lead to the belief that these liquids were secreted by analogous membranes. The meeting adjourned at half-past five. CLINICAL MIDWIFERY, BY PROFESSOR P. DUBOIS.—A woman, aged thirty-two, was brought to the hospital on May 11, 1844: she had been confined four times already, and her labours had all been natural. On May 9 she experienced the first pains, and a sage femme having been called to her, examined per vaginam, and accidentally ruptured the membranes, the amniotic fluid escaped, and the pains ceased. The patient was left, and slight pains having reappeared on the morning of the 11th, the sage femme returned, assisted by a physician, who recognised a transverse presentation, and endeavoured unsuccssfully to turn the child. When the patient was brought to the hospital, the right arm was lying in the vagina, and the thorax was descending through the brim; the head was firmly fixed in the right iliac fossa. Spontaneous evolution was beginning; the mother being extremely exhausted, its progress was very slow; and, no doubt remaining as to the death of the foetus, M. Dubois determined upon performing decapitation. With a pair of strong scissors, the vertebral column was speedily divided, but the soft parts were left untouched. The section of the cervical vertebræ permitted the completion of spontaneous evolution, and the preservation of the soft parts of the neck rendered easy the extraction of the head. The child weighed six pounds, and was well constituted his length was forty-nine centimètres. The placenta was removed immediately after the foetus. Two hours after delivery the mother expired without any pain, but to all appearance completely exhausted. On dissection, an enormous effusion of blood was found under the peritoneum, and in the cellular tissue of the pelvis. The anterior wall of the uterus, the os tincæ, and the superior part of the vagina were ruptured; and the laceration referrible to the efforts made for the purpose of turning, after the amniotic fluids had escaped, occupied a length of nine centimètres. No traces of peritonitis were observed. LA CHARITÉ. CLINICAL LECTURE, BY PROFEssor Velpeau. EFFUSIONS OF BLOOD. When, from the action of external violence, or from any other cause, blood is extravasated into our tissues, the transformations which it undergoes constitute one of the most important and one of the most curious objects of study. Blood effused in our tissues does not coagulate, but spreads in accordance with the laws of gravity. It will, therefore, generally descend from the knee to the foot, from the elbow to the hand. But this natural tendency to descend is frequently interfered with by the different density of the various layers, and by the presence of aponeuroses, &c. Thus, when blood is extravasated in the region of the knee, instead of descending towards the foot, it sometimes is observed to ascend in the thigh, in consequence of the difference of density of the structures of each part of the limb. The absorption of infiltrated blood is a phenomenon of equal interest. But the extravasated liquids undergo other, and perhaps more important, modifications. When circulating in our vessels, blood is assuredly a living fluid-its life is in its movement, and repose is death. When extravasated and not absorbed it becomes a foreign body, and is soon converted into - various productions, the origin of which sometimes remains enveloped in doubt. Thus it divides into clot and serum; the serum itself into colouring matter, by which is constituted ecchymosis, and pure serous fluids, which the vessels easily absorb when they are infiltrated. This facility with which infiltrated blood is taken up is in itself a remarkable and interesting fact: it teaches us that an infiltration, even extensive, is not generally dangerous, provided it is not complicated by the presence of a wound of the integuments. ORIGINAL CONTRIBUTIONS. 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'Altena tion Mentale," "Médicine Clinique,' Nosographie Philosophique," &c. &c. Translated, with Notes, illus trative of some important Doctrines in Physiology, Phrenology, and Moral Education, BY DR. COSTELLO, blood seem to us to be, in a great measure, dependent upon the organ or the texture in which the extravasation has taken place. Thus, effusion in lamellated structures is often followed by complete The Nature, Causes, and Treatment of absorption-an event of more uncommon occurrence in serous cavities. Let us not, therefore, forget the following capital conclusions:-Infiltrated blood generally disappears; accumulated blood exposes the patient to various local disorders; blood extravasated into porous textures can be absorbed readily, but when effused and collected in serous cavities usually requires the interference of surgical art. It is natural that the therapeutist, bearing in mind the difference of prognosis which distinguishes Principal of Wyke House Asylum, Editor of the Cyclopedia two affections so closely connected, should inquire of Practical Surgery, &c. if it be not possible to convert one into the other. Infiltration disappears spontaneously; it is, therefore, the first thought which strikes the surgeon, to convert, if possible, collections of blood into infiltrations. Not only this transformation is possible, but it is easy. Suppose, for instance, an effusion of blood to exist in a serous cavity, a communication can easily be established between that cavity and the neighbouring porous textures, into which the effusions should be infiltrated. By the introduction of a narrow-bladed knife, the parietes of the sac which encloses the blood should be opened, and the infiltration of blood facilitated as much as possible. As to the consequences of effusions of blood in the breast, in the lung, in the prostate, in deepseated organs, they may be judged of by induction. It sometimes happens that, after separation of the clot from the serum, neither is absorbed; but, by the dissolution of the former in the latter, a chocolate-coloured fluid is produced. When the coagulum remains alone it is converted, after a time, into a tumour, resembling closely the concentric layers of aneurisms. When the effusion has taken place in a region where movements are frequent, the clot is divided into numberless bodies, as it happens in the knee, the wrist, or the elbow; and these were formerly mistaken for hydatid cysts. When the blood has been effused in the parenchyma of deep-seated viscera, still more remarkable changes are observed: the blood becomes again or ganized, and gives rise to living tumours, susceptible of growth, and perhaps of acquiring a malignant nature. These opinions, which we brought forward many years since, were then the result of analogy and inference; now it is different: microscopic observation has shown the blood discs to form the chief, sometimes the only, element of these tumours, which we supposed to be due to extravasated blood. According to the tissues in which these tumours are developed; they vary considerably. In the prostate we see them resembling closely the texture of the gland; in the womb we meet with them under the name of fibrous growths; in the breast, again, they form fibrous productions: in a word, hæmatic tumours in each organ seem to take an aspect closely approaching that of the organ itself." D. M'CARTHY, D.M.P. NAVAL PROMOTIONS AND APPOINTMENTS. Mr. Marmaduke Cremour French, Assistant-Sur: geon, to be Surgeon; Assistant-Surgeon Robert P. R. Sparrow, confirmed to the Resistance; D. N. Tucken, Assistant-Surgeon, to the Ocean; W. Swainson, Surgeon, to the Penguin; Surgeon James Wilson (B), to the Caledonia. ROYAL COLLEGE OF SURGEONS.