suffer from atransient delirium .2. Insanity may occur in a hysterical person, exhibiting the proteiform neurosis as the determining cause, and as occurring in thevarieties of partial or general delirium.3. In a great number of cases, the hysterical phenomena and theintellectual disorders which accompany them are spread from oneperson to another, and frequently by imitation, and constitute genuineepidemics of insanity characterised by predominance of religious or demoniacal ideas.Alcoholism and the Delirium of Persecution. -It cannot be saidthat all patients labouring under delusions of suspicion have causedtheir illness by excessive drinking, but it is undoubtedly true that ina large proportion of cases there is this relation, and that they forma most dangerous class.

In this short paper the particulars of four cases are recorded, andDr. Cullerre tries to show that the delirium of persecution andalcoholism are sometimes united in the same patient; that their special characters are generally easily distinguished; that either mayhave the priority of development; and that their union in the same patient is peculiarly dangerous, so far as other persons are concerned .One of the cases recorded is unusually interesting, as affording an example of the hemi-anesthesic form of chronic alcoholism describedby Magnan.On wandering Lunatics. -As the result of a very careful examination of the history, symptoms, &c. , of fourteen patients, Dr. Foville,fils , concludes:1. Certain lunatics undertake journeys more or less long from the character and development of their insanity. The wanderings ofthese lunatics are voluntary acts, well considered, and the logical622 Psychological Retrospect. [Jan.,sequence of a systematized delirium. They should not be confoundedtherefore with those unconscious impulses to change of place to whichimbeciles, " instinctifs," epileptics, and dements are subject.2. All the wandering lunatics whom I have observed are hallucinated melancholics. They form two groups: in some there exist onlyideas of persecution, and by expatriation they hope to escape theirimaginary enemies; among others, to the delusions of persecution areadded ideas of grandeur. The latter labour under megalomania, andtravel in foreign countries, in the hope of there obtaining the realization of their dreams, and of obtaining that justice which is denied them at home.3. Nothing could be less justifiable than considering these lunaticsas affected by a special form of insanity, the monomania of travelling.Their delirium is not limited to a single point; it is always more orless complicated, and should be classified with lypemania.Medico-Legal Case. -It may be well to give more details of thiscase, for it raises the very important question, Is it right to punishthose who can be considered only partially responsible for their actions?A commission was appointed to examine the mental state of C. C.,accused of theft. The following is the substance of the report. Theaccused C. C. is 26 years of age, strongly built, of a stature abovethe average; he is fair, of a fresh complexion, and of a sanguineolymphatic temperament. There is a very marked disproportion between the dimensions of the face and cranium. Whilst the face isunusually developed through the lengthening of the jaws, thecranium is completely flattened behind , and is so reduced in volume asto present the characters of genuine microcephalism . This defect inconformation, which is necessarily accompanied by an arrest ofdevelopment of the brain, is not merely accidental and peculiar to thedefective organic evolution of the person; it is the result of morbidheredity, and is evidently associated with other signs of physical andintellectual degeneration in his family, notably in his mother, whowas goitrous, and one of his sisters was a congenital idiot .In 1866, at the age of 19, C. C. was for the first time prosecutedfor theft, but was acquitted, a medico- legal report having been presented, certifying him to be irresponsible on account of his imbecilityand monomania of theft. Since then he has been at liberty, andemployed in various houses, where his conduct never attracted thenotice of the judicial authorities. Lastly, he was employed at thebrewery Robert, where the thefts occurred of which he is accused;the articles stolen were a wax ornament and a surplice from two churches.As to his mental condition at the time of examination, it iscertified -We have examined and questioned C. C. on variousoccasions, and every time we have found him calm, reserved in his speech, polite and respectful towards us; our general impression was1877.] Psychological Retrospect.623at the same time that he could carefully weigh his answers, whosehabitual slowness must not only be attributed to the laborious evolution of his thought. At our first visit, we at once questionedhim as to the thefts of which he was accused; he immediately deniedhis guilt with the greatest vehemence. He said he did not know whatwe meant; he was indignant of being accused not of a simple theft,but of one a hundred times more wicked , of a theft from a church.We insisted upon this point, we varied our questions; we reminded the accused that in January, 1867, he was convicted of thefts, whichhe had fully confessed, and that his sentence had been remitted onaccount of his mental state; we even gave him to understand that the same might occur this time.In spite of all our efforts we did not even get the shadow of a confession: "I am, said he, neither mad nor imbecile, I know what Iam doing. If I had not known what I did , and had not been capableof behaving myself, I could not have served in the houses where Idid serve; I never put my foot into the churches of Larangeot andFalletans, and those who accuse me are the real culprits."At noneof the visits which were made to him did the accused vary in anypoint in his denials.Not succeeding in obtaining any confession relative to the crimesof which he then stood accused , we returned to the thefts committed in 1866 by C.; we asked him if he remembered havingstolen at that time various articles of clothing, which he afterwards hid in the woods. The prisoner seemed very much surprised at ourquestion, and assured us that he had no recollection of theoccurrences of which we spoke. We then showed him his signatureat the foot of the examination containing his confessions; he wasquite taken aback, got up hastily and appeared to be greatly agitated .This extreme astonishment and sudden agitation were evidently notthe result of C.'s learning for the first time that he had been guiltyof thefts in 1866. We rather attributed them to his ignorance of theexistence of judicial records, and the surprise caused by our unexpected revelation. At any rate, he sat down, recovered his selfpossession, and said, " I inay easily have forgotten it , for I have nomemory. "We continued our investigation, and questioned him as to his usual occupations and actions. His answers were comparativelysatisfactory; they were clear, precise, without any manifestation ofdelirium or other intellectual disturbance. His answers were not thoseof a genuine imbecile, and he appeared to enjoy at least that commonsense which nothing authorised us in denying to him. He gave usan almost exact account of his life during the last two years; if wenoticed any inaccuracies, the reason was easy of discovery. Thusfor example, C. stated that he had served with Dr. Rouby at 15fr.per month for 10 months. On interrogation he added that he leftthat house to gain more elsewhere. All that was perfectly correct,624 Psychological Retrospect. [Jan.,and indicative of an excellent memory, with one exception-the reasonof his leaving. We learned that Dr. Rouby had dismissed him forclimbing the wall during the night, and stealing the melons from thegarden where he worked. It results from the details which we havegiven that C. knew how to leave in the shade facts which wereunfavourable to him, but that his memory appeared perfect at least inregard to recent events.There still remains one point for examination. Was the accusedunder the influence of a moral perversion which, irresistible, impelledhim to steal? Ought he, in a word, to be considered as affected by agenuine monomania of theft? Upon this point we must state thatneither in the depositions, nor in our own investigations, did we find any sufficient ground for this opinion. It is true we know that hewas differently judged in a previous report, but this was in January,1867 , the accused was only nineteen years old , he was backward,and presented at that time all the characters of imbecility with want offree will. The recent examination which we have made as to hismental condition obliges us to state that his intellectual and moralfaculties have progressively developed since, and that his instinctshave undergone a favourable modification at the same time. In an interval of seven years C. C. the accused was notthe subject of any judicialprosecution; he appears to have conducted himself almost normallyduring all that time, and yet, in his capacity of servant, opportunitiesfor stealing cannot have been wanting. If, then, we suppose that thetendencies to theft always existed in him, it did not present on alloccasions the character of irresistibility or, consequently, of irresponsibility.Conclusions.-1. The accused C. C. is affected by congenital andhereditary intellectual feebleness.2. He knew the consequence of his acts, which were not due toany irresistible influence.3. His responsibility was limited, as also his moral and intellectualcapacity.This report is signed by Dr. Lizaret, and a note is appended to theeffect that C. C. was condemned to six days' imprisonment. Onenaturally asks , did he deserve it? It is impossible here to discussadequately the question of limited moral responsibility, but it maybe asked, what good results from punishing an imbecile? It doeshim no good, it makes the law ridiculous, and can have no effect indeterring other imbeciles from breaking the law. Very many would,on the strength of the above report, have saved the poor creaturebeing degraded and punished, and have recommended that he should be better looked after. It is really amusing that the fact that hisbehaviour had been so good so long should have been one of the chiefreasons for putting him in prison . He did not steal from his masters(except some fruit) because he was a good creature; he stole somethings of no value to him because he was a fool; the nature of the1877.] Psychological Retrospect.625theft proved his folly. Why should we be astonished that hestedfastly denied his crimes? Many imbeciles are most amusingliars, who have not the sense to speak the truth even occasionally. Ifa will by a lunatic stands or falls by its internal evidences of reason,why not treat an imbecile in the same manner? If his acts in themselves (no matter how cunningly devised and dexterously executed )showthe mental weakness of the accused, then means should be takento keep him out of mischief. For medical experts to aid inpunishing such miserable objects is not right; it is cruel of the law tobe guided by such advice.Medico-Legal Case. -Railway Accident. -The details of this caseare most interesting and amusing; interesting because insanity so rarelyimmediately follows injuries received in a collision , and amusing_onaccount of the ridiculous conflict of the medical evidence. Dr.Dubian has arranged the facts of the case admirably, and clearlyproved that the patient did not simulate convulsions and insanity .His conclusions, as given in the following paragraphs, indicatesufficiently the nature of the case: -1. In consequence of the railway accident on the 16th April,1868, M.D.'s health was seriously injured; his nervous system wasshaken, his mental faculties disturbed, and his reason upset to suchan extent that he attempted suicide.2. Various witnesses proved: 1º. That M. D. was quite well, andattended as usual to his business up to the time of the collision .2º. No mental disorder was observed in him during his residenceat Nantes or Bordeaux until the accident.3. No proof was produced against these assertions . It is , there- fore, logical to impute the alteration in his health and mental facultiesto the disturbance caused by the collision , the more so as there areon record cases of mental alienation produced by physical causessuch as shocks , blows, wounds.4. As the result of the accident, M. D. has been incapacitated more or less for a year in his work. Besides he suffers from the socialstigma of having suffered from an attack of insanity.5. Really M. D. appears to enjoy sound mental and bodily health. But by the single fact of his having had one attack ofinsanity he is predisposed to a relapse, to prevent which he ought to be careful of himself, and avoid too much work and long and violent mental exercise .Clinical observations on some cases ofLocomotor Ataxy in Insanity.-That this is an interesting paper does not admit of doubt, and yet itdoes not help to solve the difficulties which surround the relations oflocomotor ataxy and general paralysis. This , however, is notsurprising, as the paper is almost entirely clinical in character, only one post- mortem examination being recorded in it . Seeing thatauthorities differ as to the clinical characteristics of general paralysis ,and that locomotor ataxy is frequently complicated by symptoms .626 Psychological Retrospect. [Jan.,dependent upon lesions other than those of the posterior columns,we must look to pathological anatomy rather than to clinical observation for help to escape fromdifficulties we experience in differentiatingthe various symptoms, and to refer each to some nervous area.Soconfused are we at present in our ideas that some maintain that thereis no essential difference, except in degree and locality, between thetwo diseases. Those holding an opposite opinion fail to convincetheir opponents of their error; and so the matter stands.Dr. Rey's position is plain enough when he says: progressivelocomotor ataxy, formerly known as tabes dorsalis, has rarely beenstudied in its relations with mental derangement; the association ofthe two diseases is not very frequent. His resumé of the literatureis short but good, and shows (1) that in cases of simple locomotorataxy writers have proved the integrity of the mental faculties;(2 ) that locomotor ataxy may be complicated by various disorders ofthis intelligence, from simple enfeeblement to complete delirium;(3) that this complication is often general paralysis. Whilst admitting that there are many symptoms common to the two affections ,which may account for error in diagnosis, he states that there is acharacteristic symptom of locomotor ataxy which he has employed inhis observation as a test, the increase of inco-ordination of movements during closure of the eyes. It is scarcely to be doubted thatthis test will be rejected by many as inconsistent with their experience.The details of nine cases are recorded by Dr. Rey, and in all ofthem the disorders of intelligence appeared consecutive to the locomotor ataxy, always after the incoordination of movement, andbefore the ataxic symptoms became well marked in the upper limbs .The disease was of the usual character, and marked by the commonsymptoms. All the patients presented a certain degree of muscularenfeeblement, always more marked on one side of the body, on thatin which the ataxic symptoms, pains, incoordination were most decided. They suffered from cephalgia, vertigo , buzzing in the ears, fora longer or shorter time before the appearance of the mental symptoms. The inequality of the pupils observed in some of the cases isfrequently met with, according to Charcot, in locomotor ataxy, freefrom all complicationThe drunken habits of case 4 necessitates some remarks upon therelations ofataxy and alcoholism. In alcoholic intoxication , we observealmost always disorder of the sensibility, pains, spasms, formicationwhich give rise to false sensations and characteristic hallucinations.There is also cutaneous and tactile anesthesia, perversion of taste andsmell, and disorders of sight, ambliopia, diplopia; besides occasionallydisorders of locomotion and awkwardness of the hands. M. Charcothas pointed out the relations of the two diseases.Intellectual disorders appeared in Dr. Rey's patients when theprimary disease was in its acme, and presented nothing peculiar.1877.]627 Psychological Retrospect.In the cases of ataxy with general paralysis, it was difficult tofollow the progress of the two affections , because the muscular symptoms of the latter soon obscured those ofthe former. Besides , the intelligence and memory changed rapidly, and the patients were soonincapable of explaining their sensations. On the contrary, in thecases where a mental affection other than general paralysis complicated the disease of the cord, it was possible to observe the phenomenaproper to each, and their relations . In these cases the ataxy andinsanity, considered separately, followed their usual course. Further,where the two diseases presented exacerbations and periods of repose,a direct relation was often noted between the ataxic phenomena andthe delirium. Thus two patients (4 and 5 ) had an attack of excitement on admission to the hospitals, that is to say at an acute periodof the spinal affections. In the case of the woman P. ( 4) , the .pains diminished, the disorder of locomotion became less, and themental state improved parallelly . Cases 6 and 7 were also remark- able in this respect. In the former, to the acute state of the spinalaffection corresponds the greatest activity of the melancholic delirium;then, perhaps under the influence of the febrile state, the symptomsimproved pari passu, and the patient was discharged decidedlyimproved.In another patient ( 7) the explosion of the delirium coincided withthe loss of vision and the aggravation of the pains. In him the disorders of sensibility had a remarkable influence upon the manifestationsof delirium . He believed that they fired balls at his legs and eyes.He saw his feet mutilated with a hatchet; they made him inhale badodours; eat fæces. These were evidently the delirious interpretations ofvarious ataxic symptoms, lancinating or boring pains, alteration ofthe senses of taste and smell. In this patient the mind improved, asalso the ataxic symptoms. Then the intelligence remaining unimpaired, the spinal disease resumed its progress.Another patient (5 ) presented analogous disorders during hisperiod of excitement; then the two diseases had a period of simultaneous calm; finally, the mental state remaining stationary, theataxy became general.In case 8 the two affections were stationary, and presented theirrespective symptoms.The mental state improved in case 9, and the ataxic symptoms continued with a certain degree of intensity.

