"Fortieth Annual Report of the Glasgow Royal Lunatic Asylum for 1853," under the able management of Dr. Mackintosh, the resident physician, is of peculiar interest. In the preliminary portion of the report, Dr. Mackintosh refers to the remarkable increase of cases of lunacy in the west of Scotland, by which all the accommodation, good, bad, and indifferent, has been called into requisition. It appears that

"The number of patients admitted during the year was 319, being 53 more than last year. And the increase would have been greater had it not been found necessary to cease admitting patients for the reason already specified-viz., the want of room. So great appears to be the increase of lunacy in this part of the country, that though a very great number of patients have been taken to parochial receptacles whenever the parish was of sufficient population to admit of having a poor's house, the numbers in this asylum have always, more or less, tended to increase."

When attempting to account for this increase of cases of insanity, Dr. Mackintosh observes,

"The more immediate cause of the increase of lunacy is to be sought for rather in the social condition of the time in which we live. Ours is a time of great mental activity and excitement. Men's minds are constantly on the stretch. Nor is this state of things confined to the higher and more opulent classes of society. Among the great mass of the labouring population during the past year, there has been much commotion and excitement, manifesting itself particularly in the shape of 'strikes,' and the like. There has been, if not war, at least rumours of war. In the increase of population, and the excitement of the times, in the varied mental emotions to which passing events have given birth, and probably to the increase of intemperance, do we look for the more immediate cause of the increase of lunacy which has characterized the past and some of the preceding years."

According to the statistics of the asylum, it appears that

"The cases of mania exceed those of monomania, including melancholia; that the number of males exceeds that of females; and that the ratio of melancholia to mania is much higher in females than in males."

The number of married and unmarried patients were nearly equal. The married and widowed together considerably exceed the number of those unmarried. The ages of the patients

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Range between 20 and 90. There were none under 20 years of Between the ages of 30 and 50, or in the prime of life, it is found that there were by far the greatest number of patients."

age.

It appears that the cases of insanity from intemperance were in a ratio of 1 to 5 in the whole number of patients admitted. Hereditary predisposition appears to have been a fruitful cause of insanity. It is observed that

"It sometimes happens that two, three, or even four members of the

same family are confined in asylums at the same time; and there are some families who have at least one member constantly in confinement. From the unwillingness which the friends of patients manifest to reveal the circumstance of the previous existence of insanity in the family, whether in the direct line or in lateral branches, the above can only be considered as an approximate estimate of the numbers of those in whom the malady is hereditary."

Dr. Mackintosh says that

"In those admitted during the past year, we find that the physical causes very much exceed both the moral and mental ones combined, a result which does not coincide with the speculations of many eminent men on this subject, and which may, according to M. Guislain, arise from insufficiency and incorrectness of investigation, or the want of close personal intimacy with patients. As to the latter circumstance, it is to be remarked, that a very great number are either unable or unwilling to give correct information on the subject, and that the information which many communicate is found to be manifestly and totally at variance with the truth. As to the insufficiency of investigation which is supposed to be inevitable, in the inquiries of physicians connected with large public institutions, this may be true to a certain extent, as regards the minute psychological analysis, which is presumed to be necessary to the discovery of the moral causes, by which, in many cases, the disease has been produced."

This physician concludes, from the table recording the occupations of those who were admitted, that one occupation does not predispose more than another to insanity. He says, "The active or sedentary, the mental or physical nature of the occupation does not seem to exercise any particular influence in the production of mental disorder."

One hundred and sixteen patients were discharged as cured. Out of this number

"Thirty-eight males and 57 females were cases of mania; 3 males and 16 females were cases of monomania; and one male and one female were cases of dementia ;-in all 42 males and 74 females.

"Of the whole, 50 or about one-half were less than a month ill previous to admission, showing what all statistics prove, that recovery is most likely to occur if the patient is put early under treatment; that the probability of recovery becomes less and less according to the length of time during which the patient has been ill previous to admission till all reasonable hope disappears."