-Gentlemen admitted members on Friday, Nov. 27:-W. Meehan, J. Newell, D. Wilson, M. Ledger, G. Baddiley, J. F. Jackson, H. H. Tribe, F. Manger, J. J. Halls, R. Graveley, and J. G. Mushet. There is a vacancy for a surgeon in the Marylebone General Dispensary; also in the Westminster Hospital, for a surgeon and house surgeon. THE NEW BOTANICAL GARDENS AT CAMBRIDGE.-The works at these grounds have at length been commenced. On Monday the cereIf, on the contrary, the blood be collected, trans-mony of planting the first tree was gone through formation becomes possible; either the clot or the serum will remain unabsorbed: in the first case, hæmatic tumours will be produced; in the latter, a cyst or a bydrocele. These transformations of the by the Vice-Chancellor, near the intended entrance in the direction of the Trumpington-road. The Professor of Botany planted the second on the east side of the garden, HYGIENIC TREATMENT OF INSANITY. In affections of the brain, when the delirium is so great or so prolonged as to cause complete mental derangement, the patient must be subjected to constant surveillance, and must, as a matter of course, be placed in a locality possessing such arrangements as his safety, comfort, and the tranquillity of others require. It is therefore absolutely necescary that the establishment in which he is to be received, whether it be public or private, shall be properly constructed, and arranged throughout its smallest details so as to present all the conditions suitable to its peculiar purposes. This material arrangement of the establishment, simple as it may appear, and without which proper treatment is impossible, is nevertheless subject to certain rules and principles which have only of late years been reduced to precepts of easy application; although physicians have always acknowledged the immense resources that might have been rendered available, from the combination of hygienic means in a proper disposition of the places of habitation with the advantages of alimentary regimen, manual occupations, intellectual and gymnastic exercises adapted to the degree and kind of derangement, as well as to the rank and habits of the patient. Viewed in this light, hygienic treatment is deserving of very particular attention. We may even go so far as to suppose, in order to place the practical truths which such treatment would establish in a stronger light, that we are called on to organize an establishment which would be a healthy and secure refuge for unhappy beings labouring under insanity. Our first care would be to select a proper site. We should prefer it at a short distance from a town, on a gentle elevation, which would not be commanded by any importunate neighbourhood, and with an abundant supply of good water at hand. The walls of enclosure, built up in open cuttings, should be sufficiently high for security without shutting out the views of the surrounding country. In this way the appearance of liberty is combined with seclusion. The site the least susceptible of damp, and the best for the buildings themselves, would be that in which the foundation was sand or gravel. The buildings should present to the east, a disand south winds through the courts, and protects position which gives free circulation to the north the patients from exposure and inconvenience during the great heat of summer. The whole superficies should contain twenty-five acres, including the ground required for the labour of farming and gardening. consist of two divisions, entirely separated--one for Every establishment for the insane ought to the males and one for the females. Before entering on the details of the arrangements appertaining to each of these divisions, and the classification of the patients, we shall speak of the general service, that is, of the administrative department, the chapel, kitchen, pharmacy, baths, laundry, and farm. The administrative department forms the centre of the façade, and consists of cellars, store-rooms, offices, saloons, and the apartments of the physician and clerks. The cellars and ground floor form the stores for provisions of every kind. By this arrangement, the bustle caused by the arrival of carriages, and the passage of strangers through the interior of the buildings, is avoided. On the ground floor, to the right and left, are situated the parloure for the male and female convalescents, where the enables us to take in at a glance the measures to physician allows of the visits of friends. In the offices all the business relating to admissions, discharges, and deaths, and to the accounts, is transacted. Many physicians of eminence, and of known moral character, will not hear either of chapel or clergymen in asylums for the insane. This proscription is too rigorous. It certainly cannot be doubted that in those countries that are under Catholic authority, and where religious monomanias are reproduced under a great variety of mystic forms, the influence of the temple and of its ministers may be attended with serious inconveniences. But on this point the head physician should be invested with the whole authority: in him should be the right of refusing access to the indiscreet, as well as of pointing out such of the patients as may be allowed to attend worship without danger. Many of those unfortunates, in recovering their reason, feel the want of returning to the religious habits in which they had lived, and derive from the practices of religion motives of hope and resignation. In our opinion, therefore, the chapel is a necessary part of the asylum, and its site should be at the entrance of the establishment. The kitchen should be flagged, and furnished with boilers and hot plates. At its angles should be four cabinets-the pantry, larder, butler's room, and office. It should be large, well ventilated, and of an elevation equal to two-thirds of its width. In the middle the furnace should be placed, thirty inches high, with a surface of twelve feet by six. It should be furnished with six