wards, the chloric ether should be discontinued, and, should the complaint run into diarrhoea, chalk mixture, with or without tincture of catechu or kino, may be substituted..

nected with mesenteric disease, will be found, to
answer best; while acetate of lead and sulphate of
copper, with opium, should be tried in the cases of
adults, when the more simple remedies fail, but
should be prescribed with great caution, as it is well
known that poisonous effects may be the conse-
quence of either, when carried too far (I have known
acetate of lead produce paralysis of the sphincter
ani), and that such substances substitute themselves
for the earthy bases of the animal tissues...

GOSSIP OF THE WEEK.

WAR-OFFICE, Nov. 3.-49th Foot-H. Beckwith to be Assistant-Surgeon, vice Garrett, promoted to be Staff-Surgeon, 2nd class. Nov. 6.37th-Assistant-Surgeon James William Fleming, from the 70th Foot, to be Assistant-Surgeon. 70th-Assistant-Surgeon John William Johnston, M.D., from the 1st West India Regiment, to be Assistant-Surgeon, vice Fleming, appointed to the 37th Foot. 1st West India Regiment-William Sedgewick Saunders to be Assistant-Surgeon, vice Johnston appointed to the 70th Foot.

UNIVERSITY OF LONDON. M.B. SECOND EX

walked till we arrived in a deserted, lampless, back street, and, entering a dark passage, began to ascend a flight of still darker stairs. Groping our way up, we at length reached the top; when the Mexí Colic may next be touched upon. A purgative can opening a door to the right, we suddenly found of castor oil, with a certain proportion of tincture ourselves in the lady's bedroom; and, what was of opium, in the first instance, and the turpentine more, with the lady in bed. The delicacy of an Engfomentations, or flannels wrung out in hot water, lishwoman was of course outraged by this heedless will in most cases cure the complaint; but, when exposure before her countrymen. But why in bed the stomach is so irritable as not to bear it, calomel at this early hour of the evening? Was the lady and opium, with enemas, are the only and, accordunwell, we inquired. No answer was returned. ing to my experience, the most efficient means of She was some time before she recovered from her affording relief. Dysentery, as its fatality has been embarrassment, though we had seated ourselves, more than ordinarily great this year, deserves someand did what we could to pass the matter off. what more consideration than either of the two The Mexican officer sat simpering upon an old box preceding. It has many peculiarities, as I have at the foot of the bed, and grinned as he looked seen it (and I only speak from my own observafrom her to us, and from us to her, in the very mistion), which are very interesting; and in its complitaken notion that he understood what we spoke of, cations requires more tact and judgment, on the He now made an attempt to ask us, in broken En part of the practitioner, than any other form of glish, something about what money we had? The bowel complaint. If called in to a case in the Englishwoman suddenly stopped him with a kick commencement, give the castor-oil mixture. I from beneath the coverlet, slily given as she never lay down any general rule as to the doses of thought, and then made a very bad excuse, in the medicines; but would say, in this instance, an shape of a false translation of what he had said. ounce of castor oil, rubbed up with mucilage or We let this pass, and began to ask about the nature yolk of egg, with a drachm or two of tincture of AMINATION, 1846.-The following candidates have of her indisposition, as she certainly appeared opium to the half-pint mixture, is the maximum recently passed this examination, viz. :-First very sallow and languid. She answered coolly, that quantity. Two table-spoonfuls for a dose, every Division: Bompas, Joseph Carpenter, University she was recovering from the yellow fever! My second, third, or fourth hour, according to the College; Day, John Climenson, London Hospital; companion and myself looked at each other in disurgency of the symptoms. Sometimes the stomach Elam, Charles, Leeds School of Medicine; Good-may. She had had it about a fortnight, she said, rejects it; in such a case, about four drops of ridge, Henry Frederic Augustus, University Col- but she really was recovering; and he (pointing to creosote added to the mixture invariably cause it lege; Hawksley, Thomas, King's College; Johnthe grinning Mexican) would