of the patients when admitted, is by no means an unfavourable result."

Nothing can be more just than the following remarks on the importance of early and prompt treatment :—

"In cases of recent occurrence, however, the importance of early removal cannot be too strongly urged. All experience and all authority assert that when once insanity is manifested, the very foundation of curative treatment consists in removing the patient from the external influences which have occasioned or are likely to protract the disorder, in overcoming resistance to remedial agents, and in adopting an appropriate regimen and diet. These conditions of treatment, so far at least as the indigent classes are concerned, can only be complied with by removal to an asylum; and any delay in effecting this, whether from false economical motives on the part of parish authorities, or from repugnance of friends to the separation, is fraught with injury to the patient and ultimate expense to the ratepayers. A week's procrastination may protract the treatment to months; a month's delay may allow a favourable crisis to pass by unimproved, and determine the chronic stage of the disease."

When alluding to the previous occupations of the patients admitted, as well as the hereditary character of the insanity, it is observed

"As would be expected in a county whose population is essentially agricultural, the admissions have included a large number of farmlabourers, their wives and families. From the healthful and unexciting nature of its employment, it might be supposed that such a population should enjoy a larger immunity from insanity than that of manufacturing counties, but such does not appear to be always the case. The proportion of insane paupers to the population of Lancashire is as 1 in 1083, in the West Riding of Yorkshire as 1 to 1176, and in Staffordshire as 1 to 1079; while in Lincolnshire it is as 1 to 806-a proportion which, it is believed, is largely attributable to hereditary predisposition. In many of the cases received from the towns the mental disorder has been distinctly traceable to habits of intemperance and dissipation; but in those coming from the rural districts of the county such causes have been comparatively rare, and a congenital want of mental power to resist ordinary excitants and depressants has appeared pretty generally to have been the fons et origo mali."

A high authority has declared that the necessary in the treatment of the insane. have become of Dr. Palmer's patient if he the stomach by means of this instrument?

stomach-pump is never What would, we ask, had not forced food into

"A few instances of refusal of food have occurred, but, with the exception of one female patient, yielded to change of diet and medical treatment. The patient alluded to fell, soon after her admission, into a cataleptic state, during which no inducement whatever succeeded in getting her to swallow anything. If her mouth was opened, and food put into it, she would remain with the food resting on her tongue

until somebody removed it. After several days' abstinence her strength began to fail, and the odour of her breath indicated that feeding could be no longer delayed with safety. The stomach-pump was employed three times a-day, without her offering the least resistance, for six weeks, when her health became much improved, and she began to eat again of her own accord. She subsequently mended very rapidly, and has since been discharged quite recovered.'

There appear to have been four inquests at the asylum; one patient died during a fit of epilepsy; the second died suddenly from ulceration and perforation in the upper portion of the intestinal canal; the third was a case of suicide from hanging; and the fourth case was "also a male patient, who died in consequence of his ribs having been severely injured during a paroxysm of maniacal violence, and while two of the attendants were conveying him down a flight of stairs for the purpose of placing him in a padded-room. The verdict returned by the jury was 'homicide by misadventure.' The whole of the circumstances attending the case were subsequently investigated at a special meeting of the visitors, who were of opinion that the verdict of the inquest was entirely supported by the facts."

We do not affirm this accident could have been averted if the strait-waistcoat had been at once applied; but of this we feel strongly convinced, that it is much more humane to apply such restraint for a short period than for four or five powerful men to struggle with a patient in "a paroxysm of maniacal violence." Severe and serious injuries may and do often occur from these absurd contests with the insane.

Dr. Palmer's report does him great credit. We congratulate the committee on having so active and intelligent an officer at the head of the Lincolnshire Asylum.

According to the "Eighth Annual Report of the Medical Superintendent of the Devon County Lunatic Asylum, for 1850," there were admitted

were women.

"During the past year, 96 patients, of whom 49 were men and 47 The largest number resident at one time was 472; the number under treatment has been 555; and the average number resident has been 460.

"The number of patients at the commencement of the year was 459; and the number resident at this date is 445, of whom 195 are men and 250 are women.

"Sixty-two patients have been discharged, of whom 26 were men and 36 women; of these 55 were discharged recovered-6 were discharged relieved-and 1 unimproved.

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Forty-seven patients have died, of whom 25 were men and 22 were

women.

"The mortality which last year was 6.6 per cent. of the average

number resident, has this year been 10 per cent. of that number, and 8.4 per cent. of the number under treatment.

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Many of the patients whose deaths have this year swelled the obituary, were admitted in a dying state. No. 1072, a melancholic, was unable to retain any food after admission, and died in twenty-six days, from disorganization of the stomach. The appearance of this organ suggested the probability that the unhappy man had taken some deleterious substance before admission, with a suicidal intent.

"No. 1099 was admitted in a state of extreme exhaustion, from general paralysis, with mania, and sank twenty-two days afterwards from decay of the powers of nature. No. 1151, who died in six days after admission, was a similar case. No. 1100, a miner, was admitted with both lungs in a state of disorganization from that form of consumption, known as coal miners' lung; he survived about four months. No. 1110 survived nearly as long; he had sustained two attacks of apoplexy, and was suffering, on admission, from double hemiplegia, which paralysed both sides of the body, and left him in the most perfect state of wreck-mental and bodily. No. 1163, who had been insane three years, (but had only recently become chargeable), was admitted in a dying state, with one lung and part of the other in a state of decomposition, from pneumonia; he survived sixteen days. No. 1168, admitted with inflammation of the intestinal canal, survived six days. With the exception of the last, who was 68 years old, the above patients were of middle age.