boilers, two of them being large, two middling, and two small, and with cast-iron plates, and ovens of different sizes. The kitchen should also be provided with a sink. The pharmacy is another important department. It should consist of the shop, the laboratory, the dispensary, the drug-store, a sink, and an apothecary's room. In insanity, baths form a powerful means of treatment. A well-regulated establishment ought to be provided with baths of every kind abundantly. Common baths, medicinal baths, douches, moist, and dry stoves. Each division, male and female, should have its baths entirely separate, besides several smaller bathing-rooms for the service of the house. Over each of the large rooms destined for the patients' baths should be placed the apparatus for douches, water-cisterns, furnaces, and vapourbaths. In the room below there should be six baths, besides two others set apart for sulphurous baths. The flooring of the bath-room should be of oak, and moveable from the flagging be neath. The laundry is of extreme importance in an establishment. It prevents the inconvenience of sending the washing out, and furnishes occupation both useful and profitable for certain patients. It should be provided with two washing-troughs, two steepers, and a large boiler. The upper parts of the building should be reserved for the drying and folding of the linen. The farm is not an idle appendage to such an establishment. Laid out in the usual way, it contributes produce for the service of the establishment. At the head of this small agricultural institute we should havean intelligent man, accustomed to having patients work under his direction. He should have discernment to set them to such manual labour as best suits them. The formation of earthy mounds, the raising of vegetables or corn, the care of animals, gardening, the in-door work of the farm, and all the occupations of a property in full profit, will afford scope for employing the patients according to their strength or inclinations. He should know how to interest them, and make them take pride in the performance of their task. We admit into the farm none but the convalescent, or those who are almost restored to reason, especially reserving for the females the washing and care of the linen. After these general arrangements come the particular ones which relate especially to the distribution and classification of the patients, according to the degree or nature of the alienation. Such a classification, well ordained, is, in itself, a most powerful auxiliary of the treatment. "A methodical distribution of the patients into different classes be taken respectively for their food, cleanliness, and their regimen, physical and moral." This truth, proclaimed more than forty years since by Pinel, has been but tardily reduced to practice, although its obviousness was much greater as a practical want than as a precept. It has only been slowly and bit by bit that successively at the Salpetrière and Bicêtre some slight order has been obtained in the classification of the patients; and even this has been effected without any general views, and always under the imperious necessities of the old buildings. Desportes is of opinion, that the insane should be arranged in twelve classes: the first, for the furious under treatment; the second, for the furious incurable; the third, for the tranquil residing in cells; the fourth, for the incurable to be placed in cells; the fifth, for the furious epileptics; the sixth, for the tranquil epileptics; the seventh, for patients in dormitories; the eighth, for the incurable in dormitories; the ninth, for the melancholic; the tenth, for the imbecile; the eleventh, for those who are in the infirmary; and the twelfth, for the convalescent. This distribution of the patients is much too complicated, and falls, perhaps, into the opposite extreme. In our opinion, it may be much simplified, and without infringing upon its importance, by reducing it to the six following subdivisions, applicable, of course, to the male and female divisions respectively. First, the convalescents residing near the centre of the house, and having ready communication with it; second, quiet patients under treatment, the melancholic, hallucinating, and tranquil maniacs; third, the tranquil incurable, and imbecile; fourth, the refractory incurable and epileptic; fifth, the furious in cells; sixth, the infirmary, part of which is for accidental diseases, and part for the reception of the paralytic and dirty. With this distribution of the patients in buildings upon the ground floor and separated from each other, each having a garden enclosed by a wall to prevent the escape of patients, an effective order and surveillance are readily established and easily maintained. The remainder of the establishment, the farm and its enclosures, should be open to the patients only as a momentary walk, and always under the surveillance of one or more attendants. But, whatever be the principles that direct such an establishment, and the modifications which it must undergo, either from locality or necessity, the physician by the nature of his studies, and the deep interest which he must feel in the success of his treatment, must be supreme judge, and the soul of everything that occurs in the establishment. Reil, and those who, sharing in his opinion, require that an asylum should be governed by a triumvirate, composed of a physician, a physiologist, and a moralist, could have had no experience on this subject. And, moreover, ought not the physician of an establishment to be in himself fully competent, in regard to these three conditions of qualification? The chief point of importance is to impress on the patients the idea of power being centred in one only, who holds their fate in his hands, who punishes, pardons, and restores to liberty. It is only by the force of his influence that he is enabled to overcome the obstacles of routine, and to impart regularity to all parts of the service. Even in this, it is humiliating to avow that the good encounters as much resistance as the bad. Each day the physician sees his patients, arranges their classification, transfers them from one division to another, prescribes measures of discipline, delivers certificates of cure, and authorizes the visits of friends. He lives in the midst of them, bestowing upon them almost all his time, in order the better to observe them, and thus to be the better able to cure them. Such a degree of abnegation can only spring from the most eminent qualities of mind. He requires a peculiar organization, and an exterior and appearance of command. He must have a strong and active constitution, to enable him to bear much labour and loss of sleep. He must have a dignified and calm address, a full-toned voice, a benevolent look, and an agreeable countenance. The