cure her at last, she to remain. I look upon this as an admirable reston, James, Queen's College, Birmingham; Sturt, was sure. "He !" exclaimed we in surprise. Oh, medy, not forgetting the very serviceable adjuvant-Thomas James, King's College. Second Division: Yes," was the answer, "he is a doctor!" The in all cases of purely spasmodic pain-the turpen- Arlidge, John Thomas, King's College; Birkett, truth now pretty clearly appeared, and we could tine stupe; and I should be wanting in justice, George, Charing-cross Hospital; Cowdell, Charles, bensions, at the whimsical impudence of the not forbear laughing, notwithstanding our apprewere I not here to mention, that to your excellent University College; Duncan, Peter Martin, King's roguery, in bringing men, under the pretence of an periodical I owe the compliment of first suggesting College; Eton, Edward William, St. George's introduction to a country woman, that they might to me the use of this mixture. Though, as I have Hospital; Mason, Thomas Peter, Original School catch the fever, and give a professional gentleman previously said, the castor oil may sometimes be re- of Medicine, Peter-street, Dublin. jected, yet I have been surprised to find, in many of Vera Cruz the honour and profit of endeavouring cases, that it will remain on the stomach, where being considered a protection from infection; and, to cure them! We drew out our cigars, smoking almost everything else is thrown up. The majority of the cases under my care, this year boldness, we sat with grim quietude for nearly a by way of supporting the English character for as well as last, have had these striking pecuquarter of an hour after receiving the above plealiarities, viz. : fulness of the abdomen, throughout the course of the complaint; no fever; the tongue comparatively clean, and generally, when furred, remarkably white. This is the ordinary form of the complaint-the least dangerous, the most tractable, and the soonest cured. Great prostration of strength too, in most cases, remains for a considerable period. Other peculiarities are, the tendency to a relapse; absence of tenderness on pressure, except occasionally over the cœcum, which is indicative of inflammation, and which requires the free and repeated application of leeches; as also touching the gums with the hydr. c. creta, combined with opium. The complications sero-enteritis and general muco-enteritis-require more active treatment; regulated, of course, according to the circumstances of the case. The further auxiliary treatment consists in administering enemas of starch and laudanum, starch and port wine, or even cold water. Notwithstanding my vaunted faith in these measures, I must candidly confess, cases have occurred in which they have failed; the dilute nitric acid with mucilage and opium have been then resorted to, as also chalk mixture and creosote (and here I may make a passing observation on the employment of creosote, and that is, my condemnation of it in large doses; and in no case should it be given, in whatever dose, where the mucous membrane is extensively ulcerated, or in those few cases characterized by extreme redness of the tongue and enlargement of the papillæ), acetate of lead, &c. &c., all of which seemed to me to have little or no effect, the complaint running on and generally terminating "Sta bueno," said he; and, seizing our favourably, when all medicines were discontinued, arms, entered into conversation in Spanish, occaand when, as a last resource, port wine was freely sionally interspersed with bits of very broken administered our great sheet-anchor, the renovator English. He took us round to the principal illu of the vital fluid-when life appears to be at an ebb.minations, where different devices were formed, Lastly, diarrhoea, as the sequence of dysentery, or as and rude transparencies, expressive of liberty, and a primary disease, is frequently very infractable, national independence. Our conversation now but more so in children than adults, for many turned on the beauty of the Vera Cruz ladies, and reasons that it would be here superfluous to detail. our new friend informed us that he had married In the cases of children, chalk mixtures with various an English wife, and asked us to accompany him combinations, with a milk diet, when not con- to their residence. We agreed; and accordingly.

--

sant information. The adventure was not altogether unworthy of Gil Blas.

MORTALITY TABLE.

