INDEX. Accumulation of Chronic Lunatics in Asylums 192 CONOLLY, DR. Note on Non-Restraint 7 ACT OF PARLIAMENT (Lunatic Asylums) condensed 17 Justice Coleridge upon AMERICA. Meeting of Association of Medical Second Notice Fourth Notice APPOINTMENTS. 32, 48, 96, 112, 128, 144, 176, 222 Coton Hill Asylum 26 Notice of the Eighth Report of the Com- 134 Asylum for Northumberland and Cumberland BEALE, DR. On the Miscroscope (Review) 93 Ear, Sanguineous Tumour of, by Dr. Arlidge 96 Epilepsy and Allied Affections, by Dr. Radcliffe (Review). 55 Bedfordshire County Asylum, Appointment of Epileptic Patient Injured by Burn HYPOCHONDRIASIS diagnosed from Melancholia. 213 PARSEY, Dr., м.s., Warwick. On Statistics of Kent Asylum, History and Description of . On Fractured Ribs Librarian of College of Surgeons asks for Asylum LIFE IN LUNATIC ASYLUMS Lincolnshire, Description of County Asylums for 73 32 Lycanthropy, or Wolf Madness; Dr. Parker upon MANLEY, Dr., M.S., Hants. On Prolonged Fasting Magistrates of Norfolk, Dr. Foote's Letter Matron, Dismissal of, from Worcester County Asylum 52 150 с 127 PROSPECTUS. page 1 On the Head Dress of Pauper Lunatic Men, by the EDITOR. Circular of the COMMISSIONERS IN LUNACY suggesting page 11 Precautions against Cholera 14 7 On the Condition of the Grey Substance of the Brain 'after excessive Mental Exertion, by PROFESSOR ALBERS, of Bonn 14 7 On the Treatment of Incipient Mental Disease, from the Lectures of GEORGE JOHNSON, M.D., Assistant Physician to King's College Hospital Opinion in Germany respecting Non-Restraint 10 Chloroform in Child-birth preventing Puerperal Mania 15 16 16 unless by some calamitous reverse the progress of the world in civilization should be arrested FROM the time when Pinel obtained the and turned back in the direction of practical permission of Couthon to try the humane barbarism. Since the public in all civilized experiment of releasing from fetters some of countries have recognized the fact, that inthe insane citizens chained to the dungeon sanity lies strictly within the domain of mewalls of the Bicêtre, to the date when Conolly dical science, new responsiblities and new announced, that in the vast Asylum over duties have devolved upon those who have which he presided, mechanical restraint in devoted themsevles to its investigation and the treatment of the insane had been entirely treatment. Many circumstances have tended, abandoned, and superseded by moral influence, not indeed to isolate cerebro-mental disease a new school of special medicine has been gradually forming. from the mainland of general pathology, but to render prominent its characteristics and to stamp it as a specialty. That period which is marked in the annals of France as the Reign of Terror, saw the When The Citizen of the World exclaimed, star of hope arise over the living sepulchre of "Is the animal machine less complicated than the lunatic. Pinel vindicated the rights of a brass pin? Not less than ten different science against the usurpations of superstition hands are required to make a pin, and shall and brutality; and rescued the victims of the body be set right by one single operator ?" cerebro-mental disease from the exorcist and he forgot that "the physician who pretends to the gaoler. But the victory was not gained cure disorders in the lump," does not pretend in one battle; the struggle was carried on to make the animal machine, but only to set it with undulating success, until in this country to rights when it may be somewhat out of rethe good work was definitely consummated pair. The division, however, of medical science by the labors of Conolly. into the numerous specialties at present existing, may in some respect be expedient, but in others cannot fail to be disadvantageous. The The Physician is now the responsible guardian of the lunatic, and must ever remain so, exclusive study of a specialty may enable the practitioner to become more adroit, but will at the same time almost compel him to become less profound. Exclusive devotion to one disease or set of diseases, may produce marvellous accuracy of diagnosis, but will infallibly retard the study of general pathology and therapeutics. Under an impartial estimate, reasonable doubts may therefore be entertained to which side the balance of good or evil results will incline. Another potent reason for the constitution of cerebro-mental diseases into a strict specialty, exists in the demand they make for separate and peculiar institutions for their treatment. A general hospital will admit cases of all other forms of disease to which mankind are liable. Patients suffering from mental disease are obiviously inadmissible, and were it otherwise could not there be successfully treated. The distraction produced in the wards of a geBut the treatment of insanity has not alone neral hospital by one of the patients becoming become a distinct branch of medical science, insane under treatment, is greater than can in the same manner as other specialties have readily be imagined by those who have not done so; namely on account of the greater witnessed such occurrences. Distinct hospitals convenience and practical address attainable for the insane are not less a medical than a by division of labour. In parts of the country social necessity of the times. The State abthinly inhabited and unable to maintain any solutely forbids the detention and treatment other special division of medical practice, the of pauper lunatics out of asylums; therefore, specialty of lunacy treatment is strictly main- as insanity pauperizes all except the positively tained. Laws, therefore, affecting the treat- wealthy, the strong arm of the law accumument of insanity must be in operation more lates such patients in special institutions, and general and imperative than those which in interferes to mark the disease as a medical great cities divide the profession into coalesc-specialty. If the public has any right to ing sections. These laws appear to be twofold, expect from the physicians and surgeons atas they relate to the physician himself, and tached to the great general hospitals, such to the means needful for successfully treating efforts to promote the advancement of medical the malady. Concerning the first, the profound Feuchtersleiben makes the following judicious remarks. "Since in the so-called psychical mode of cure, one personality has to act upon another, and since in this case the vehicle, as it were, in which the medicine is exhibited is the person of the administering physician himself, this is the first point to be considered. His circumstances (i. e. those of the psychiatric physician) must be such as to allow him to devote himself more or less exclusively to this branch of medicine; that is, to give it the greater portion of his time, which is more necessary in this than in other branches, because the treatment in most instances demands a second education. He must be able by his personal demeanour to obtain influence over the minds of other men, which, though in fact an essential part of a physician's mode of cure, is a gift that nature often refuses to the most distinguished men, and yet without which mental diseases, however thoroughly understood, cannot be successfully treated." The necessity of such exclusive devotion to the study of insanity, of such a second education, would by itself of necessity constitute diseases of the mind into a strict specialty: and it would be difficult to instance any physician, who has ever become celebrated in the treatment of mental disease, or has written any work of standard authority thereon, who has not previously separated himself from the wide field of general medicine. science, as their advantageous position enables them to make; still more has it a right to expect such efforts from the medical officers of lunatic asylums; seeing that the diseases to be found in general hospitals are to be met with and studied elsewhere, whereas the diseases of the mind cannot to any extent or with any facility be studied, except in the public institutions devoted to their treatment. The medical officers of lunatic asylums have not only a right to speak with authority on the subjects of their vast and privileged experience, but the public have a right to expect that they shall so speak. They do the public, not less than themselves, injustice, if they stand by in silent disdain, whilst in medical societies and ephemeral books, crude theories of insanity, founded on the observation of a few isolated cases, are propounded with all the positiveness of inexperience. Their own especial interests, not less than those of humanity, would eventually suffer from such silence. If it has to any extent existed, the causes of it may not be very hard to discover. The medical officers of asylums are daily engaged in active and engrossing duties; their occupations of governing large establishments, and of bringing themselves beneficially "en rapport" with many diseased minds are greatly antagonistic to literary habits. Daily work like theirs, while quickening the perception and strengthening the judgment, can scarcely fail to take off the edge of the theorizing, or even |