insane do not forgive the slightest deformity in their physician. In his conversation with the female patients, his manners and his actions must be more soothing and affectionate. For them knowledge alone does suffice. He must employ a sort of coquetry of knowledge, whilst appearing to interest himself, and even to give way to their childish fancies; he must, either in the form of a request, or of disinterested advice, insist upon the execution of his orders. The great art of the physician is to appear to take seriously all those little secrets and mysteries which, although of no importance in themselves, may serve as the means of gaining confidence, and thus serving as the first step towards that cure which the slightest indiscretion might defeat. Then the medical service must also have its executive. At the head of each division of the male and female there must be a superintendent, having under their orders all those that attend upon the patients. Each of these superintendents, in their respective division, must be responsible for its good management. They must see to the execution of the rules, to the direction of the management, to reprehend the failures of service, to look to the food, linen, the keeping of the dormitories, and the patients. They must be able to give an account at any moment of the state of every petient. They must govern with justice and benevolence, grounding their authority upon the respect which they inspire, and not by harsh and arrogant manners. Another point not less important is the choice of the attendants themselves, who are to take care of the patients. Destined to be continually with them, they exercise rightfully over their minds an influence more powerful perhaps than that of the physician himself. One must have lived long amongst the insane to conceive how difficult it is for those who attend upon them to control the impulses of revenge, or anger arising from the provocations, insults, blows, and hoinicidal attempts of certain furious patients. Such force of character and self-denial are rarely found in the class from which those attendants are chosen. It is therefore necessary to form them and to instruct them without ceasing in their duties towards those patients. They are constantly to be reminded that the insane are under the influence of a disorder which takes away all responsibility from their words and actions; that they are to employ, in regard to them, that mildness and persuasion of which the heads of the establishment give them an example, and that they are dealing with fellow-beings deprived of the use of reason. This wisdom, the more difficult from being practical, and to be made use of unceasingly, can only be developed through a strong feeling of Christian charity. And hence several physicians, especially Horn, have proposed to form schools for such attendants. Pinel himself has greatly simplified this question by demonstrating the advantages of employing at the Salpetrière and Bicêtre as servants, patients who had recovered; they are in general more mild and compassionate, treating with indulgence a malady from which they had suffered themselves, and to which they are still perhaps liable. The remark is profoundly true, and ought to be turned to account whenever it is possible. REFLECTIONS AND OBSERVATIONS By JOSEPH WILLIAMS, M.D., &c. &c. &c. "Nemo mortalium omnibus horis sapit." There are occasionally particular periods when the introduction of a friend may prove of the happiest effect, as is well illustrated in the case which came under the notice of Dr. Gooch, of a lady, twenty-eight years of age, who suffered from melancholia a few months after the birth of her second child. She was sent to a cottage pleasantly situate, and separated entirely from her friends. She was gloomy, and for several weeks manifested no improvement. At length she imagined she was to be 178 THE executed for crimes she had committed, and fancied MEDICAL TIMES. indisposition, and there cannot be a doubt that rect. actions; these friends applied to a mad doctor, who, be as essential for every medical man to know how Hospital, strongly advocated the importance of cated-it is so; but there is no very great difficulty rally hitherto been adopted. Disease of the mind in estimating the amount of benefit resulting from I am aware it is said mental disease is compliany established rules of treatment which have gene is complicated, and the persons who have specially gesting either therapeutical, moral, or general individually done very little in the way of sug disorder, and this too with ample means of inundertaken to cure that disease have, at present, vestigation before them; the desire has always been means for alleviating or curing such an afflictive pirical. to keep the system or plan of treatment "close." Even to this day their practice is often secret, em by the talented and humane physician at Hanwell, changes wrought in the most violent recent cases, "As soon as I entered the drawing-room where she usually spent the day, she ran into a corner, hid her face in a handkerchief, then turned round, looked me in the face, one moment appearing delighted at the thought that I was alive, but immediately afterwards assuming a hideous expression of countenance, and screaming out that I was dead and came to haunt her. actly what Dr. This was exsome minutes I thought all was lost. Finding that had anticipated, and for persuasions and arguments only irritated and confirmed her in her belief, I desisted, and tried to draw off her attention to other subjects. It was some time since she had either seen me or her children; I put her arm under mine, took her into the garden, and began to relate what had occurred to me and to them since we parted. This excited her attention; she soon became interested, and I entered with the utmost minuteness and circumstantiality into the affairs of the nursery, her home, and her friends. I now felt that I was gaining ground, and when I thought I had complete possession of her mind, I ventured to ask deeply resentful, to see him strongly excited? The her, in a joking manner, whether I was not very whole circumstances, subsequently to the profesWho can wonder to find this unfortunate patient communicative for a ghost? She laughed. I sional visit at his own house, have been sufficient immediately drew her from the subject, and again engaged her attention with her children and powerful than that of many men now daily transfriends. The plan succeded beyond my hope; Iacting their various vocations. to overweigh the balance of a mind far more dined, spent the evening with her, and left her at night perfectly herself again." which it leads. I highly deprecate the very idea to the removal that I object, as to the whole cirIt is not so much of a medical man being the proprietor of an asylum cumstances