When speaking of medical and moral treatment of the cases confided to his care, Dr. Bucknill observes,―

"During the past year no efforts have been neglected which were requisite to maintain the medical treatment of the patients in proximity with the ever-advancing steps of medical science. Among the novelties of treatment it may be mentioned that epilepsy has been relieved in the most satisfactory manner by tracheotomy; that dementia has been relieved by phosphuretted oil; that chorea with mania, threatening a fatal termination, has been cured by the internal administration of chloroform; and that extreme excitement, in which other remedies had failed, has been removed by frequent small inhalations of the same remedy. Of these results some have already been communicated in detail to the profession, and others will be so through more appropriate channels than this general report.

"The same system of moral treatment mentioned in former reports has been continued with satisfactory results in the recovery of those patients whose malady was capable of cure; and in the reform of bad habits, the amelioration of symptoms, the increased quietude, comfort, and happiness of those whose malady is irremovable, and for whom the asylum must be considered a permanent home.

"During nine months of the year (and in all the wards except those occupied by the idiots) the evening reading classes are kept up with benefit and punctuality four evenings in every week. Of the other three, one is devoted to the duties of Saturday night, and the other two to recreation.

"During the three summer months the evening reading classes are discontinued, as the patients remain in the pleasure grounds until bedtime.

"The useful and profitable employment of the patients has been carried as far as appeared to be consistent with their sanitary condition."

Appended to the report are several valuable tables, and a highly eulogistic report from the Commissioners in Lunacy, who speak in glowing terms of the condition of the asylum. With deference to the medical officers of county asylums, we question the good taste of publishing these reports of the official visits of the Commissioners; they are not written for publication, and we think should not be ostentatiously paraded in the annual records of the asylum. However, Dr. Bucknill errs, if error it can be called, in good company, and is only adopting the course generally pursued by all the medical superintendents of public asylums.

The "Sixteenth Annual Report of the Suffolk Lunatic Asylum" embodies many interesting particulars. But first, as regards the statistics of the asylum, it appears from Dr. Kirkman's statement that

"At the close of the last year there were 255 patients in the house; there have been admitted in this year 93; 42 have been discharged cured; 9 have been removed or returned to their friends very much relieved, and 36 have died. The numbers of male and female patients have been nearly equal in the admissions, discharges, and deaths.

"These numbers show but little variation in any respect from those of the late previous years. The mortality, which was unusually low last year, has been increased by nine this year; an event most fully anticipated, and noted in the report for 1852, from the different stages of great bodily exhaustion, in which many of the aged inmates were received."

The subjoined facts speak volumes in favour of this institution :"If the general expressions of contentment amongst the patients are any proof of this healthy feature, we have as conspicuous indices to judge by as any to which we could point at any time. A man after an absence of several years was lately re-admitted; he was a tailor, and directly he entered the house he went up to take possession of his former place of occupancy, and he asked for some work with the expression of satisfaction, Well, I'm glad to get home again.' It is this home character that we would endeavour to secure; and lest the paramount importance of this domesticity should ever be lost sight of, it may be well to record it as being the chief object of at

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tainment for successful treatment of the insane. They are almost universally ready to recognise it themselves, and it is a feeling which is very seldom disturbed or broken by the patients in this house.

"The truth of the above was shown in no small degree only a few weeks back, by two out-county patients who left us for Essex. They were both old residents; one having been here twenty-one years, the other twenty-five years. They were much distressed at leaving, the longest resident the most so. She had always looked upon this house as her permanent home, and she would echo the desire of another old patient, most singularly but expressively conveyed, that she should have the privilege of being buried in the asylum ground.' This attached faithful creature had been for all these years a most valuable assistant in the wash-house and laundry, she was always regularly and willingly employed. Three days in the week in each of these places she worked for twenty-five years, taking little notice of others, unless something very provoking excited her displeasure. When she was prevented from going into the laundry on the morning of her expected removal, and when the reason of it was explained to her by signs (for she was very deaf), she looked very sorrowful, and said, she would not take any clothes with her, but leave them till she should come back again,' she positively refused to believe that she was going entirely away. It was a 'sorry sight' to witness the removal of this grateful and attached patient: as the carriage came up to the gate she turned very pale, and the tears dropped into her lap, as she took leave of one after another, fondling over them and kissing them. Her industry had procured her some trifling articles of fancy dress, and which always delighted her, but she could not be persuaded to take any of them with her. We have always encouraged this feeling of possession in trifling changes of dress, and we look on it as one of no small importance to gratify."

We have only room for the following account of a remarkable case of attempt at suicide. We would premise that this patient had on several previous occasions endeavoured to accomplish self-destruction. Immediately before admission he had tried to strangle and drown himself:

"On the afternoon of the 15th the house surgeon was suddenly called to him by his attendant, and he found him suffering from symptoms evidently arising from the existence of some foreign body in the throat, nothing either solid or fluid could be swallowed, there was a choking sensation with sudden spasmodic cough. A probang with an ivory top was introduced into the oesophagus, which rested half-way between the lower part of the pharynx and the cardiac orifice of the stomach upon something hard. By careful manipulation this substance was pushed down into the stomach, and now several hard bodies conveying the sensation of stones could be distinctly felt with the probang. Upon questioning the man he acknowledged that he had swallowed 200 common gravel stones, with the hope that they would kill him, at the same time he expressed great thankfulness for