VACCINATION IN IRELAND. (From a Cor-
respondent.) The following is one of the evils
vaccinating under the Poor Relief Act in this
arising from the "cheap and wholesale" system of
country:-"A well-known itinerant medical quack
visited Kilfinane a few days since, and inoculated
a number of children with the smallpox virus. The
greatest anxiety, strange to say, was manifested by
parents to avail themselves of his presence. There
seems prevalent an opinion that this disease, when
communicated by inoculation, is not so dangerous
as when taken in the usual way, notwithstanding
that, on a former visit of this same person in July,
two out of every three children that died of small-
pox had been inoculated by him. Vaccination is
sinking into disrepute. Repeated instances of its
inefficacy as a preservative from the smallpox
having occurred of late years, these instances were
perhaps only apparent from neglect to procure
pure vaccine matter, or when the incision was made,
from subsequent inattention as to whether the vac-
cine infection was mingled with the blood. We
have now to add, that six children inoculated for
the smallpox in the above district died of the dis-
ease."-Limerick Chronicle. I may remark that
the above district is evidently not one of those Dropsy, Cancer, and other
where the practitioners hand over the vile " fee" to
"the Medical Benevolent Relief Fund," as was
agreed some time since at a meeting of the Medical

For the Week ending Saturday, Nov. 7, 1846,

Association of Ireland.

A MEXICAN PHYSICIAN.-Imagine all the dilapidated streets illuminated by lamps and fireworks, and two young men slowly pacing along to see whatever the festival might produce. We soon fell in with an officer of the Mexican army, with a profusion of hair on his face, and lace on his pantaloons. He saluted us without introduction, except by looking at the Mexican crest on our buttons.

Causes of Death

ALL CAUSES....
SPECIFIED CAUSES...

Zymotic (or Epidemic, En-
demic, and Contagious)
Diseases

SPORADIC DISEASES.

Diseases of uncertain or
variable Seat

Diseases of the Brain, Spinal
Marrow, Nerves, and
Senses...

Diseases of the Lungs, and
of the other Organs of
Respiration
Diseases of the Heart and
Blood-vessels.

Diseases of the Stomach,
Liver, and other organs
of Digestion
Diseases of the Kidneys, &c.
Childbirth, Diseases of the
Uterus, &c.
Rheumatism, Diseases of
the Bones, Joints, &c.
Diseases of the Skin, Cellu-
lar Tissue, &c.
Old Age..

Violence, Privation, Cold,
and Intemperance.......

Average of

Total. 5 au- 5 tumns. years,

944 1000 968 939 992 961

167

206 188

138

103

104 104

151 157

PROCRESS OF MEDICAL SCIENCE,

INCLUDING CHEMISTRY AND PHARMACY.

|

Court of Cassation has on various occasions ruled
that secrecy is still the right of the physician, and
has even decided that, when pressed by cross-
exmination, the physician may obey only his
conscience in the discrimination of the facts which
he should conceal. M. St. Pair was therefore per-
fectly justified in his silence.
DAN M'CARTHY, D.M.P.

ORIGINAL CONTRIBUTIONS.

-At the last meeting of the Academy of Sciences,
M. Pelouze made some observations on the mode
of preparation of his explosive paper; and stated,
that two of his pupils had discovered an easy
method of ascertaining whether or not the paper
had been properly prepared. If the paper dis-
solves in sulphuric ether, it is perfect; and when it
is not fit for use, it is insoluble. With the balistic
and explosive properties of this new agent of
destruction, by which is truly realized a maxim
laid down by a celebrated French author-" Nothing
in the universe is half so dangerous as a sheet of
white paper"—and with the value of the discovery The Nature, Causes, and Treatment of
in the arts of war, we have nothing to do. M.
Pelouze asserts, that by the action of nitric acid
upon vegetable matter a compound is produced
which consists only of cellulose and nitrogen,
which, resembling albumen, casein, and fibrin,
by its elementary composition, might, like them,
yield an alimentary substance. Experiments have
been made upon three dogs; during four days each
animal was fed on rice and explosive paper, taking
every day nine oz. of rice and three of paper; it is
true that the dogs did not lose weight during the
period, but the exhibition of the rice must invali-
date the experiment.