To sum up the whole in nine patients affected by locomotor

ataxy with insanity, three were general paralytics . Six suffered fromvarious forms of delirium, independent of that disease.In all, the mental derangement was developed subsequent to a longeror shorter period from the beginning of the ataxic symptoms, andalways at the period of their greatest intensity.In the general paralytics, the mental disease presented nothingpeculiar. The ataxy was ofthe paraplegic form with its usual charac-628 Psychological Retrospect. [Jan.,ters. The general paralysis considerably obscured the ataxic phenomena: it advanced whilst the spinal affection appeared to remainstationary.In the other cases the ataxy presented its usual symptoms, as did also the mental diseases . The two affections followed at first aparallel course, they became better or worse together, or were stationary.Finally, the mental derangement having been cured or improved, thelocomotor ataxy resumed its progress,2.-Italian Psychological Literature.By J. A. GASQUET, M.B. Lond.The volumes of the Archivio, for 1875 and 1876, which we havereceived contain an unusually large amount of interesting originalmatter, which we are unfortunately only able to notice very inadequately.The "Società Freniatrica Italiana " met for the first time at Imolaon September 21 , 1874. At this meeting, and also at the second,held at Milan, in July, 1875, the proceedings of the meeting and theclass of subjects discussed closely resembled those of our own Society.But in November and December of the latter year, the Society had aseries of five meetings, to consider certain proposed changes in the lawrelating to lunatics, which were subjected to a very minute and searching criticism. The result of their deliberations cannot fail to haveconsiderable weight in guiding the legislature of Italy and publicopinion in that country.There has been much attention devoted to transfusion ofblood, as ameans of treatment, in several Italian asylums. Some physicianshave employed defibrinized human blood, but others have preferred touse arterial blood from the lamb, which is allowed to flow directlyfrom the artery through an elastic tube into the vein of the patient.This treatment has been particularly tried in cases of profound melancholia with refusal of food, and of pellagrous cachexia. No evilresults have been noted, but occasionally a considerable amount ofcyanosis has followed the operation: this has by some been ascribedto vaso- motor paresis, but Dr. Ponza is more probably right in supposing it due to increased pressure on the right side of the heart. Theoperation has generally been followed by improvement of the mentalcondition, and this is sometimes considerable and lasting. It does notscem usually to follow so immediately upon the transfusion as tosuggest that it is merely a result of the shock of the operation; itseems rather to be generally considered in Italy to be due to thestimulant effect of arterial blood upon the brain. I may take a caseof Prof. Livi's as a good example: the patient had been insane forfive years, and in a state of complete stupor for ten months. No othertreatment having been of any avail, transfusion was tried; after the1877.]629 Psychological Retrospect.first operation, the patient began to speak and move; after a secondthere was a further improvement, and after a third he had days ofcomplete lucidity, alternating with stupor. It will be interesting towatch the results of a more extended trial of this very novel, and sofar promising, mode of treatment.Dr. J. B. Verga has made some trials of the nitrite of amyl inhalation in various states of mental depression (melancholia and silentdementia) . A temporary improvement was sometimes observed tofollow the inhalation in even the worst cases (the patients smiling oranswering a question), but, although the treatment was continueddaily for periods varying from 15 to 73 days, no permanent good ever resulted.Dr. Frigerio has been for some time engaged in treating epilepsyby the hypodermic use of Bromide of Potassium . The average doseinjected is about 5 grains, and this has usually determined none beyonda very slight local irritation at the spot where the injection is performed. The urine is generally found to be considerably increased inquantity, and yields evidences of the presence of bromine to chemical tests. Dr. Frigerio claims for this method, that the number of fits ismuch more markedly and rapidly diminished than when the bromidesare administered in the usual manner, and that there is also less disturbance of the general health, particularly of the digestive organs.Drs. Albertoni and Michieli, of Padua, have been repeatingHitzig's and Ferrier's experiments on the grey matter of the convolutions of the brain; and have been led to the conclusion that thesecertainly contain centres of voluntary motion, which, however, onlyact mediately through the nervous ganglia at the base of the brain ,which are the true motor centres . The pathological evidence theyhave been able to collect points to the same inference, since it wouldappear that disease of the cortical grey matter produces imperfect andtransitory paralyses, accompanied by spasms and twitching of themuscles whose motor centres are affected , while disease of the otherganglia results in complete paralysis.Lussana has published some further researches into the nature andfunctions of the corpora striata. He believes comparative anatomyand embryology both imply that these ganglia are only a part of thecerebral hemispheres, and he thinks the consequences of their destruction depend only upon the severance of connection between the convolutions and the lower portions of the nervous system.Some experiments of considerable importance have been made inthe course of the past year in the physiological laboratory of Sienna.Dr. Albertoni has made a series of experiments to determine certainproblems connected with the production ofepilepsy. He finds, as othershave done before him, that stimulation, by a very slight galvaniccurrent, of the motor centres for the limbs in the cerebral convolutions of either side produces epileptiform attacks. In order to de- termine whether this effect was immediate, or reflexively. produced by630 Psychological Retrospect. [Jan.,influencing the lower motor centres, he removel the motor centres onone side of the cerebrum, and, after an interval , applied the stimulusto the other side; bilateral convolutions were produced as before. Ashe remarks, this seems to imply that the influence of the cerebrum inproducing these convulsions is a mediate, and not a direct, one. Theseattacks are often accompanied by salivation; apparently due to astimulation of the salivary glands transmitted through the cordatympani, since it no longer occurs after division of that nerve.Drs. Bufalini and Rossi have been investigating the effect upon thenutrition of the spinal cord of section of the nerves connected with aportion of it . They find that, after two or three months, the whitematter in the segment of the cord corresponding to the nervesdivided is diminished in amount, but that the grey matter undergoesno change.They have also observed the effect of irritating the roots of thespinal nerves upon the heart's action. The number of pulsations isconsiderably increased ( 40-80 beats per minute, in dogs) when theroot of the 3rd dorsal nerve is irritated; when the root of the 4th isirritated, the increase is only 10 to 12 beats; when the root of the5th is irritated, there is usually an increase of from 30 to 40 beats,but sometimes there is no effect. (Occasionally the 4th nerve seemsto replace the 3rd in its special effect upon the cardiac pulsations . )Dr. Bonfigli ascribes the diarrhea often accompanying insanity andother chronic nervous disorders to paresis of the vaso-motor nervesin the intestinal mucous membrane. From this theoretical view, hewas led to administer chlorate of potash, which, according to Sasse,acts by increasing vaso- motor contraction. He has found it verysuccessful, provided it be given in larger doses than usual, and continued for some time after its good effects have been produced .There is a very able paper by Dr. Vigna, of Venice, on Delirium.which I regret cannot be satisfactorily abstracted.Dr. Bini gives an interesting account of the clinical teaching ofmental diseases in the different countries of Europe: but he is mistaken in supposing that only two courses of lectures on insanity aredelivered each year in the United Kingdom .The " Rivista Sperimentale di Freniatria e di Medicina Mentale, " ofwhich I briefly noticed the prospectus in the last Retrospect, has nowappeared for two years, and besides dealing with forensic medicine,contains many original articles on subjects connected with insanity.Most of the writers are connected with the asylum at Reggio; and abulletin of the condition of that establishment is added to eachnumber of the Review.Drs. Morselli and Tamburini give a minute analysis of the shape and size of the cranium in twelve idiots, and of their bodily peculiarities, which they compare with those of the inferior human races(particularly the Akkas, Australians, and Bushmen) , and with the various apes. They are led to the conclusion, though (as they justly1877.]631 Psychological Retrospect.99 remark) from a very small number of cases, that most of the pheno- mena of idiocy are instances of " reversion or "atavism," theminority only being due to arrested development.Dr. Tebaldi has been experimenting with the amyl-nitrite inhalations: he has used it very carefully in six cases of stupor or of melancholia attonita: he selected those cases in which the general physicalcondition, and the pallor of the face, led him to believe there wascerebral anæmia. He found the amyl nitrite act almost invariably asa powerful excitant; the face became flushed, and patients who hadpreviously been completely inert, were at once aroused, answeredquestions, took food, &c.: but these effects were always transitory,although the inhalations were continued once or twice a day for sometime. He thinks, however, that this may be an important adjuvant to other treatment of a tonic and stimulant character.Dr. Livi publishes a very minute account of the pathology ofGeneral Paralysis. He combats the views of Westphal on the onehand, and Poincaré and Bonnet on the other, looking to the encephalon itself as the primary source of the disease.Dr. Tamburini gives a very interesting description of salivation, as it occurs in lunatics. Eckhardt pointed out some years since, thatwhereas the saliva produced by irritation of the corda tympani or ofthe auriculo- temporal or lingual branches of the 5th nerve is wateryand thin, that caused by stimulating the sympathetic is thick and viscid . Stark applied this to the ptyalism of insane patients , andsuggested that the character of their saliva, when in large quantity,might be an evidence whether their insanity was produced by some primary cerebral disease, or by reflex action from other organs. Dr.Tamburini adds two more cases to those already mentioned by Stark,which conform to this rule.Professor Schiff, of Florence, publishes a very interesting critiqueupon Hitzig's and Ferrier's discoveries. The main point in it is this;that the centres which they have discovered are not centres of motionbut centres of sensation. He points out that the movements producedby irritating these points in the convolutions resemble reflex ratherthan direct action in several particulars (the power of motion is lostduring profound anæsthesia; the moment of closure of the galvaniccircuit acts more notably than the moment of aperture; the timethat elapses between the application of the stimulus and the production of movements is as long as in the case of ordinary reflex movements). Moreover, the movements are associated with secretory,cardiac, and vaso-motor phenomena, which are undoubtedly reflex in their origin.Schiff believes that the effects of removal of these points in theconvolutions prove that they are really centres of the sense of touch.Animals from which these have been removed ( he states ) suffer notfrom a true paralysis, but from phenomena of an ataxic character,which are absolutely indistinguishable from those produced by section632 Psychological Retrospect. [Jan. ,of the posterior columns of the spinal cord. The want of spontaneousness and co-ordination , which is very evident in such animals whenthey first begin to move, disappears if they are made to run fast. Sofar there is nothing inconsistent with Hitzig's view that these arecentres of muscular sense; but Schiff denies the existence of thissense, and argues that all the phenomena may be accounted for bylocal anesthesia, which may be otherwise proved to exist.Dr. Tamburini publishes a careful analysis of the local diseaseexisting in 331 cases of aphasia, being all that he has been able tocollect, and he finds that1. When the condition is one of mere amnesia, or of verbal ataxia(misuse of words), the part affected is generally one of the frontallobes.2. When there is verbal paralysis (logoplegia) the part affected is,in 37 per cent. of the cases, the marginal convolutions of the Sylvianfissure; in 31 per cent . the insula; and in 47 per cent. the corpus striatum.3. When there is glosso-ataxia the pons, or the medulla oblongata,is affected, and in the latter case most frequently the olivary bodies.These pathological data agree with the author's inferences from thepresent state of physiology. I may add, that he agrees with Wernick in supposing that the receptive centre for the auditory " images"ofsound is in the first temporal convolution which is connected by com- missural fibres with the insula.He calls particular attention to the varieties of disturbance ofspeech in general paralytics, which have been hitherto too littlenoticed, but have been lately pointed out by Voisin. I wish that Icould dwell more fully upon this extremely learned and interestingpaper.Dr. Berti has described two cases of what seems to be novcalled " Krishaber's disease," and is really chronic vertigo, graduallyincreasing in intensity, and not connected with anæmia, epilepsy, or affection of the internal ear or stomach. Such cases appear to bealways due to disease of the pons varolii.Dr. Morselli has taken occasion from five cases of broken ribsoccurring in the asylum at Reggio, to make a very elaborate study ofthe whole question. After a review of all the medical literature onthe subject, he is led to the conclusions that there is a tendency ininsanity to softening and atrophy of the cortical part of the bones,with hypertrophy of the medullary canals, and fatty degeneration ofthe medulla that this condition is usually not recognizable duringlife; and that the cases of fractured ribs noted in asylums are to beascribed to this pathological change, and not to violence or ill- treatment.The drawing up of a new penal code for the kingdom of Italy hasgiven rise to some discussion on the question of the legal responsibility of persons of unsound mind. The law, as recently laid down,1877.] Psychological Retrospect 633 .is that every one who has been deprived of the consciousness of hisacts, or of the power of resistance, by reason of infirmity of mind orexternal violence, is nevertheless responsible, but the punishment shallbe diminished accordingly. This is very ably combatted by Ziino.and Tamassia, who argue that, if insanity be once admitted, all responsibility ceases, and there should equitably be no question whateverof punishment.One of the most valuable features of this Review is a very carefulanalysis of the progress made ( particularly in France and Germany)in the anatomy and physiology of the nervous system: this is moreclearly and agreeably done than in any Retrospect with which I amacquainted.Dr. Tamassia has forwarded a pamphlet, containing his account ofthe post-mortem appearances in 235 cases of insanity. His accountconfirms, on the whole, Dr. Howden's and Dr. Balfour's observations,and, as it deals wholly with figures, I am unable to give any analysisof it, and will only add that its carefulness and evident trustworthiness will make it indispensable in any future study of the subject.3. English Retrospect. - Asylum Reports for 1875.(Continued from page 487.)THIRTY-EIGHTH ANNUAL REPORT OF THE SUFFOLK LUNATICASYLUM. This report, among other interesting remarks, containssome of which all superintendents will admit the truth, and which ,though not now delivered for by any means the first time, arevaluable as tending to remind the public at large of important factswhich they are very apt to forget . Speaking of the objections todischarging patients who are insane, but quiet, orderly and industrious within the Asylum, Dr. Kirkman says: -" It is perplexingto keep within the letter of the law, and to resist importunateentreaties; when they are complied with, feeling too often prevailsover judgment. " It will be said that a certain man, he continues,"might as well be working at home, and earning his living , asspending such capabilities for the benefit of the Asylum, where he is detained as an insane man. But how often is half a truth provedto be the greatest falsehood; it is the secret of quiet protection andasylum security in the background, which renders such occasional orconstant display possible; work is his happiness, his physic, and hiscure; he could not do under different circ*mstances , without medicaltreatment, or without the latent sense of treatment, what he does inthe asylum, and under its sheltering care. This is but a vivid instance of a very large class of patients who can and will work withadvantage here, but with whom friends make the fatal error, that theycould work just as well at home." Dr. Kirkman might have addedthat the percentage of those who do a really good day's work in asylumsis very small indeed, while that of those who do a good year's is634 Psychological Retrospect. [Jan.,almost fractional. Dr. Kirkman announces his determination toretire from the post which he has now held for forty- five years, andwe only express the sentiment of all the members of our Association,when we say that we trust that the committee of visitors havesufficiently rewarded his long and valuable services, and that he maylong enjoy their liberality. Neither the Committee of Visitors' nor theCommissioners' Report is printed, which we think is a mistake. Thedeath rate is 10.5 per cent.SIXTH ANNUAL REPORT OF THE LEICESTER BOROUGH ASYLUM.-The murder of an attendant in this asylum was committed by anepileptic patient, who was in the ordinary course committed for trial.The case is instructive as showing the indisposition of judgesand juries to admit the plea of insanity in cases where therecan be no reasonable doubt of it. The counsel for the patient , orprisoner, as he is termed in the visitors ' report, very naturally objectedto his being called on to plead at all, but the judge and jury, on theopinion of the two surgeons of the County Gaol that he " appearedto be quite rational, " and able to understand the witnesses, and instruct counsel, over- ruled the objection, and the trial proceeded.According to Mr. Finch, the medical superintendent, he seems to havebeen as troublesome, sullen, malicions, abusive and dangerous anepileptic as one could desire to meet with, but the judge, who will begratified to hear that it is the opinion of the chairman, and severalmembers of the committee of visitors, that he summed up the casewith great legal ability, charged the jury that " there was no doubt theprisoner was suffering under a delusion, but they must not say that aman was insane because he was suffering from delusions, unless theywere satisfied that he did not know what he was doing was wrong. Ifthejury came to the conclusion that the prisoner's mind was unsound atthe time he committed the act, that he was suffering from defectivereasoning powers, and insanity in his mind, that he was not able tounderstand he was committing murder, and only meant to wound thedeceased in order to gain a hearing for his alleged grievances, it wouldbe competent for them to say that the prisoner was not guilty, on theground of insanity. " The Verdict was nearly as lucid as the Charge," guilty, " therefore, not insane, but " strongly recommended to mercyon the ground that he occasionally suffered from delusions " of, wepresume, an insane description . The patient was sentenced to deathin the usual manner, and the sentence was afterwards commuted topenal servitude for life at Pentonville, thus marking an important stagein the history of the treatment of criminal lunacy. The death rate is9.6 per cent.THE FOURTH ANNUAL REPORT of the HEREFORD CITY AND COUNTYLUNATIC ASYLUM.-Dr. Chapman and the Commissioners both drawattention to an outbreak of erysipelas within this asylum, and ascribeit to a defective drain. 