connected with it, and the abuses to for the insane; but when I find that this very person was, until very recently, selected to judge whether he was to be removed to his own asylum, I Bowden (late Miss Powell), the matron of the Hanwhether the alleged lunatic was or was not insane, morandum relative to restraint, furnished by Mrs. titioner could place himself in such circumstances. cases, almost all of which were in constant restraint cannot but feel surprised that any medical prac- well Lunatic Asylum: "it comprehends forty-one I may here with great propriety refer to a meAnd should this opinion be considered unjust, my answer is, turn to history, read what man has been, Fourteen of these cases were almost always fastened what man is. There is sufficient in legal and in of some kind or other previous to September, 1839. ledging the philanthropic feelings which actuate the chair, and at the same time in sleeves, or the muff, medical literature to justify strictures much more majority of the profession-a profession which is severe than I have made; and while acknow-ral were in complicated restraints, and some in a in restraint chairs, and twenty were almost always second to none in usefulness, in kindness, or in in a kind of strait waistcoat, called sleeves: sevecharity-still I know that there is a class, and tell them has been in restraint since. is a class who, preferring self to the interests of or in leg-locks. All these patients were liberated me in what society they are not to be found, there yet in the asylum, and there is not one who may before the end of September, 1839. Not one of others, provide for themselves in a manner which Thirty-seven are dangerous at all times are now occasionally seen at will not bear the scrutiny of honest men. not be pointed out as an instance of the improveduring two years. Some who ment of the mental faculties, or of the habits, in have done. Some who were sinking into dementia consequence of never being subjected to restraints who were said to pursue visitors through the ward considered the work-table, smiling and pointing out what they Foreign Review," vol xiii., p. 280.) are now never known to do so." or imbecility are now lively and talkative. Some ("British and The next morning, in a state of great anxiety, he went to know whether his success was permanent; but her appearance at the window with a cheerful countenance soon relieved his apprehensions. While there, Dr. went up stairs, without knowing the result of the interview, and came arrived, "It looks like magic!" She was ordered to the down saying, sea-side to bathe. As soon as the day of her departure was fixed, she began to droop again, and the evening before leaving she was very low, and on the morning of setting off was as bad as ever. This state continued for several weeks, in spite of sea air and bathing, and then ceased as suddenly as it had done before, apparently in consequence of interviews with friends, calculated to remove those apprehensions which haunted her. She has since then continued perfectly well, and has had another child, without the slightest threatening of her former malady. Agreeable, pleasant, and useful occupation, with plenty of exercise in the open air, should be constantly employed in the treatment of insanity; the farmer in the north of Scotland, who derived so high a reputation for his success in curing mental disease, trusted entirely to physical labour in the field, which was often of a most laborious cha racter. Mere irrationality does not require restraint; control or guidance may be necessary; but how wicked to confine a person, merely because he is irrational. As Dr. Mason Good has said-" While several, or even all, the mental faculties are slightly weak or sluggish, or inaccordant with the action of the rest, they are scarcely subjects of medical treatment, for otherwise half the world would be daily consigned to a strait waistcoat." It is in fact only when these changes are most striking that they constitute real disease of the intellect. Just as there are maladies of the body, so there are also diseases of the mind. scribe quiet and confinement for every corporeal No one is so silly as to pre large, very large; the stake being high, the tempta- from home-he is irritable, perverse, inconsistent; were persons; their mental power and vigour fail, they and the conversation and actions of the patient Composure. Contradiction can do no good, and a kind and conciliatory manner should always be exhibited towards the insane; the delusive opinions they hold, however absurd, are to them realities; and a greater degree of irritation is produced by laughing at them than we should ourselves feel if our word were doubted, or we were jeered at by others. A conciliatory disposition, with a manner sufficiently authoritative, is the great desideratum. It is considered advisable, that, whenever a person's means will at all admit of his being treated at home, this is always preferable, and especially in the first instance: for to send an incipient or slight case to mingle with lunatics, or persons holding deluded opinions, is very likely to aggravate and confirm those symptoms already present, or even by imitation to cause him to assume those fictitious ideas or characters which are so powerfully and so perpetually impressed upon him. As there must be lunatic asylums, and as the majority of them are unfortunately densely thronged, the importance of classification cannot be overestimated. And it is not sufficient to separate the rich from the poor, the noisy from the quiet, the dirty and offensive from those who are clean, or to keep the dangerous either separately or by themselves, or to remove the paralysed and imbecile from convalescents, but the convalescents themselves require classification; and who presumes for one moment that a patient recovering from erroneous ideas and perceptions is more likely to be favourably impressed by another convalescent, than by those of sound mind?