the physicians in charge of the different Cholera Hospitals, and from Dr. BAUM, PhysicianGeneral of the Town Hospital. This important document I was unable to recover, although I made proper inquiry for it.

It appeared that the Board of Health, instituted in the beginning of the Summer of 1831, had duly received the medical report in question; but that, at the time of my arrival in London, it was not in possession of the Committee of the College of Physicians,—subsequently instituted, and at the same time, I believe, with the Central Board of Health,-as will appear from the following extract of a letter, dated Nov. 30th, 1831, from the Secretary of the Committee of the College to me:~

'I have to regret extremely that I did not send you Medical Report A before you quitted London. One of the Members of the Board, who did not hear it read publicly, took it home, and never returned it, and I have been unable to recover it. I must again express my great regret in having exposed you to additional trouble.'

The Committee of the College would, I need not say, most certainly have delivered up that Report with the rest, had it been in their possession.

In a question of such vital importance as that of the contagion of Cholera, it is not a little singular that such a document should be thus missing. Had any accident happened to me whereby my papers had been lost on my passage home, or had I left Dantzick without getting the rough drafts of my Reports authenticated, which I might have done but for the friendly and judicious advice of Mr. GIBSONE, the British Consul there, my Reports, with only the remaining facts furnished in support of my conclusions, though highly important in themselves, must appear deficient. The isolated cases, and the first four cases of the Epidemic, contained in that Report, I have inserted in the history of the disease; and the communications from the physicians before-mentioned, in the article of the Question of the Contagion of Cholera at Dantzick, considered solely from Facts.

Finding, on my arrival, that the principle of contagion had been adopted by Government-and as my details upon the subject, with the inferences drawn from them, were decidedly in opposition to that principle, I had some reason to apprehend that such extracts as I had to make from my Official Reports, would not be published,—still, as containing so many facts of high importance to the public, I imagined that they would not be overlooked.

Having, without delay, made out Extracts from my Official Reports, 'they were approved of, [as I was assured by authority, without one dissentient voice, by the Committee of the College of Physicians,'-and recommended to the Privy Council in the following terms:—

'The Committee of Physicians, to whom the Reports of Dr. HAMETT upon the Cholera Spasmodica at Dantzick were submitted by His Majesty's Privy Council, have approved of the accompanying Extracts, and recommend the printing of them for the public information, as a very valuable addition to the present knowledge of the disease, procured by great diligence and painful and unremitted observation.'

From this official recommendation, it evidently appears that the Committee of the College behaved in a liberal,—as, indeed, they previously had in a courteous manner to me. Pursuant to this recommendation their Lordships ordered my Extracts to be printed,* and a proof copy was, in due time, sent to the Superintendent-General of Quarantine. But, notwithstanding the said recommendation and consequent order, they were not published, -and yet, howeyer paradoxical it may seem, they were not suppressed by Authority.

"An attempt was now made by the Superintendent-General of Quarantine to induce me not to print the authorized Extracts above-mentioned"

After the first rough copy had been printed, it was in vain that I waited in expectation of hearing of an order being given for their publication. On one occasion, indeed, it was indirectly intimated to me by the Superintendent-General of Quarantine, that the Privy Council did not sanction their publication,—but this, not only from what I have just stated, but according to what I have since learned from authority, could not have been the case. The reason, ultimately given for delay in the publication by the publisher of the Official Reports upon Cholera to Government, was, that it was intended to bind up and circulate them with the second edition of the St. Petersburg Reports, not completed. This was rather an unfair arrangement, inasmuch as the facts and results of the two Reports were diametrically opposite, and inasmuch as the contents of the latter were apparently greater; while the comparative labour and observation bestowed upon each could not be readily perceived, except by such persons as are acquainted with the various consequential and inductive steps necessary to be pursued in the investigation of epidemics "—Introd. p. xi.

Such are the tactics of the ultra-contagionists in this country-and such have been the tactics throughout every ramification of that faction, from the metropolis down to the dirtiest village of Scotland and Ireland. How we have resisted the demoralizing doctrines of quarantines and contagion is well known to our readers. The above extract contains a sample, and a very favourable one, of their manœuvres in a bad cause. As such we have recorded it, for the edification of the present and future generations.