14 patients suffered from the disorder, four ofthem succumbing. Dr. Chapman devotes a considerable portion of his1877.]635 Psychological Retrospect.report to a discussion of the causes of the high rate of lunacy in Herefordshire; but he rather begs the question by assuming that Herefordpar excellence supplies many emigrants to other countries, and has comparatively few immigrants. Dr. Chapman does not produce any evidenceof this, and even if it were so, it might be used as an argument on theother side of the question , for if Hereford has so many emigrants, and so few immigrants, the former must acquire settlements in othercounties sometimes, and the latter, being few, can only slowly swell thenumbers within Dr. Chapman's district.ELEVENTH ANNUAL REPORT OF THE JOINT COUNTIES ASYLUM,CARMARTHEN. -In this asylum also, erysipelas has been epidemic, but fortunately it proved fatal in only one case. Neither the Commissioners nor Dr. Hearder assign any cause for the outbreak, and it hasnow disappeared. The commissioners make some very justifiablystrong remarks on the custom which it appears prevails in Carmar- then of taking patients, male or female, to the asylum, under thecharge of a policeman only; and in the case of a woman unaccom- panied by one of her own sex. Such a state of matters is mostobjectionable, and should at once be put a stop to. The death rate is12.6 per cent.ANNUAL REPORT OF THE CUMBERLAND AND WESTMORELANDASYLUM.-Dr. Campbell enters into an elaborate enquiry into theincrease of patients in this asylum, but refrains from drawing anyconclusions as to whether it argues an increase of insanity in his district, until the next census, in 1881. The commissioners give a veryfavourable report of the asylum. They note an employment ofseclusion and restraint considerably above the average, but do nottake any exception to the custom . The restraint was used for surgi- cal reasons, but the seclusion seems to have been resorted to as a methodof dealing with excited patients. The commissioners do not say anything in favour of this, but as we have said, they make no remarks incensure of it, and by a curious coincidence their next paragraph isdevoted to praising the increased quietness and order in the wards.It is every year becoming a graver and more important question whetherthe determined set against seclusion which has obtained for so long hasnot been in itself a mistake. It is certain that there is a dispositionon the part of some to break down the hard and fast lines whichhave hitherto been followed, and to judge every case on its ownmerits. With the fierce light of public opinion which now, thanksto the strenuous efforts of the Boards of Lunacy, beats on lunaticasylums, there is no fear of any of the abuses of former days beingrevived, and at any rate the medical staff of asylums are now recruitedfrom men of much higher standing in the profession than they usedto be. The death rate in this asylum is 6.6 per cent.TENTH ANNUAL REPORT OF THE CITY OF LONDON LUNATICASYLUM. -Dr. Jepson reports two cases of death during the night,while the patients were not under direct supervision, one from42 XXII.636 Psychological Retrospect. [Jan,,accidental suffocation in an epileptic female, but not, Dr. Jepsonthinks, during the occurrence of a seizure, and the other from diseaseof the heart. The commissioners, in their report, point out that intheir opinion the former case indicates the necessity of establishing award for the special supervision of epileptic and suicidal patientsduring the night, but the smallness of the asylum will perhapscause a considerable difficulty in carrying this out. The death rateis 7.23.TWENTY- SEVENTH ANNUAL REPORT OF THE NORTH WALESLUNATIC ASYLUM. -The occurrence of several cases of diarrhoea in thisasylum created some suspicion as to the purity of the water in use,and an analysis was made by a qualified chemist with the result ofshowing that it was utterly unfit to be used for drinking or cookingpurposes. And to this it may be added that the supply is scanty,which, though apparently advantageous, is not really so, because inhot or dry weather there is little or no flow through the reservoir, andthe water becomes stagnant, thus adding to its impurity. The committee have utilized a spring at a little distance from the asylum, butit only yields about 5000 gallons a day, which is, of course, far toolittle for an average number of 391 patients , with an appropriatestaff; and though they say it will only be used for drinking andcooking, while the contaminated fluid will not be employed exceptfor washing and bathing purposes , there is always a practical difficultyin carrying out this, and we fear that it will be found impossible toprevent considerable consumption of the inferior water, especially as it is stated, when at its worst, to be free from taste and smell. Thedeath rate in this asylum is 13 per cent.REPORT OF THE NORTHUMBERLAND COUNTY ASYLUM.-In this report, which is still published in royal quarto, or something like it,Dr. McDowall's remarks are chiefly confined to reporting alterations either proposed or carried out. The death rate is 11.9 percent.THE ELEVENTH ANNUAL REPORT OF THE STAFFORDSHIREASYLUM, AT BURNTWOOD.-This is chiefly remarkable for the fact thatDr. Davis inserts, in his own report, a letter from the Guardians ofthe Walsall Union, expressing their " entire satisfaction with allthey saw" at a recent visit to the asylum. The Guardians ofthe Walsall Union are no doubt very worthy men, but they are hardlyauthorities on the manner in which asylums should be managed, and,indeed, if they are anything like some boards of guardians we know,what they call " their sense of the admirable manner in which theestablishment is conducted, " is hardly likely to be satisfactory testimony. The death rate is 17.37.TWENTY-FIFTH ANNUAL REPORT OF THE BIRMINGHAM BOROUGHASYLUM -In the end of 1874 , and the beginning of 1875, there wasan outbreak of small-pox in this asylum. One patient in whom thedisease was attended with hemorrhage, and a nurse who had refused1877.] Psychological Retrospect.637•to be vaccinated , died . There was also a violent epidemic of erysipelas, eight persons dying from this disease. To show the veryunfavourable nature of the cases in this asylum, there were two brokenlegs, one broken thigh, two broken collar bones, one broken rib, andtwo fractures of the neck of the femur, a dislocation of the shoulder,an accidental amputation of a finger, a thigh badly gored by a hog,and two cases of accidental suffocation. Altogether we mustsincerely congratulate Mr. Green on being rid of a very tryingyear. The report of the commissioners is not published.death rate is 13.6.TheTWENTY- EIGHTH ANNUAL REPORT OF THE SOMERSET COUNTYASYLUM. In this asylum also there was an outbreak of erysipelaswhich, however, appears to have resulted in death in only one case.Dr. Medlicott complains of the custom of sending patients to theasylum at so advanced an age as 83, 88, and 94 years. Certainly,except under very special circ*mstances, it would seem that theymight be as well cared for elsewhere. The report of the commissionersis not published . The death rate is 12.10.ELEVENTH ANNUAL REPORT OF THE GLAMORGAN COUNTY ASYLUM.-Dr. Pringle following up a subject to which his predecessor,Dr. Yellowlees, paid considerable attention, enters at some length intoa discussion of the large percentage of his cases in which the insanityis alleged to be due to intemperance. 33 per cent. is a very largeproportion, and even allowing an ample margin for false information,and for fallacies , there must still be a great number due bona fide tointemperance in the use of intoxicating liquors. Dr. Pringle is oftheopinion that the love of drink has not been the origin of these badhabits in the majority of cases, but that it is believed that in beeralone the men will acquire and retain the strength necessary for thework they have to perform, which is frequently very arduous indeed ,and entails exposure to a very heated temperature. Dr. Pringleseems to think that an improvement would take place if the simpleelements of physiology and of hygiene were taught to boys atschool, and we hope it may; but we fear that the flavour of a pint ofstout will be to the toper a much more cogent reason why he shouldindulge, than all the physiology in the world why he should abstain.The death rate is 9.8.FIFTY- SEVENTH ANNUAL REPORT OF THE STAFFORD COUNTYASYLUM, AT STAFFORD. -There is nothing calling for special remarkin this report. The death rate is 19.6, which is very high, but thereseems to have been a very large number of feeble and aged persons.Of the 104 deaths, 28 are ascribed to general paralysis, of whichnumber the large proportion of 5 were females, and 18 were cases ofsenile decay.ANNUAL REPORT OF THE HANTS COUNTY ASYLUM. -This report,which is almost of the same inconvenient shape and size as theNorthumberland one, relates the story of an assault on Dr. Manley,638 Psychological Retrospect [Jan., .the superintendent, by a male patient who had armed himself with aportion of an iron spoon . Fortunately, the attack was unsuccessful.The patient had recently been in the Colney Hatch Asylum, andhad prepared to make a similar attack on the superintendent of thatinstitution on the day that he was transferred to the Hants Asylum.He told Dr. Manley, " I will kill you; I will bathe my garments inyour blood; I am not mad, but being in an asylum, I can do whatI like and not be responsible for it; " and he quoted the instance ofthe melancholy death of Mr Lutwidge by a patient who, beingdemented, was held irresponsible. Dr. Manley remarks on thiscase, " this homicidal propensity has existed ever since, and still continues, and I may add that in my opinion the patient is quite asdangerous to others as to myself. To prevent his making suchanother attempt, his arms are confined to his sides by a waist- beltand armlets, so that his arms cannot be raised above his head to strikea heavy blow. Some persons would call this man's conduct uncontrollable, ' I call it uncontrolled; ' but, at all events, whilst he is sodangerous, I see no good reason why the lives of those about himshould be risked from a sentimental objection to the use of restraint, and, until I see very good reason to the contrary, I shall continue to prefer the safety of others to the freedom of limb of awould-be assassin. " Dr. Manley also calls attention to the advancedage at which patients are admitted , the ages of 14 averaging 73years. The death rate is 9.7.TWENTY- THIRD ANNUAL REPORT OF THE KILLARNEY DISTRICTASYLUM. The first thing that struck us on glancing through thisreport, was the commendable brevity of the Inspector's entries.The result of a two days' visit is chronicled in half a page of the report, and such sentences as the following occur: " The food Iexamined was very good; "The visits of the external officersare regular; " " The body clothing of the patients is on the wholefair, save so far as shoes are in question; indeed, in most IrishAsylums, I find more or less neglect in this particular. " The EnglishCommissioners visit Asylums in couples, and so are entitled to theuse of the pretentious " we;" but who ever heard of the Scottish,who visit singly like the Irish, using the " I? " With them it isalways " it is recommended," " it is suggested, " and so forth . Inthe report of this Asylum there is a singular remark in this sameInspector's entry. " The matron complains, and I think properlythat there is little or no amusem*nt for the females. I have requestedher to submit to the Board ofGovernors any means for that object shemay recommend." We cannot but regard it as fatal to the progresstowards improvement of the Irish Asylums that the responsibilityof management should be so divided. In a few English and ScottishAsylums the matron is still vested with exceptional and independentauthority, but these are notably the most badly managed institutions.We wonder that Dr. Nugent does not make strenuous efforts to1877. ] Psychological Retrospect 639 .have matters placed on the proper footing, and to make the MedicalSuperintendent responsible for everything, even the amusem*ntsof the females. The percentage of deaths is 11.25.TWENTY- FIFTH ANNUAL REPORT OF THE WILTS COUNTY ASYLUM.—If we remember rightly, Dr. Burman wrote the longest report of all thereports that reached us last year, and this year he has a fair chance ofa*gain bearing off the palm in this respect. The Committee of Visitors ,too, are not behind hand, but are almost as voluminous for a Committee as Dr. Burman is for a Superintendent. Much that is said in theMedical Report is of considerable interest. It seemed scarcely necessaryhowever, to insert a copy of the correspondence between the Commissioners and the Asylum about special supervision at night ofepileptic and suicidal patients , in which the Secretary asks if the Committee have taken any steps in the matter, and Dr. Burman repliesthat they haven't. A copy, too, of the Section of the Lunacy Actrelating to the ill- treatment of patients is very properly handed toeach attendant on his entering the service of most Asylums, butthere is no occasion to embody it in the report. Erysipelas has beenprevalent in this Asylum also, and one death resulted from it, andDr. Burman's heavy responsibilities have been still further increasedby outbreaks of measles, scarlatina, and typhoid fever. In their reportthe Committee draw attention to the fact that patients are sent to theAsylum as paupers, the whole cost of whose maintenance is borne bytheir friends, which they seem to think an abuse of a building erectedby the ratepayers of the county for paupers only. This is an illiberaland not a philanthropic view of the matter, and one which, if itsworking were strictly enforced, would cause far more evil and miserythan it would prevent. Every one who has had the charge of apauper Asylum knows that there is a very large number of peoplewhose circ*mstances are such that they have the greatest possibleobjection to going on the parish, but who could not afford to pay thelowest rate of charge in any private Asylum. To these the CountyAsylum is a great boon , and if its doors were shut against them,there would be nothing for them but to remain at home until thedisease is almost past the chance of recovery, and their money all spent, when the whole family would be thrown on the parish. Wespeak from personal knowledge when we say that there are many instances in which the slender savings of years are proudly parted withweek by week to the Guardians rather than allow an insane relationto go on the parish, and the habit is one so productive of good inevery respect that it should rather be encouraged than checked. Thedeath rate is 10.7.REPORT OF THE LANCASTER COUNTY ASYLUM AT WHITTINGHAM.-This Asylum, which has been opened for three years, and whichappears to have been built for 1,140 patients, already contains 891,or about five sixths of what it can hold, a state of matters whichcannot fail to make the county ratepayers of Lancashire feel uneasy.640 Psychological Retrospect. [Jan.,The yearly increasing requirements for the accommodation of lunaticsis one of the gravest social questions of the day, and to all appearancewe are as far from its solution as ever. The death rate is 10:39.REPORT OF THE LANCASTER COUNTY ASYLUM AT PRESTWICH. -TheCommissioners commence their statutory report by saying that theinspection occupied them about a day and a half. Considering therewere at the date of the visit 1,028 patients, and taking a workingday and a half as 12 hours, this is at the rate of 42 seconds perpatient, inclusive of inspection of wards, registers , &c. They makea very favourable report of the condition of the Asylum. Mr Ley'sreport is , as usual, thoughtful and pointed, and in many respects amodel of what a report should be. The death rate is 8.83 .REPORT OF THE NORFOLK COUNTY ASYLUM. -In this Asylumerysipelas has been prevalent, and two deaths are ascribed to it; butin addition to these we observe in the table of the causes of deathother fatal cases from blood poisoning. We have, in this article,noticed already so many Asylums in which such epidemics haveoccurred, that we confess we feel some alarm on the subject. Thecontinued cry for more accommodation is quite bad enough withoutthat already in existence being unhealthy. The death rate is 13.11 .FORTY-SIXTH ANNUAL REPORT OF THE BELFAST DISTRICT ASYLUM.-During the year this Asylum had the misfortune to lose, by death,the venerable services of Dr. Stewart, who was for so many years theIrish Secretary of this Association . Every one who knew him knewthe great interest he took in his work, and those who visited theAsylum when it was under his management had reason to testify tothe intimate personal knowledge he had of those under his charge.Both the Inspector (whose reports are, as usual, of the shortest andpithiest description ), and Dr. Merrick, his successor, make suitableallusion to the loss the Asylum has sustained by his death .death rate is 4.2.TheEIGHTEENTH ANNUAL REPORT OF THE CAMBRIDGE COUNTY ASYLUM.-An outbreak of erysipelas occurred in this Asylum of a very serious character, and carried off four cases. It seems to have brokenout in February, and it did not disappear until the end of September.The Commissioners ascribed it to the serious over-crowding of theAsylum, which they say has been officially known to the Committeesince 1870, and has at each statutory visit been the subject of comment by the Board of Commissioners. The Committee have at lengthbestirred themselves in the matter, apparently not before it wasnecessary. The death rate is 19.2.SEVENTEENTH ANNUAL REPORT OF THE SUSSEX COUNTY ASYLUM.—In this Asylum there were two deaths from erysipelas, but as no remark is made by either the Commissioners or the Superintendent, wesuppose the disease was not epidemic. Dr. Williams complains ofthe trouble he experiences in getting the relieving officers to have the papers for the admission of a patient properly filled up. It is1877.]641 Psychological Retrospect.a very difficult thing to know what to do when a patient arrives froma distance in such cases, for it is practically impossible to refuse admission to, for instance, a desperate suicidal case, yet in even such acase the Superintendent makes himself liable to heavy penalties if headmits the patient. Dr. Williams writes with approval of his classesfor teaching reading and writing as productive of excellent results.The death rate is 15.2, and of the 120 deaths no less than 54 areascribed to epilepsy, general paralysis , and other diseases of thebrain.THIRTY-SIXTH ANNUAL REPORT OF THE ROYAL CRICHTON ANDSOUTHERN COUNTIES ASYLUM.-The only topic of particular interest treated of in this report is in a paragraph on Voluntary Patients,which we should have been glad to see much longer. At the presentday when there is so strong a desire on the part of some to legislatefor habitual drunkards, and so much difference of opinion even amongst the parties themselves as to how it ought to be done, amore detailed account of Dr. Gilchrist's opinion of the working ofthe voluntary system among the insane would be very acceptable.We believe he has had more experience of the system than any other Asylum physician. Numbers of papers have been written onthe subject, but there is no really satisfactory account of the resultsobtained . He had 16 " voluntaries on the 31st of December, 1874,and 14 on the 31st of December, 1875 , having admitted 12 duringthe year.We gather from what he says that he does not view the system with much favour, as he says they seldom remain until re- covery is completed , and our own experience coincides with this view.When they begin to be a little better, they, like most other patients,feel the restraints of Asylum life irksome, and demand their discharge.This may be refused by procuring an order and certificates for theirdetention, but such a plan is seldom resorted to except in extremecases, for it is considered by the patient as taking an unfair advantage, and , so to speak, setting a trap for him, thus increasing theirritation which he feels at being detained at all, and prejudicing his chances of recovery. The statistical tables given at the end of thisreport are very inadequate, and we would suggest that the tables ofthe Medico-psychological Association, now happily in force in nearlyall other Asylum reports, should be adopted next year. The deathrate is about 7.6.-THIRTY-FOURTH ANNUAL REPORT OF THE SURREY COUNTY ASYLUMAT WANDSWORTH. The Committee of visitors of this Asylum takevery liberal and advanced views of the ultimate economy of providing ample accommodation for the pauper lunatics of the district. Theirremarks may be read with advantage by many like bodies. Talkingof a decrease in the numbers of lunatics within the county during the year they say, " It is not for us to say what effect this diminution innumbers may have upon the question of building a third Asylum, but whatever steps may be taken, we hope it will be remembered that there642 Psychological Retrospect. [Jan.,is no surer way of keeping down the numbers than by taking care thatthe Asylum accommodation shall constantly be somewhat in excessof the demands upon it." This opinion may be true, but we fearthere is no proof of it in the experience of the English counties.According to the report of the Commissioners restraint by means of"gloves appears to be freely employed for destructive and forsuicidal propensities. The death rate is 9.3.ANNUAL REPORT OF THE GLOUCESTER COUNTY ASYLUM. -Mr Tollerhas apparently nothing to say, for there is no medical report. Thedeath rate is 13.REPORT OF THE ROXBURGH, BERWICK, AND SELKIRK DISTRICTASYLUM. In the report of one of the Commissioners, it is said thatat this Asylum " the removal of unrecovered patients appears to be judiciously encouraged. " As all the information that Dr. Griersongives of these cases is that of the 8 discharged " relieved," which we suppose answers to the " unrecovered " of the Commissioners, 5 wereliberated at first on probation , and 2 removed to England and Ireland,we should be glad if he had enlarged a little on this subject. With so many Asylums in the United Kingdom, too small to supply thewants of their districts, the discharge of " unrecovered " patients islooked upon as almost a necessity by some; but it is obviously asystem to be adopted with discretion, and some details from those whoemploy it would be extremely valuable. The death rate is 6.1 .theSIXTH ANNUAL REPORT OF THE STIRLING DISTRICT LUNACYBOARD.