proceeding which regulates itself rather by the etiology of particular maladies, than by present symptoms in themselves considered, will be regarded as the best practice; a proceeding which determines the indications of treatment by the genesis of disease, rather than by the physical changes discoverable in structure. Now let us contrast the ailments which have their starting point, so far as we can judge, in the nervous centres, from causes directly acting upon their functions, with those wherein the primary disturbance is for the most part in the vascular system, in consequence of agencies operating more immediately thereupon. I conceive that, by doing so, we may obtain at least some limited guidance in discrimination of the instances of disease which tolerate sedatives, from those in which their extensive use may be prejudicial, and possibly fatal.

In

If a parturient woman of strong constitution, and in previously good health, become pulseless and apparently moribund from the sudden occurrence of uterine hæmorrhage, the admirable effects of laudanum in extraordinarily large doses are very demonstrable, and well known to those who are much engaged in obstetric practice. In these cases, the remedy seems to stimulate and uphold the nervous systemthus keeping the patient alive-until the vessels can accomodate themselves to their reduced contents, and until by alcoholic aids and dietetic agencies more permanent results can be accomplished, and compensation be obtained for the loss which the blood-vessels themselves have sustained. such instances as these, it is assumed that we have an abundant source of nervous energy to draw upon, and that this vital attribute vigorously reacts, when the peculiar influence of opium is exerted upon it. Again, in delirium tremens, a large proportion of cases originate in lesion of the blood-the nervous centres becoming affected but secondarily. Undoubtedly, there is an asthenic state of the brain in these instances; but it is one apparently that is attributable to a certain toxic condition of the blood, rather than to primary exhaustion of proper cerebral vitality. Under such circumstances the somniferous effects of opium, whilst invigorating function, appear to antagonise the prejudicial action of the alcoholic poison, and at the same time to facilitate an elimination of the toxic material itself. But, even in delirium tremens, there are numerous examples of opium producing very injurious effects; and I have myself seen one instance in which the sleep provoked went on to death; and I consider that this result may be regarded as not only

possible, but probable, in cases wherein the nervous force is already so used up by antecedent circumstances, as to make all re-action impossible, and to be itself destroyed entirely, if once overpowered by narcotic agency. The superinduction by opium of sleep in typhoid fevers of an adynamic type, is suggestive of similar considerations, and in practice would probably demand the same qualifications. When nervous exhaustion is not direct and quasi-independent, but has its phenomena determined rather by perverted blood, the beneficial action of the medicine will most likely follow the rule which obtains in delirium tremens.

Thus, then, it has occurred to myself that, in the employment of opium in the treatment of insanity, regard should be had to the presumable degree of residual nervous tone, whenever there is question of artificially inducing sleep; and that, in forming a judgment upon this point, prominent consideration should be given to the antecedent eircumstances originating any particular malady-to its genesis. In the fatal cases recorded in this paper, there had been melancholic depression for some months prior to the maniacal outbreak; and, as is customary in such instances, there had also been a feeble condition of the digestive organs. Deficiency of food and defective sleep had in this manner, in addition to lowness of spirits, been directly and immediately exhausting nervous vigour-nullifying, indeed, its conservative agency. The circulation was feeble, but did not otherwise indicate anything abnormal. And thus we have seen that, when the cerebral and nervous power was fairly brought under by the administration of opium, fatal collapse very soon ensued. On reverting in memory to cases in which the results of employing this medicine have been different, I think that in such instances there were grounds for inferring the existence of much residual energy in the brain and nervous system, although temporarily perverted so as to prevent sleep. Of course, it will be remembered from my earlier remarks, that I am not now referring to the mild, soothing influence of small doses of opium, but to the severer, the sleep-compelling action of this remedy.

I am somewhat in doubt as to whether, by this reasoning, I shall have made myself quite understood. Anything that so much as resembles speculation, is now so unpopular with medical men, that discussions of this nature are very generally passed over, or if any way attended to, are rapidly dismissed from mind, as misty, obscure, and unpractical. But it should be recollected that speculation gives form and con

sistency to thought, and that thought must always guide practice; and that, in medicine more particularly, the required thought cannot always rest upon phenomena patent to the senses. In this view of things, I should like to see a better philosophy pervade our profession; and I have no hesitation myself, in giving utterance to a certain measure of speculation; for, indeed, does not this mental process stimulate inquiry and guide investigation? And is it not sometimes inevitably applied in the practical exercise of our art? Why, therefore, as a profession, should we affect to disregard or undervalue it?

But, after all, is not this neglect of even rational speculation on the part of so many members of our body, one of the causes why psychological medicine is so unreasonably overlooked? why, in fact, it obtains no sort of recognition, either in medical examinations or in the curricula of medical education? Has not the modern rage for accumulating mere sensible facts, held together by no sort of logical connection, and an almost exclusive attention to the minutest circumstances of physical diagnosis, somewhat prejudiced the professional mind, and thus rendered it less competent to grasp many of those larger questions which concern ourselves probably more than any other class of the community? Certain it is that when we would elevate ourselves above and beyond the technicalities of our science and art, and when we are brought for some practical purpose to the enunciation of our philosophical views coram judice, the acuteness and comprehensiveness of our mental powers do not usually exhibit to any remarkable advantage. How much of our deficiencies in these respects comes from professional dislike of speculation?

