whilst all the routine practice had been employed in vain. Change of air and scene had been tried in vain. I cannot help believing that the long and painful probation which her family had to endure might have been spared them had she been removed to a well-regulated institution at an early period of her disorder.

Some interesting statistical returns of Bethlem Hospital, referred to by Dr. Webster in a valuable paper which he read before this Society several years since, afford incontestable proof that the treatment of puerperal mania, as conducted in large asylums, is pre-eminently successful. Dr. Webster observes-" As to the curability of this form of mania, nine recoveries more were reported than in the other varieties of lunacy; eighty-one puerperal patients having been cured, or at the rate of 61.83 per cent., whereas the average recoveries during the last twenty years in all cases of insane females treated at this institution was 53.67 per hundred. Hence three in every five cases of puerperal insanity may be confidently expected to recover within a year.

My friend, Dr. Theodore Boisragon, the medical superintendent of the Cornwall County Lunatic Asylum, has obligingly favoured me with the following information, strongly corroborative of the opinion I have advanced. He says, in reference to his experience of puerperal mania at various asylums-"The majority of cases recover; in fact, I do not remember having discharged a single case that was not convalescent. I perfectly coincide with you as to the propriety of sending these cases to an asylum. It is of course perfectly clear that they are for the time decidedly insane, and need that description of treatment for which the structure and appliances of an asylum are peculiarly adapted. When at Warwick I had charge of a case which affords a good illustration of this assertion. A private patient was treated at her own home by a distinguished physician of that town; but his advice was completely frustrated by the injudicious interference of the patient's mother. The consequence was that over indulgence was resorted to at one time and mechanical restraint at another, so that the patient might have become incurably insane, had not her husband insisted on placing her under my care after the disease had persisted for thirteen weeks. The means employed were quietude, seclusion, and amusement. The result was very striking at the end of thirteen weeks more she was discharged convalescent, and her ultimate recovery was perfect."

The preceding facts must convince every unprejudiced mind, that with regard to the treatment of puerperal mania, the removal to an asylum, so far from proving prejudicial, is attended, on the contrary, with the happiest results to the patient, and cannot be too strongly advocated.

There are some, however, who admit the efficacy of this plan of treatment, but disapprove of it on the ground that the mere recollection of having been confined in an asylum will produce an injurious effect on the mind of the patient in a subsequent labour. I have never noticed such a consequence, and in the case to which reference has already been made, as occurring in my private practice, the patient's subsequent labour was unattended with the slightest mental aberration.

Another common prejudice which has not unfrequently interfered with the timely removal of a patient to a lunatic asylum, is the dread entertained by the friends of the individual lest some sort of opprobrium be incurred by her having been the inmate of what is vulgarly called a mad-house. This prejudice, which arises either from ignorance or mistaken delicacy, is rapidly passing away. Did the knowledge of Robert Hall's and Cowper's insanity diminish, in the slightest degree, the affectionate admiration in which these highly-gifted individuals were held? Did it not rather tend to increase public sympathy and private regard? The supposition that puerperal mania is generally a very transient affection is another erroneous opinion, which has frequently interfered with the early removal of patients.

The yearly records of our lunatic asylums furnish many examples of the chronic and protracted form of this disease arising entirely from the early neglect of appropriate measures.

In conclusion, I wish it to be clearly understood, I do not recommend the hasty and indiscriminate removal of a patient. There are many cases that may be cured without this measure being adopted. At the present time I have a young lady under my care, whose aberration of mind arises from derangement of the uterine functions, but who is rapidly recovering under the influence of a treatment, which has chiefly for its object the removal of the physical disorder. This lady had been ill for a considerable period before she came under my she had tried change of air and scene, with a variety of remedies; but the somatic treatment having proved so strikingly successful, I have not deemed it necessary to place her under surveillance.

care;

In the humbler walks of life, cases of insanity should be generally removed at an early period to an asylum. For rich patients this measure may not always be necessary; they can obtain a quiet residence, all the comforts, and many of the advantages of an asylum. Not so with the poor. Confined, perhaps, to a close room, in a narrow and noisy street, insufficiently nourished and badly nursed, the poor patient is cut off from all hope of a cure. For cases of this description an asylum offers the only chance of cure.

THE MATERIALISM OF INSANITY.

BY J. HAWKES, ESQ.,

House Surgeon, Infirmary, Bolton-le-Moors.

"Nay, I'll ne'er believe a madman till I see his brain."

Twelfth Night, Act IV.

