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be made to bring about absorption by spirit lotions with arnica. Section and evacuation of the tumour, or the cutting out a small piece of the outer wall, filling the wound with lint, and exerting moderate pressure by bandaging, may sometimes be demanded and be followed by a happy result, where the deformity

differ from the former only in their developement between the pericranium and the skull bones, and in being more readily absorbed. The two are alike in respect of their mechanical origin, the separation of the pericranium from the subjacent bones, and the consequent laceration of the vessels. Is it not probable that the poverty in fibrin of the blood in new-and swelling are great, and no process of absorption born infants may be a predisposing cause? The observation of a sanguineous tumour of the head in an insane patient who suffered also from a like tumour of the ear, has convinced Dr. Fischer of the close similarity of the two lesions.

Tumours of the ear are more common on the left than on the right side; in paralytic dementia the pupil of the eye on the same side as the diseased ear is more frequently larger than the other; but no relation is discoverable between the cerebral hemisphere involved by disease and the side on which the swollen ear is found. The organ of hearing is itself always normal.

goes on. Cold applications ought not to be omitted.
Leeches and astringent lotions are of little avail, and
irritating substances and issues are prejudicial. Strong
compression does harm, and very few patients will
bear with it. Medicines to improve the general
health, good nutritive diet, and pure air are of the
first importance.

Two leading questions of practical moment attaching to the condition of the external ear above considered, are: 1, As to its restriction to the insane, and 2, as to its causes. Both indeed have been treated of by Dr. Fischer, but a few additional notes may not be deemed superfluous.

The state of the external ear (pinna) described entails no further misfortune to the patient. Except the swelling and thickening be very great, the sense of hearing is unaffected; but even when those are very considerable only a slight hardness of hearing is in-persons not mentally disordered, and two instances of duced.

At p. 48 of the Asylum Journal it is quoted, as an observation of Rupp, that the swollen ear occurs in

this fact are noted as having occurred in the practice of M. Langenbeck, the eminent surgeon. We are able to add another example recorded by Dr. Wilde, of Dublin, in his Practical Observations on Diseases of the Ear, (Medical Times, vol. xxv. 1852, p. 437,) under the heading "Tumour of the Auricle."

Neumann remarked, in his Clinical Aphorisms, that the swollen ear was always associated with a decrease of mania, not indeed, so far as he had ever observed, preparatory to a restoration of the understanding, but to a transition to dementia. Flemming says, that the socalled erysipelas of the external ear is no certain basis “J. E., æt. 24, male, printer. A tumour the size of for the prognosis of mental aberration. In two cases, a small pear occupies the upper portion of the left after the appearance of the swelling, he saw death auricle, between the helix and concha. It is immoveensue; in one the patient suffered from dropsy, in the able, has a tense elastic feel, like that of a hydrocele, other an effusion was found between the cerebral and the skin covering it is smooth and of a dusky red membranes and a plastic exudation in the abdomen. In color. It is of three months' duration, and has been two instances he witnessed complete recovery; in one several times lanced, and a quantity of glairy matter the ear was much deformed, in the other only slightly discharged. As the wound healed, the fluid reaccuthickened, after convalescence. In Siegburg, as Ja-mulated. Hearing unimpaired. The whole auricle is cobi informed Dr. Fischer, cases of complete recovery very hot, and the pain is not great. Free incision have occurred. In Illenau, there were two cases per- made; a glairy, tenacious, yellow fluid mixed with fectly recovered, and three others had much improved. portions of flocculent matter escaped. Sac smooth Treatment. Bird advises antiphlogistic measures, and polished. Dressed with lint, and the fluid did such as leeches behind the ears, warm fomentations to not accumulate again, but the auricle presented a promote the bleeding, and other means to lessen the hard, thickened, nodulated feel and appearance, which blood in the head. Flemming recommends poultices remained for months, and completely effaced the natuand cold water or lead lotions applied freely, and he ral curvature and sinuosities of that portion of the believes incision of the tumour mischievous, because it external ear." No other instance is referred to by sometimes so much increases the inflammation that it Mr. Wilde, who adds, " This is a rare form of disease attacks the cartilage, and renders it necessary to re-in man." This remark and the absence of any allusion move portions. Wallis treated a case at Sonnenstein to the not uncommon occurrence of 'swollen ear' by laying open the swelling, but the result was so among the insane, imply the non-acquaintance of this unfavourable that he gave up the practice, and con-eminent aurist with the latter circumstance. The obtented himself with using poultices mixed with liquor servation recorded is however very valuable in proving plumbi. Rupp first uses cold applications, and after- these tumours of the auricle to be not peculiar to the wards punctures the swelling, slits it up, or introduces insane. No note unfortunately is made as to the a seton through the integuments, avoiding the car- cause of the tumour in the case mentioned, and none tilage. as to the physical condition of the patient; but the The nature of the disease, says Dr. Fischer, at first tenor of the remarks appears conclusive with respect demands antiphlogistic means. The local treatment to the mental integrity of the man. The omissions with cold water, snow, or ice, or with solutions of sal named we could wish supplied by Mr. Wilde, from ammoniac, or of lead and similar substances, is, during whom we should also like to learn if his more extended the existence of active inflammation, most to be re-experience has brought other cases to his knowledge? commended. In this stage an attempt may otherwise A remark made by that surgeon must not be omit