-The first thing which strikes one in reading this report isvery large proportion of admissions to the average number resident, viz., upwards of 100 per annum of the former to about 215 ofthe latter. To speak in actual figures, the number of admissions in6 years (we purposely omit the first year of the Asylum) is 630, or105 per annum, and the average number resident in those 6 years was220. The number of admissions to the English County Asylums in1874 was 9,693, and the average number resident was 32,062, but ifthe percentage of the Stirling District obtained, the admissionswould have been 15,302, or in other words they are in England atthe rate of only three- fifths of the Stirling rate. Dr. Frederick Skaeenters at considerable length into a discussion of this, and thekindred subject that the Asylum is over- crowded, and he by no means allows that such a state of matters is of itself an argument foradditional building. He, on the contrary, seems to think that themore accommodation you provide the more you will be asked for, andhe would try the plan of boarding the surplus in other Asylums.He says, " should the Asylum again become crowded it will be better,instead of building, to rent beds for the surplus patients in some otherAsylum, and to meet the extra cost for the patients thus boarded byraising the general rate of maintenance." He thinks that by thusdirectly raising the cost of keeping pauper lunatics in the Asylum ,instead of doing it indirectly by county rates for additional build-1877.]643 Psychological Retrospect.ings, a wholesome check to the system of sending all and sundry tothe Asylum would be given . The chief objection to the plan is thatall the District Asylums are either full or with every prospect ofspeedily becoming so, and such a remedy could therefore only be of avery temporary nature. Besides, the system, where it has been tried,and it has prevailed to a very large extent from time to time in England , during the erection of County Asylums, operates with unduehardship on the patients, who are thus removed for an indefiniteperiod from all chance of seeing their friends. This is not a triflingconsideration, for the patients thus transferred are generally takenfrom the quiet and orderly class , the Superintendent to whom they are going naturally objecting to receive the worst cases . Dr. Skaestates, that from information he procured, he knows he might havedisposed of 50 patients in this way last year by paying from three tofive pounds a year more than the Stirling rate of board. The Commissioners suggest in their report that the Asylum should be enlarged,but Dr. Skae " hoists them with their own petard " by quoting passages from their former reports strongly condemnatory of largeAsylums. The death rate on the average number resident is nearly 9· 1 ,which is not of itself particularly high, and Dr. Skae very fairly points out that the unusual number of admissions which he has every yearshould be considered, the death rate being always higher in the recentcases. A really correct mode of calculating the death rate in Asylums isstill wanting. Dr. Skae has been appointed Inspector of Asylums forNew Zealand since his report was written, an appointment on whichwe congratulate him and the New Zealand Government. He willthere have a new field before him, and we shall mark with muchinterest the methods adopted in that colony under his guidance for the care and treatment of its insane.66REPORT OF THE COUNTY LUNATIC ASYLUM AT RAINHILL. -Erysipelas has been epidemic in this Asylum, and carried off 2 patients.Dr. Rogers shows the importance of receiving with caution thealleged " causes of insanity in cases admitted to Asylums, in thecase of a sailor whose disease was charged to attendance at " revival "meetings, but who, on enquiry, was proved to have been living a dissipated life for some time before. The death rate is 11.77 per cent.THIRTIETH ANNUAL REPORT OF THE DEVON COUNTY ASYLUM.-From the medical report it would appear that the Superintendent ofthis Asylum is occupied, to a great extent, as a Clerk of Works;at least, we cannot see what bearing on the treatment of the insanethe erection of new boilers , gasworks, and laundry cisterns has.These things belong rightly to the report of the Committee of Visitors,and if they do not think themselves competent to remark on them,they should employ somebody who is, and not throw the burden andresponsibility on the Superintendent . That officer , to whom theyallow only one assistant, has surely quite enough to do in lookingafter a daily average of 683 patients, without having in addition to644 Psychological Retrospect. [Jan.,be directly answerable for the efficiency of gas, scrubbers, and retorts .The death rate is 7.9.SIXTEENTH REPORT OF THE THREE COUNTIES ASYLUM. -Erysipelashas been prevalent in this Asylum, but it is not assigned as the causeof death in any case. There is a strikingly large number of deathsfrom " senile decay," viz. , 23 out of a total of 81 deaths, or nearly30 per cent. The Commissioners, in their statutory entry, state thatMr Swain, the new Superintendent, has entirely abolished the use ofseclusion, and from what they say, and from what he says, we gatherthat he carried out his views immediately on his arrival by summarilydispensing with it in all cases whatsoever. Mr Swain evidently gratified the Commissioners very much by his alacrity in conforming totheir views. The death rate is 11.34.NINTH ANNUAL REPORT OF THE SURREY COUNTY ASYLUM ATBROOKWOOD. -Dr. Brushfield calls attention to the increasing percentage of registered lunatics to the population within the county ofSurrey, and he shows pretty plainly that it is rising in a higher proportion than the population itself. We need scarcely point out that this has no bearing on the question of the increase of insanity in thecounty. His remarks about the water supply are a little alarming,and are worthy of being quoted. "We have had no reason to complain as to the daily quantity. As to the quality, having some reasonto doubt its purity, it was, at my request, analyzed by the county analyst, and his report was far less favourable than that of theanalysis made in 1868. Since that time a considerable tract of landhas been drained into the sources of our supply, and a number ofhouses erected in their vicinity, from which there is reason to fear sewage percolation may occasionally take place. As yet the contamination is not very much, but is likely to increase year by year. Muchmay be and is done by filtering the whole of the supply through a thick bed of sand, gravel, and animal charcoal, before being furnished tothe Asylum, and through filters placed in each ward." Dr. Brush- field proposes, as a remedy, the sinking of an Artesian well, andcertainly something of the kind should be tried. Want of water inSurrey, and contamination when you get it, are not a satisfactory state of matters. The Commissioners' entry is not published, as it wasprinted with last year's report. This is, in our opinion, a mistaken plan; each year's report should be complete in itself. The death rate is 10.61 .REPORT OF THE CHESTER COUNTY LUNATIC ASYLUM AT CHESTER.-From a remark in the report of the Committee we infer that theythemselves engage and dismiss the attendants of this Asylum.Speaking of the conduct of the servants of that class they say it was," on the whole, satisfactory, with the exception of a want of sobrietyon the part of a few of the male attendants, but the Committee havingexercised the necessary discipline in their cases trust that, " &c. Suchpowers would be much more appropriately exercised by their Superin-1877.]645 Psychological Retrospect.tendent. If a Superintendent is fit for his place he is fit to be entrusted with arbitrary powers in regard to the engagement and dismissal of all the servants, the Committee holding him responsible fortheir conduct, and it is a notable fact that by far the best managedAsylums are those in which the Superintendent's authority is paramount. By leaving everything connected with the administrationof the Asylum in his hands, the Committee are only making apractical acknowledgement of a fact which they would never attemptto deny if it were placed plainly before them-that he knows muchmore about it than they; and if he is the proper man for the placethere is no fear of his exceeding his duty, while, if he is not, theyought to get some one who is. We think the Committee of Visitorsof this Asylum do grave injustice to Dr. Davidson, and seriouslyperil the discipline of the institution by their plan of administration.The death rate is 15.2 , but there has not been any epidemic.Report of the ROYAL EDINBURGH ASYLUm for the Insane. -Dr.Clouston goes into the question of the connexion of intemperanceand insanity. It is of importance that this should be rigorously andscientifically enquired into by those who have such ample means at theirdisposal as Asylum Superintendents, for the subject is of vast consequence to the true solution of a question which relates to one of thegravest social evils we have; and if the answer should happen to cutaway a good deal of the ground from under the feet of the complacentplatform orator, we are not sure that much harm would be done, forwhen philanthropy runs counter to truth, though some good may be done at first, evil is sure to ensue in the long run. There were 320admissions of all classes. The death rate is 9 per cent.ANNUAL REPORT OF THE WARWICK COUNTY ASYLUM.-There hasnot been any epidemic here, but there were one or two accidents of aserious character, one being loss of the sight of an eye by a patientwho was pushed against a table by another. An attendant committedsuicide. Dr. Parsey gives an interesting account of the inmates ofthe new idiot wards of this Asylum, but it is too long for quotation ,and does not admit of being curtailed. The death rate is about 9.8.We have now reviewed every report which reached us in time, and,in conclusion, one remark appears to be called for with reference tothe English Asylums . We have read the entries by the Commissioners in Lunacy, when they have been published , most carefullyfrom beginning to end, and while we have no hesitation on the wholein calling them sensible and practical, there is anan omissionwhich strikes us as being not a little peculiar, and that is, there isnot in a single instance, so far as we can remember, any allusionmade to the " Deaths, Injuries, and Violence " column of the MedicalJournal. Superintendents are bound by the Act to be as careful andpunctilious in registering every black- eye, as they are in the case ofinstances of restraint. Every one knows how particular the Commissioners are about the entering of seclusion, but the section under646 Psychological Retrospect. [Jan.,which they proceed is just as peremptory about injuries and violence.A Superintendent once candidly said to us that he never entered suchinjuries as bloody noses, black eyes, ordinary scalp wounds, andsuch like, because he did not think them of sufficient importance,and also because if he once began he would have little else to do.The Act, however, is plain enough, and does not permit any discretionary powers whatsoever, any more than it does about restraint andseclusion. We trust, therefore, that the English Commissioners willnext year institute careful enquiries into the practice in vogue in thevarious Asylums, and we shall be much surprised if they do not findthat the greatest possible difference prevails . Apart from thenecessity, to which we have before alluded, of the Commissionersbeing strict in requiring a rigid and unvarying compliance with therequirements of the Lunacy Acts, it is certain that a comparison ona large scale of the restraint and seclusion , the medical treatment,and the deaths, injuries, and violence columns, if they were kept asscrupulously in all Asylums as we know they are in some, would beof the utmost value with regard to the results of treatment, if nothingelse. It would be an improvement if the Journal had to be signedby the Medical Officer, as is the case with similar records in theScottish and Irish Asylums; but, at any rate, it is almost impossibleto overrate its value as a ground work for statistics. With thissuggestion, which we urge on the Commissioners, we beg to takeleave of the subject of the Asylum reports.PART IV-NOTES AND NEWS.QUARTERLY MEETING OF THE MEDICO- PSYCHOLOGICALASSOCIATION, HELD IN EDINBURGH.A meeting of the Medico- Psychological Association was held on the 1stNovember, in the hall of the Royal Society of Edinburgh. Present,-Dr.Jamieson (who presided), Drs. Tuke, Howden (Montrose), Grierson, Cameron,Anderson, J. A. Campbell, Rutherford, Fraser, Smith, Howden (Haddington),Sanderson, Brown, W. C. McIntosh, and Ireland.Dr. HOWDEN (Montrose) exhibited a tubercular tumour from the brain of ayoung woman, and read the notes of the case. (See Clinical Cases.)ARTIFICIAL FEEDING.Dr. ANDERSON read a paper on " The Mechanism of Artificial Feeding," atthe same time showing the apparatus which he used for the purpose.The CHAIRMAN said that he thought they should be greatly obliged to Dr.Anderson for explaining his mode, which was exceedingly ingenious. The improvement on the old method was very distinct, and he would be glad to hear observations from some of his brethren on the subject. He was not fond offeeding artificially by instruments if he could avoid it; and he thought that of late years an advance had been made by kinder treatment of patients, and bythe exercise of more patience. He did not think that they had fed a patient1877.]Notes and News. 647artificially in his hospital for a year, and they had an average of 470 or 480 people in it. He recollected that when he began to be a superintendent, and when there were about 150 patients, he used to feed once every two or three months. He thought that they must feed, but that the cases were rare. When they had to do it, it was of importance that they should have it well done,without injury to the patient, who should be fed, not only once a day, but two or three times, to keep the physique in good order.Dr. CAMPBELL said he thought they ought to be now well-up in the subject ofstomach-pump feeding, as they had discussed , it twice in Edinburgh, andtwice in Glasgow. He was of opinion that the old- fashioned pump was alto- gether as good and as safe as any other mode. Whenever they had an acutecase of a patient being starved for a day, or at most two days, they ought to feed, as in such a case, if the patient was allowed to starve too long,the recovery was retarded. In cases that had come under his care he had fedtwice a day, as a rule, with the stomach-pump. The quantity was a pint of milk a day, and sometimes two glasses of whiskey in it. He thought they were much obliged to Dr. Anderson for his paper, but he must say that he did not at all agree with him as to feeding. He was of opinion that nothing wasbetter than a simple acting pump, without fine points about it.Dr. MCINTOSH said he never used anything else but a spoon.Dr. TUKE said he was of opinion that when they could not get a patient to take food in the course of 24 or 48 hours, artificial feeding was necessary.The older he grew the less he was in the habit of feeding patients; but therewere cases in which it was absolutely necessary, and he saw no difficulty in the use of the old stomach- pump. In regard to the position of patients, he laidthem on the floor, opened the month gently, although it sometimes took a little time, then put down the stomach- pump, and fed in the ordinary way.Hehad had considerable experience of different kinds of instruments; but for the sake of convenience and utility he had come back to the old stomach-pump,and having used it many hundreds of times he had had no occasion to regret it .Dr. HOWDEN said he agreed with Dr. Jamieson in his remarks that the seldomer they fed the patients the better, and also with Dr. Tuke that the olderhe got the seldomer he did it. He had tried the funnel many years ago. The first person he saw use it was Dr. Scott, Musselburgh, consulting Physician of Inveresk, and he thought it was more convenient than the stomach- pump. With the stomach- pump they required the food to be more finely broken down than whenthey used the other instrument. They could use mince meat more readily withthe funnel or the bottle than with the stomach- pump . Sometimes they found thatthe stomach- pump got clogged, and the contents squirted out on the operator.He did not think that anything could be simpler than the funnel, as it could not go wrong unless they broke it . He thought that the soft tube was more easy ofapplication than the ordinary stomach- pump. There was another point to whichhehad referred once before, but he did not think that he got many sympathisers- namely, the question about the possibility of accident from food getting intothe larynx. He thought that possibly in some cases the presence of a foreign body might be the cause of producing disease in the lungs.Dr. RUTHERFORD said that here they had also shown them an apparently new instrument, the pipette, by which small quantities of food in process of digestion could be drawn out of the stomach. He thought it might prove a very useful instrument, in showing how the process of digestion was going on.Dr. IRELAND said it struck him that it might be very useful in diseases ofthe stomach.The CHAIRMAN said he had no doubt that food occasionally entered the larynx ,and led to disease.Dr. ANDERSON said he was very much obliged to the members of the association for their remarks. It had struck him that they had not specially referred648 Notes and News. [Jan.,to the paper which dealt more with the mechanism of artificial feeding, or to the two instruments on the table. In referring to Dr. Campbell's remarks about asoft pipe, he said that the pipe he used presented great advantages, as it allowed gas easily to escape. He had seen patients with stomachs very much distended by gases and the soft tube did not allow these to escape so readily.If in certain cases of indigestion they wished to make the patient comfortable,by getting rid of gas, and to ascertain the state of the digestion, they would find this instrument, the pipette, a very practical one.The CHAIRMAN said that the subject was so important that he did not thinkthat they could have it two much discussed, and he was sure they were all much obliged to Dr. Anderson for his paper.The Association then dissolved, and a meeting of Superintendents washeld for the consideration of the subjoined petition, Dr. Jamieson being in the chair.HUMBLY SHEWETH ,Unto the RIGHT HONOURABLE THE LORD ADVOCATE FOR SCOTLAND.The Petition of Superintendents and other Officers of The Scottish District and Parochial Asylums for the Insane, adopted at aMeeting held in Edinburgh, " on the 1st November, 1876.That provision has been made by the Legislature for granting Superannuation Allowances to the Superintendents and other Officers of the County and Burgh Asylums in England, the District Asylums in Ireland, and the Royal or Chartered Asylums in Scotland.That this provision has been withheld from the same classes of Officers in the District and Parochial Asylums in Scotland.That your Petitioners feel that, under this exclusion, they are placed at a disadvantage in comparison with their English and Irish brethren; that this has been so far acknowledged by the Government of the day that, in the Bill which passed into the Lunacy Amendment Act,166, a clause was inserted to have your Petitioners placed on the same footing a similiar officers in England and Ireland, by authorizing District Boards to grant pensions to Asylum Officers who had served for at least fifteen years, of any amount not exceeding two- thirds of their yearly salaries; but that, from some cause unknown to your Petitioners, this part of the Bill did not pass into law.That this distinction , unfair in itself, has a prejudicial effect in the management and conduct of the District and Parochial Asylums in Scotland; that the duties, particularly of the subor- dinate officers, are not such as naturally to attract them to the work; and that the inducement of salary to cease with employment is found to be insufficient to induce a superior class of men and women to give their permanent services to Asylum work; that the constantly recurring changes in the subordinate staff prevent that training and education in their duties which,especially in the treatment of the Insane, are very necessary.That your Petitioners are of opinion that were District Boards of Lunacy and Committees of Management of Parochial Asylums empowered to grant a superannuation allowance of any amount not exceeding two- thirds of tl eir salary, out of the rates of their respective Districts,to any officer or servant who shall have served at least fifteen years in the District or Parochial Asylum of said Board or Committee, it would materially conduce to the efficiency of the service, and, consequently, to the welfare and