It is some-but a small consolation, to find that our worthy, not worldly, author has had the satisfaction of receiving the following brief and official acknowledgement of his zeal and diligence.

"Council Office, Whitehall, 25th August, 1932.

SIR, I am directed by the Lords of His Majesty's Most Honourable Privy Council to inform you, that they will accept with pleasure the dedication, which you are desirous of making to them, of your Medical Reports on Cholera; and their Lordships take this opportunity of renewing to you the assurance of their satisfaction at the diligence and zeal, which you evinced in the performance of the very arduous duty imposed upon you, in your Mission to Dantzick, in June, 1831.

I am, Sir,

Your obedient Servant,

C. C. GREVILLE."

To Dr. Hamett.

To attempt an analysis of the present volume, would be to repeat the whole of what we published in a former Number, with additions. We can only, therefore, recommend our readers to patronize the author, who has gone to a great personal expense, by procuring the work; or, at all events, by proposing it in the various book-societies throughout the kingdom.

There is a long chapter (XII.) appended to this edition, entitled "the Question of the Contagion of Epidemic Cholera more fully considered," which we would strenuously recommend to the perusal of contagionists and anti-contagionists. It is a very able document-and may serve to confirm the creed of the latter party, and mitigate the confidence of the former.

XV.

OBSERVATIONS ON THE MEDICAL TREATMENT OF INSANITY. By E. J. Seymour, M.D., Physician to St. George's Hospital, &c.

THIS little volume contains the substance of Dr. Seymour's Croonian Lectures, delivered at the College in 1831, and the author considers himself much indebted to the learned treatise of Dr. Guislan, of Ghent who has written with much talent on maniacal diseases.

Dr. S. bespeaks indulgence for his observations on insanity, on account of the extreme difficulty of the enquiry, and the darkness in which it is enveloped. A drawback on the progress of mental pathology is, he thinks to be found in the circumstance of insanity being chiefly attended to by exclusive practitioners in that branch of the healing art"medical men who resign the care of other diseases, and, with few and eminent exceptions, lose the power of investigating the aberrations of intellect, in conjunction with the other functional diseases of the human frame."

Dr. Seymour aims only at the merit of a faithful and judicious compiler-at laying before the public "an outline of the labours of others"-an analysis of what has been recommended with the view of simplifying our knowledge of causes, and determining upon what cases are, and what cases are not, remediable in the present state of the medical art. Although insanity is too often incurable, yet, under judicious treatment, a considerable proportion of patients recover. Thus, Mr. Warburton's establishment contains 400 lunatics. In the year 1829, of 200 admitted, 50 were discharged in the course of the year. Instances are given, from other authorities, of the cure of insanity under apparently desperate circumstances.

Dr. S. next adverts to the division of those cases which result from moral, and those from physical causes. The physical causes of insanity are very puzzling. We see great organic diseases of the brain without insanity-and great insanity, without any organic affection appreciable by the senses. Still we must suppose that functional disorder of the brain exists, and is essential to, the phenomena of mental derangement. In the brain, as in the stomach, liver, kidneys, and other organs, intense functional disturbance may exist, and that for a considerable time, without any change of structure that can be demonstrated on dissection. This is the key to the difficulty respecting the pathology of insanity.

Dr. S. dwells very properly on the disturbances of the cerebral functions from sympathy with varions other organs, as the stomach, heart, liver, &c.