In the "British and Foreign Medico-Chirurgical Review" for January of the current year, appeared an admirable paper by Dr. Bucknill on the Pathology of Insanity. It is not without some hesitation that I can subscribe to the doctrines therein laid down, and it is not, moreover, without consideration and some diffidence that I can presume to question their full force and truth. The metaphysician, though never so good a theorist, the physician, however sound a practitioner, must both give place to one who, sitting by the well of knowledge, dispenses with grace and justice to his thirsting brethren. He who, by opportunity and industry, can draw the deepest, to him we may look for the best and clearest supply. The pathology of insanity is still in its infancy; nothing is at present positively known, concerning the subtle change which the vesicular neurine undergoes in its state of transition from health to disease. We cannot investigate the secret and mysterious laws which govern and control the organization, development, degeneration, and decay of the great nervous centres, until we have arrived at some general understanding and agreement as to the premises on which they are based, and the conditions by which they are framed.

The scalpel and microscope will alike fail; the meditations of metaphysicians will come to nought; the disease will remain in statu quo, a phantom and a fear. To the pure doctrine of physiology, we must look for the first glimpse of truth, and by the close application of its principles shall we soonest find the path; while without its help in the study of cerebral disease we shall never attain our end. We must, then, at the outset, bear in mind those grand fundamental laws of development and decay, such as are busy in their operation throughout the entire system.

Cell growth, the first indication of vitality, is promoted and carried on by

the one universal fiat of creation. Disease, which mars and destroys the fairest work of God, has, in this self-same law, its element and rise. We speak of nutrition, and perverted nutrition, results proceeding from the same source, but variably adapted and carried out under altered conditions. And, without any positive or appreciable change in the circumstances under which the rule is administered, there may be a peculiarity in the system, from the existence of which the healthy working of the law will ultimately produce the inevitable consequence of disease.

Insanity, by which term we understand a disordered state of the functions of the brain, dependent upon alteration of structure, appreciable or otherwise, and through which the phenomena of the immaterial mind are exhibited in a distorted and abnormal condition irreconcileable to reason. The word stands for a symptom of itself, it proves nothing, and though commonly employed in reference to the mind, per se, as the fons et origo mali, yet the mind of a madman may be sane, the fault resting on the medium through which its existence is manifested. Supposing, for the sake of illustration, we liken the mind, with its many radiant points, to the sun whose bright beams penetrate every transparent medium. We shall see that through such as are clear and without blemish they pass in perfect purity, while through those that are dim or opaque, their passage is retarded, if not prevented; or if we offer a coloured medium, each pencil of light, as it passes, alters its character, borrowing one from the medium traversed, and as such to be received. Applying the metaphor to the consideration of insanity, we may conceive that the mind, perfect in all its parts, and itself of spotless purity, yet the medium through which alone we can judge of its condition having become obscured or impaired, the discase should be held essentially one of matter, tangible, appreciable, comeatable, in short, if we only knew how. If, then, we start with this theory, the materialism of disease, we shall have gained a step to its elucidation, if not to its cure.

The materialism of insanity, is a theory which assigns the fundamental seat of disease to the brain rather than to the mind, and to the brain-cells or corpuscular neurine in preference to the tubes or fibres which are the conductors, not the foci, of volition. The disease, then, we must expect to find, if found at all, situated in these cells, and consisting of some form of derangement occurring among their constituent particles. Irrespective of active inflammation, the traces of which can be discovered by diligent research, there is a subtle and unknown change taking place in these cases which is hid from mortal eye, and shall be so till the labours of science have placed in the hands of her children more perfect instruments by which to bring to light the mysteries of creation and decay. But how is this carried on, and when? We need only remember how cell growth is maintained in other organs to answer the first question; how readily this phenomenon is urged to its completion under the influence of a due supply of nourishing fluid, or how tenfold it is increased by any vascular excitement in the part undergoing change. Of this we see examples everywhere, in the reflection of epithelial cells on the lining of secreting glands, especially in the organs of digestion. The same cause, increased vascular supply, obtains in the brain, with the like results, cell growth and decay, as elsewhere. Increased nutrition, as we well know, leads to increased activity, whereby the functions of the part are more ably performed, and cell growth hastened to its completion; but here the law steps in and fulfils its end, there must likewise be decay, the worn-out, used-up cell disintegrates. As in the blood, so in the brain, the analogy is perfect. But have we any cause to suppose that the phenomena of repair and reproduction are carried on only during sleep, and that the reverse occurs when the brain is more actively engaged; that, as our author says, "in sleep, the cell may be growing from the capillary walls, or filling itself, and emptying or decaying