comfort of the Insane.Dr. MCINTOSH said he thought that they were all as one on the importanceof this subject. There was nothing in the request made in the petition that their brethren in England and Ireland did not now possess . Moreover, he had theauthority of the General Board of Lunacy in pressing the matter, for in the9th Report the Commissioners had expressed a hope that before long theauthorization to grant superannuation allowances would be extended to theDistrict Asylums. That publication was in 1867, and now, after nearly tenyears, nothing had been done in the matter. He thought that they were allthe more justified on that ground in proceeding with it now. Further,he had very important documentary evidence from the General Prison of Perthon the subject, where the pensions had been long in action. The Governor wrote to him as follows:-GENERAL PRISON FOR SCOTLAND, PERTH.October 10th, 1876.DEAR SIR, -I have much pleasure in answering your query " as to the effect of the pension clause on the efficiency and permanency of our staff."In the first place it weeds the candidates, excluding that unsatisfactory class of beings who1877.] Notes and News.649are perpetually trying to better themselves by change of employment, for to such the Labour Market offers better terms elsewhere.It does much to prevent men from throwing up there situations in a moment of irritation, or under the inducement of temporary high wages; for, as soon as they have been a few years in the service , they feel that a portion of their remuneration has been laid by for them, and will continue to increase so long as they perform their duties with vigilance and fidelity, but is liable to forfeiture if they fail in these points.Nor are they the losers in surrendering somewhat of their freedom; for they are guarded against the possible caprice of a governor, by the fact that any charge against them wou'd have to be thoroughly sifted before an able and impartial body of men ( H. M. Prison Managers) ,and establishedto the satisfaction of the Home Secretary before the permancy of their employ- ment could be effected , and they have, by an almost unfelt exercise of self- denial, made pro- vision for declining years or failing health.Again, new hands, on entering an establishment where the majority of the officers are men of long service, find themselves in an atmosphere of discipline, and either, as in rare cases,feel it so irksome as to resign before much time has been wasted in the attempt to train them,or are gradually absorbed into the system, acquiring value year by year as their individual capacity is developed by experience, and the routine becomes instinctive.The most important point in introducing a system of pensions appears to meto satisfy those employed that they cannot be subject to arbitrary dismissal or forfeiture, and to admit no one who does not physically and mentally give fair promise of long service.Changes with us are comparatively rare, our Pension List very small, most of our old officers remaining in harness until the last and I cannot speak too highly of the whole staff at my disposal, the coherence of which , I believe, to be owing to the Pension Clause,W. McIntosh, Esq. , M.D.I am, my dear Sir,Yours faithfully,HENRY MAY.He also went to the office of the department of prisons and judicial statistics,where Mr. Danaldson, the gentleman in charge, showed him every courtesy, and where he had an opportunity of examining the various salaries and allowances for the ordinary warders in the general prison, so that he had statistics which would be valuable in detail by and by, as showing the respective rates they gave.There no pension was granted till after ten years' service. He did not think that it was so much in regard to pay that asylum attendants were so unsettled.His opinion was that it was more the monotony and the trials of temper ex- perienced, notwithstanding all the available means of amusem*nt they could bring to bear for their behoof, and he was strongly of opinion that the pension system would not only keep the nurses male and female, at their posts, but it would give them a better class.Dr. TUKE said it appeared to him in the first place that the petition, as it stood now, and the remarks made by Dr. McIntosh, pointed to two very different things. The one was a very right and proper thing, the passing of apermissive clause by which District Boards might give pensions to their officers of any class; but he gathered from Dr. McIntosh's remarks that he pointedmore to an organised system of pensioning than to the mere purpose of this petition . To his mind an organised pensioning of attendants and servants of an asylum would be most prejudicial to those establishments. And he thought that nothing pointed more vividly and distinctly to the injury that would bedone to the discipline of asylums, than the letter which Dr. McIntosh had read.From that they would see that the first thing that was done was, as soon as an officer or servant had a vested interest in his position, a withdrawal fromthe superintendent, the centre of the institution, of the right of engaging and dismissing. In the case of an inquiry into the conduct of an attendant arising,it would come before a tribunal, and he would ask:-Where would be theposition of a medical superintendent of an asylum, if, in every case in which the conduct of an attendant was being taken into consideration, it were to go and be argued before the District Board? That was his strongest objection toit. They would lose that power which made their position in asylums-that of engaging and dismissing their servants. Another thing was that even thoughthey had the power of dismissing the servants, their hands would be tied very closely indeed, when they had to take into consideration that the dismissal of aservant involved the loss of so much money. Again, he was by no means con-650 Notes and News. [Jan.,vinced that it was of so great importance as some thought, to retain a large number of very old servants in an asylum. If they were to have such a largenumber as twenty out of thirty- seven, who had been from ten to twenty yearsin the asylum, they knew that they gradually had a very extensive power overwhich the superintendents had practically no control whatever. For these reasons he was convinced that any such system as a systematic arrangement of pensions for asylum services would be highly objectionable. The thing toinduce servants to go to an asylum was to give good present pay.Dr. HOWDEN said that his mind was by no means decided on the question.He thought there was a good deal of truth in what Dr. Take had said. There wasa difference between the case of warders in a prison and attendants in anasylum. He held that the superintendents ought to have complete control over attendants in engaging and dismissing them. There was a great risk, if they made the plan on the same footing as that of prison warders, that they would be saddled with inefficient servants. He thought a great deal of thedifficulty might be got over by giving the attendants high wages, and let them pension themselves, as most men and women did who were saving. At the same time, if it would have the effect of getting a better class of people, and getting them to remain, it would be a great advantage to have pensions both for officersand attendants. He thought that they should know something of the experience of their English brethren on the subject before deciding the matter. Was it afact or not that they got better attendants in England than in Scotland? He thought that the changes in the English asylums were very frequent if he couldjudge from the advertisem*nts in the Scotsman.Dr. RUTHERFORD said that the question was whether the privilege ought to be withheld from the district asylums. The object was to place the district asylums on the same footing as the chartered asylums, and to give the district boards the power of granting pensions.The CHAIRMAN said it seemed reasonable that their district asylum brethren should be placed on the same footing as those belonging to the charteredasylums. He agreed with that, but as to getting up a petition for the pensioning of officers and other servants, he was not prepared to approve of such a pro- ceeding. Dr. Tuke had expressed his (the chairman's) own view of the matter.He did not think that they should have anything to do with the getting of retiring allowances for the servants. It was important that they should engage the servants, and be able to dismiss them. If the proposed alteration was made it would come to this that a committee would hire their servants , whom theywould not be at liberty to dismiss without the consent of the General Lunacy Board. He thought it was important that they should have their servantsunder their own authority; and it would introduce a disturbing element if they were to lead these people to suppose that they had other masters. He didnot believe that he could get very much better servants than he had at present.He gave the wages of the district, and more when he found it was necessary.He thought that a committee should be appointed to deal with the matter, and report to a future meeting of superintendents of asylums.This was agreed to , and after votes of thanks to the Chairman, and to theRoyal Society for the use of their rooms, the meeting separated.THE LATE THOMAS LAYco*ck, M.D.By the death of PROFESSOR LAYco*ck, the Association -of which this Journal is the literary organ-has lost one of its most distinguished members and brightest ornaments. In electing him to the office of President in 1869, and enrolling his name in the list of its Honorary Members, the Association gave ex- pression to the high estimation in which it held him. And no one upon whomthese honours have been conferred, took a deeper interest and contributed1877.]Notes and News, 651more zealously in promoting the highest aims of the Association . He willalways be remembered as among the most eminent of those who have helped to raise the study of medicine to the dignity of a science; and his work in demonstrating the interdependence of physiology, pathology, and psychology,will constitute his chief claim to this honourable position. The following extract from the "British Medical Journal " of September 30th is an apprecia- tive notice of his life and work:-" On September 21st, there passed away in Edinburgh one of the most voluminous writers, ingenious thinkers, and hardest workers in our profession.Dr. Layco*ck, the erudite Professor of the Practice of Medicine in the University, died of pulmonary consumption at his house in Walker Street, Edinburgh,on that day. He had been unable to attend to his professional duties for about five months, his disease being a fresh outbreak of phthisis, with which he hadbeen threatened twenty years previously. At that time his life was pronounced to be a most precarious one by several of the best men in London, but he seemed to have quite recovered. In 1866, he had his left leg amputated by Mr.Spence for disease of the knee joint, and, for a time, his life was in the utmost danger, while his sufferings were most intense. Ever since then he has beensomewhat of an invalid, but active and hard-working as ever. In April lasthe caught cold on a railway journey; the old mischief in his right lung seemed to have been roused into fresh action; he began to cough, and to suffer fromdyspnoea and vomiting after meals, and those symptoms steadily increased in spite of treatment. His strength was utterly prostrated at the last, butmentally he was quite clear, and as fond as ever of speculating about his ownsymptoms and sensations and his favourite medical questions. The post mortem examination showed old disease of both lungs, with a considerable amount ofrecent tubercular degeneration all through the right. The brain showed someatrophy, the convolutions were exceedingly numerous, and it weighed forty- eight ounces. He was sixty- four years of age." Dr. Layco*ck was the son of a Wesleyan minister, and was born on August 10th, 1812 , at Witherby in Yorkshire. At fifteen, he was apprenticed to Mr. Spence, surgeon, of Bedale. He afterwards studied at University College,London, and then , in 1833, went to study in Paris under Louis, Velpeau, and Lisfranc at La Pitié. After his return, he was appointed Resident MedicalOfficer of the York County Hospital; and, in 1839, he took his M.D., summâcum laude, at Göttingen. He was appointed Physician to the York Dispensary in 1841, Statistical Secretary to the British Association in 1844, Lecturer onthe Theory and Practice of Medicine at the York School of Medicine in 1846,and, in 1855, he attained the crowning point of his professional life, by being elected Professor of the Practice of Medicine and Clinical Medicine in the University of Edinburgh, succeeding Dr. Alison in the Chair of Cullen. Hetaught there and practised as a consulting physician up to his death, with the exception of the session 1866-67 , while he was suffering from the knee- joint disease and the effects of the amputation, when the late Dr. Warburton Begbie lectured for him in the Practice of Physic Course, and Dr. W. A. F. Browne inMedical Psychology; and the summer session of 1876, when Dr. Clouston, who had, since 1873, been associated with him in the latter course, and in thecliniques at the Royal Edinburgh Asylum, took his place with the assistance of Dr. Murdoch Brown. He was an F.R.C.P.E. and F.R.S.E. , and Physician toHer Majesty for Scotland. He was chiefly consulted for nervous diseases, but his practice was never extensive in Edinburgh."Dr. Layco*ck began to contribute to medical literature at a very early period of his professional life , and continued to do so unceasingly ever since. Anything like the list of all the papers and works he wrote could not possibly come in time. It is sufficient to say that they numbered over three hundred; andare to be found in almost every medical journal and periodical published in this country. His first paper was On the Acid and Alkaline Reaction of the Saliva,XXII. 43652 Notes and News [Jan., .published in the London Medical Gazette, in 1837; and his last was On Reflex Automatic and Unconscious Cerebration, in the Journal of Mental Science for January and April, 1876. He translated Prochaska's Nervous System, and Unzer's Principles of Physiology. He published his Nervous Diseases of Women in 1840; his Principles and Methods of Medical Observation and Research in 1856; and his Mind and Brain in 1860. Many of these went through more than one edition, and each new edition always contained much new matter-in fact, was generally re- written throughout.What"On considering this work of a man who has contributed so much to medical literature, the questions that naturally arise are: What has he done for medical science? What discoveries will be associated with his name?generalisations has he made? We think that those questions can be answered in Layco*ck's case very satisfactorily now; and that, a hundred years hence,they will still be capable of being answered to his lasting fame. We shall place his work in what we think the order of its importance. The doctrine of the reflex functions of the brain, which he was the first to formulate in 1844 (British and Foreign Medical Review, January, 1845) , has slowly but steadily acquired a strength of belief that now places it among the accepted laws of brain- physiology. It threw a flood of light on many obscure points-and all points were then obscure-in brain and mind function and disease. It has been extended by Carpenter, and admits of still further extension. His next mostimportant work, we think, may be reckoned to be the series of facts, generali .sations, and speculations, contained in his work on Mind and Brain, in regard to the connection of mental power and deficiency, evolution and decay, pecu- liarity and disease, with the molecular changes in the encephalon and with states of brain. No one can say that his attempt to correlate consciousness and organisation, in all their myriad phases, was a completely successful one ,but few physicians will now deny that Layco*ck's point of view is the true one;that his whole governing idea is that of the genuine medical philosopher; and that the very attempt was a noble and masterly one. The mere labour of collecting and arranging the facts was gigantic; and we believe that, if his lucidity had been equal to his depths, and his power of exposition equal to his thinking, his book would have marked an epoch alike in physiology and in psychology. It will ever remain a landmark in the region of the contact of mind with organised living matter. His work on Hysteria and Ubscure Nervous Diseases will, we think, stand the test of time. It brought some order out of absolute chaos. His observations and hypotheses as to the effect of the brainand nerve- centres in the causation and regulation of animal temperature in health and disease, of nutrition, of anasarcas, of rheumatic and gouty inflam- mations, and in diseases generally, were both highly original and practical. He did much to make trophic centres in the brain real to medical men. His theories of diathesis and their applications to disease were most original, and brought into notice facts of importance to the practitioner. His theory of limited vascular areas ' in the brain corresponding to certain functional areas,and of the general correspondence between this development in embryo of the great nerve- centres and the great vascular tracts in the brain, have received much confirmation from the investigations of Heubner and Duret. His theory as to the division of the brain into the three systems of the basilar correspond- ing to animal life, the middle to sensorial-animal, and the higher to the intel- lectual and inhibitory functions of man, no doubt, contains much truth. His theory of the functions of the cerebellum being that of storing up and giving out, in a regulated way, supplies of vis nervosa, is highly ingenious. He was one of the first to apply the doctrine of evolution to the development of the nervous centres in the animal kingdom and in man; and, indeed , in one of his early papers he foreshadowed the evolution theory. His speculations as to ' organic memory, ' and its hereditary transmission, are well worthy of study.And the last, but not least, of his achievements which the space at our dis- posal will allow us to mention, are his labours and writings in regard to public1877.]Notes and News. 653health. His papers on the Development of a General Law of Vital Periodi.city and of the Return of Epidemics, on the Vital Statistics of England,and the Public Hygiene of Great Britain, and his Report of the SanitaryCondition of York, were of the greatest importance to the science of hygiene at a time when it was struggling and unheeded. They clearly showed that Layco*ck was no mere theorist. Looking at Dr. Layco*ck from a psychologicalpoint of view, he was a man of immense and unceasing industry, both inreading and thinking, of wide grasp, and of great mental ingenuity. His was a speculative and philosophical mind, with a strong tendency to look into thereasons of things, to think about everything, and to generalise in regard toeverything he thought about. This was, in other respects, his weak point, for he could not help coming to general laws in regard to his facts, whether they admitted them or not. In his lectures on fever, he had every pyrexia to which a name had ever been given all marshalled in genera, and species, and groups,just like a botanist with his plants. He was systematic and orderly in hiswork, in his reading, and in his storing up of facts, of which he was a close observer and collector. The daily newspapers contained for him many factsillustrating medical psychology, which were duly cut out and put in their proper places. The medical press always contained cases illustrating his theories or suggesting others. His cases in hospital were always suggesting new ideas, and, above all , his reading of medical books -and we believe he was the best read man in English, German, and French medical literature in hisprofession was ever bringing new ideas, and adding to his facts."As a teacher, we must admit that Layco*ck did not always reach or interest the average medical student. He was, however, highly suggestive to themore thoughtful in his classes, and his teaching influenced them permanently throughout their lives, often giving a direction to their studies. He did verymuch for the teaching of mental diseases in the University of Edinburgh. He originated a summer course of lectures on ' Medical Psychology and Mental Diseases, ' and had often as many as forty students. Many men took to asylum life in this way. His class was the nest from which many of the Northern Asylum superintendents took their fledgling assistants ." Personally, he was a man rather under the middle size, with a beautifully shaped head and very well cut features, of the Neuro- arthritic diathesis,' as he described himself, with rather a cold manner, giving the impression of beingsomewhat egotistical, and not sufficiently alive to the feelings and amour propre of others. But, to those who knew him better, he was a genial com- panion and friend. He was a widower since 1869, and leaves a son anddaughter; the former, Mr. G. L. Layco*ck, took his M.B. degree in the Univer- sity of Edinburgh in August last. "THE RELATION OF DRINK AND INSANITY. -LETTER BY DR.PEDDIE.To the Editors of THE JOURNAL OF MENTAL SCIENCE.SIRS.