thought it extraordinary food, and hence they imgained that an attempt was being made to poison them. He thought that all practitioners should be very cautious how they meddled with such a system, which tended to create obstacles to the recovery of the patients. Dr. SANKEY: As to the administration of food artificially, it might be morally effected by having a large apparatus at hand, without using it; but the more simple the instrument the better. He had had a case where he had recourse to forcing the food. The patient continued in that case for three months with great resolution to refuse food. At last it was found that the application of two spoons was the most effective mode of proceeding-better than any amount of persuasion. One spoon was forced into the mouth to keep it open, and to keep down the tongue. The appearance of a large stomach pump, with its brass fittings, had an effect. The introduction of a tube into the nose might sometimes act well; but two spoons, he was of opinion, were often the best instruments. Dr. SHERLOCK said in chronic cases it would suit very well. Dr. SANKEY: If there was a struggle, a gag must be placed in the mouth, and a simple spoon used. He should prefer a wooden one. Dr. WOOD: He presumed that it would take a long time to convey a sufficient quantity of food into the system by the mode now suggested. Dr. SANKEY replied that he would undertake to administer a pint of beef-tea in a quarter of an hour or less. On the motion of Dr. BUCKNILL, seconded by Dr. CAMPBELL, a vote of thanks to Dr. Tuke for his excellent paper was carried by acclamation. The PRESIDENT informed the members that Messrs. Tyerman and Marshall, the Superintendents of the Middlesex Asylum at Colney Hatch, had a communication to make to the Association. Mr. TYERMAN then said that the Committee of Visitors of the asylum at Colney Hatch, had requested him and his colleague to communicate to the Association an invitation to visit and inspect that asylum on the morrow. A convenient train would start from King's Cross at 12.25; and after their inspection, luncheon would be prepared for the members in the board room. The PRESIDENT said that the Association felt greatly obliged by this courteous invitation, and he did not doubt that many of the members would avail themselves of it. Dr. Wood observed that they had had a large and long meeting, and much trouble had been entailed on their respected President, to whom, on behalf of the meeting, he begged to tender their best thanks. The proposition was carried by acclamation. The PRESIDENT replied: He accepted the compliment which had been paid him. It was with satisfaction to himself, pride, and pleasure, that he had had to preside over so large and influential a body of gentlemen connected with the treatment of the insane. Dr. ROBERTSON, on the part of the Committee, gave notice that they would, at the next annual meeting, propose certain alterations in Rule II., and also in the designation of the Association. The meeting then adjourned. In the evening, the members dined together in the hotel, and were joined by Dr. Copland, and Mr. Gaskell, one of the Commissioners in Lunacy, [an honorary member.] The arrangements of the hotel, the dinner, wines, &c., gave the utmost satisfaction. THE PRESIDENT'S CONVERSAZIONE. On the evening of the 1st July, the President (Dr. Forbes Winslow,) received the members of the Association at a brilliant conversazione, at his residence, in Cavendish Square, which was attended by 400 persons, including the leading members of both branches of the profession in London. The Pathology of Insanity, by JOHN CHARLES BUCKNILL, M.D. (Continued from Page 334, Vol. III.) It has been unfortunate for the cause of cerebral pathology, that those writers who have devoted much care and attention to the observation of cerebral changes presented in post-mortem examinations, have either lacked the desire or the opportunity to make themselves acquainted with the mental phenomena which had preceded death. The careful and minute detail of appearances observed in the brains of persons supposed to have died insane, disconnected from any account of the symptoms which existed during life, are of comparatively little value in the present imperfect state of pathological science. A few fossil teeth and bones enable Professor Owen to reconstruct the probable similitude of an extinct animal; bnt the science of pathological anatomy has attained far less certitude than that of comparative anatomy; and even the able descriptions of the post-mortem examinations made in Bethlem by Dr. Webster, have their practical value diminished from the want of some account of the symptoms which in each case preceded death. The descriptions of the older anatomists, Morgagni, Bonetus, and others, have the same defect; a defect, indeed, of which Morgagni was fully sensible, and of which he offers an explanation, or rather an excuse, in the fact that the medical men who had observed the cases during life frequently did not know whether to call the patients melancholics or maniacs; and that, indeed, "melancholia is so nearly allied to mania that the diseases frequently alternate, and pass into one another, so that you frequently see physicians in doubt whether they should call a patient a melancholic or a maniac, taciturnity and fear alternating with audacity in the same patient; on which account, when I have asked under what kind of delirium the insane people have laboured whose heads I was about to dissect, I have had the more patience in receiving answers which were frequently ambiguous, and sometimes antagonistie to each other, yet which were, perhaps, true in the long course