A. REPORTS.
FORENSIC MEDICINE.

A British subject, an M.D. of the Faculty of Paris, received from the mayor of the city of T-, in Normandy, instructions to report on the death of a person whose body was found suspended from a door. The report was not accepted by the Procureur du Roi, on the ground that," although the medical degree conferred upon the graduate the right of practising medicine, it did not confer that of practising legal medicine, a report being the act of a public functionary, which could only be accomplished by a French subject." Against this decision, Dr. O. appealed to the Dean of the Faculty of Paris, who referred the matter to the Association de Prévoyance des Médecins de Paris. A commission was named to inquire into the subject, and the following are the conclusions of the reporter, Dr. A. Cardieu, Professor Agrégé of the Faculty of Paris:

"Whereas, the report of a physician in a case of legal medicine is by no means a public act, but a simple document, which may be neglected, disused, or even contradicted, notwithstanding the acknowledged importance.

"Whereas, the formula of the oath does not bind to allegiance, but merely to truth.

Mental Diseases.

By M. PINEL, M.D., Member of the Academy of Medicine,
formerly Physician to the Bicêtre and Salpetrière Asylums,
Author of the "Traité Medico-Philosophique sur l'Aliena-
tion Mentale," "Medicine Clinique, Nosographie
Philosophique," &c. &c. Translated, with Notes, illus-
trative of some important Doctrines in Physiology,
Phrenology, and Moral Education,

ments and ideas become perverted; the beloved object now inspires indifference or repugnance, and the best course to take will be to endeavour to efface every recollection of the unhapy passion by substituting for it another which may prove more fortunate.

We must, therefore, act continually in the sense opposed to the habitual delirium of the maniac, and this requires no less tact for its opportune employment, than for its suspension when necessary. There is a note, p. 72 of the first edition of Pinel's work on Mania, relating to a patient who fancied himself the fourth person of the Trinity, and that his mission was to save the world, and who, under this unhappy monomania, committed several murders. Pinel was anxious to try the effect of moral means to combat his delirium, and he thus relates the case :

"Amongst my attempts to correct his fatal bigotry, I should mention one that proved a failure. I placed him in company with a very Principal of Wyke House Asylum, Editor of the Cyclopedia cheerful convalescent who declaimed gracefully of Practical Surgery, &c.

BY DR. COSTELLO,

EDUCATION OF THE BRAIN.

If the moral treatment must be made to act in

every way on the mind of the insane man by the
numberless indirect and external means which it
may call into play, it should follow up its work, so
that by a kind of education it may form the brain to
new habits which would supplant those inequali-
ties and defects previously observed in the thoughts,
feelings, or affections. This is a noble task, and
requires in the physician such a thorough con-
sciousness of elevation of mind as will enable him
to descend to the level of the most painful in-
firmities, and to put in practice that untiring
patience which teaches him, by observing the
patients, to guess the motives of their actions, and
to act powerfully, and at the favourable moment,
on their intellect. But he is not to perform this
difficult task alone; all his subordinates should be
animated by his views, promoting them when he is
present, supplying his place when he is absent,
and thus, by a continuous agency, carrying out
his plans still more efficaciously than he can him-
self, during the short periods of his visits.

This education of the brain cannot be reduced
to practice at all periods, or under every form of
delirium; it must be employed at the proper time,
like everything else. When a calm begins to suc-
ceed to the first explosion of insanity, and isola-
tion, and the administration of medicines has
subdued the general irritation, when the ideas lose
that degree of fixity, and that excitement which

"Whereas, the right of reporting in such cases does not constitute a civil right, nor a public func-prevented the brain from receiving or appreciating tion, no plausible reason can be brought forward to refuse to foreigners, graduates of French faculties, the power of reporting in a case of legal medicine, which the diploma confers upon all who have obtained it."

