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he is obliged to dispense his own medicaments, the habit is growing of charging rather for his skill than for the number of bottles he crowds upon his unhappy patients. We think there can be little doubt that the practice of homæopathy has had something to do with this change. When a certain enthusiastic class of the population took up this new doctrine, and it was seen that by perfect abstention from physic (for the infinitesimal doses given practically amounted to this), the patients, in the majority of cases, where some simple derangement of the system existed, got well; the lesson taught was twofold—in such cases the curative value of drugs was of secondary importance, and the power of the mind over the body was the primary cause of cure. Faith in the physician-what a power it is ! and he who can command it may throw much of his physic to the dogs. Nevertheless faith stops short of actual bodily derangement; it will not stop an ague-fit, or cut short a fever; it will not set the lung of the consumptive patient to rights, nor give motion to the paralysed arm. In such cases where destruction of vital parts has ensued, the mere mockery and snare of the homeopathic theory is at once apparent. And here the specific value of certain drugs discovered during the last half-century steps in to restore the balance to the orthodox practitioner. Among these may be found first and foremost cod-liver oil, that has stayed the band of the destroyer in many a patient that would otherwise have succumbed to pulmonary disease; iodine, gallic acid, and hydrocyanic acid have proved of great value; and last, but not least, we credit the medical profession with the introduction of electricity as a most potent agent in rousing the vital powers of the system. Day by day its potency in reviving the failing nervous system is becoming more apparent. Faradization, or the passing of the constant current, is the best stimulant known in rousing the paralysed limb, and in cases where the heart's action has stopped, the current has once more set the machine of life going again. By the hydrate of chloral, on the other hand, overaction of the nervous system is met and checked, and all the evils of opium-sickness, constipation, and headache-are avoided. But in addition to these actual additions to the agents by which the physician fights disease, we must allude to the much more effective and scientific method in which he applies them. The modern discovery of the alkaloids, or the active medicinal principles of our vegetable materia medica, is very important. Instead of coarse bark that used to choke us when we were attacked with ague or weakness, science now presents us with the elegant quinine.

Instead of the nauseating dose of jalap an infinitesimal portion of jalapine is far more effectual, and morphia with a drop seals up our senses, where the larger dose of opium defeated its object by refusing to remain upon the stomach. Even the mode of action of this drug has been greatly improved of late years. In cases of neuralgic pains and spasmodic agonies subcutaneous injection of the drug now acts at once effectually upon the local affection, without our having to go the roundabout way to give a cure through the system generally. Sir James Simpson has, we think, very shrewdly suggested, that the principle of rapidly affecting the whole system, on the other hand, by means of the wide-extended blood surface of the lungs, may not be far off.

• If it is ever (he says), for instance, a matter of importance, in some inflammatory or other ailments, to affect the system rapidly and fully with mercury, why may not the chemist discover some gaseous and respirable form of mercurial combination, the inhalation of which should salivate in as many hours as days are now required for the induction of that effect?' His own discovery of chloroform has indeed shown us the potency of the lung form of administration, and why other medicaments may not be in the same way employed we do not

As Watt said of the application of an old invention to perform some new office, it would only be employing a knife - to cut cheese that had previously cut butter.

We cannot conclude this paper better than by alluding to the great advance made during the period we have marked out to ourselves in the treatment of Lunacy. In the last century Bedlam used to be one of the public sights to which holidaykeepers, on the payment of two-pence, were attracted, to watch the piteous objects caged and confined within their filthy dens. They went in much the same spirit as they visited the lions in the Tower, and we question whether the human creatures were not considered the more dangerous of the two. The treatment of the lunatics in Bedlam at that time was rather a favourable specimen of what was considered to be the best method of curing the mentally afflicted. It makes us shudder to read the accounts of this place in the beginning of the century. When Mr. Westerton and Mr. Calvert visited its wards in 1808, they found ten patients in the female gallery, each fastened by one leg or arm to the wall, with a chain so arranged that they were able to stand up at a bench; they were dressed each in a filthy blanket, thrown poncho-like over their otherwise naked bodies. This was, however, only an ordinary arrangement. When any



patient was looked upon as dangerous, special arrangements were made that were still more outrageous. Poor Morris, for instance, was treated more like a wild and furious beast than a human being. Esquirol was even horrified at the spectacle, and we have no reason to believe that the treatment of lunatics in France was one bit better than in England before the time of Pinel. The following is the description of the method in which they secured this helpless individual :

"A stout iron ring was riveted round his neck, from which a short chain passed to a ring, made to slide upwards and downwards on an upright massive iron bar, more than six feet high, inserted in the wall. Round his body a strong iron bar, about two inches wide, was riveted. On each side of the bar was a circular projection, which being fastened to, and enclosing each of his arms, pinioned them close to his body. Thus fixed, like a crow on a wall, this poor creature was enforced to wear out his existence of more than twenty years !'

These horrors have all been swept away by greater intelligence, greater kindness to the patient, and a more just appreciation of the physical causes of mental disease, as we had occasion to show more fully in the review of the life of Dr. Conolly published in this Journal in April 1870, to which we refer our readers. The same improvements are still going on, more especially from the removal of lunatics from the larger asylums to smaller abodes where they have the benefit of a more cheerful mode of life and better air.