"But the most evident causes for the disturbance of the functions of the brain, from sympathy with the disturbed functions of other parts, are found in the various changes which occur in the generative system. In women, from the commencement of puberty to the termination of that period, when the uterus becomes unfit for its specific purposes, the brain is liable to be disturbed by every change, whether healthy or disease, of the uterine system. In early life,. when the catamenia first occur, at each returning month, in delicate girls principally, the mind is affected. If imperfectly established, great bodily pain, with violent headachs, arise; if the catamenia are profuse at an early age, quick and irregular action of the heart, and arteries, faintings, fretfulness, and visionary alarms, and even epileptic fits, ensue. Some females are obliged at this period to seclude themselves entirely from the family; their minds being disturbed in every gradation, from feelings of distress or discontent to absolute aberration of intellect. Who shall attempt to describe all the variations of spasmodic disease which attend this period of life? Sometimes the disturbance of the mind is shewn in the numerous forms of imposition attempted by the patient on the attending practitioner. Sometimes inordinate pains are complained of in the region of the bladder; and if the disease be doubted, the patient will have recourse to some means, in her own idea conclusive, to convince all beholders: thus persons, at this period of life, have professed to have passed gravel, or sand, which, on examination, proved that it never could have been generated or contained in an animal body.

At other times, inordinate vomiting is the symptom for which medical advice is required; and it has occurred to me, as it has doubtless to others, to find this incessant vomiting kept up by substances taken for the very purpose by the patient herself. Sometimes the patient cannot swallow; at other times she loathes food, and will exist on almost incredibly small quantities of it: and yet these patients have received an education which would make them shun falsehood on any other subject, and are of a rank in life where nothing was to be gained but pity, except that commiseration, attention, and astonishment, which excite and occupy the mind.

Is it possible to conceive such cases, otherwise than the result of an alteration in the mental faculties nearly allied to mania? As far as I know, such cases always occur in young females, and mostly in persons labouring under some deviation from a healthy con dition of the menstrual discharge: I have never met with, nor heard of a case of this description, in women who have borne children." 23.

Among the physical causes of insanity, the introduction into the system of alcohol, opium, and mercury is generally mentioned by authors-the former more especially. Moral causes, however, are far more productive of insanity than physical causes. They are very numerous, including almost the whole of the passions, and the various mental emotions, dolorous or joyful, arising from the accidents and diversified scenes of life. Of 442 cases of mania, examined by Esquirol, 121 arose from physical, and 321 from moral causes. Other physicians, however, have not found the proportion of moral causes so great.

In the second chapter, Dr. S. discusses the moral causes, which are chiefly grief, jealousy, ambition, terror, and superstition. Monomania, mania, and amentia are defined, and examples of each adduced. The most imperfect of the external senses-hearing, is that which is most frequently affected. Nothing is more common than to find men asserting that they have communications with the invisible world-that spirits whisper to him— or that animals abuse him-or that his enemies employ tubes, constructed on acoustie principles, to goad him into madness. Dr. Seymour saw a lady who heard, with her left ear, swearing and obscene expressions..

The memory is often affected, and may be either increased, diminished or destroyed. In monomania it is generally increased; in mania, it varies from great strength to great feebleness. Patients restored to reason often remember, with remarkable exactness, what befel them while under restraint.

It is well known thað monomania is the most difficult form of insanity to discover, the patient often concealing his infirmity or delusion, especially if he imagines that the inquirer is endeavouring to detect it. Instances of this kind are innumerable, and have even been portrayed by novelists and dramatists. We may refer to Makenzie's Man of Feeling for instance. Dr. S. is led from this consideration to another-the expediency or otherwise, of confining a monomaniac. It would appear that such cases frequently end in suicide. Dr. S. mentions the case of a lady, who had contracted suspicions, that those about her harboured malignant intentions towards her. Suddenly, and in the night, she arose, and threw herself from her window into the area, breaking both her legs by the fall. Dr. insists on the propriety of great caution in examining monomaniacs. They may display the greatest powers of mind, till, by chance, the cracked cord is struck. Then is the melody marred, and the discordance becomes apparent. Dr. S. expresses then, no decided opinion on confinement or non-confinement. It would obviously be mere twaddle to lay down a dogmatic rule. An intelligent man will be guided by the circumstances of the particular case, in spite of any dogma, and a fool will not be the better for a rule, which must necessarily be half eaten up with exceptions.