B. SECRECY.

In 1844, Dr. St. Pair being called before the Juge d'Instruction of La Pointe à Pitre, in order to make his deposition on the facts of a duel which had taken place a short time previously, and in which one of the principals had been wounded, refused to answer the questions put to him, on the plea that the knowledge he had obtained of the facts in question had been acquired by him in the discharge of his professional duties. Dr. St. Pair was condemned to pay a fine of 150 francs. Dr. St. Pair appealed, and a short time after was summoned before the assizes, to bear witness in the same case, and the court ruled that his deposition should not be heard. The affair is at present before the Court of Cassation, and the Association de Prévoyance laid before the court, in defence of Dr. St. Pair's conduct, a consultation, of which the following are the principal points :

When a physician is called to a patient, whatever he sees, hears, or knows, is only seen, heard, or known by him in his professional capacity, and under the seal of secrecy. Silence on these facts is therefore for him a duty, and at the same time a right. According to the statutes of the ancient Faculty of Paris, he should recollect that "Egrorum

arcana, visa, audita, intellecta eliminet nemo.'

When revelation is demanded by a tribunal, the

duce to practice that education of which we can
new impressions, diminishes, then should we re-
furnish only the general principles.

We ought carefully to avoid exciting the minds
of the insane on the subject of their delirium ;
but it is an error, too generally prevalent, that we
ought not to thwart them in their delirium, but
that, for fear of exasperating them, we ought to
give full scope to their extravagancies. This is an
infallible means of rendering their insanity in-
curable; and this fatal humouring, which it is im-
possible to prevent when the patient is treated at
home, is one of the chief reasons that render the
change of place necessary. If you allow a patient
under the influence of ideas of mysticism, or ex-
aggerated religious feeling, to give way to what an
over-scrupulous zeal inspires-if you continually
flatter the ambitious maniac who thinks himself a
king or an emperor, who proclaims himself to be
a messenger from God, and that you encourage by
your silence or your approbation, his illusions of
authority, command, and superiority-you are cer-
tain of never curing; and you may very often
make of him a very dangerous madman. The
same holds good as regards delirium from love:
uniting with the object of her love, a person whose
reason has been deranged by the breaking off of
a marriage, or by jealous suspicions, will not
effect her cure. Had such a union been con-
tracted before the breaking out of the insanity,
it might have prevented or delayed its explosion;
but the delirium once established, both the senti-

the poetry of Racine and Voltaire. I made the latter commit to memory part of Voltaire's poem on Natural Religion, and I took special pains to make him practise, so that he should deliver it distinctly, the third chant, which answered my views more nearly. When he at last came to the following verse :

"Penses-tu que Trajan, Marc Aurèle, Titus,

Noms chéris, noms sacrés que tu n'as jamais lus. De l'univers charmé, bienfaiteurs adorables, Soient au fond des enfers empalés par des diables, Et que tu seras, toi de rayons, couronné D'un chour de chérubins sans cesse environné Pour avoir quelque temps, chargé d'une besace, Dormi dans l'ignorance, ou croupi dans la crasse ?'" Pinel adds, that" the fanatic on hearing the last lines became quite furious, heaping on the declaimer the grossest abuse, calling him an im pious blasphemer, and at last, after invoking fire from heaven to consume him, he shut himself up in his cell. I was unwilling to renew the attempt, lest it might excite anew his sanguinary ideas."

This case contains some valuable instruction, showing, as it does, that as regards the ideas of monomaniacs. moral treatment has some very rigorous obligations to observe, and that to the tenacity of those ideas, it has to oppose a tenacity still greater, as we shall see by-and-by.

In attempting to combat the general delirium of the maniac, we should, when the occasion requires, be ready to bring to our aid the degree of address or precaution needed. The excited maniac does not think himself ill, and whenever he becomes convinced that his health is seriously impaired, his cure is not far distant; he is convinced that his words and actions are perfectly consistent and directed by proper motives; if you tell him that he is talking nonsense, he will not belive you; nay, more, you will become an object of aversion to him, and you will have forfeited that confidence of which you will stand so much in need when he becomes calm; then you will bring to his recollection, cautiously, what he may have said. If his countenance betrays a too vivid emotion or shame, you must be prepared to turn aside

a

remembrance, which can be recalled if occasion require it, and to efface the painful impression by comparing it with his present tranquil state, his gradual amendment, and the assurance of a speedy restoration to health and liberty.