ted, viz. that he has "frequently seen it (tumour of the auricle) in dogs, where it forms a hard lump attached to the end of the long flexible auricle." This observation is highly interesting, but to prove the identity of such tumours with those of the ears of the insane, anatomical and other enquiries are necessary. The long ears of dogs certainly present us with conditions favourable to the production of sanguineous tumours, in their tissue, in their remoteness from the centre of circulation, and in their liability to injuries.

But apart from any evidence deducible from comparative pathology, we think there is sufficient proof that the morbid state of the ear in question is not peculiar to the insane. Why it should be especially prevalent among them, we must seek in its predisposing causes.

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The reading of Dr. Fischer's essay will, we believe, tend to the conviction that a peculiar dyscrasia' is a necessary element in its production; that such is indeed the determining cause, and that external injury, of some kind and degree, is an accessory and immediately existing cause.

The experience of all asylum superintendents proves the association between these tumours of the auricle and a depraved or impaired nervous and circulating force. The victims of general paralysis are particularly prone to suffer from this state of the ear; and next in proclivity are the debilitated demented; but the lesion is also seen among more recent cases without paralysis. We have seen it, at St. Luke's Hospital, in a man suffering from mania with restlessness and terror, passing into stupor; and quite lately, in a female maniacal and constantly restless; and both these cases attended by great debility and wasting, and by extreme nervous exhaustion.

It may be argued that prostration, an impairment of the nervous, of the circulatory, and of the nutritive organs, may be equally a consequence of other disease besides insanity, and does not account for the greater frequency of the local lesion of the ear in that malady. But perhaps in no other disease do we have the same accessory or concomitant conditions, the same nervous erethism and exhaustion, the same gradual and progressive operation of a general pathological process, the same abnormal vascularity of the head, the same proneness to injuries of the external ear, and lastly, the same lesion of the blood as that which the analyses adduced by Dr. Fischer seem to indicate.

Our experience warrants the inference that some external force or injury must necessarily precede the effusion which causes the tumour. The subjects of this lesion of the ear are prone to receive injury either from their helplessness or restlessness, and even lying upon the ear, rubbing or scratching it, may at once determine the effusion. It is an important statement of Dr. Fischer, that the disintegration of the ear-cartilages, the separation of the perichondrium, and the formation of the cavity, precede its occupation by liquids, and that such may be detected by handling

the auricle.