Is it better to remove patients from their homes and usual habits? A's a general thing it most undoubtedly is so; the common experience of men has decided it. But, under peculiar combinations of circumstances, an opposite plan may be adopted. The remarks of the late Dr. Gooch on this subject, and the case of the lady, told in his characteristic style, must be fresh in the minds of many of our readers. The cases in which this is recommended by Dr. G. are those in which the patient is not recovering,. but when month after month elapses without amendment, and the mental delusions assume a shape aces sible to moral impressions. We must not expect much from this methedr

Dr. S. next adverts to coercion. There has no doubt been a good deal of cant on this subject; yet still it is a distinguishing and a gratifying feature of the state of society, that their feelings or their prejudices, say which you will, have abolished the employment of violence and cruelty, and rendered the corporeal management of the insane both more humane and more philosophical. The balance of good inclines greatly to this side, though now and then a maniac may abuse the gentlensss of those who have the charge of him. Dr. Heberden's predilection for cribs and straw may, for aught we know, be very just but certain we are, that it is better for mankind that the feelings both of medical men and the public should run counter to those agreeable receptacles for madmen. Dr. Seymour feels convinced, from observation, that polished iron handcuffs are more merciful engines of coercion than leathern gloves; or, in the cases of the very violent, waistcoats. Dr. Seymour reprobates, feelingly and eloquently, the abominable maxim of the Augustan Celsus "Ubi perperàm aliquid dixit aut fecit, fame, vinculis, plagis coercendus est."

Of all the remedies applicable to derangement from moral causes, employment and exercise are perhaps the best. All are agreed on this point. Bodily exercise seems, for evident reasons, most applicable to monomania. In mania it is chiefly useful during the lucid interval and convalescence; and even during the paroxysm, if it can be strongly exercised until some degree of weariness can be induced, calm, tranquillity, and sleep, not unfrequently ensue. The kindlier feelings and affections of the mind, when excited, tend to banish melancholy. In the upper classes, especially among females, the tending of domestic animals, rabbits, pigeons, &c. has been found serviceable, and Dr. S. found many of these means resorted to in the Quaker's Retreat, near York.

Dr. S. next alludes to the power of enduring cold which maniacs are said to possess. We think it probable that this is greatly exaggerated. It is well known that man under the influence of strong emotions, or under the physical influence of stimulants, as alcohol, will resist to a certain degree, the operation of external irritants or injuries. Maniacs, in some cases, are nearly similarly circumstanced, their minds exclusively directed to some object, or occupied with one feeling, or their whole frame under the influence of maniacal passion or excitement. In such it is likely that cold will be comparatively innocuous, or that blisters or cauteries may be applied unregarded. But we doubt whether this immunity be general, and we are happy to perceive that this view is taken by Dr. Seymour.

"Notwithstanding such observations and examples, gangrene not unfrequently seizes the extremities when frostbitten, and the usual diseases of diarrhoea, and inflammatory affections of the thoracic viscera, not unfrequently attack maniacal patients. The best explanation of these apparently contradictory facts is to be found in the perverted mind of the patient; his limbs suffer, for their sensibility is probably not really altered from the natural condition. But the disordered mind perceives not the bodily ailment, or, to use the illustration of a foreign writer, a blister applied does not, perhaps, attract a momentary attention from the maniac, but it does not the less produce inflammation and suppuration." 56.

It has often been a matter of surprise, that an invasion of mania occasionally disperses or mitigates other maladies, and, inversely, that an attack of acute disease will suspend or altogether remove mania. That this is occasionally the fact there can be no question, nor need it occasion our astonishment. Is it not known that pregnancy will at times suspend the march of phthisis, that acute diseases will put a stop to pregnancy, and cause abortion? Do we not see cold produce inflammation of the lungs, and check gout, and the external appearance of gout relieve internal inflamination? Is it not on the principle implied in the frequency of these facts, that we found the employment of our long list of counter-irritants? In short, there is nothing surprising in the matter. Epidemic discases are also said to have seldom prevailed in lunatic asylums. But this may be owing to their seclusion, their regularity of habits and of diet, rather than to any preservative power on the part of madness. The cholera has prevailed in several lunatic establishments. Dr. Seymour relates several curious and interesting cases of mania relieved or removed by other diseases. We need not dwell any longer on the subject.

The third chapter or lecture is occupied with the consideration of treatment, or the application of medicine to the cure of insanity.