The physician, in his quality of supreme chief of an establishment, exercises very great influence on the minds of the insane; those who are still destitute of reason soon learn from the tranquil or the convalescent, that their fate depends on him, and that they must attend to and obey him in order to obtain for themselves whatever is just and reasonable; he is, therefore, the natural centre towards which all ideas and hopes are directed. With such influence, he has only to will in order to obtain the most happy results; the patients, subjugated by a kindness at once firm and just, are docile; they take the medicine ordered for them, and submit cheerfully to whatever is required of them. At his first visit especially, his influence will be the more striking, if, from previous knowledge of the cause of the disease, he

after the perfect restoration of his faculties, we
should still be on our guard, lest, through hurry
or precipitation, we may revive a delirium, so
easy to be renewed.

the same importance for the insane as it has in so directs his questions as to show that he peneit is one of the motives for avoiding the bad, or trates into certain points which the patient endeathe ordinary affairs of life, as it has in education; seeking the good. The surest means of producing vours to conceal, and thus induces him to confess certain fatal inclinations, faults, or a disposition It is in the calm, chronic insanity more espe- pain in the insane is the douche, and in such case to suicide, which are always dissembled, or conor as a remedy, but as a means of fear. A person, cealed with the utmost care. Astounded at socially, the more difficult to be uprooted, from is not employed either as a means of repression, much penetration, the patient soon avows the finding in its very calm the motives of a more a king. We here see the principles on which the truth, and that he has been suffering from high fixed conviction, that the moral treatment must for instance, under a delirious idea, thinks himself "When remedy is employed: to think that one is a king, fever. This point once gained, confidence in the risk and dare everything, and that with a perseverance proportioned to the difficulty. physician is the chief characteristic in the subsequent treatment. In public hospitals, the influence the disorder of the passions and ideas exists alone, while he is not, is a disease; the remedy for this as in monomania, where an ungovernable passion disease is the douche and dashings of cold water; as long as the disease lasts we shall employ the of the physician is greater on the female than on or an hallucination are often the sole source and the male patients: many of the former submit to every sacrifice, and eagerly obey every order of the sole expression of a delirium, pharmaceutical remedy; as soon as the disease disappears, we treatment cannot change the patient's convictions, shall discontinue the remedy. The patient who the physician, from the sole reason that he is a repress his propensities, or dispel his hallucina- is placed in the alternative of being a great lord, or a great sufferer, or of ceasing to be a great man, and that they like him. It appertains, thereThe important point is, to distinguish in fore, and of necessity, to moral influence, that the tions." physiciau should not labour under any physical a practical point of view the intellectual phe-lord, and of being no longer subjected to incondeformities that might make him an object of nomena from the physical-a distinction which has venience, soon gives way. Hallucinations are to not hitherto been either studied or established be combated in the same way; pain and permanent thwarting form the basis of the treatment. derision. rigorously, and has only been alluded to in a general way by M. Leuret, who has shown his sense The douche is only one of the thousand means of its importance by founding upon this distinc- which the physician will suggest according to the tastes and particular ideas of each patient. When tion the exclusive application of moral treatment We should, besides, deeply all the acts and manifestations arising from the in certain cases. ances on the patient, and on the other hand, that analyse the feelings, propensities, and thoughts disease are found to entail a thousand annoyof the insane, and dive into the mechanism of the intellectual derangement, to come at the order of all the determinations and acts in conformity with more liberty, and enjoyments varied according to production and succession of the irrational ideas, the wishes of the physician are rewarded with the tastes and desires of each patient, habit will and to hence deduce appropriate steps to be taken at length what reasoning had failed in shaping the application of moral treatment. We must, in a word, endeavour to discern and restore set apart the patient, whose attention, thoughts, and passions are likely to be fixed and mastered by the physician, in order that he may be able to take advantage of opportunities for calling moral influences to his aid, and to avail himself of the best manner of employing them.