—as Dr. Conolly says—"Convalescents should not even associate with convalescents, except under the strict watching of persons of sound mind; they can hardly assist, and they may retard, the recovery of one another." How powerful is the effect produced on those who habitually associate with the insane; how many keepers, both male and female, become insane! what has been the consequence? The gloominess In the Commissioners' Report we find "that the It is far better to control a patient by encouraging him when tranquil, and soothing him when irritable; the object should be to induce him to place confidence in his attendants and in himself, to do nothing which diminishes his selfrespect; and the authority obtained in such a manner is greater and more permanent than when resulting from hobbles and buckles and straps and strait-waistcoats. Coercion is always unjustifiable, and where a patient is very violent, he should be placed in a padded room, where he cannot injure himself; and if necessary one or more assist ants must remain with him during the height of a paroxysm. It is true that where the system of restraint is abandoned, there must be a greater number of superintendents; but owing to the improved moral discipline, and the better classification, the extra number required is not so great as may at first be thought necessary. At Hanwell there is about one attendant to eighteen patients; and they are instructed to show great forbearance, never to argue with patients, and above all things never to hesitate, but to act promptly, and especially that they are placed there not to punish, but to prevent mischief. To show the practicability, and also the advantages, of the conciliatory system, it is only necessary to refer to the Report of the Commissioners, made April, 1846, on visiting the Hanwell Lunatic Asylum, which then contained 413 males and 568 females: total, 981. Of these, none were under mechanical coercion, and only two persons, females, were under seclusion. This, of itself, speaks volumes, and supplants all theories. Restraint is justifiable where the property or life of the patient or of others is endangered; his holding fictitious ideas, however foolish, does not de- A person may hold very extravagant opinions, mand restraint; but the instant such ideas really and yet discharge public and domestic duties with threaten danger to himself or to others, that mo- propriety; but a man having once suffered from ment strict surveillance is necessary. By this I do mental hallucination or aberration, while in the army not mean that the mere possibility of danger de- or navy, should be considered incapacitated from mands such strict interference, because, if so, where any such future service, because, as such persons neis the lunatic who would not be under restraint? cessarily have to be intrusted with arms of destrucBut what I do mean is this, immediately a patient tion, as each holds a situation of trust, varying of thought it his duty to "send a child to heaven"; course greatly as to responsibility, and as relapses that he had "a mission from above to take away not unfrequently occur, and as the greatest danger life," or in any other manner showed that his hal- might result from any sudden attack, it is conlucination was dangerous, then the utmost pre-sidered most impolitic to run any such risk. Only caution is essential. Many lives might have been a short time since, we remember the Cove of Cork saved by attending to these precautions; the mo- to have been placed in the greatest danger by the ment a man even thinks of taking his own life or commander of one of her Majesty's ships having, that of another, vigilant superintendence should while insane, ordered the guns to be loaded, and always be at hand. pointed at the town; happily mischief was prevented by the promptitude of one of the lieutenants. It is, perhaps, hardly right at present to refer to the great danger which might have resulted to our troops in India, by an officer, who, under a temporary fit of insanity, ordered the artillery and cavalry to the rear; and, finally, to retreat upon Ferozepore, thereby depriving the infantry of their support, and also preventing them from so fully following up the advantages they had subsequently gained. Although this error did not lead to any serious result, yet it is almost impossible to conceive how perilous might have been the situation of the infantry, had they not found themselves intrenched within the enemy's camp. Such a case as this strongly points out the necessity of the rule which has just been laid down, with respect to an attack of insanity necessarily disqualifying for any future military or naval duty. Insanity is not very prevalent in the service, which strongly tends to prove the advantages of discipline, because, if the habits of regularity as to drill and regimental orders did not strongly antagonize and oppose the injurious effects of debauchery and revelry, we should reasonably anticipate a greater accession to the number of lunatics. It is important to ascertain whether a man has been, and continues to be, dangerous to himself or others; and if so, and more especially if it be a chronic case, confinement may be necessary. Even here I think it very undesirable that a patient should be confined for more than two or three months, without a special inquiry being made into his case; and if, according to the provisions of Lord Ashley's Act, the Commissioners act fully up to their instructions, it must have the effect of preventing many of the errors and abuses which have prevailed. It is quite evident, on reading the last report made by the Commissioners, how great a difference of treatment exists in the various County lunatic asylums: thus a suicidal patient in one County would be allowed considerable liberty, under proper surveillance, while if placed in another County asylum he might be hobbled and chained and treated worse than a felon. It is now a matter of fact that chains and bars increase the frenzy of maniacs, and often tempt the insane to commit suicide. Pinel, who first denounced and abandoned the restraint system, found the number of furious maniacs diminish immediately the chains and manacles were abandoned. In the summer of 1842, upwards of nineteen tons weight of iron bars and gates were removed from the Lancaster County Lunatic Asylum; and As we consider it would be inexpedient and improper ever to readmit into the service for actual duty any one who had been insane, so we also hold that any person who has committed a serious crime, and who has been acquitted on the ground of in sanity, should be confined for life. In either instance there may be a relapse, and danger would almost necessarily result. Early treatment is of the greatest importance; a few days neglected, and the case may be irremediable; whereas, had attention been at once directed, and proper remedial and general means adopted, such a person might, in a short time, be again fitted for his usual avocation, and possibly be never so again afflicted throughout life. To send such cases to a lunatic asylum is not to be recommended; where persons can afford it, they should be visited by their ordinary medical man, who can, should he think it necessary, avail himself not only of judicious and experienced nurses or attendants, but also of the opinion and advice of physicians who have devoted considerable attention to this particular subject; but in the case of poor persons, or parish paupers, they should either be attended at their own houses by the parish doctor, or a special room should be set apart as an infirmary in the workhouse-a great object, however, being never to