When speaking of the social treatment of the insane, Dr. Mackintosh makes some sensible remarks :—

"To many who are convalescent, the restraint of an asylum becomes irksome in the extreme; but when there is a farge number freely associating with one another, and meeting daily-in the library, billiard-room, or drawing-room, in the bowling-green, and in the grounds of the asylum-friendships are formed and feelings are excited of a wholesome and salutary kind; so much so, indeed, that not unfrequently, however strange it may appear, it happens that some

leave the asylum with feelings rather of regret than pleasure. And though such feelings are considerably modified by return to the active business of life, they delight to revisit and correspond with their less happy friends in affliction."

We regret that the pressure of other matter upon our space deprives us of the pleasure of quoting more at length from this excellent and interesting document. This asylum, we can report from personal examination, is in capital order, and reflects great credit upon the talented physician who presides over it. Dr. Skae's "Report of the Royal Edinburgh Asylum for 1853" is, like the preceding one, replete with valuable and interesting matter.

The subjoined table gives the general statistics of the year :

When speaking of the causes of insanity, Dr. Skae remarks :— "Of the males, two were caused by imprisonment; in the one, the disease was suddenly developed by the shock experienced at being imprisoned on a charge of theft, of which the lad continued to protest his entire innocence; and, in the other, the insanity seemed to have developed itself under the peculiarities of prison discipline acting upon a mind naturally weak. In another, the terrors incident to having been left alone in a house with the dead body of his master; and in another the anxiety, and fatigue, and grief of nursing a young gentleman who died, appear to have operated in the development of the malady. Two of the young men had been abroad; the one in America, the other in Australia; and in both the novelty, excitement, and mode of living, are supposed to have been the principal causes of the insanity. Of the females, three became insane as the sequence of early marriages, for the anxieties and responsibilities of which they were incapacitated, partly by natural deficiency, and partly from deficient education. Three were servants, brought up in the innocence and seclusion of pious homes in the remote north, and suddenly exposed to the worry, and exactions, and temptations attendant upon service in metropolitan houses."

We quote in extenso Dr. Skae's account of the post mortem examinations made in 61 cases :

"Of those examined, 3 had been cases of acute, 2 chronic, and 1 periodic mania, 23 dementia, 3 dementia with epilepsy, 1 mania with epilepsy, 1 melancholia, 1 moral insanity, 1 delirium tremens, 11 monomania, 12 general paralysis, 2 congenital imbecility.

"Calvarium was of unusual thickness in 32 cases: 1 of chronic mania, 1 of acute dementia, 13 of dementia, 1 of dementia with epilepsy, 5 of general paralysis, 8 of monomania, 1 of moral insanity, and 2 of congenital imbecility.

“Calvarium was thinner than usual in 13 cases: 3 of acute mania, 1 of chronic mania, 1 of melancholia, 3 of dementia, 2 of monomania, and 3 of general paralysis.

"Diploe was absent in 14 cases: 1 of acute mania, 1 of acute dementia, 6 of dementia, 3 of monomania, 1 of moral insanity, 1 of general paralysis, 1 of congenital imbecility.

"Elongation of anterior clinoid process on right side was observed in one case of mania with epilepsy.

"Etheromatous deposit in arteries of brain was found to a great extent in one case of general paralysis.

"Increased thickness of dura mater was found in 18 cases: 1 of acute mania, 1 of moral insanity, 4 of dementia, 2 of dementia with epilepsy, 3 of monomania, 6 of general paralysis, and 1 of congenital imbecility.

"Thinness of dura mater was noticed in 5 cases: 3 of dementia, 1 of monomania, and 1 of general paralysis.

"Ossific deposit in falx cerebri existed in 2 cases: 1 of dementia, and 1 of monomania.

"Adhesion of dura mater to calvarium existed in 17 cases: 3 of acute mania, 1 of chronic mania, 1 of melancholia, 3 of dementia, 1 of dementia with epilepsy, 5 of monomania, 1 of moral insanity, 1 of general paralysis, and 1 of congenital imbecility.

"Opacity and thickening of arachnoid was found in 39 cases: 2 of acute mania, 1 of periodic mania, 1 of chronic mania, 1 of acute dementia, 9 of dementia, 1 of dementia with epilepsy, 1 of melancholia, 7 of monomania, 2 of moral insanity, 12 of general paralysis, and 2 of congenital imbecility.