[The following Paper is published unwillingly by us, on account of the reflections it contains upon a gentleman whom we greatly respect. We declined to publish it in the last number; but the author having claimed its publication as a right, and having invited us to append unto it any observations in way of protest or disclaimer which we might think proper, under these circumstances, and looking to the position of Dr. Huxley, and also to the fact that the article is a public document, upon which the Visitors of the Kent Asylum have acted, we have not thought fit to incur the responsi

bility of refusing its admission into the pages of the Journal of an Association of which its author is a distinguished member. The subject-matter of the paper, however disagreeable, is one of great importance; and although individually we do not concur in Dr. Huxley's views respecting night watching and the prevention of dirty habits, we are glad on all occasions to ventilate the observations and opinions of a practical and experienced mind. It is to the tone of the paper alone, as it affects Mr. Gaskell, that we feel bound to enter an editorial protest. Mr. Gaskell's opinions ought, at least, to receive the high degree of respect due to them, as emanating from one of the most experienced and practically successful of asylum superintendents. This ought never to be forgotten, even when the value of these opinions suffers deterioration by being averaged with that of other Commissioners, who know nothing practically respecting the management of asylums, or the treatment of the insane. Mr. Gaskell at least, is no carpet knight in the ranks of psychology. He has spent a lifetime in earnest, humane, and successful efforts to alleviate the condition of the insane, and any recommendations emanating from him cannot be other than the contrary of cruel or reckless. On these personal grounds, we feel that the remarks which affect Mr. Gaskell in the following paper are not warranted; and we greatly regret that their publication has been imposed upon us.--ED.]

THE KENT ASYLUM, MAY, 1857.

Report of the Superintendent to the Committee of Visitors, on the Plan of getting-out Patients at Night to keep them from soiling their Beds.

At the interview between the Visitors and two of the Commissioners in Lunacy, on the 27th March last, Mr. Gaskell, one of those Commissioners, represented the prevention of dirty habits as an easy thing, and one dependent for success on the possession of what is called a special night attendance.

He detailed a case in point, to the following effect :-Suppose the case of a dirty patient: the night attendant, in course of experience, becomes acquainted with the hour of the night when it is usual for the evacuation to take place-say, for instance, 12 o'clock-then by going just before that hour, and getting the patient out, the attendant saves the soiling of the bed. In so doing he spoke unfairly by the whole question, because this expedient can be but partially applicable, and is even then of uncertain success.

I addressed him privately, in consequence, putting two questions. The first is contained in the following quotation

from my letter: "This case wherein the periodicity of the foul habit comes to be known, and of which, therefore, it is possible to take advantage, is an exceptional one. Individually, it is perfectly true, and is, I suppose, within every one's experience; but as it is exceptional in itself, do you think it was right to use it for an illustration to persons not able to judge of its real value by their own experience? The statement of the existence of so easy a means of counteracting the great evil in asylums of dirty habits, must be perfectly captivating to any one who, not having personal knowledge, may thus be led to conclude, that a very simple thing is all that needs to be done to remove that strong characteristic of perverted instinct, the dirty habits of many of the insane."

The second question is contained in the following extract: "You would not, I think, say that the objectionable habits of epileptics and of paralytics, both of which classes are often unconscious of the passage of the evacuations, are of the sort to be anticipated like your case in point. Epileptics are wet during the fit, and paralytics are frequently evacuating a little at a time, imperfectly and often. Nor would you say, I also think, that those patients who seem to delight in their foulness, first passing their evacuations anywhere, and then smearing their bedding, clothing, persons, and rooms therewith that such are amenable to the simple preventive you have named? How large a proportion of all the dirty cases in an asylum exists in the three classes I have mentioned, not to speak of the sick and the feeble from age!"

In replying, Mr. Gaskell told me I was under a misconception, and did not answer the questions. I wrote again, repeating them. He replied still without answering, or even referring to them; and they remain unanswered by him. Mr. Gaskell was Superintendent of the Lancaster Asylum. It was in that institution, I believe, that he first devised his turning-out plan. I have obtained a copy of the night attendant's report of that asylum, for the nights of Feb. 3 and 4, 1856. It represents, for the male side only, 45 patients to have been got up in the course of the former night, 4 times each, namely at 8, at 10, at 2, and at 4 o'clock; 45 multiplied by 4 gives 180; 180 times, at (say only) 4 minutes a time, would amount to 12 hours. On the second night, 43, instead of 45, were got up, requiring, at the same rate, 11 hours.

Is this possible by one night attendant, except the dirty cases were placed together in the dormitories, the patients being also able-bodied, so as to turn out simultaneously when awakened and told to do so? On the 27th of April last, I