One means of mutual education, infallible for convalescents, is that of bringing them together habitually in their occupations, meals, and recreations.

You begin to discover in these meetings the feelings of intimacy, from the enjoyment of which those unhappy beings have been so long withheld; their confidence in each other waxes strong in proportion to their participation in one common interest-that of returning to the bosom of their family, and of resuming the course of their usual Occupations. They no longer feel any distrust of their former attendants, to whom they were so troublesome during their delirium. They become cheering examples, one to another: he who is dis. charged from the hospital to-day becomes an object of emulation for those who look forward to the same boon; they advise and help each other as regards the future. A convalescent who is only waiting for his discharge often adopts another not so near cure, and makes it his whole study to amuse him, until he effects the complete restoration of his reason; these disinterested attentions, these intimate confidences from one sufferer to another, this return of feelings of sympathy and affection, are of such incontestible utility in the moral treatment, that we must attribute to the absence of them the great want of success that attends the treatment of the rich, either in private lodgings or in their own homes. When a patient has become sufficiently calm and rational to admit the visits of his relatives and friends, this new disposition becomes, as regards the moral treatment, a continual subject of salutary impressions; the time of those visits, how ever, and the manner in which they are to be made, deserve consideration. It is only at the instance of the patient, and not at those of the relatives, who are always blind and precipitate, that those interviews, which are often followed by a complete relapse, are to be granted. The patient to whom such a permission is given ought to be informed beforehand of the day and the name of the person who is coming to see him, or of the persons who are to accompany him; if, during the interview, he remains quiet and reasonable, without requiring to be removed immediately, or without showing too much emotion, it is a favourable sign. The following interviews may be more and more prolonged. These family conversations powerfully revive old affections and interests, and render the convalescent more docile to submit to the last trials, that are still looked to as the test of fully restored health. In chronic, incurable mania, these visits are attended with no sort of danger, but at the same time are productive of no sort of result; they may, however, be used to effect a vivid surprise, or an unexpected commotion; but it happens most frequently that the insane patient either pays no attention to those who visit him, or, while with them, he remains insensible or irrational.

We must never forget that there are rules to observe in the convalescence of the brain as in that of other organs, and that great circumspection is required in directing the gradual exercise of the emotions and affective sentiments. Nay, more,

It is in such cases that the physician is called upon to make the most of his resources to overcome the repugnance and opposition of the patient when he resists his pressing solicitations. He will, in order to compel him to take to some occupation, have recourse to some continuous moral restraint, or to those sudden shocks, or fortuitous impressions, the sudden impulse of which will sometimes awaken the reason.

to do.

"The same is true as regards children, the reOf all sults we have in view being the same. means, occupation of the mind is the most sure, An educated insane person should be employed in breaking the persistence of dominant ideas. in teaching his companions to read, write, and cipher; he who knows nothing, has everything These different employments are to learn; music, as a study, is a very valuable more favourable even than manual labour, espeoccupation. cially that of women, when it keeps them in too sedentary a state."