of the insanity." (De Sedibus et Causis Morborum, Epist. VIII.) Of the thirteen examinations recorded, Morgagni himself made eleven; his pupils made one; and the other one was made by Valsalva. The appearances noted by them in this small number of dissections, include a large part of the morbid appearances which extended observation, and the advantages derived by later anatomists from the instructions of those preceding them, have been able to distinguish. In one or other of the cases, the dura-mater was found thickened and adherent to the cranium-the vessels of the meninges distended with dark blood; serum was found between the meshes of the pia-mater, sometimes in large quantity; there were also air bubbles in the vessels of the pia-mater; the consistence of the brain altered, sometimes soft, sometimes more or less hard; discoloration of the medullary substance, from distension of its blood-vessels; serum in the ventricles, sometimes clear, sometimes turbid; the choroid plexus sometimes injected, in others containing cysts; the vessels of the brain sometimes distended with black and fluid blood; in one instance the coats of the arteries were unusually firm (query Of the thirteen insane persons dissected by Morgagni, it is remarkable that no less than four came to an untimely end. One threw himself out of a window in the night, and was killed. One was tied by the throat by his keeper so that he was strangled. One was starved to death during severe weather; and one, after recovery from insanity, died from inflammation of the intestines, occasioned by a finishing dose of black hellebore. Morgagni concluded that the cause of insanity existed in many cases in the morbid changes of the pineal gland, and We are in many others in an induration of the brain. informed, that in his examinations he was in the habit of removing the head from the trunk, for the sake of conThis indicates venience, before he examined the brain. forcibly the difference between the accuracy and delicacy of the examinations made by the greatest of the old pathologists and those of the present day. An examination conducted after this fashion would be little likely to offer evidence of moderate serous effusions, or the less obvious conditions of hyperæmia. The pathological records of insanity made by other anatomists of the last century are still less marked by exact observation than those of Morgagni, and are, perhaps, more interesting to the medical antiquary than to the modern pathologist. A brief reference to them may, however, be instructive, as shewing that the changes which still most readily catch the attention of observers were noted. Bonetus observed hypertrophy of the brain; obliteration of the sutures; the dura-mater adherent to the cranium and turgid with blood; the pia-mater turgid with blood, and not insinuated between the convolutions; water in the ventricles and other parts of the brain, in large quantity; the substance of the brain marked with a black spot, and sometimes with an infinite number of bloody spots, especially on pressing it-in one case, dry, hard, and friable. Boerhaave mentions, that the brain of maniacs has been found dry, hard, and friable, and of a yellow color. Haller classified the observations made by others upon the brains of insane and phrenitic persons, and concludes thus: "From these few observations, for which we are chiefly indebted to Morgagni, but little certainly can be derived; since it not only frequently happens that we can discover no disorder in the bodies of maniacs, or even of such as have been totally insensible; but where we do, we are as far from being able to perceive a uniform connection between any one disorder of the mind and some corresponding preternatural state of the contents of the skull, that the very same appearances are exhibited after those most opposite disorders, idiotism and phrenzy; which last seeming inconsistency may possibly appear less extraordinary if we consider the symptoms of drunkenness and phrenzy, in which we may observe that the very same cause produces at first delirium, and afterwards, as the disorder advances, drowsiness and insensible stupor. This, however, seems evident, that in the disorders of the mind the brain and its connections are usually affected; and when, in some rare instances, we can discover no disease of these parts, we may conclude, either that it is seated in their very elementary particles, or has not been sought for with sufficient patience and attention. (Elements of Physiology.) Greding, in 216 cases, found the skull unusually thick in 167 cases; the dura-mater adherent to the cranium in 107 cases; the pia-mater thickened and opaque in 86 out of 100 cases of mania; and beset with small spongy bodies in 92 out of 100 cases. He observed effusions of serum between the dura and pia-mater in 120 out of 216 cases of insanity, and in 58 out of 100 maniacal cases; the lateral ventricles were distended in 52 cases. The choroid plexus was found healthy in only 16 out of 216 cases of insanity; and it was thickened and full of hydatids in 96 out of 100 maniacs. These records will convey strongly the impression, that however exact the observations of this pathologist might have been, he did not interpret the morbid appearances as we are accustomed to do at the present day. Effusions of serum between the dura-mater and the pia-mater, and diseased conditions of the choroid plexus, are certainly not so common as he represents them. Meckel remarked the increased density of the cerebral substance in the bodies of the insane. Sæmmering and Arnold confirmed this observation; and the latter expressed his conviction that insanity was occa |