during wakeful hours." We cannot come to any such conclusions without denying the universality of nature's fundamental law; for how can we say that the brain, apart from any other collection of cells, is not under obedience to this rule, or, why should not development and growth be carried out at the time when the supply of blood is increased, when the nerve-cells are more thoroughly replenished by their oxygen carriers, the capillaries? Why, in short, should decay be alone transacting at the chosen moment for growth to abound? But let us not forget that, in proportion to the supply of oxygen, only another name for nourishment, so must the march of decay be advancing, Thus do these twin phenomena, development and decay, go ever hand in hand. But the demand might, perchance, exceed the supply, though the reverse, we may presume, usually obtains; however, in such case, the result is obvious, inevitable decay. A decay, the exact nature of which we cannot at present more than speculate upon, characterized, perhaps, by a deficiency in the phosphate of lime, in fact, a general want of earthy salts; it may be a redundancy of fat or animal matter, or, by some error in the vital function of the cell, through which it fails to eliminate from the matters presented to it, the sort of ingredients proper for the healthy discharge of its functions; or again, without failing in the adaptation of its elementary particles, there might be a simple waste of material; decay, in fact, outstrips repair, and derangement of the faculties ensues. In this case the demand must be stopped, and time given for bringing up supplies. Sleep is the grand panacea-"Want of sleep," says the author whose paper we are considering, "I believe to be the true origin of insanity, depending on moral causes." This is a most just observation. If, at the onset of the malady, sleep can be obtained, sweet refreshing sleep, half the

cure is won.

Thus, on physiological grounds, we should proceed in the treatment of this disorder, and till we can better trace from cell to cell the inroad of disease, we cannot, with any propriety, wander from the path. By the simplest means, the greatest ends are often obtained, and it may well be supposed, that, by aiding Nature rather than preventing her, we shall ultimately win success.

MISCELLANEOUS NOTICES.

Bethlem Hospital.-We have read with much pleasure the last report of this hospital. It appears that on the 1st of January, 1854, there were (including those out on leave) 329 patients in the hospital, of whom 176 were males and 153 females. From this date until the 31st December 1854, there were 232 admitted, 218 discharged, and 21 died; leaving in the establishment on the 1st of January, 1855, the following 317, with 5 out on leave:

The number of admissions during the year was below the usual average. The average of those reported as cured is 50 on the admissions. The health of the patients during the past year has been remarkably good. Dr. Hood makes some sensible observations in reference to the employment of the criminal lunatics. He says the marked effect of constant recurring occupation on the bodily health is only equalled by the improvement in the mental condition of the patients. We regret that, owing to this report only having just reached

us, we are unable to quote more extensively from its pages. It is well and carefully drawn up, and embodies many points of deep interest. In our annual summary of the reports of British asylums, we shall again refer to this document.

The American Journal of Insanity continues its onward career of usefulness. The papers published in this periodical are always of great practical value. In an early number we propose doing ourselves the pleasure of analysing, at length, the last five or six numbers of this journal. We hope, in this article, to make amends for all our past omissions, quoad this able magazine. Want of space has alone prevented our doing so before.

On the Construction, Organization, &c., of Hospitals for the Insane. By Thomas S. Kirkbride, M.D., Physician to the Pennsylvania Hospital for the Insane, Philadelphia, 1854. This is an able, valuable, and deeply interesting work, from the pen of an eminent physician, who has a thorough practical knowledge of the subject-matter of the book. We have only space in this number to direct the attention of our readers to this essay. In our next publication we intend to review Dr. Kirkbride's work in detail, and to quote extensively from its pages.

Letters to His Excellency Governor Manning on the Lunatic Asylums. By Dr. H. Tregevant, M.D., Columbia, S. C., 1854. We postpone our critical remarks on this deeply interesting series of letters until our next number, when it will be reviewed in conjunction with Dr. Kirkbride's essay. The pamphlet has only just reached our hands.

Insanity in Italy. The observations of Dr. J. M. Galt (of America), and of Dr. Girolami, of Italy, relative to this subject will form the basis of an article that will appear in an early number. Dr. Girolami's books were unfortunately sent through the general post, and, in consequence of the extravagant postal charge demanded, we were reluctantly obliged to refuse the parcel. Many American periodicals, alas! meet with the same fate. It occasionally happens that four and five shillings are asked for magazines, the selling price being only one and two shillings! All books and periodicals should be sent through a London bookseller. Pamphlets and books are occasionally entrusted to private hands, and they consequently find their way into the post office. Hence their non-delivery, in consequence of their being charged as letters.

To Correspondents.

LETTERS and Books for the Editor may be transmitted either through the Publisher or direct to Dr. WINSLOW, 23, Cavendish-square, London.