affection, which, as I have shown, is a pulmonary affection connected with a general vitiation of the blood.

Once only have I found a state of complete mono-sitophobia apart from all combination with other symptoms of alienation. I am speaking of a young person, who, in consequence of a moral cause, a wound to her self-esteem, evinced a repugnance for every kind of food. This state degenerated into absolute refusal to eat, and finished by exhibiting itself under the form of a partial mental alienation. It is one of the most curious cases I have ever witnessed. For a long time the condition of this patient was looked upon as the result of an affection of the stomach, an anorexia. Her unconquerable obstinacy in refusing nourishment, her progressive emaciation, at length opened the eyes of her parents, and she was sent to me. The success of a moral treatment energetically pursued, followed by the recovery of the patient, testified to the justness of the diagnosis.

I shall have an opportunity of showing you the reasons which lead me to believe that in the refusal to eat, the eighth pair is morbidly affected.

This vesania is rarely a simple affection.

We have here some daubing madmen, who, if allowed, would do nothing but daub the walls with grotesque figures.

There are hiding monomaniacs, who conceal everything that comes in their way. There is also a mania for theft: this resembles criminal theft. Cleptofolly is usually observed as an element of association, or a transitory phenomenon in the alienations with exaltation of the passions. It also characterises the decadence or obliteration of the faculties of the intelligence; it is met with as an epiphenomenon in dementia, in idiocy, and epileptic convulsions. This morbid form is never observed in melancholy or in ecstasy.

Here is a madman who is incessantly digging the earth in the garden. I have entered his disease under the name of talpafolly. His proceeding resembles the action of the mole. It is not the first time that I have observed this phenomenon.

We have here fools addicted to oratory, declamation, monologue, and dialogue. Some affect to speak languages they do not understand. I have met patients who always repeated twice the same phrase.

There are shrieking and howling madmen. Others imitate the song of birds, the mewing of cats, or the barking of dogs.

These affections have often an intimate relation with hysteria. They even constitute diseases of transition, mixed conditions, phrenopathies on the one hand, a subconvulsive state on the other.

Gesticulating madmen.-Sometimes folly constitutes almost a variety of chorea. I have brought before you some patients who perform without ceasing the most singular movements of the mouth, tongue and face. This is mimofolly. The patient to your right is a striking example: for four years that he has been here, he has never left off executing a fantastic contraction of the muscles of the left cheek.

Sometimes they preserve a crooked attitude. It is in vain that you offer them a chair, a stool, or a bench.

There is in the asylum a girl who for eight months has never opened her eyelids.

Fantastic automatism is often the prelude or the accompaniment of dementia. When in the course of a mania or a folly, the intellectual functions undergo insensibly a subtraction of energy, when there is a progression towards dementia, there is often observed a quite peculiar excitation in the gait, in the gestures, in certain acts. These acts, these gestures appear under an automatic form. There is in reality an antagonism between what have been called for some time past the instinctive acts and the intellectual acts. In proportion as the latter decline, the former become exalted.

It is then especially that we remark the balancing of the body, the act of netting, a species of carphology; the fancy for stripping naked.

There are fools who present the phenomena of hysteria, of catalepsy, of epilepsy. Epilepsy, however, belongs more especially to mania than to folly.

INSTITUTIONS FOR THE INSANE IN PRUSSIA, AUSTRIA, AND GERMANY.*

THIS Volume contains an interesting record of a very extensive personal examination of many of the numerous institutions for the insane in Prussia, Austria, and Germany.

Familiar as we have become with all the prominent hospitals for the treatment of mental disease in Great Britain and France, only a limited number beyond these countries have been seen by any of our professional men, who have visited Europe for the purpose of profiting by the improvements which, within the last twenty or thirty years, have been introduced into most of these institutions. "A general impression appeared to prevail, indicated, it is true, more by negative than positive signs, that, aside from the countries mentioned, the nations of Europe had made but little progress in this department of the profession, and hence could furnish us nothing commensurate with the labour and expense necessary to its acquisition," and yet the literature of the Germans on this branch of medicine is able and voluminous. Much of it is, perhaps, unprofitable, as being devoted to a zealous advocacy of specious theories, but still containing a great amount of valuable information, and exhibiting very strikingly the talent and industry which, in that region, are devoted to the study of mental discases.

Various institutions for the care of the insane, too, are to be found throughout these countries, which have a deservedly high character for their liberal arrangements, and the admirable manner in which their whole service is performed.