These principles are also often applicable ir private practice, but their success is far greater in This treatment should be applied exclusively in the large establishments, which always contain so and who are so only because they are allowed to cases of hallucination, monomania, and melan- large a number of the insane reputed incurable, cholia, whenever the delirium appears to be uncomplicated by any organic lesion. The insane become so. Abandoned by the world, their friends, become reconciled from habit to their mode of whose brains offer no deep-seated alteration ought and relations for 10, 15, 20 years, they have not to be allowed to remain in constant repose seem to understand you; they are sure of being and inertness, as this would. infallibly destroy life. If you propose to set them free, they don't their intellect; and in such cases the moral treatment should not be confined to gentle emotions, fed, clothed, and lodged, where they are, and they We know well, if sent forth into the world again, they which often produce but little or no effect. must seek, from whatever quarter we can, other in- would be entirely destitute; besides, they have fluences; all means are good provided they be made up their minds to live, or to appear to live, powerful, the important point being to know the with their delirium: it is so easy for them to approper time and method of employing them. The pear irrational; they have only to give their brains physician of the insane must possess the courage full scope. Some melancholics and monomaniacs and firmness of the surgeon. The instruments he is take a sort of pleasure in their sombre ideas and to employ are the passions and thoughts, and delirious conceptions; they always find some them, and in this manner they establish for themthese he must be expert to wield. He must excite other patient madder than themselves to listen to the patient to anger, if by anger he can create a diversion from his delirium; let him give him selves a kind of influence, which they display by cause of complaint, if he think fit, against some- marking a place at table, the position of their bed, body, himself even: for a feeling strongly excited, the use of a particular spoon, knife, or any trifle, distinction. If they receive any assistance from and for a real motive, will often prove the best which they magnify into an important mark of their friends, they become doubly important in the assistance that can be called to his aid. eyes of those who had previously looked up to them. Other patients, whom isolation alone would restore to reason, continue to utter nonsense because they are mad, or incurable, or because they are with incurable madmen. Of this they are well aware, and they deduce from their very position an additional motive for being irrational: habit, slothfulness, the fear of being discharged, and of being obliged to work for a livelihood, all these feelings enter more than we imagine into the calculations of those persons, who seem at first blush to be doomed to incurability.

"When," continues M. Leuret, "we would endeavour to relieve a person plunged in grief for the loss of a friend, we make every effort to con. sole him, and divert his mind by directing it to other objects. And if he be pressed by hunger, if he be in want of work from which to gain a livelihood, if he be drawn into a lawsuit in which the care of his defence requires all his time, we see his grief soften according as his attention is the more powerfully and for the longer time diverted from the recollection of the friend he has lost. If necessary, then, be for your patient as tormenting as a lawsuit, as harassing as the fear of want; he will hate you for your worrying, but you will cure him.

"Pain forms a part of moral treatment; it has

Yet it is on such patients that moral treatment, even after many years, produces the most salutary We must not be afraid of subjecting effects.

It has been mentioned by Dr. Burrows that he did not recollect a single instance of religious insanity occurring, where the individual had remained steadfast to his early opinions. This is easily accounted for: such a person, either as the result of conscience or of disease, is led to doubt, opposite and conflicting opinions continually assail him, he is carrying on a mental controversy, he hesitates and wavers, then again believes, until this dreadful uncertainty harasses him night and day; the very points he would avoid continually force themselves upon him-he cannot shake them off; he neither sleeps nor eats; the system, now sympathising with the mind, becomes irritable and excited, and thus doubly aggravates the mischief; so that what in the first instance was merely a metaphysical error, has now led to a physical defect; that which was originally a mere mental inaccuracy, delusion, or deception, has now produced organic disease.

Amongst Roman Catholics, religious insanity is very rare, which may be accounted for not only from their general ignorance upon this particular subject, but from the implicit faith they place in the doctrines and tenets of their own Church. The priests themselves are, however, by no means exempt, but, as a class, yield more than their respective ratio in proportion to their numbers, which probably arises from the unbelief known to exist amongst them, as well as from other causes which need not now be entered upon.

Amongst Quakers, where enthusiasm is unknown, it is not to be expected that they would become ex

cited upon religious subjects; and their contentment, together with a self-approving conscience, seldom allows them to become depressed or melancholic on any points connected with religion.

I quite agree with Mr. Bakewell, that "the visionary fervours of devotion, which have been stated as the causes of insanity, are frequently the first effects of it."

It is seldom useful to argue with a religious maniac, but there are times when a word judiciously used may be of the happiest effect; to contradict them is only to excite their worst symptoms, and it will seldom be advisable to refer to their particular point of error, unless introduced by the patient himself.

Exercise, constant occupation, reading history, travels, anything which amuses and draws off the attention of a patient from himself and from his error, form the rational mode of treating these