In the developement of the lesion we may assume, that the blood is retarded and at length arrested in the capillaries of the perichondrium. This event is favoured in the debilitated patient by the remoteness of

the vessels in the ear, by their mode of distributionapproaching the cartilage and then turning back on themselves, and by their exposure to external agencies, cold and the like, in the thin expanse of the auricle. As the next step, the consequence indeed of the stagnation of the capillary circulation, is the arrest of nutrition, and hence the softening of the cartilage and the separation of the perichondrium; and now it is, as Dr. Fischer has observed, that effusion of blood and of serum from the gorged, dilated, and attenuated vessels so readily takes place.

Attention to the structure of the external ear will at once explain the nature of the tumour and its peculiarity to it, and we need not Dr. Fischer's hypothesis of the dyscrasia localizing or centreing itself in the diseased auricle.

Nowhere else do we meet with tissues of the same character and in the same relation, wiz. a non-vascular cartilaginous plate covered by its perichondrium, supporting-just like the periosterum of bones—its nutritive vessels, and the whole enveloped by the common integument. Dr. Fischer, as before noted, indicates an analogy between the sanguineous tumour of the head of newly-born infants (the caput succedaneum) and the tumour of the auricle; and in the structural relations of the tissues in the two, an analogy is moreover visible, the pericranium covering the cranial bones corresponding to the perichondrium overlying the cartilage of the auricle. Again, we are of opinion that an analogy subsists between the sanguineous effusion into the tissues of the external car, and that occasionally seen in the same class of debilitated patients, beneath the thick horny integument of the heel of the foot. This latter condition appears to occur spontaneously, and is due to similar pathological conditions as sanguineous effusions of the ear, We have remoteness from the centre of circulation, exposure to cold, to pressure, and to other external agencies, and a large number of tortuous vessels, turning back upon themselves,, and rendered still more liable to congestion owing to gravitation opposing the return of their blood.

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Dr. Fischer adverted to the opinion of some writers, that external violence would of itself produce sanguineous tumours of the external ear. To this notion few will assent. Dr. Bucknill informs us, that having pointed out the lesion to an experienced member of the ring,' he enquired of him whether he had ever witnessed the like, but was informed by that individual that though he had seen men most severely knocked about over the ears, such tumours were unknown to him.

Much has been said about this lesion of the ear as a prognostic. Its developement is certainly of no good omen. Sir A. Morison tells us he has never, in his long and large experience, seen a patient recover in whom this condition of the ear has exhibited itself. In Dr. Fischer's paper, however, it is stated that at several asylums instances of mental recovery have occurred in patients with this lesion. Indeed, as sanguineous tumour of the external ear is not confined to insane patients, its existence cannot of itself be adopted as a prognostic in cases of insanity.

J. T. A.

To the Editor of the Asylum Journal.

York Lunatic Hospital, July 12, 1854. Dear Sir,-Allow me to acknowledge, with thanks, No. 6 of the Asylum Journal, which I duly received on the 9th instant.

evils which have arisen from an injudicious or empirical exhibition of mercury, which has, not unfrequently, not only aggravated an already existing malady, but sown the seeds of a future and yet more intractable disease.

not rank, in the hands of a skilful practitioner, as one of the most valuable weapons he possesses, in the treatment and controul of disease? Should we hesitate to administer a few grains of grey powder to a child, because of the terrible abuse of calomel or blue pill by the reckless practitioner, or the impudent charlatan?

Nevertheless, is mercury, even in its more active As a co-operator with yourself in that most im- combinations, much less in its mildest preparations, portant and interesting branch of science, the manage-discarded from our pharmacopoeia; but rather, does it ment and treatment of the insane, may I not venture to trespass for a few moments on your valuable time, in offering a few remarks, suggested by a perusal of your opening article, on the system of non-restraint. In doing so, I need hardly observe that, although personally acquainted with Mr. Hill, I am not aware that he has even seen your article, having had no communication with him for some months. I state this with a view of shewing that I am actuated by ro personal feeling whatever, but am simply desirous of stating my views upon a subject confessedly of vast practical importance, affecting, as it does, the immediate well-being of those entrusted to our care.