designate it by a term which might prejudice the recovery or the feelings of those who occupied it; consequently it should never be called the madward, or the lunatic-house; and it would be much more discreet in medical men, when speaking tô non-professional persons, to call such cases, those of preternatural excitement or morbid irritability, or cases of inflammation of the brain: the fact being that many persons never regain their social position when once said to have been insane; whereas, where excitement has depended upon inflammation, the evil or injurious tendency is scarcely remembered after the patient has convalesced. To show how important early treatment is, turn to the deplorable condition of the insane in North and South Wales, where the unfortunate pauper lunatics are shamefully neglected. In North Wales there is not a single public or private asylum, the lunatics being imperfectly and badly boarded out, their worst cases being sent to the Liverpool Asylum, the governor of which states "that he never remem bers an instance of recovery in an insane pauper from Wales." It is to be strongly advised that those friends who have justly placed a lunatic in an asylum, should be the persons selected and allowed to liberate them, because, although a convalescent may feel gratitude to those who had considered it necessary to have him taken care of, yet sometimes there is a very decided antipathy manifested towards them, and this, too, notwithstanding a perfect restoration to mental vigour. Great caution is often necessary in discharging á patient, when presumed to be cured; and the utmost care and precaution should be taken where danger of any sort has been threatened. Many persons have committed suicide who were considered convalescent, but who merely simulated convalesence to have the opportunity of destroying themselves. A young man in the Bicêtre was by Pinel considered cured, and the commissary, after a most lengthened examination, pronounced him sane, and ordered his discharge. The patient, however, had to give his signature, and subscribed himself as Jesus Christ," and then sustained that delusion. Another much more remarkable and more important case occurred in Paris, in the person of another of the patients in the Bicêtre, who, when liberated by the mob during the Revolution, pleaded his cause so pathetically and rationally that he almost brought down the vengeance of the armed rabble on the governor of the asylum, whom he had accused of cruelty. The rescued patient was led about in triumph amidst the shouts of "Vive la Republique !" The whole scene was too much for the unfortunate lunatic; he seized a sword, and wounded his liberators indiscriminately, and was then, by them, again taken to the Bicêtre, when the mob acknowledged their misconduct, and the injustice of those suspicions which had arisen from their ignorance. So we also read of a medicai man in this country, who had left a patient, relenting, as he rode along, that restraint had been proposed, and resolving to postpone it; before, however, he had gone half a mile, a mounted messenger informed him that his tranquil patient had nearly blown up his house and family with gunpowder. But, probably, one of the most dreadful recent instances is that of the enthusiast Thom, alias Sir William Courtenay. This man had been previously found insane, and had been confined for six months, but, being considered cured, was released; he put himself at the head of a band of riotous fanatics, in the neighbourhood of Canterbury, and was himself shot, whilst in actual collision with the military, but not before ten other lives had been sacrificed. turbed possession of his property is, evidently terly Review," pp. 405, 406, vol. xv., 1816; alderman, on the ground of his being a lunatic and for imprisoning him until he procured him to execute a letter of attorney to his wife, under colour of which he disposed of £1,000, apparently to his own use. It appeared, moreover, that he had debauched the wife, handcuffed the husband, given him strong medicine in the night, and carried him out at one or two o'clock in the morning bareheaded, when it rained. The physician was sentenced to stand in the pillory, be sent to the house of correction in South year, pay a fine of £600, and find sureties for bis good behaviour during life. (P. 509, Collinson, vol. i.) ARB The enormities which were formerly all but uni-lehem Hospital, pp. 11, 12, &c. See also" Quar-wark, whipped naked, kept at hard labour for a versally practised in the treatment of the insane, throughout this country, cannot now be so common, still much reformation is required. It is to be hoped we shall never again hear of such a case as that of Mrs. Hawley, who was released by Lord Mansfield, having been brought before him by a writ of habeas corpus. It appears she was inveigled into a madhouse at Chelsea, and there kept and treated with severity; without the use of pen or paper, or any communication with her friends; and even when a physician was ordered to visit her by the Lord Chancellor, and applied at the house where she was supposed to have been taken, he was refused admittance, and was told no such person was there, although at the very time he saw Mrs. Hawley at one of the windows, and subsequently spoke to her!! This was by no means a rare case, and a husband who found his wife in the way, or a parent wishing to dispose of a child who was troublesome, had nothing more to do than to go to a madhouse, and these relatives or friends were immediately admitted, without any other warrant or authority than the mere application! It was not unusual for persons keeping madhouses to live away from them, and to leave the management to persons ill adapted for so responsible an office-such, for instance, as one engaged in the "wool trade"; indeed it was just such a superintendent who, when asked by a committee of the House of Commons upon what authority he admitted persons charged with drunkenness into a lunatic asylum, replied, "upon the authority of the persons who brought them." One husband justified to Dr. Battie his sending his wife, though sane, to a lunatic asylum, that he understood it to be "a house of correction." How many such instances have there been, as of a husband locking up his wife for life, or perhaps until a son has come of age and released his mother; of families keeping in confinement brothers or sisters for the sake of their property; means having in some instances been adopted to prevent their recovery!! How disappointed has a husband been on the unexpected recovery of his wife; or how much vexation has it caused a mother to see her only son restored to reason! And even where there has not been such villainy and such criminality, yet ignorance and superstition have sometimes prevented indiscreet parents from allowing