During the summer of 1849, Dr. Earle visited many of these institutions, under peculiarly favourable circumstances for obtaining a knowledge of their actual condition. Long devoted to the study of diseases of the mind, and for several years engaged in the superintendence of a large American hospital, he went abroad with a degree of practical knowledge of the subject, and a familiarity with the wants of such establishments, which rendered him well qualified to judge of the excellences, as well as the defects, which are to be found in abundance in the different German institutions.

The first chapter of the work before us is devoted to a brief history of insanity in Germany, of the German periodical and other literature on the subject, and an interesting notice of the prominent men who have been distinguished in this speciality-which, although receiving only a brief notice at our hands, will well repay an attentive perusal.

The following estimate of German hospitals, as compared with our own, is interesting:

:

"A large proportion of the buildings occupied as hospitals or asylums for the insane in Germany, were formerly monastic establishments. Their architectural arrangements are not only of a former age, but were adapted to a different purpose, and hence are less convenient than most of our institutions. Still, their conversion into asylums for the insane has already been productive of at least one advantage. It has accustomed the officers of these institutions to large

* Extracted from No. 54 of "The American Journal of the Medical Science," edited by Dr. Isaac Hay. "Institutions for the Insane in Prussia, Austria, and Germany." By Pliny Earle, M.D., one of the Visiting Physicians to the Lunatic Asylum of the City of New York, &c. Utica, 1853. 8vo, pp. 229.

rooms, so that, in the construction of new buildings, the principle of providing accommodations for the greatest number of patients in the least possible space does not enter into consideration. It is really a delightful treat to see the large, well-lighted, and airy corridors of Eichburg and the asylum at Halle. The number of cubic feet of inclosed space in the principal German institutions is probably not less than twice as great, in proportion to the number of patients, as those in the United States. Such asylums as have been recently erected, and specially designed for the purpose-as, for example, those of Halle, Illenau, and Eichburg-are great improvements upon the others, and yet, in point of convenience, are unequal to some of ours. In their asylums generally, the apartments for patients have not that finished aspect of comfort which is found in many of the American institutions. This is particularly owing to the universal absence of carpets. Yet, relatively to the prevailing customs of the people, they are probably as well furnished as ours. In the conveniences of the kitchen, the laundry, and the means of distributing food throughout the house, they are inferior. Cooking is rarely done by steam. I saw no wringing-press, and no dumb-waiter. Mechanical appliances for the purpose of bodily restraint are probably somewhat more extensively used than upon this side of the Atlantic."

It appears that, during this visit, Dr. Earle found several establishments in which he was shown through only a portion of the wards, and occasionally he had no opportunity of seeing those for violent patients. We trust few, if any, American superintendents can be found but that will cordially agree with Dr. Earle, that when a professional brother, engaged in the same speciality, visits an establishment for the purpose of becoming familiar with its arrangements, it is a duty, and ought to be a pleasure, to conduct him through every ward, and to throw open every part for his inspection. The credit should be given such a visitor that he comes "to learn the advantages of the institution, not to seek for demerits or matters for cavil."

In regard to moral treatment, Dr. E. considers the German asylums fully equal to those of the United States. "In the most important point of all—if reference be had to curative treatment, or the quietude, order, and hygienic condition of the patients-that of manual employment for the inmates, they are superior. The radical source of this superiority lies, undoubtedly, not in the more ardent wishes, or the greater efforts, of their superintendents for the welfare of their patients-for, in these respects, none can excel the officers of the American asylums-but in the education of the people, and the nature of the political governments under which they live. Obedience to authority becomes, by education, more a matter of principle or of habit. Furthermore, the asylums are more independent than ours, and the retention and management of patients more optional with the officers."

Of the forty-nine public, and eight private, establishments of which mention is made, and a more or less extended description given, in the volume before us, seventeen were visited by Dr. E. They embraced those of Sieberg, Andernach, Eberbach, Frankfort, Dusseldorf, Hildesheim, Halle, Berlin, Sonnenstein, Leubus, Brieg, Vienna, Hall, Giesing, Winnenthal, Illenau, and Stephansfield. Nine of these are among the thirteen which Dr. Julius calls the best in Germany.

Want of space prevents our giving a more extended notice of the author's visit, or referring to the many interesting facts and judicious criticisms scattered through the volume. We can heartily commend the work to the attention of all who take an interest in the insane, or are disposed to become familiar with the views of prominent German physicians on this important subject, and to learn from a competent observer the actual condition of the various institutions which, in that wide and populous region, are specially devoted to the treatment of the various forms of mental disease.