Perhaps it will be better to follow out those views as suggested by your observations, seriatim. By way of preface, however I must be permitted to say, that (as the accompanying Report will, I think, abundantly testify) in an unqualified abhorrence of barbarities into which restraint had degenerated some thirty or forty years ago, I will yield to none. Common humanity shrinks from such enormities; but it appears most unreasonable to charge upon the principle itself the abuse into which it may degenerate in the hands of the injudicious, the unskilful, or the inhumane.

Where then a patient threatens his own life,* or the lives of those around him; or is generally destructive to everything within reach; or is given up to the most foul and loathsome habits, sinking below the level of the brute creation; are we to peril the life and limbs of others? are we to incarcerate in solitude? are we, in fine, to shrink from painless restraint, in every possible case, absolutely and for ever, because of the chains, the manacles, and the shrieks of a by-past age?

Which is the lesser of two evils? Which is the truer humanity? On the one hand, to endanger or peril the safety of others, to permit self-inflicted wounds, to confine in gloomy solitude; on the other, to associate, by means of (I repeat) a painless restraint, the otherwise dangerous maniac with the cheerful and inoffensive of his companions.

Regarding humanity, in its strictest sense, as the very guiding principle in the treatment (alike medical and moral) of the insane, I do not hesitate to affirm that there are cases, in which, to withhold painless restraint, would be as flagrant an act of inhumaniiy as it would be an act of barbarism to use it in any single case, where all other resources had not previously failed; and thereby, its application been imperatively demanded.

May I be allowed to say a word with respect to your definition of the term "spencer." Having used the same word myself, I think it only right to state that, so far as regards the spencer occasionally used in this institution, your definition would, if received, convey an impression absolutely erroneous and incorrect.

In your remarks "We had flattered ourselves that the day had been gained, the victory secured, and that practices which had rendered the name of madhouse an abomination, and even the mad doctor odious, had been finally discarded from all the public asylums of this country," I presume you refer to the preceding paragraph, where reference is made to the "rattling of chains" and the "shrieks of patients;" for that such were the abominations of restraint in days gone bye is true; and it is most true, that such abominations have (at least, in the public institutions of this country) long since passed away. For it would be manifestly absurd to regard the mildest forms of restraint sanctioned, in rarely exceptional cases, by some of the most practical and distinguished men in this country, as constituting a mad-house an "abomination," and the physician an abhorrence. And yet, from the context, where in the subsequent paragraph you open with the words, "It was therefore with much disap-mer does no such thing; the latter oppresses the pointment and sorrow," etc., it might be supposed, chest, the former permits of its perfect freedom, and either that there is no appreciable distinction betwixt yet prevents, without pain, destruction of property and a principle in its legitimate and simplest application, clothing, injuries to others, as well as self-inflicted. and the most cruel and criminal abuse into which that It supersedes the evils and wretchedness of an indeprinciple may sink; or else that, as in the chains, the finite solitude; it obviates that worst † form of remanacles, and the shrieks of old, some terrible bar-straint, human coercion, but it does not deny the barism were suspected still to exist. blessings which social intercourse may perchance ef

Assuredly, if we consult science, we shall find that the greatest boons to mankind, have not unfrequently been converted into the greatest curses, through their abuse in the hands either of the unskilful or the malicious. In therapeutics, for example, the truth of this will at once be evident, if we regard the terrible

The spencer we use is one thing, the strait-waistcoat is another: the former we have, the latter we do not possess, and have not possessed for years; the latter secures the arms and hands across the chest, the for

* I need not observe that this applies to very rare cases; as,

e. g., where the patient will tear open vital wounds, etc.

Worst, in truth; for but lately I read a case in a Report, where fatal injuries were received by the poor struggling maniac, in an encounter with two attendants who were removing him to a padded room.

fect even in the most aggravated, if not the most hopeless cases.