I have (says Dr. Bucknell) recommended the erection of an inexpensive building, detached from but within the grounds of the present asylum, in preference to an extension of the asylum itself. My reasons for this recommendation are, that such a building will afford a useful and important change for patients for whom a change from the wards is desirable. The system of placing patients in detached buildings, resembling in their construction and arrangements an ordinary English house, has been found to afford beneficial results in the so-called cottages which this institution at present possesses. These cottages are much preferred to the wards by the patients themselves, and permission to reside in them is coveted. I am also convinced that such auxiliary buildings can be erected at a much less expense than would be incurred by the enlargement and alteration of the asylum itself. I propose that in the new building the patients shall cook and wash for themselves.'

If those who devise these vast establishments would only study human nature and the English character, they would not be surprised at these cottages being preferred to the tyranny of the big houses. Those who are harmless and hopelessly insane need not even the protection of the asylum walls. They are now very judiciously drafted back to their own unions, where, in the comparative freedom of the house,' they pass the last years of their lives happily, and at a diminished cost to the rates. Here, again, we can see a return to an old state of things, but with better safeguards to the good treatment of the patients than our forefathers insisted upon. There is a moral infection in asylum air, which depresses and injures the patient, as much as the fever infection injures the inmates of the surgical wards of the great hospitals. Isolation in both cases is the best treatment. Healthy minds surrounding the one, are as much required as pure air for the recovery of the other.

In the colony of Gheel, in Belgium, the harmless lunatics are placed in cottages, and live the life of the people--a people trained by hereditary habit to treat them properly. Here they labour in the fields, live with their hosts, play with the children, and partake of the joys and the sorrows of the household. In this village, or combination of villages, the purely medical treatment is under the control of medical inspectors. There is perfect freedom, and we question if the runaways are as numerous as from any of our large asylums. Our Commissioners are with faltering steps making advances towards this primitive state of things, which puts as few impediments as possible in the way of the recovery of the patient, and which gives the lunatic mind the surroundings and support of healthy minds—the true psychological medicine when judiciously applied.

We see with great pleasure that the Scottish Commissioners recognise the advantage of giving more freedom to the pauper patients suffering from chronic mania. When possible, they are transferred from asylums and workhouses, and sent to reside with the_labouring classes in the country villages. Kennoway, in Fife, may be said to be growing into a Scottish Gheel, as the village is becoming peopled with the incurable insane. So far from the freedom of the new life acting to their disadvantage, it has proved quite the contrary. Patients who were noisy in the asylums from which they were removed, have actually become quiet in the homes of the cottagers, and two patients, who were considered hopelessly insane, have recovered after experiencing the mentally bracing effect of a cottager's life. We trust the example will not be lost upon the English Commissioners.

But the improved treatment of the insane has been helped on in this country by a better knowledge of the disease itself

. Mind being now considered an emanation of the body taking place through the nervous system, and its derangements merely the results of nervous disease, the speciality is merged

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within the broad scope of medicine, and the intelligence of the whole profession is being gradually brought to bear

As a necessary consequence an enormous increase of experience is the result, and the unity of bodily and mental disease and their effects one upon the other demonstrated. Dr. Maudsley, in one of his thoughtful Gulstonian lectures, has written an admirable chapter on the special psychological expression of different diseases, and has shown that the inter'nal organs are plainly not the agents of their special functions * only ; but, by reason of the intimate consent in sympathy of ' function, they are essentially constituents of our mental life.' The heart, the lungs, the liver, and the reproductive organs, when diseased, have their voice, if we may so speak, in the varying emotions which they give rise to. The wonderful exaltation of hope which takes place in the consumptive patient we are all familiar with. The fear and oppression which accompanies heart disease, and the depression and envious feelings which master us when subject to derangement of the liver, have long been patent to the poet as well as to the physician. To a still larger extent sex influences character, and it is in the power of the surgeon to wholly change the tone of mind of either man or woman.

With proofs like these of the solidarity of mind and matter, we need not fear that the study of psychological medicine will in future be hampered by the subtleties and words of the metaphysician, but that it will become amenable to scientific inquiry as a purely physical disease.

But whatever may be our hopes for the future, the present and the past alike show how much mankind owes to medicine and surgery. We cannot conclude without asking what has medicine received in return from the State? In France, Germany, Russia, Italy, and Spain, honours and rewards from the nation await the men who are useful to their country. In England it is certainly most unjust that while national honours are heaped upon those who have distinguished themselves by military courage or political talent, no public recognition beyond a baronetcy is given to men who have been preeminently benefactors to humanity. A tardy and insufficient tribute has, it is true, been paid to the discoverer of vaccination ; but there live at this moment men in the profession of medicine who have done as much to deserve public gratitude as did Dr. Jenner. There are great men who have robbed operative surgery of half its horrors by abolishing its pain, and there are those who have manfully overcome every, opposition which prejudice threw in their way, and have trium

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