-When I put my letter of 21st July into your hands for publication in the October Number of the Journal, I gave you in writing a most cordial permission to send a proof of it to Dr. Bucknil in ample time for a reply in the same Number if he chose to make it. If, therefore, there was any blunder.ing of the printer afterwards, the responsibility did not rest with me; but even supposing it had been otherwise, I think there can be but one feeling withyour readers, that the whole strain of Dr. Bucknill's letter in reply displays an animus and intemperate zeal unaccountable considering the nature of the question under discussion , and uncalled for by any remarks made by myself on his Rugby speech and letter to one of yourselves. Indeed , this remarkableproduction is written in a tone which to me at least is unexpected, as coming654 Notes and News. [Jan.,from a man of science and supposed seeker of the truth, and from one having a literary and professional character to maintain, and with whom, also , I had some previous acquaintance. In any remarks, therefore, which I now feel itnecessary to make, I may be excused in throwing courtesy and professionalconsideration aside, and speaking in unpleasantly plain terms.Dr. Bucknill in opening his assault attempts to secure me in a quasi- logical trap. He says, in substance-" You accuse me, first , of misstating and mis- representing your opinions; secondly, of ignoring them; and thirdly, of notreading them." And then he fancies to raise a laugh at the inconsistency of such an indictment " which no man can understand. "This is a good example of the complexion which may be given to a case by the way of putting it, namely, by keeping some important facts out of view,and by ingeniously shuffling and rendering words; and it is, indeed, quite inthe spirit of " the old pleadings- now happily abolished -even in the casuistry of the law."First. The misstatement or misrepresentation of my views consisted in Dr. Bucknil averring that I considered " drunkenness as a disease in itself; "and, again, that I held the " unqualified opinion that drunkenness is a disease in itself." Then, secondly, the ignoring of my opinions consisted in Dr. Bucknillsetting aside or wilfully disregarding them-as any dictionary will inform my learned censor to be the meaning of the word ignoring—and that because, in his estimation, my views possessed no value as coming merely from a Physicianand not a lunacy specialist like yourselves, and not possessing sufficient " quan- titative and qualitative " capacity to bear on the relations of vice and mental disease. Now, as these two counts against Dr. Bucknil are literally true,and quite consistent with each other, the third accusation, that I could not believe he had read my British Medical Association paper, or any of my other publications on Dipsomania, was a most natural inference. It wasbut reasonable to suppose that having in them, and in the evidence givenbefore Mr. Dalrymple's Committee, drawn very full and explicit distinctions between drunkenness the vice and drunkenness the disease-not so much,certainly, but sufficiently so-in the Association paper when limited in time,and addressing an audience the most of whom must have had ample opportu.nities of seeing and distinguishing the various phases of intemperance , -it was most reasonable, I say, to doubt that Dr. Bucknill had read either that paper,orthe others, and to suppose that he had taken for granted my opinions to be such as he desired them so as to give point to his remarks, otherwise he could never have so completely misrepresented them. This was a mostcharitable inference, which I regret, for his own sake, is not correct, since he confesses that he read the association address several times through!I sincerely trust that there may be few of the readers of the quotations given at pages 423, 4, and 5, so deficient in " quantitative " capacity as not tocomprehend statements so plain, and distinctions so explicit. The length of those quotations has irritated Dr. Bucknill not a little, doubtless because they brought under his own eyes what he seems unwilling to look at, and furnish toyour readers a ready reference to, and an explanation of the points underdiscussion, and consequently a refutation of his assertions. On these quotations I am quite content to rest the soundness of my position regarding the general relations of drink the vice and the disease. What is said in themexpresses in a condensed form what I have elsewhere more fully distinguishedand explained; and so far as I can see accord entirely with the evidence tendered to the Dalrymple Committee by those eminent Lunacy Specialists,Drs. Crichton Browne, Skae, Mitchell, Nugent, Boyd, and Mould, to which Dr. Bucknil in a curiously contradictory manner seems to adhibit his approval.I have carefully read over their evidence, and my general inferences from it are that they as well as myself consider vicious drinkers to be those who casually go in for a debauch, or are facilely led into one on a Saturday night oron a holiday excursion, or at a convivial party; or those who drink more or less1877.]Notes and News.655to excess systematically for the purpose of mental exhilaration or supposed physical support, or the love of drink, or to experience its intoxicating effects,but who all do so voluntarily, with some ability remaining to control themselves when they choose to do so, and are, in fact, to some extent, fit to manage their own affairs; but, on the other hand, consider that the vice of drunkenness in alarge proportion of cases passes into or produces a disease, which in turn occasions more frequent and excessive drinking; and that thus the habit which in the first stage was unquestionably a vice enters-through alcoholic influence affecting the brain and nervous system-the domain of disease, in which ere long, aided doubtless by constitutional and other causes, the moral nature isweakened and perverted , and, as Dr. Crichton Browne felicitously expresses it,"the will is paralysed." Dr. Browne also (Evidence, 2: 458) describes the one condition of drunkenness as brought about by a vis à fronte, and the other by an inevitable vis àtergo. With this mode of distinguishing ordinary drunkenness from dipsomania, Dr. Skae (610) expresses his entire agreement. Dr. Arthur Mitchell, in his admirable evidence , says ( 1216) "an habitualdrunkard "—using the term synonymously with dipsomania-"is a man with an ungovernable and remitting craving for drink, which has no reference to anything external; it comes from something within him." And,again (1189), "the very root of the mental unsoundness of the habitualdrunkard is an ungovernable craving for alcohol." Then Dr. Mould says (642),"intemperance as a vice is the result of a vicious and immoral habit; intemperance as a disease is attributable to an impulse which the patient cannotcontrol; in the other stage he can control it, he can be made to control it."Thus it appears that while the ordinary drunkard voluntarily seeks the in- toxicating effects of alcohol, the dipsomaniac drinks in consequence of an in- voluntary and irresistible impulse which no reasoning can control.If, therefore, this form of intemperance is not virtually an insanity, it is clearly allied, or analogous to it, or " a special form of it "-as the BritishMedical Association has put it-ranking as a monomania,-the attainment of drink being the one fixed idea in the mind of the individual, although, as in other insanities, there may at times be more or less of a lucid interval. As inthis morbid condition, therefore, there is real mental disorder and moralobliquity, without the controlling power of the brain-centres to guide theconduct, it seems an act of humanity and social expediency to be expected in a civilised and christianised country, that the wretched--we must not sayfortunate "-victims of it should be treated under control, as other insane persons are, without regard to the causes-vicious or otherwise-from whichthe mental ansoundness may have originally sprung; with this difference, that as drink craving continues to be the chief manifestation of it, reformation as well as cure must be aimed at." unAlas! that anyone in our noble profession should ever appear to scout orjeer at such wrecks of humanity as confirmed drink cravers are, and not lenda hand kindly, yet firmly and forcibly, to rescue them from utter helplessness and misery, and from sinking lower and lower in the social scale; or that heshould shut his own eyes, and attempt to withdraw the eyes of others from thedistress and ruin which happen to friends and families in consequence of the downward progress of confirmed drunkards; or that he should try to keep outof view even the economical aspect of the question which has to do with warding off the heavy local and general burdens entailed on a community fromthe poverty and crime inseparably following in the train of such a complication of evils.The asserted inability of myself and others to discriminate betweenordinary drunkenness and insane drink craving, and the attempt to imputeSynonymously also with these are employed the terms " Confirmed drunkard," " Drink craver," and Insane drinker; " and although there may be a difference of opinion as to the best term to adopt, all popularly are meant to describe the condition of the individual destitute of self - control in connection with the gratification of a propensity to indulge in alcoholic drinks.656 [Jan.,Notes and News.ignorance of or indifference to the amount of the former in our large cities,and which, indeed, everywhere disgraces our country, is singularly note.worthy. Dr. Bucknill's sympathetic lament in the contemplation of abestially drunken and debased populace; then his rage in fancying that we wish to "fondle the subject of the casual rich man's drunkenness, withdainty considerations of how he is to be placed in a golden cage, " " his palate pleased, " and furnished with other " new and relishable enjoyments;"next, his derisive sneers at the idea of " a highly philanthropic movement, "and "humane ends in view," for the reformation and cure of such individualswhich he chucklingly attributes to the sordid desire of earning " gold dust "by making "the rich man's captivity profitable; " and, lastly, winding up all this with a hilarious exclamation of desire to be himself an inebriate, andunder my care, is highly farcical, and fitted to produce on all rightly con- stituted minds a profound and lasting impression.Thus the whole scope and spirit of this letter is unworthy of its author, and incomprehensible; for while he affects concern for the ordinary drunkards of society-the tens of thousands of the lower orders who occasionally or frequentlygive themselves up to drunkenness, and taunts us with beginning at the wrong end in our efforts to do good, or, as he elegantly expresses it, " taking hold ofthe stick by the wrong end," he overlooks-nay, even seems to jest with the unutterable sorrows of the thousands in the better classes, including, besides the confirmed drink cravers themselves, those closely connected with them.Dr. Bucknill keeps out of view the important fact that such confirmed drunkards are so, in spite of the advantages which he seeks for the generalmass of vicious drinkers; nay, that in many instances, in spite of highmental culture, wealth, and rank, they are unable to help themselves in contending against the drink craving impulse, and at last sink to the lowest depths insocial life, dragging along with them those they should rather have elevated in it. Such considerations, however, are of no importance in his estimation, for todesire the rescue of such disreputables-to attempt to reform them, and to avert the grief and misery to others from their course of life, is to " dally with thetarnished fringe of drunken society," for whom, probably, he considers a stick taken by the right end would be the best mode of treatment!Who amongst us in the medical profession has not had occasion to mournover the sad extent of drunkenness among the poor and labouring classes; the festering mass in the wynds and closes of the large city; the clustering crowd of tattered, miserable wretches around our whisky, gin, and beershops;the number of incapables in police and prison cells; and the broken down anddegraded residents in poorhouses and Houses of Refuge? All this , too,appears to be on the increase in the lower strata of society, notwith- standing the strictness of our criminal laws, the educational, moral,and religous advantages now brought to bear on the people; the increase of wages and leisure to the working man, and the institutions of reading rooms, libraries and popular lectures, and the encouragement of public amusem*nts-all of which have been thought the best means forarresting intemperance and counteracting its manifold evils. But while this increased drunkenness is deplorably true, and whilst it is evident that we must with redoubled energy persevere in combating the demon enemy among themasses through the Schoolmaster, the City Missionary, the Clergyman, and by every other agency capable of bearing on this vast and disgraceful evil, who in his senses, would ever contemplate, or even dream, of placing all these drunkards in reformatory sanataria? A number of confirmed drunkardsveritable dipsomaniacs-among the poor, and criminal, and labouring classes,might be picked out of this seething mass of drunkenness and sent into public reformatory asylums-not " golden cages"-but suited to their condition in life.This could be done were the Legislature to confer the powers which are at present solicited; and if so, I am convinced that ere long the wisdom of thepolicy would be apparent and acknowledged by all from the amount of good done1877.]Notes and News. 657tothe individuals themselves, the amount of social evil averted, and the saving in public money. We are taunted with beginning at the wrong end; but let it be remembered that educating and reforming at the right end has been begun long ago, and is still in active operation. Why, therefore, should we not try it now at the other also? It is one thing to attempt to repress and mitigate the general amount of drinking, and another to endeavour to cure and reform those who appear to be the subjects of a drink craving which presents so much of the features of a mental and moral insanity, requiring peculiar re- medial treatment.But even supposing we cannot do much more for the larger heap of miserable inebriates than punish them, preach to them, and pray for them, that is surelyno reason why we should neglect any means practicable to reform confirmeddrunkards of the more intelligent and well-to- do class of working people and those of the various strata of society overlying it?Now, does it not strike everyone that when this sad condition occurs in thosewho possess educational, religious, or social advantages, or those who have every thing within reach to favour an enjoyment of the comforts and luxuries of life ,and every inducement to maintain their status in society, that there must be something peculiar in this drink craving propensity? Besides, is it not acurious fact, that there is a comparatively small -very small -amount ofordinary drunkenness in the middle and upper classes, and yet in them the excessive morbid craving for stimulants is found most frequently to exist , and assuming the worst phases? This, doubtless, arises from the varied andassociated effects of overworked brain and body, high mental culture, refinement, luxury, losses and crosses in business, and other causes -all inducing excitement of the nervous system which leads to a course of solitary indul .gence; and this takes place all the more readily if there is any hereditary proclivity in that direction, or to insanity in another form, or if the nervous system has been damaged by a sunstroke, severe accident, or sudden mental shock. But in whatever way the habit originates and becomes confirmed, or whether the course to it may be a long or a short one, that impulsive and uncontrollable desire for stimulants which is not amenable to human persuasion or divine precept, must be viewed as a form of mental unsoundness in whichthe function, if not the nutrition of the brain, is implicated, and must betreated under control as such; for self- esteem and self- control being entirely lost under the tyranny of the disease, it is obvious that this is the only hope of ultimately delivering its victims from the bondage in which they are held;and as such is the case, it is equally obvious that the Legislature, as in the cases of the general insane who are assumed to be unable to manage themselves or affairs, and to require remedial treatment, should dictate the kind andamount of control necessary both for the protection and chance of cure of the individuals chiefly concerned , and for the comfort and well being of others.But no, says Dr. Bucknill, this must not be. It is vice and not disease; leave these drunkards to their own sweet wills; punish them if their conduct in anyway affects the interest of others, or is an offence to the community, and all the more severely if they are educated , know the Truth, and are possessed of wealth; but rather let them drink, drink, drink on uncontrolled, injuring theirhealth, dissipating their means, beggaring their families, entailing disease,mental and physical, on their offspring, endangering the lives as well as the property of others, and let them, as they deserve, go down lower and lower todegradation and ruin. They are British subjects, freemen, and never shall be slaves (except to drink), and they have a right to go from bad to worse in drinking if they please. It is disgraceful, brute-like conduct, but it is their own choice, and they should know what it will lead to. No doubt it is a pityto see families and friends agonised, perhaps even apprehensive of their lives,and suffering in many ways besides the bitterness of shame from exposure to the world of living sorrows, and the dissipation of means, with the prospect ofcomplete ruin in the end; but let the poor wretches go, they are but threads in658 [Jan.,Notes and News.the "tarnished fringe of drunken society. " That they have money remaining,and available by their families to place them under safe control, or that friends are desirous and able to secure for them firm but kind treatment in thehope of ultimate cure and reformation, does not alter the case. The law,continues Dr. Bucknill, in stern and harsh tones, must not be permitted to interfere with the liberty of the subject in the amount of his libations, nor canit ever be allowed to license institutions for the reception of confirmed drink cravers, even although such institutions-except those for the lower classesshould be self- supporting and cost the State nothing; some are said to spend almost a lifetime in short confinements at the public expense in prisons for crimes committed under drink, or to obtain it; some among the workingclasses might probably support themselves and families for years if cured of the drinking propensity, but go speedily to the Poorshouse and leave their families destitute and a burden on the rates, or become vagrants or thieves.But such events, such sad results, cannot be helped; the principles of liberty must be respected, and we must still go on punishing for crimes committedunder drink, and being ourselves at the same time punished as the unavoidable result of this social evil. Institutions, continues Dr. Bucknill, even for confirmed drunkards in a higher grade of society than those just referred to which might be made self supporting, and establishments or homes for theupper classes which might even be made profitable to their proprietors, cannotbe tolerated . They are " drunkards' gaols," " sponging houses," or " golden cages "-all alike condemnable. They may be strictly temperance establish- ments, and have their apartments, cookery, occupations, within-door amusem*nts and out- of- door recreations, and many other well-devised arrangements for the station in life, means, former habits, and innocent fancies of theinmates, but yet the whole thing is bad. To attempt by any such means todisplace the craving for stimulants, to restore the health of the body, to encourage industrial habits, to occupy the mind pleasantly and profitably, to produce contentment and happiness, to beget self-esteem and strengthen the power of self- control, so as to fit the individual for liberty and the duties oflife-all these means which have been found beneficial by those having experience in the treatment of confirmed drink cravers are, says Dr. Bucknill,"philanthropic fribbles which make me right angry!"Such is the spirit and tenor of this remarkable letter, and such are the socalled fribbles which, I believe, almost the entire medical profession in Britain are at present desirous should be legislated for, and in support of which theeminent Lunacy Specialists before the Dalrymple Committee gave more or less decided evidence. Thus, Dr. Arthur Mitchell in his evidence ( 1201) enterswith much particularity into the consideration of those institutions which he thought might be founded by Government, and associations, and private enterprise, and licensed with powers to receive and detain persons who entered voluntarily and non-voluntarily. Dr. Crichton Browne (462) says, " I believe the foundation of such institutions to be the