With regard to your remarks respecting the "probability of the Commissioners having neglected to denounce with vigour any recurrence to the evils of the past," I would beg to observe that, to denounce with vigour, would necessarily imply a strong repugnance to the evil denounced. Assuming that the minds of the Commissioners are imbued with this repugnance to every form of restraint, then, the insinuation that they had neglected to pronounce a vigorous denunciation merely because they had been "charmed by the lower but more conspicuous attributes of an asylum," would be rather a reflection than otherwise on their penetration or their candour. That they had, in short, overlooked the greater evil, attracted by the lesser good; or, detecting the one, had failed to denounce it, carried away by the admiration of the other.

Nor, on the other hand, were it so, that the Commissioners themselves did entertain the non-justifiability of restraint in any form and in any possible case, can it be allowed that they would seek to reconcile such convictions with a total omission of any expression of disapproval.

In short, in every rule exceptions must ever occur, and from such exceptions, howsoever rare they be, the system of non-restraint itself cannot claim for itself any special exemption.

I remain, dear Sir, very respectfully yours,
Medical Superintendent.

To the Editor of the Asylum Journal.

Belfast District Asylum, July 31, 1854. Dear Sir,-Permit me through your pages to express to the Members of the Association of Medical Officers of Asylums and Hospitals for the Insane my regret I humbly submit that neither position is applicable that I was unable to attend their Annual Meeting on to the Commissioners. For, about the same period, the 28th ultimo. The most imperative duties alone we also received a visit from the Commissioners. I prevented my doing so, and participating in the useful drew their especial attention to two particular cases, and important business of that meeting.

where mild restraint had been applied, as a 'dernier resort,' upon which an interesting discussion followed. Now, although no vigorous denunciatory clause, or even the slightest expression of disapprobation, is to be found in their report, I most certainly cannot regard the favourable paragraph with which it closes as constituting, in the slightest degree, a “culminating pile of praises," to the all-absorbing influence of which the omitted denunciation is to be ascribed.

Notices to Correspondents. We regret that press of matter compels us to delay the remainder of Dr. Baillarger's excellent Lecture, Dr. Tuke's Review of the Meerenburg Report, with other reviews of interesting works.

Mr. A. L. We are not aware of the best mode of keeping floors clean and bright by dry rubbing. If the floors are of oak the matter is easy. If they are of pine or fir we know that the task is a difficult one. We should feel obliged to any of our readers who would give us information on this subject. The floors in the Lancaster and Stafford Asylums are of wood and are dry rubbed.

I am, my dear Sir, yours faithfully,

ROBERT STEWART, M.D., Secretary to the Irish Branch of the Association.


MR. DENNE, Medical Superintendent of the female side, Hanwell Asylum, to be Medical Superintendent of the Bedfordshire County Lunatic Asylum. MRS. DENNE to be Matron of the same.



Who can immediately enter upon the duties of

this Establishment. He will be expected to devote the whole of his time and energies to the duties of his office, and be precluded from private practice. Preference will be given to a Gentleman who has had GENTLEMAN, who has had an extensive expe- is £350 a Year, together with Furnished Apartments, experience in a Public Lunatic Asylum. The Salary rience of several years duration both in Public Coals, Candles, Washing, and Vegetables from the and Private Asylums, and who can produce high testi-Garden. He will have to Board himself, and find his monials and give unexceptionable references, is desirous of obtaining a Medical Appointment in a Private Asy-married or single, and what family (if any). Testiown Linen. Candidates to state their age, whether lum. Apply to Medicus, 76 Strand, London.


N. B. The above is enabled to recommend two or three excellent Female Attendants to any persons requiring their services.

Solicitor, Worcester, before the 26th instant. The monials (sealed up) to be sent to Mr. Martin Curtler, Election will take place on Monday, the 4th September. MARTIN CURTLER, Clerk to the Committee of Visitors. no application shall be

Worcester, Aug. 14, 1854.

