enema apparatus. It is now commonly seen in the shops of dealers in articles of gutta percha. I think it must eventually supersede all other means of injecting fluid in medical or surgical practice.

The administration of food having been once effected by this means, and the patient having seen the contents of a bason of soup vanish, as if by magic, into his stomach, it will seldom be necessary to repeat the process. I have found it of great importance, especially in hysterical cases, to treat the operation as one of no consequence, and as not entailing any great trouble on myself. I think it very advisable in many cases to add, in the presence of the patient, some remedial agents, such as wine, or quinine, or even purgatives, to the soup or other fluid I am about to injeet, so as to mark the distinction between food forcibly injected, and food taken voluntarily. Patients should not be encouraged to like artificial alimentation, as in some cases they certainly do; and I so far agree with M. Briérre de Boismont in the opinion, that feeding our patients should not be our only object, but that we should also attempt to overcome the force of the delusion which prompts the refusal of food; to treat, in fact, the cause and not the symptom. These remarks are intended to apply to recent cases, and to specific delusions more particularly.

The question, as to the quantity of food to be injected at a time, must be decided by our knowledge of the individual case, and the rules as to diet which guide the physician. As a general rule, small quantities are best. Dr. Seymour says, a few ounces only at a time; but where there is violent resistance, it is better to give as large a quantity as the stomach will bear, in order to obviate the necessity of feeding soon again, with recurrent struggles and consequent exhaustion. In ordinary cases, however, the resistance is not prolonged beyond the second or third time, if the operation has been done with activity and apparent ease. I must not omit to mention one important hint, in cases of prostration with excitement, such as is seen in phthisical mania,-food or medicine may be given at once, by pouring it from a spoon down the nostril. Such a case was recently so treated by my friend, Dr. Sibson, with great benefit to the patient.

It has been suggested, in cases where forced alimentation is necessary, that chloroform should be given as a means of diminishing resistance. I have not myself had any experience of this plan. In a case, where there was great terror

at the idea of instrumental feeding, conjoined with refusal of food, the inhalation of the vapour to a point short of insensibility would be very advisable, but then it must be with the patient's own consent. I should think it quite unjustifiable to resort to chloroform to overcome a difficulty that can be surmounted in any other way. There are many cases where chloroform would be highly dangerous. I should only venture to give it against the will of the patient in cases where life was in peril; or where, after mature deliberation, it was thought likely to have a permanent good effect on the mental symptoms. It is obvious, that if force must be used, it would be as easy, and far less dangerous, to pass the tube down the nostril, as to compel the inhalation of the vapour of chloroform.

The employment of nutrient enemata, by which life can certainly for some time be prolonged, is not often necessary in the treatment of the insane. As in the administration of chloroform, force must be used, and the injection of food into the stomach may as well be at once effected. There are many patients who would rather submit to the stomach-pump than the enema apparatus.

I have used injections 'of beef-tea, with good effect, in cases where there was great exhaustion, before resorting to the stomach-pump. By this means the patient has gained strength enough to make the struggle attendant on forced feeding, less dangerous. Injections of this kind would also be indispensable where there was disease of the alimentary canal, preventing the passage of the catheter; and in such a case as that mentioned by Dr. Winslow, where there was stricture of the pylorus, life may be preserved for some weeks under their use; but the question of their employment is rather in the province of the general physician, and does not come altogether within the scope of my present subject.

I have to return my thanks to the President and to the Members of the Association, for the kindness and attention with which they have listened to my remarks. I feel that much which I have said, must be very trite and familiar to many now present; but they have remembered, that I undertook to answer those who are opposed to the forcible administration of food, and that one of their strongest arguments is, that compulsory feeding is generally painful and often dangerous. I hope that I have shown that it need not be so, though I have been forced to admit, that this mode of feeding is not altogether free from objection.

I need not make any further apology for the length at which I have treated this apparently trivial subject. I know that by my present audience, no point of treatment conducive to the advantage of those entrusted to their charge is considered unimportant, and that they will freely pardon my dwelling with detail on this frequent symptom. I trust they will believe that my object has been not so much to describe my own practice as to elicit their views, and place on record their opinions.

An account of a visit to the Asylum for the Insane, on the Isola di S. Servolo, Venice: by C. LOCKHART ROBERTSON, F.R.C.P., Edin.; M.B., Cantab., &c., &c., &c.

Before proceeding to give a slight description of a most interesting visit which I paid last September to the Asylum for the Insane, on the Isola di S. Servolo, Venice, conducted by the Padri Ospitalieri di san Giovanni di Dio, I am tempted to extract, from Dickens' Pictures from Italy, an account of his arrival by night at Venice, as it so prettily tells the story of my first impressions there, as leaving the railway station I embarked on board one of the black gondolas, just as the bright harvest moon rose in all its glory on the broad waters of the Grand Canal.