only chance of benefiting habitualdrunkards; " and, again (464) , the existence of such " is the only hope of curing a certain proportion of cases. " Dr. Skae ( 610, 11) entirely agrees with Dr. Browne's opinions; and Dr. Forbes Winslow says ( 1332) , such institutions "areto my mind one of the great and crying wants of the age; " and, again (1338)," they would be a national blessing, and in many cases self- supporting."In support of these opinions many other psychologists, alienists, and dis- tinguished physicians might be quoted; but I need not dwell further on thispart of the question, than to say that dipsomaniacs of any class are not fit subjects for lunatic asylums, not because of any doubt-as insinuated by Dr. Bucknill-that they are not mentally unsound, but because they have been found most troublesome and mischievous when associated with the generalinsane, and because they require special medical attention and government.This is fully attested and explained in the course of the evidence already re- ferred to, and, indeed, by all asylum superintendents.1877. ]Notes and News.659In regard to contemplated institutions for the treatment of confirmed drink cravers of the lower classes, of course, government could not be expected to do more at first, at least, than sanction tentatively some reformatory accommo- dation on a small scale, and at the public expense; but to meet the wants of the other grades of society we would confidently look to the efforts of associa- tions, and to private enterprise. Respecting sanataria for the upper classes,Dr. Bucknill has thrown out an insinuation that " gold dust "-the expectation that the " rich man's captivity made profitable "-lies at the bottom of the present movement to obtain a permissive law; and he has endeavoured to torture this conclusion out of what I said as to the various arrangements-even luxuries to the rich man-which he has a right to expect-necessary to make such establishments successful. The sole motive thus assigned is so vulgar,and the objection so absurd and equally applicable to every private asylum for the insane, that I shall not condescend to discuss the matter. I do nothesitate, however, to say that should power be granted to control confirmed drunkards, the founding of establishments to meet the requirements of the upper classes would be a perfectly legitimate investment of money, energy,and medical skill; and, further, I believe that any man undertaking such aresponsibility, and bringing mental power, and moral and religious worth to bear on his work, would assuredly make the enterprise profitable to himself,while he would be conferring a great blessing on individuals and the public.In conclusion, I must thank Dr. Bucknill for the opportunity given by his letter of enforcing anew the obligations of humanity and the law of love inconnection with this disputed question. The quotations , too, at pages 429, 30,and 31 , answer my purpose excellently; for that evidence being hidden in a bluebook is not readily accessible to many; and while the alleged " torment " bythe Select Committee of the House of Commons may be seen to have beenagreeably mild, I do not apprehend any serious consequences to myself or the important psychological and social question at issue fromthe torment attempted on my letter of the 21st July, or in any remarks which may hereafter be made.However, considering the strong animus which has been shewn by Dr. Bucknill,and the uncourteous-I may say virulent-strain of attack on myself, I must view him - so far as I am concerned -beyond the pale of professionalfraternity, and decline replying to any further communication he may chose to make in your Journal.15, Rutland Street, Edinburgh,4th November, 1876.I am, Sirs,Your obedient servant,A. PEDDIE.JOHN HOWARD.To the Editors of THE JOURNAL OF MENTAL SCIENCE.SIRS, I believe that I am not altogether out of order in asking you to allowme space for a few remarks provoked by the exceptional manner of your publi- cation of my paper on John Howard in your issue of July, 1876.In the first place, allow me to correct two printer's errors. At page 184,line 10, for " there alone," read " the real ones;" and at page 196, last line,after the word " more" insert " good."I scarcely complain of the " comments" of the gentleman (or lady) whom you consider " singularly qualified, by study of Howard's life and character, togive a just opinion concerning both; " as they are so evidently, not only one- sided, but also hasty, that I imagine that they are rather calculated to createan impression in my favour from their very unceremonious severity. Scarcely one of them can be called justifiable.With respect to his qualifications for the task he undertook, I have one remark to make. It appears most extraordinary that so qualified a criticshould have been wholly ignorant of the particulars of Howard's remarkable660 Notes and News [Jan., .interviews with the Emperor of Austria, at Vienna, which are related as characteristic of him in his life , by Dixon, at page 354-360. Yet, he says, inhis third note (page 188) upon my statement that Howard kept Emperors " standing for hours in deference to his unbending humour." " This is new to me!" I propose to give other examples to shew that his study of Howard'slife and character seems rather to have had the effect of incapacitating himfrom giving a just opinion of what I wrote, or from giving it even ordinary or necessary attention.His first note (page 182) is one example. My remark to which it refers,plainly related to prisoners in general. The particular prisoners with whomhe suffered in France, he would have been a very chief butler to forget. But thefact alleged makes it all the more remarkable that his interest in prisoners ingeneral was not excited till 18 years after. I am conscious of no oversight.The 2nd note, on the same page, is equally pointless, or misdirected. Thoughhis general reforms quite early included the prevention of gaol diseases, his attention was not devoted to other diseases till near the end of his career.The note on page 183 shews entire inattention to the text. I had stated that no expense was spared on Howard's education; and in the sentence criticised , Iremarked upon the effect of unwonted (not unexpected) wealth on-not an individual, but-a family. It is not those who become wealthy so much astheir children, who become liable to mental aberration. ( See Maudsley's Phys. and Pathy. of the Mind," 1st Ed. , p. 206.)66At page 186 my critic twice complains of my omission to notice particularly the motives that Howard alleged for his conduct. My reasons for generally rejecting all reasons alleged by anyone for his own acts, applied of course par- ticularly to Howard, or they would have been irrelevant. For obvious reasons,I thought it unwise, as well as superfluous, to touch more on the subject of hisreligion than I did at page 193, lines 21 to 29, which evoked no remark from my critic.The note at page 187 scarcely touches my position.On page 188, the first note shews the animus and the hastiness of my critic.My statement that Howard was far from impoverishing himself, is strictly accurate, and can scarcely have received proper attention. He was-if hisbiographies are at all accurate-wealthy-not poor at his death. He may have been less wealthy than formerly, but he certainly had not reduced himself to poverty, which would have to have beenthe case for my statement to be inexact.The second note (page 188 ) is worse. I deny the alleged inconsistency withany previous statement, and I say that such an allegation should have been more specific. I had said (page 181 ) that the severity with which he had beencharged (and which was direct and personal) could scarcely have permanently affected his son's mental constitution . I had said that perhaps over-care inexpenditure and selection of guardians may have had a bad, instead of a good effect on his son. But I had not anywhere excused him for the continuedpersonal neglect-by absence to which I alluded at page 188. It was nonethe less neglect, because his personal care would perhaps have been more mischievous.The third note (page 188) as before observed, admits incapacitating ignorance of some of the most remarkable incidents of Howard's life.The fourth note on this page is entirely incorrect, if Dixon's life of Howardis to be depended upon (see pages 390-4) with which my statement of thecirc*mstances is in strict conformity. I appeal also to the inscription on his statue.The first note ( page 191 ) is either the expression of an extraordinary misconception, or is inexcusable after the grounds of my assertion had been given at page 186. Had those grounds not been given, I should have guarded againstbeing supposed to mean that all men desire to do good, without expecting to benefit or please themselves. But I had, surely, sufficiently explained (page 186)that " all men desire good by whatever means they propose to attain to it."1877. ]Notes and News. 661Good, of course, for themselves. If they err, they err in judgment, not from adesire for evil per se.The second note here shews animus to an extraordinary degree. I neverquestioned that Howard did good to others than prisoners.In the sameparagraph I had mentioned examples. But I challenge all impartial, and evenmost partial persons to shew how my penultimate sentence in it is not strictly accurate (page 191 ) .The note on page 192 is very inconsiderate and unfair. No one can possibly be in a position to say that Popham would not have succeeded in completing what he had well begun, had Howard never lived. But I recognised the possibility that Popham might not have succeeded nearly so soon. My criticassumes that Popham failed because he had not already done what he had just begun. He forgets that Howard likewise had not then succeeded in doing it.But did I depreciate him for that? My critic here objects to my application of the term enthusiasm to Howard's work. He may perhaps know the meaning of the word enthusiasm better than anyone else , but when he writes for others to read, he should use words in the sense in which they are generally under- stood, if he wishes for attention or comprehension . Did he never see a bookcalled, " Ecce hom*o?" From it he may, at least, learn what enthusiasm means.In his next note (page 194) my critic rudely says " obviously untrue." Is he prepared to deny that poverty is one cause of crime? Yet, that is the basis of my statement. He can scarcely think that " they" (line 1 ) refers to the children .But if he can, let him ask the opinion of some one who understands English.In the next note (page 194) he says some proof of this" (the larger propagation of the unfittest) " ought to have been given. " This is done-I thinksufficiently-in the remainder of the paragraph. Proof is not exactly the word,but no more proof than reasons should have been demanded.66In the first note on page 195, I am accused-if serious-of inconsistency.This remark indicates an inadequate grasp of the subject. The reason I urgefor the extermination, " with tenderness and humanity," of the mindless, and of infecters with poisonous diseases, is the promotion of a higher social andmoral feeling than now anywhere subsists; a superior regard to larger and ultimate, rather than immediate good.As to the second note on the same page, I admit that, strictly speaking, all action in nature is equally natural, and that in subdividing nature into- artificial, or a class of facts influenced by civilised man, and natural or a classof facts not so influenced by civilised man, another term, than the general one,which includes both, should have been used to connote the latter. But not evenmy critic could misunderstand me, for it is notoriously customary to use the terms natural and artificial in the same manner contradistinctively. And, is it not a fact, that the natural law of the survival of the fittest fails solely when artificially interfered with by man? Ask Mr. W. R. Greg.On the last page my critic remarks-upon my statement that the nonsurvival of the fittest is a great and increasing fact-that Howard did largely save the healthy and moral from disease and degeneracy. That I never questioned. But he did not do all he might have done to save his son fromeither. My contention, however, is that he did importantly more towards the non-survival of the fittest-physically, morally, and intellectually.His last note is not quite intelligible. But if he meant that Howard did not,as I affirm , principally work to improve the condition of criminals or prisoners,the world is at issue with him as much as I am.I can only say that these notes impress me strongly with the incompetency of the writer to deal in any way with the subject. They are inconsiderate,inexact; and apparent haste seems their only excuse.The principal defect of which I am aware in my paper is unnoticed by my critic. The proof is inadequate that Howard should be held responsible for the irrational, immoral, and fatal sentimentality, in deprecation of which my paper was written. In fact the action of Mr. Popham and of the Committee of662 Notes and News [Jan.,.1701-2 might be taken as evidence that it was strong, and perhaps excessive before Howard's time. This view would, of course, detract from Howard's originality and precedence, which might not suit such a blind admirer of himas my critic. But, in any case, I maintain that my general contention is just and true. I am, Sir, yours &c. ,Melbourne, 4th October, 1870.HOKOR,Author of the paper on John Howard.The author of the short foot notes appended to the " Essay on JohnHoward," printed in the " Journal of Mental Science," July 1876, p. 189, has forwarded to us the following explanation and remarks:-In the first place, he wishes it to be distinctly understood that his notes were written as a short running commentary on the original MS.; thatthey were not intended for publication; that he did not see them again till theessay appeared in print; and that, consequently, he had neither the advantage of seeing his notes in type, with the text to which they referred , nor theopportunity of modifying or correcting them. (For two of the foot notes the Editor is responsible.)A running commentary, made under these circ*mstances, cannot need any apology; and, on referring to the notes in detail, their author finds little to alter or to add. He cannot even take blame to himself for misunderstanding thewords at p. 188.-" Emperors he kept standing for hours in deference to hisunbending humour; "-for he failed to recognise in them Hepworth Dixon's account of the " singular interview" between Howard and the Emperor Joseph II. at Vienna. The facts, as recorded by Dixon, are these-Prince Kaunitz, having arranged that an interview should take place at nine o'clock onthe morning of Christmas day, Howard kept his appointment with his usual punctuality. But he had peremptorily refused to be bound by the " servile etiquette" then enforced at the Austrian Court of approaching the Emperor on bended knee. This appears to have been the only difficulty Howard raised.The arrangement that the interview should take place standing, seems to have been entirely due to the Emperor himself; and, though obviously made out of consideration for Howard, does not appear to have been at his instigation. It was, therefore, in an indirect, not in a direct sense, that Howard kept anEmperor (not Emperors) standing for hours (two hours, the length of the interview), and his refusal to conform to an objectionable piece of Court etiquette, is surely not rightly designated as an " unbending humour." Aconscientious feeling led him to decline the invitation of an Empress (the infamous Catherine of Russia); a like feeling forbade him to take part in aCourt ceremonial which implied a degree of reverence due to no human being,but only to his God.There is one point on which the Author of the notes desires to say a few words. Hokor speaks of the survival of the fittest as a natural law. If forfittest we substitute strongest, we give expression to the only natural law which has really been established. The application of that law to human beings in the modified form of the survival of the fittest is rendered difficult, if not objectionable, by the obvious necessity of defining the word fitness. The laggard in a herd of antelopes is the fit prey and food of the lion. Here the natural lawapplies itself. In the case of man living in a state of civilization the work ofdestruction would be found to be surrounded by very serious difficulties.THE TRAINING OF ASYLUM ATTENDANTS.To the Editors of the JOURNAL OF MENTAL SCIENCE.GENTLEMEN, ―The emphatic and eloquent Paper by Dr. Clouston, in the July number of your Journal, on " Getting, Training, and Retaining the Services of Good Asylum Attendants," must have called forth a response and an aspiration1877.]Notes and News. 663in the mind of every Medical man who is or has been intrusted with the care or cure of the insane. We have favoured and fortunate fellow-labourers , whohave by intuition secured, or have manufactured, a staff from the ordinary materials offered , with the assistance of which they are satisfied and successful.It may be that their standard is too low, or ours too high, that they are content with custodians, while we crave curators, companions, co-operators: but, what- ever may be the cause of the discrepancy, there prevails a general complaint of the absurdity, the cruelty, and the failure which must, and does, attend the employment of rude instruments in the manipulation and re-construction of the most fragile and delicate of fabrics, and an equally general desire and demand,we cannot believe that it will be altogether Utopian, for trustworthy, teachable,intelligent and humane assistants, through whose instrumentality much that is now left undone would be effectively done; for upon the guardians of our patients must ever mainly depend the execution of our schemes and suggestions, evenour medical treatment, as well as the application of the varied means vaguely comprehended under the term Moral treatment. My impression is, that the getting and retaining suitable attendants must, in some degree, be com- mensurate with the influence of the " immortal dollar, " and some modification of Dr. Lauder Lindsay's plan of retiring and rewarding allowances. In refer.ence to " Training, " I have not one word to say in addition to what has beenalready so well said by your contributor, and my present purpose is chiefly torecord that similar wishes and proposals have been propounded, and more than once carried practically into effect, by humble individuals who must now rejoicethat what was inchaste or incomplete in their hands is now likely to be care- fully formularised and applied upon a large, if not upon a Catholic, scale. It cannotfor a moment be suspected that I cherish any arriére pensée, any quiet intention of seeking the fame of priority, in submitting to you the following extracts, as the want which I felt, and the design which I cherished, must have been feltand cherished long before and since my days of work by many " worthier sonsin our specialty than I can pretend to be; but I conceive that the subjoined quotations may serve as contributions to the history of the progress of our department, and may swell the consensus of convictions in support of Dr. Clouston's project.19I. The first extract is from the Annual report of the Crichton Institution,for 1854:-" A course of lectures upon mental diseases and their management has been commenced, and will be continued during the winter. It is addressed to theofficers, and to all members of our community engaged in the treatment of the insane. A certain amount of education and experience is expected in everyartizan, is demanded from those entrusted with the care of even domesticanimals; but for those to whom the happiness and tranquility of the human mind is consigned, no training is provided , no instruction accessible. A guardianis appointed who may have no higher qualification than physical strength and courage, who never saw a case of insanity, who may attribute the errors he isexpected to correct, the propensities he is compelled to control, to the manifes tation of perversity, malice, or to demoniacal possession, and who may remain for a quarter of a century in daily contact with these ebullitions, in utter ignorance of their real character, and with no guide as to the mode in whichhis duties are to be performed, except a series of brief regulations associated in his mind with fear of punishment. No means are taken to remove ignorance,and we punish the ignorant. The errors and offences of the attendant upon theinsane are less frequently the offspring of deliberate cruelty , of cold indifference and neglect, or of self- sufficiency, than of want of knowledge of their line ofduty, and mistaken views as to the mode in which that duty should be dis- charged. Since the diminution or discontinuance of physical restraint, since the introduction of education and amusem*nt as remedies, these officers arecalled upon for greater intelligence, higher motives, and a clearer comprehensionof what that human and morbid nature is which they are required to guide and664 Notes and News. [Jan.,govern; and instruction of some kind is obviously essential. To these persons is in great measure committed the management and moral treatment of theinsane. They pass the whole day with their charges, whilst the visits of the officers