"Crystalline-like deposit over general surface of arachnoid was noticed in two cases: 1 of dementia, and 1 of general paralysis.

"Congestion of membranes was noticed in 19 cases:

2 of acute mania, 1 of periodic mania, 1 of chronic mania, 7 of dementia, 1 of dementia with epilepsy, 2 of monomania, 4 of general paralysis, and 1 of congenital imbecility.

"Adhesion of membranes to cortical substance was found in 10 of general paralysis.

"Serous effusion into sac of arachnoid existed in 53 cases: 3 of acute mania, 1 of periodic mania, 1 of chronic mania, 1 of acute de. mentia, 18 of dementia, 2 of dementia with epilepsy, 1 of mania with epilepsy, 11 of monomania, 2 of moral insanity, 11 of general paralysis, and 2 of congenital imbecility.

"Sub-arachnoid serous effusion was found in 47 cases: 3 of acute mania, 2 of chronic mania, 1 of periodic mania, 1 of acute dementia, 17 of dementia, 2 of dementia with epilepsy, 10 of monomania, 2 of moral insanity, and 9 of general paralysis.

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Sero-sanguinolent effusion into sac of arachnoid was found in 5 cases: 1 of chronic mania, 2 of dementia, 1 of dementia with epilepsy, and 1 of general paralysis.

"Sub-arachnoid sero-sanguinolent effusion occurred in 2 cases: 1 of mania with epilepsy, and one of dementia.

"The convolutions of cerebrum were noticed to be remarkably diminished in size in 4 cases: 1 of dementia, 1 of epilepsy with dementia, 1 of general paralysis, and 1 of congenital imbecility.

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Wasting of optic nerves and commissure occurred in one case of general paralysis.

"Paleness of the grey matter was noticed in 24 cases: 1 of acute mania, 1 of periodic mania, 1 of melancholia, 13 of dementia, 3 of monomania, 1 of moral insanity, 3 of general paralysis, and 1 of congenital imbecility.

Grey matter was of a dark tint in 10 cases: 1 of mania with epilepsy, 1 of dementia, 2 of monomania, 6 of general paralysis.

"Grey matter of a violaceous tinge in 3 cases: 1 of chronic mania, and 2 of general paralysis.

"Grey matter was softened in 31 cases: 1 of acute mania, 2 of chronic mania, 1 of acute dementia, 10 of dementia, 5 of monomania, 1 of moral insanity, and 11 of general paralysis.

"White matter was softened in 16 cases: 7 of dementia, 1 of dementia with epilepsy, 5 of monomania, 3 of general paralysis.

"Serous effusion into lateral ventricles was found in 37 cases: 2 of acute mania, 1 of chronic mania, 1 of melancholia, 11 of dementia, 2 of dementia with epilepsy, 6 of monomania, 2 of moral insanity, 11 of general paralysis, and 1 of congenital imbecility.

"Sero-sanguinolent effusion into lateral ventricles occurred in 2 cases: 1 of acute mania, and 1 of mania with epilepsy.

"Foramen of Monro unusually large in 15 cases: 1 of acute mania, 1 of chronic mania, 3 of dementia, 1 of dementia with epilepsy, 4 of monomania, 1 of moral insanity, 3 of general paralysis, and 1 of congenital imbecility.

"Crystalline-like deposit in membrane of lateral ventricles was found in 8 cases: 1 of acute mania, 1 of chronic mania, and 6 of general paralysis.

"Cystic bodies in choroid plexuses occurred in 27 cases: 2 of acute mania, 1 of chronic mania, 1 of periodic mania, 8 of dementia, 1 of epilepsy with dementia, 1 of acute dementia, 6 of monomania, and 7 of general paralysis.

"Disorganisation of the right corpus striatum was found in a case of monomania.

"Pineal body was unusually large in 4 cases: 1 of chronic mania, 1 of mania with epilepsy, 2 of monomania.

"Absence of grit in pineal body in 19 cases: 1 of acute mania, 1 of chronic mania, 1 of mania with epilepsy, 1 of acute dementia, 6 of