"Before, (says Mr. Dickens) I knew by what or how, I found that we were gliding up a street-a phantom street; the houses rising on both sides from the water, and the black boat gliding on beneath their windows. Lights were shining from some of these casements, plumbing the depth of the black stream with their reflected rays: but all was profoundly silent. So we advanced into this ghostly city, continuing to hold our course thro' narrow streets and lanes all filled and flowing with water. Some of the curves, where our way branched off, were so acute and narrow that it seemed impossible for the long slender boat to turn them;

but the rowers, with a low melodious cry of warning, sent it skimming on without a pause. Sometimes the rowers of another black boat like our own echoed the cry; and, slackening their speed (as I thought we did ours), would come fitting past us like a dark shadow. Other boats, of the same sombre hue, were lying moored I thought to painted pillars, near to dark mysterious doors, that opened straight upon the water. Some of these were empty; in some the rowers lay asleep; towards one I saw some figures coming down a gloomy archway, from the interior of a palace, gaily dressed, and attended by torch-bearers. It was but a glimpse I had of them; for a bridge so low and close upon the boat that it seemed ready to fall down and crush us : one of the many bridges that perplexed the dream: blotted them out instantly. On we went, floating towards the heart of this strange place, with water all about us, where never water was elsewhere; clusters of houses, churches, heaps of stately buildings, growing out of it; and everywhere the same extraordinary silence. Presently we shot across a broad and open stream; and passing, as I thought, before a spacious paved quay, where the bright lamps with which it was illuminated, showed long rows of arches and pillars of ponderous construction and great strength, but as light to the eye as garlands of hoar frost or gossamer, and where, for the first time, I saw people walking,-arrived at a flight of steps leading from the water to a large mansion, where, having passed through corridors and galleries innumerable, I lay down to rest; listening to the black boats stealing up and down below the window on the rippling water, 'till I fell asleep." And thus, as Goëthe wrote seventy years ago, could I also say-" So ist denn auch, Gott sei Dank, Venedig mir kein blosses Wort mehr, kein hohler Name."*

'

As a rider to the novelist's picture, which no one who has seen Venice will not admit the perfect truthfulness of, I would just add, before passing on to the subject of this paper, the following poetic page, from the "Stones of Venice" a glorious book, worthy of the Queen of the Adriatic whose story it tells:

"When (says Mr. Ruskin) its walls were reached, and the outmost of its untrodden streets was entered, not through towered gate or guarded rampart, but as a deep inlet between two rocks of coral in the Indian sea; when first upon the traveller's sight opened the long ranges of columned palaces, each with its black boat moored at the portal; each with its *Italiänische Reise. Venedig den 28 September, 1786,

image cast down beneath its feet, upon that green pavement which every breeze broke into new fantasies of rich tessellation; when first, at the extremity of the bright vista, the shadowy Rialto threw its colossal curve slowly forth from behind the palace of the Camerlinghi; that strange curve, so delicate, so adamantine, strong as a mountain cavern, graceful as a bow just bent; when first, before its moonlike eircumference was all risen, the gondolier's cry, "Ah! Stali," struck sharp upon the ear, and the prow turned aside under the mighty cornices that half met over the narrow canal, where the plash of the water followed close and loud, ringing along the marble by the boat's side; and when at last that boat darted forth upon the breadth of silver sea, across which the front of the Ducal palace, flushed with its sanguine veins, looks to the snowy dome of Our Lady of Salvation, it was no marvel that the mind should be so deeply entranced by the visionary charm of a scene so beautiful, so strange, as to forget the darker truths of its history and its being. Well might it seem that such a city had owed her existence rather to the rod of the enchanter than the fear of the fugitive, that the waters which had encircled her had been chosen for the mirror of her state, rather than the shelter of her nakedness, and that all which in nature was wild or merciless-time and decay, as well as the waves and tempests-had been won adorn her instead of to destroy, and might still spare, for ages to come, that beauty which seemed to have fixed for its throne the sands of the hour-glass as well as of the sea.'

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But 1 must pass on from the glories of the Queen of the Adriatic, which are far above my powers to write of, to my humbler purpose-an account of my visit to the Venetian Asylum for the Insane. I learnt of its existence from my obliging Host of the Hotel Victoria. So one sunny September morning I rowed in my gondola to the Austrian Police* office to obtain an order of admission, and was most courteously informed that my profession would, on landing at the island, entitle me to every attention. Accordingly, I crossed under the bridge of sighs, passed the front of the

I would here bear testimony to the admirable manner in which throughout the Lombardo-Venetian kingdom the Police department is conducted. No towns in any part of Germany have an appearance of more quiet, orderly government than Milan or Venice, under the Austrian rule; none in which the masses of the people appear more happy and contented. I passed through many of the back streets and alleys of Venice late at night-was by moonlight on the canals till midnight-and I never even saw the slightest scene of disorder or riot, and this amid the most debased people in Europe.