are necessarily brief, at distant intervals, and are less social than super- visionary; the former cheer, repress; grant or withdraw indulgences , executethe plans which the other suggests: they are literally the companions, and ought to bethe friends and teachers, as well as the nurses and guardians of the patients. Yet , for this class there is no normal school, no golden road, no roadat all to knowledge. These instructions will embrace a very full discussion of the subjects embraced; but they will be so modified as to rise to the level of the educated minds addressed, and yet to fall within the grasp of the shrewd and sensible, though illiterate, individuals who compose the class of attendants.It is probable that the whole scope of the subject will not be embraced--it is obvious that the scientific details must be directed to one portion of the auditors alone; but it is believed that no one will retire from the investigation withoutsome clearer conceptions of the great work in which they are engaged, and higher views of their own responsibilities."II. The second extract is from the Annual Report of the Crichton Institution for 1855:-" It is somewhat interesting that the very time when the necessities of vastarmies developed unequivocally as principles what had long lurked in the human heart as hopes and aspirations, that a higher motive than gain is re- quired to secure suitable nurses for the sick and wounded, and that the educated as even the refined mind, is a more useful instrument amid dangers, and diseaseand difficulty, than ignorant obedience; there was made in this remote province the first attempt to educate the attendants upon the insane, to expose and explain the nature of their duties, and to raise them at once to a due appreciation of their responsibility, and to a capacity to discharge the duties imposed.A course of thirty lectures was commenced in October, 1854, and continuedweekly until May, in which mental disease was viewed in various aspects; in which the relations of the insane to the community, to their friends, and to their custodiers, were described; in which treatment, so far as it depends upon external impressions, the influence of sound minds, of love, and fear, and imitation, was discussed; and in which it was attempted to impart attraction ,by illustration and narrative, and to convey instruction by examples drawn from the actual inmates. The descriptions were powerfully aided by portraits of patients familiar to the auditors, most graphically executed by a patient who had lost , but regained, his genius as an artist. The grand objects were to impress the understanding, and to rouse the affections, by the demonstration that mental aberration was a malady, a misfortune, a misery, which was to be relieved ,which it was, so far, within the power of every kind word and consoling look to mitigate; and that it was not a brutal passion that was to be opposed, aperversity that was to be resisted or resented, or a strife that was to be pro- secuted until victory was obtained. Secondly, to distinguish the various forms under which alienation might be presented; what was to be apprehended andhoped in each; what was to be guarded against; and what might be accomplished by a judicious selection and adaptation of the means of alleviation.And thirdly, to show that every individual with whom the insane came into contact might, and must be instrumental in increasing or diminishing happiness;in building up or destroying the fabric of mind, and in guiding those to or fromlight and knowledge, who may literally be said to have eyes and see not, ears and hear not; and that this influence must be proportioned to the intelligence andhumanity of the agent, to his sense of the high and holy mission intrusted to him. It is possible that much was said which met no response nor assent; which was unsuited to the previous training of the auditors; or that all might have been clothed in a more pleasing and useful garb; but it is certain that interest of some kind was awakened and sustained. The class consisted of the officers,the male and female attendants, some of the patients who belonged to the1877. ] Notes and News. 665medical profession , and occasionally a visitor. The attendance, although per- fectly voluntary, was numerous, attentive, and grateful; and the conviction is believed to be general, that although these inquiries and suggestions may havefallen infinitely short of the objects contemplated , they elevated the tone of those engaged, formed a pleasing communion between the different members of the Staff, and have left many recollections of intellectual enjoyment."N.B. That these prelections were not altogether inefficacious, may, I think,be fairly concluded from the facts that eight of the number of attendants who listened to them are still in harness, are still trusted and efficient workers, andseveral of them have already received Sir A. Morrison's good conduct prizes;although I attribute their continued trustworthiness and usefulness chiefly to their original goodness of heart and head.III. The third extract is from a letter by my colleague, Dr. Gilchrist, dated 6th Oct. , 1876: -"My efforts at Montrose were real though not prolonged, and not to be mentioned alongside of yours. I met the attendants there on more than one occasion, and explained to them their duties, and the specialty of them, as basedon the nature of insanity . It was soon after I went. 1854."(Certain alienists in America have had recourse to precisely the same mode of instruction. )IV. The following is taken from an article on Lunacy in the United States,in the July number of the " British and Foreign Medical Chirurgical Review, "and is from the pen of an anonymous, but evidently veteran expert:-" We have before us the evidence of a Superintendent that, failing in trans- forming mere hewers of wood and drawers of water into gentle, judicious, self.denying agents, he first engaged self- educated and thinking artisans, but they turned out philosophers; secondly, pensioned soldiers, but beer proved more fatal than the enemy in the field; then the communicants in the several churches attended, but their religious impressions failed to regulate theirtemper or passions; and, lastly, he organised a school, in which he taught,lectured, illustrated, and with greater success than had crowned his previous attempts." (P. 68.) I am, &c .W. A. F. BROWNE,Now a Septuagenarian Superintendent.Crindau, Dumfries, N.B., 21st Nov., 1876.The following letter appeared in the " British Medical Journal: "-" DISEASE OF THE BONES IN THE INSANE." SIR,-You will, I trust, allow me to observe , in reference to your interesting and instructive comments on the case of the late Mr. F. W. Wimberley, in the Journal' of this day, that the peculiar liability of the bones of the insane to disease, and consequently to fracture even when no extraordinary violence is used,' has been long known. You have written thus: Numerous observa- tions on the subject have been made in recent years. Certainly to Drs.Clouston, Rogers, Brown, Sankey, and others, are due the credit of teaching, in 1870, that the osseous system of the insane is especially liable to undergocertain chemical changes, approaching that observed in osteomalacia .' Much credit is due also to Dr. Morselli, of Florence, for his article entitled Fractures of the Ribs, and a Peculiar Form of Osteomalacia in the Insane.' Let me add,however, that long years before either one of the several gentlemen named in your editorial of August 19th, 1876, had so taught, I wrote thus, in 1857: One word more; osteomalacia may be confined to one or more bones, or even to a portion only of the same bone. In the examination ofpatients who died insane— inmates of the Middlesex Asylums at Hanwell and Colney Hatch-I have met with six examples of this affection of the skeleton: the greater number of thepatients alluded to were afflicted with general paralysis. An interesting fact••666 Notes and News.6this, and one which bears me out in the views here taken of both osteomalacia andof this specific form ofparalysis so common to the alienated. (See my Ganglionic Nervous System ,' chap. iii . , 'Pathology,' p. 265. ) It was in 1842 that I detected ,at the Hanwell Asylum, the existence of osteomalacia in those dying insane.Furthermore, in the Medical Times, ' No. 170, vol. vii. p. 195 , et seq. ( 1842) , isseen recorded by me a highly interesting example of the co-existence of osteomalacia and insanity in a female patient who died under my care at Hau- well, in whom six spontaneous fractures of the long bones-femur, humerus,and so on-were found post mortem. In this case I have described the skeleton as CONVERTED, IN GREAT PART, INTO A DARK SEMI- CALCAREOUS GRUMOUS MATTER.'" Underthe circ*mstances, then, you will, I trust, afford me this opportunity to make a prior claim- one of no less than twenty-eight years' standing-to the recognition of a condition of the bones of the insane, ' of so much importance both to the jurist and pathologist.6"I am, sir your obedient servant,66 JAMES GEORGE DAVEY, M.D., M.R.C.P. , Lond. , etc. "4, Redland Park Villas, Bristol, August 19th, 1876."Appointments.BATEMAN, F. , M.D., has been appointed Medical Visitor of The Grove, a house licensed for the reception of Lunatics at Catton, Norfolk.BREE, C. R., M.D. , M.R.C.S.E., has been appointed Medical Visitor of Essex Hall Lunatic Asylum, Colchester.BRUSHFIELD, T. N. , M.D., has been appointed Medical Visitor of Houses licensed for the reception of Lunatics in the County of Surrey.CASE, Mr. H., has been appointed Medical Superintendent of the Metro- politan Asylum, Leavesden, vice Shaw, resigned .COATES, W. M., M.R.C.S.E., L.S.A.L., has been appointed a Medical Visitorof all Houses licensed for the reception of Lunatics in the County of Wilts.DAY, H., M.D., F.R.C.P.L., has been appointed a Medical Visitor of all Houses licensed for the reception of Lunatics in the County of Stafford .HARLAND, J. T., M.D. , has been appointed a Medical Visitor of all Houseslicensed for the reception of Lunatics in the County of Stafford.KEMM, W., M.R.C.S.E., L.S.A.L., has been appointed a Medical Visitor of allHouses licensed for the reception of Lunatics in the County of Wilts.KINGLAKE, J. H., M.D., has been appointed Medical Visitor of AmberdHouse, and all other houses licensed for the reception of Lunatics within theWest Division of the County of Somerset.PAXTON, F. V., M.B., M.R.C.P.L., has been appointed Medical Visitor of Houses licensed for the reception of Lunatics in the Western Division of the County of Sussex.RAWSON, J. , M.B. , L.R.C.S.I., has been appointed a Medical Visitor of all Houses licensed for the reception of Lunatics in the County of Stafford.SHAW, J. C., B.A , M.D., M.B., M.R.C.P.L., M.R.C.S.E., & L.S.A. , has beenappointed Medical Superintendent of the Middlesex County Lunatic Asylum,Banstead.WAYLEN, G. , M.R.C.S.E., L.S.A.L., has been appointed a Medical Visitor of all Houses licensed for the reception of Lunatics in the County of Wilts.WYBRANTS, J. , M.D. , F.R.C.S.E., has been appointed Medical Visitor of Downside Lodge, and all other Houses licensed for the reception of Lunatics within the East and Middle Divisions of the County of Somerset.In the List of Members published in the October Number of the Journal,Dr. Bucknill's address should have been 39, Wimpole Street, London, W.INDEX TO VOL. XXII.Acute insanity supposed to be due to syphilis, 97 Airing courts, disuse of, 163 American alienists, 441 .American association of asylum superintendents, 146lunatic asylums, 55, 568 literature, retrospect of, 142 , 328 Amyl, nitrite of, in epilepsy, 325, 477 Analogy, use of, in the study of mental disease, 58 Anastamoses of nerve cells in the spinal cord, 326 Anæmias, pernicious, 473 Ancients, prevalence of causes of insanity among, 361 , 515 Appointments, 168, 341, 506, 666 Aphasia, 469Aphasia, sudden and complete; lesion of Broca's convolution, 406 Arab physician on insanity, 241 Articulation and gait, defects of, without insanity, 249 Ashe, Dr. Isaac, some observations on general paralysis, 82 Asymmetry of the grey matter of the spinal cord, 325 Asylum reports, 298-479, 633Atkins, Dr., case of aphasia, 406 Atrophy, protopathic spinal muscular, 325 Attendants, getting, training and retaining, 381, 499, 662Barr, Thomas, case of murder, 230 Beach, Dr., medical congress of Philadelphia, 560 sporadic cretinism, 261 Behind the veil (Rev.) , 612Bethlem royal hospital, 201 Blampied, case of murder, 447 Blindness from chronic hydrocephalus, 473 Blue books, lunacy, 580Boarding out of chronic cases, 351 Bones, disease of, in the insane, 665 Brain, changes in, from traumatic inflammation, 319 Brain, lesions of in the insane, 472, 321 Broca's convolution, lesion of, with aphasia, 406Brown, Dr. , case of insanity with concomitant paronychia, 564 Bucknill, Dr., letter on American asylums, 55 "9"""" alienists, 441relations of drink and insanity, 427Campbell, Dr., notes on the reparative power in insanity, 222 Causes of insanity among the ancients, 361 Cerebration, unconscious, 1Cerebral reflex action, 151 Cerebellum, deficiency of the, 469" physiology of the, 321 6400.503451296668 INDEX.Cerebral hemispheres, functions of, 309, 598 Children, insanity in, 474 Chloral hydrate, mental symptoms following use of, 93"" in epilepsy, 463 Chorea, alteration of central nervous system in, 322Chronic insane, provision for, 348, 563 Clouston, Dr., on the relations of drink and insanity, 268 Clouston, Dr., on getting, etc., good attendants, 381Colour, effects of, on the insane, 167 Colony of insane, agricultural, 478 Comte's system of positive polity, 603 Consciousness, 1Cord, motor centres in, 468 Corpus callosum, deficiency of, 469 Correspondence, 265, 341, 421, 506, 653, 659, 662, 665 Corpus striatum, nature and functions of, 629Cox, Serjeant, and his prophet, 574 Cretinism, sporadic-autopsy, 261 Criminals, insanity among, 616 Crime and insanity, 447Dagonet, Dr., nouveau traité des maladies mentales. (Rev.) 611Deas, Dr., a visit to an insane colony, 66Death from undetected injuries, 99 Diarrhoea accompanying insanity, 630Diet in epilepsy, 458 Donald, Dr., notes on lunacy in British Guiana, 76Drink and insanity, 265, 421, 653.Dura mater, fluid in, 464Ear, the insane (Hematoma auris) , 91 , 461 Education of the insane, 416 Effects of colour on the insane, 167 Electricity, influence on nervous and muscular system, 464,, applied to brain of new-born animals, 466effects produced on the brain, 311English retrospect, 298, 479, 633 Epilepsy, 323, 460, 629 alcoholic, 617 Equilibrium, sense of, 468, 599 Ergotin in mania, 477 Erotic delusions, 439 Experimental investigations on the simplest psychical processes, 314Family treatment of the insane, 351Feeding artificially, 646 Fever, insanity during, 338 Fraser, Dr., Kalmuc idiocy, 169 French retrospect, 151, 614 Functions of the brain (Ferrier's experiments, &c. ) , 309, 598Gairdner, Dr., cases like general paralysis without insanity, 249, 331 Galvanism in aphonia, 476 Gasquet, Dr., analogy in the study of mental disease, 58German retrospect, 308-464 Gheel, a visit to, 66 Granular cells, 470 Guiana, notes on lunacy in, 76Hæmatoma auris, treatment of, 91INDEX. 669Hammond, Dr., on the mental functions of the spinal cord, 148 Headaches with lesions of motility, etc., 252 Hearder, Dr., the treatment of hæmatoma auris, 91Hearing, experimental investigations on, 317 "" hallucinations in, 475 Hemicrania, 64 Hemiplegia, movements in, 474 Heredity, illustrations of, 329 Histology of brain, 462-554, 560Hitzig's vivisections , 465and Ferrier's experiments, 629, 631 Homicide by an insane person, 552Howard, John-an essay, 180, 659 Howden, Dr., tubercular tumour of brain, 566Hurford, Dr. , case of insanity supposed to be due to syphilis, 97 Hydrocephalus congenitus et acquisitus, 471, 473 Hyoscyamin, therapeutic action of, 434, 458Hypodermic injection of morphia in insanity, 18 "" "9 bromide of potassium, 629 Hysteria in a man, 619Idiocy, hydrocephalic, 471 Idiot, Kalmuc, 161 , 169Idiots, measurement of palates in, 196 Idiots and imbeciles, 503Illegal detention of persons of unsound mind, 585Impulsive insanity, 162 Imposing female, an, 446 Increase of mental disease, 138 Influence of excitation on the beats of the heart, 311 Insane or not? 454Intellectual strain, 380 Intemperance, 265, 421, 442, 517 Intoxication, 365, 370, 375, 529 Ireland, Dr., letter of, 341Irish lunatic asylum service, 164Italian psychological literature, 628Katatony, 474 Kalmuc idiot, 161 , 169Latent consciousness , 5Lalor, Dr., better means for educating the insane, 416Layco*ck, Dr., reflex, automatic, and unconscious cerebration, 1, 158 "" obituary notice, 650Leçons cliniques sur les maladies mentales. (Rev. ) 128 Legal cases, 614, 618, 622, 625 Lentz, Dr. , observations on mental disease, 154 Letters of a patient , 454 Locomotor ataxia, 625 Lunacy acts, 162 Lungs, hyperæmia of, after injuries of brain, 473McDiarmid, Dr., on hypodermic injection of morphia in insanity, 18 Mackenzie, Dr., mental symptoms after use of chloral, 93 Macklin and Barr, cases of murder, 226Marriages between cousins, 456 Masturbation, 336Mechanism of man, by Serjeant Cox. (Rev.) 296 Medico- psychological Association meetings, 157, 331, 337, 487, 646INDEX. 670Melancholia, 59 Menière's disease, 458 Mental disease, some observations on, 154 Meynert's views on the ascending peduncle, 466Meynert on aphasia, 469 Microscopical observations of brain structure, 554, 560Microcephaly, 471"Mind."(Review) 607 Mitchell, Dr., Kalmuc idiocy, 16993 statistics of insanity, 507Moral causes of insanity, 368, 373, 379, 523, 532 Morphia, sub-cutaneous injection of, 18 Motor centres in the brain, 466Murder, cases of, 447, 552, 614, 618وو pleas of insanity in cases of, 226Needham, Dr., case of homicide, 552 Newth, Dr., Microscopical observations of brain structure, 554Non-restraint, 53 Notes on lunacy in British Guiana, 76 Nouveau traité des maladies mentales.(Rev.) 611Nuclei lenticulares, function of, 468Observations on mental disease.(Rev.) 154 Optic thalami, function of, 463, 467 "Othæmatoma," 91 , 461 Palate in idiots and imbeciles, 196, 339Paralysis, general, 82, 249, 331, 462, 463, 472 Paronychia with insanity, 564 Parsey, Dr., president's address, 343 Past and present provision for insane in United States, 42Pathology of insanity, 143 of the central nervous system, 322 Peddie, Dr. , letters on intemperance and insanity, 421, 653 Perivascular spaces in the nervous system, 145 Persecution, delirium of, and alcoholism, 621 Philadelphia medical congress, 560 Philosophy without assumptions, 288 and its foundations , 292 Philosophical treatise on man. (Rev.) 294 Positive polity, Comte's system of, 603 Potassic bromide, hypodermic use in epilepsy, 629Poverty asa cause of insanity, 367, 371, 522, 531, 578 Pregnancy and puerperal conditions, psychoses of, 324Presidential address, 361 Prevalence of insanity among the ancients, 361Priestly exorcist,a, 571 Recurrence of the same erotic delusions ina patient, 439Reflex action, 151, 157 Reminiscences of 1871, during the French war.(Rev.) 614Reparative power in insanity, 222-336 Responsibility of insane, 147, 561, 578, 632 Restraint in insanity, 53 Retina, state of, after various drugs, 461 Revue philosophique de la France et de l'étranger, 606Ribs in insane, 632, 665 Royal Edinburgh Asylum, report of, for 1875, 442ནི` ོདོན་ &x¥#*** 4<INDEX. 671Salaries of asylum officers and attendants, 595 Salivation in lunatics, 631Salpêtrière, leçons cliniques professées à la, 128 Schopenhauer, Arthur, 102Sciatic nerve in general paralysis, 460 Seaside, removal of patients to, 585Shaw, Dr., measurement of palates in idiots and imbeciles, 196 Sight, experimental observations on, 316Simulation of insanity by the insane, 562Skae, Dr., case of death from undetected injuries, 99 66 Slavery in England. " (Rev.) 613 Somnambulism, induced , 324 Spinal cord, mental functions of, 148 asymmetry of grey matter of, 325-6 Statistics of insanity, 507, 582, 586 Stomach pump, 337Stupor from anæsthesia of the skin, 476 Suffocation by food, 95Sunstroke, 327 Superannuation, 135, 648Sympathetic, pathology of the cervical, 327 Syphilis and insanity, 97 Syphilitic disease of the cerebral arteries, 311Teeth, artificial, inconvenience of, in the insane, 614Theft, cases of, in insanity, 578, 622 Thermal influences proceeding from the cerebral hemispheres, 308Torquato Tasso, 389, 538 Transfusion of blood, 628 Tubercular tumour of the brain, 566Tuke, Dr. Hack, on the provision for the insane in the United States, 42 9999 Bethlem Royal Hospital, 201 on the prevalence of insanity among the ancients, 361 , 515 Tyrol, census of insane in the, 478Unconscious cerebration, 1, 157United States, provision for insane in the, 42Vessels of the brain, changes in, 318, 145 Visit to an insane colony, 66Visits of relatives to insane patients, good effects of, 446 Vital motion as a mode of physical motion, 119Wandering lunatics, 621West Riding Asylum reports, 458 Whitcombe, Mr., suffocation by food, 95Wickham, Mr., insanity with paronychia, 564Yellowlees, Dr. , plea of insanity in case of murder, 226(The Editors are indebted to Dr. A. H. Newth, of the Sussex County Asylum,for the compilation of this Index.)!

Princeton University Library32101 074931104DATE ISSUED DATE DUE DATE ISSUED DATE DUEAPR 28 JUN 1 6 1986

See also

• Mental science
• The Journal of Mental Science

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