ARAH ELIZABETH GRICE, having lived for the last four years in an Asylum as Ward Atten-N.B.-It is particularly requested that or their clerk, by or on dant, is desirous of obtaining a similar situation. She behalf of any Candidate. If any such is made, it will be held can have a four years good character. Apply to S. a disqualification. E. Grice, at Mr. Fountain's, New Town, Bedford.

Just published, price Five Shillings,




AND PERCUSSION. From the German of WE
BER. By JOHN COCKLE, A.M., M.D., Physician to the
City Dispensary. 20 Illustrations, 5s.

London: S. Highley, 32 Fleet Street.

All communications for the forthcoming Number should be addressed to the Editor, DR. BUCKNILL,

Devon County Lunatic Asylum, near Exeter, before the 20th day of September next.

Published by SAMUEL HIGHLEY, of 32, Fleet Street, in the Parish of Saint Dunstan-in-the-West, in the City of London, at No. 32, Fleet Street aforesaid; and Printed by WILLIAM AND HENRY POLLARD, of No. 86, North Street, in the Parish of Saint Kerrian, in the City of Exeter. Tuesday, August 15, 1854.

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Eighth Report of the Commissioners in Lunacy. The Eighth Report of the Commissioners in Lunacy to the Lord Chancellor has just been issued, and a more enlightened or satisfactory document has rarely come from the State Paper Office. It not only indicates like all preceding Reports, the amount of work done by the Commission in behalf of the helpless and afflicted class, over whose interests it presides, but in several important respects it also marks a considerable advancement of opinion.

and erect new ones on eligible sites; a course which has already been taken at Manchester and Stafford, and is about to be adopted at Nottingham." There cannot be a doubt respecting the wisdom of this vigorous advice.

The abuses still existing in many private asylums are remarked upon, and the efforts made by the Commissioners to effect their reform are told: efforts, we are sorry to observe, not uniformly seconded by the authorities to whom is confided the control of private asylums out of the Metropolitan district. At Dunston The Commissioners report "with satisfaction" the Lodge the Lord Chancellor prohibited the renewal of dissolution of the union between the county and the the license to the proprietor, because he had horsevoluntary subscribers to the Nottingham Asylum, with whipped a patient while in a straight-jacket, and had the intention of removing the private patients to a sanctioned the extraction of his two front teeth: cruelseparate establishment. The same dissolution of part-ties inflicted because the patient had bitten his arm. nership has taken place at the Stafford Asylum; the The Commissioners report unfavourably of lunatic private patients going to the Coton Hill establishment. The expression by the Commissioners of a "cordial approval" of these proceedings, indicates an unfavourable opinion on their part of the system of mixing classes in asylums.

hospitals founded by charitable persons for the reception of needy patients of the middle and upper classes. They regret that their endeavours to improve the condition of these institutions have been opposed by great difficulties arising from defective construction of the The condition of several hospitals and asylums buildings and errors in the management. They replaced within the precincts of towns is severely com- conmend that the buildings, where radically bad, mented on. The asylum at Haverfordwest, St. Peter's should be abandoned, and new ones erected in eligible Hospital at Bristol, the Hull Borough Asylum, the sites. Bethel at Norwich, St. Luke's and others, share these animadversions.

They state, "So formidable are the difficulties in the way of advancement in old and badly situated hospitals, that in those instances where improvements have been attempted, large sums of money have sometimes been spent without adequate results. In such cases the only effectual mode of overcoming all obstacles to improvement appears to be to abandon the old buildings

On the subject of management they recommend to the governors of hospitals as "the most enlightened system," the appointment of medical Superintendents with "paramount authority." They observe, “Our experience confirms the opinion which we have already expressed in former Reports, that in order to ensure good management, it is essentially requisite, that the resident medical officer should, as Superintendent, be invested with paramount authority. All officers and

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