their children to be subjected to any treatment whatever, although labouring under phrenitic insanity; and this because they considered "the aberration was from the Lord," or was the result of "demoniacal possession." Mr. Bakewell says." I have known a son take measures evidently for the purpose of preventing therecovery of his father from insanity. I have known a large opulent family combine together in the use of means which they thought the most likely to prevent the recovery of a brother who had acquired a large property by his own exertions : they living at this moment in possession of his property, and he taken care of at a trifling expense. I know a female of fashion and fortune, who has pertinaciously withheld the means of recovery from an elder sister, on account of the expense, though the sufferer's own income is more than sufficient to procure the best means the country affords; but she finds it necessary to make use of part of her unfortunate sister's income to support her own fashionable style of living. I know another opulent family who have kept a brother in confinement for upwards of seven years, without any means of recovery, though they themselves believe he would have recovered had proper means been timely resorted to; but the undis Dr. Conolly has mentioned the case of a man of In the Parliamentary Minutes, Mr. Higgins, after weak mind, who appears to have been in his wife's describing several instances of ill treatment, states-way, and who, by tormenting his life out, managed "Another case, which I laid before the governors, to excite him and make him worse. He had already was that of the Rev. Mr.; he was a clergy- been confined in lunatic houses three or four times, man reduced to indigence, I believe, in consequence and when Dr. Conolly saw him, it was for the purof his mental complaint; he had at times, and for pose of signing a certificate which was then lying considerable periods, intervals of reason. In those on the table; but with that humanity which has intervals, when he was perfectly capable of under- ever characterized him, he refused the certificate, standing everything that was done to him, re- and said, he at that moment considered the wife peatedly, in the presence of his wife, he was ex- the madder of the two-she having then partaken posed to personal indignity, and on one occasion of more gin than usual. Dr. Conolly feared this he was inhumanly kicked down stairs by the unfortunate man was subsequently removed to a keepers, and told in the presence of his wife, that lunatic establishment. he was looked upon as no better than a dog. His person swarmed with vermin; and, to complete this poor man's misery, the keepers insulted his wife with indecent ribaldry, in order to deter her from visiting him in his unfortunate situation." And it subsequently appeared that he had a gold watch which was lost there, and which his wife could never recover. An equally affecting case is that of an unfortunate lady who had been a teacher of languages, who talked reasonably and was fully sensible of the mental and bodily condition of those wretched beings, who, without clothing, were closely chained to the same wall with herself. But, probably, the most complicated and most shameful apparatus for manacling a patient was exhibited in that of William Norris, who was linked and double linked by various parts of the body. It is perfectly distressing to read the account of the brutal and degrading treatment to which patients were subjected in the public and private establishments, even up to a very recent period. In some instances we read of patients having been compelled to wallow in their own filth from Saturday night till Monday morning; the air they inhaled being so bad that persons unused to it could not breathe. In the Report of the Commissioners will be seen cealed, and were never exposed even to the eyes of We read, in 1827, of an unfortunate woman who How many persons, now in lunatic asylums, would delight in being restored to their relations, and yet their affections are allowed to pine, their very existence is painful to them-they are miserable; whereas, were they permitted to return to the comforts of home, no mischief would result, they would again become happy, and their lives would be prolonged. An information was laid in the King's Bench against a physician for assaulting and beating an The treatment in lunatic asylums is daily becoming more rational, and those who should command our warmest and kindest sympathies are not now so likely to be treated worse than brutes. Public attention is being more vigilantly directed towards the abuses which have existed, and an extended and intimate knowledge of former evils will be more likely to enable wise precautions to be taken to prevent the repetition of such enormities. (To be continued.) CASE OF INTRODUCTION OF A WOODEN By M. A. BOUCHARDAT, Surgeon-in-Chief to the Thi Etiennette Blain, aged forty, short in stature, of a strong constitution and sanguine temperament. This woman, who has always enjoyed good health, complains of pains in the hypogastrium, and frequent desire to pass her urine, which has caused her entrance into the Hôtel Dieu of Lyons. When admitted under the care of M. Barrier, it was ascertained that she had iutroduced a pencil into the bladder, with the view, as she said, of relieving violent colic, which nothing else could as suage. We may suppose, from her avowal mixed with denials, that this pencil escaped from her hands while performing the manipulations of onanism. The presence of a foreign body in the bladder immediately produced pain, of a slight back, aggravated by her work, or when walking, character when at rest, or when lying on the and finally becoming excessively severe. At her entrance into the hospital, on the 18th of September, she complained of the hypogastric pains before described, of frequent desire to micturate, of shiverings, alternating with heat; the urine was thick and turbid, the skin hot, and the pulse accelerated. On the next day, this state continuing, M. Barrier passed the female sound, ascertained the presence of the foreign body in the bladder, and decided on immediately attempting its extraction. The patient was placed on an elevated bed, the thighs were separated and flexed on the pelvis, and an injection of warm water thrown up before renewing the examination with the "trilabe” of M. Civiale. The attempt to extract the foreign body, which was placed transversely behind the pubes, was vain; it was not more successful with a long and curved pair of polypus forceps, with the lithotrite of Heurteloup, and other analogous instruments, each being assisted by the introduction of the finger into the vagina. The foreign body, situated obliquely from behind forwards, and from left to right, was seized very frequently, |