while in the union house he had been provided with all he wanted for 2s.? As the enquiry was frequently repeated, we thought it worth while to enquire into the state of the idiot when in the union-house, and we found that he was in the constant habit not only of tearing his own clothing, but every article of clothing upon which he could lay his hands; so that in fact the actual cost of this idiot was greatly more when he was in the union-house than it was afterwards, because, when under the attendance provided in the asylum, his destructive propensities were converted into coir and oakum picking. We may conclude, that if the average cost of the adult inmates of the union workhouse is 5s. per week, the actual cost of any insane inmates will not be less than 8s. per week in the same place.

In regarding the question from this point of view, it must not be forgotten that the maintenance charges for the inmates of pauper asylums, are founded upon the average cost of large numbers, including many who are quiet and harmless, and many whose industrial earnings would form no small setoff to the cost of their actual maintenance. The average includes on the other hand, the violent and acute cases of insanity, and the sick and helpless, whose extra attendance, diet and necessaries, entail an expenditure greatly beyond the sum charged for their maintenance. The Bolton guardians refer to the system adopted at Bethlem, where recent cases only are kept under treatment; but they are probably not aware that the actual cost of the treatment of a patient at Bethlem, is more than twice as much as that charged for the maintenance of a patient in the Lancashire asylums. If the harmless and chronic inmates were excluded from the Lancashire asylums, the rate-payers whose interests are misrepresented by these guardians, would be called upon to pay twice as much as at present, for the care and treatment of the insane poor in these asylums. The fact is, that the proper care and treatment of acute insanity is unavoidably costly, that the proper care and treatment of chronic insanity is much less so, but still far beyond that of the mere maintenance of a sane person; that owing to the large numbers over whom expenses are distributed, and to the economy of good management, the actual cost of a chronic lunatic properly cared for, and supplied with a good dietary, in a county asylum, is not greater than that of a chronic lunatic, supplied with a coarse and scanty dietary, and detained in neglect and wretchedness as the inmate of a union workhouse. If the chronic insane are to be provided with proper care and treatment, their main

tenance in small and scattered asylums, attached to union workhouses, will necessarily be greater than that for which it can be effected, under the more complete organization of a central establishment.

We must yet refer to one opinion which has been positively advanced by some guardians in Lancashire, namely, that the pauper insane do not require a better dietary than that meagre subsistence which the laws of the country give to every destitute person as a right. They say that the workhouse dietary is quite good enough for chronic and harmless lunatics. We agree with them that it is good enough, if the object is to punish insanity with death, and to disembarrass themselves of the burden of the insane poor by the effectual means of an immensely increased mortality.

The insane cannot live on a low diet, and while they continue to exist their lives are rendered wretched by it, owing to the irritability which accompanies mental disease. The assimilating functions in chronic insanity are sluggish and imperfect, and a dietary upon which sane people would retain good health becomes in them the fruitful source of dysentery and other forms of fatal disease. Pinel has left an instructive lesson upon the fatal results of the parsimony which existed in the Bicêtre in the year four. The diet in the Bicêtre, under the Constituent Assembly, was fixed at a kilogramme of bread daily. In the fourth year of the Republic, it was reduced to seven hectogrammes and a half. "And," says Pinel, "I have seen many convalescent patients relapse into a state of fury, crying that they were dying of hunger. The sad progress of misery was still more marked in its subsequent effects. In two months the number of deaths in the asylum was twenty-nine; while in the whole year two, it was only twenty-seven. In the Salpetrière, the consequences were still more deplorable; a mortality of fifty-six having occurred in that hospital in the winter of the year four, from dysentery, brought on by insufficient diet."

In Dr. Thurnam's work on the statistics of the insane, page 95, is the following valuable testimony as to the effects of diet upon the insane:

"The seven asylums may be fairly divided into two groups, in one of which the diet is, or was at the time to which the table refers, considerably above, and in the other considerably below, the average diet of the county asylums as a class. The first group includes the three establishments for the counties of Nottingham, Stafford and Gloucester; the second, those of Lancaster, (this together with

Hanwell, has been materially improved) the West Riding of York, Suffolk, and Middlesex. The difference in the amount of the diet in the two groups, is in the first group, as regards solid food, the diet was 50 per cent. better than that in the second. In the relative amount of solid food, considered separately, the difference amounted to 130 per cent. In the three asylums with the more liberal diet, we find that the recoveries averaged 43.7 per cent., and that the mean mortality was 9.35 per cent.; whilst in the four institutions, in which the diet was less liberal and nutritious, the recoveries only averaged 36.75 per cent., and the mean mortality was as high as 14.54 per cent."

A more recent example is afforded in the Thirty-ninth Report of the Stafford Lunatic Asylum, just published. The Commissioners in Lunacy, who visited this asylum last year, report that an epidemic of the mucus membrane of the bowels had prevailed, which had proved fatal in twelve cases. They attributed much of this illness to the low state of the health of the inmates, and the poor and insipid soup which formed the dietary on three days of the week. They recommended meat to be subtituted for this broth. In the report of the Visitors, signed by their Chairman, the Earl of Talbot, it is stated: "Acting upon the recommendation of the Commissioners in Lunacy, and well aware of the exhausting nature of insanity, we have increased the dietary scale; and the amount of animal food now supplied weekly, namely, thirty ounces of meat cooked, and free from bone, has proved of service in maintaining the health of the patients."

We must conclude by expressing our opinion, that much of the present dissatisfaction which exists in Lancashire, Middlesex, and elsewhere, has arisen from the dilatory and partial manner in which the justices have discharged the duties imposed upon them by the Legislature. It was their clear duty to provide asylum accommodation for all the insane poor chargeable to parishes in the county who needed care and treatment. This they have not done, and in default of asylum accommodation, the guardians of the poor have been compelled to establish workhouse lunatic wards.

In the county from which we write, no insane pauper brought to the doors, with the legal papers for admission, has been refused admission since the asylum was opened, thirteen years ago. The consequence has been, that there is not a workhouse lunatic ward in the county; and even the workhouse wards belonging to boroughs not contributing to the county rate, have one by one been absorbed into the county asylum; and we are happy to give the guardians in this

county, generally, the credit of possessing wise and humane views with regard to the care and treatment of the chronic insane, which we should be glad to see in the guardians of of the poor in more wealthy and populous counties.

In the county of Lancashire, a special committee of fourteen Justices of the Peace has been appointed to report to the Quarter Sessions on the most feasible manner of suppyling the increase of asylum accommodation, which is so urgently needed in that county. They have unanimously recommended that the sum of £12,000 shall be expended in enlargement of the Rainhill Asylum, near Liverpool, by the addition of detatched buildings after the manner adopted in the Devon Asylum, and described in the first article of this number. These buildings with additional single rooms to the main building, and some increase of accomodation in the asylum offices, are estimated at the moderate sum of £12,000 for 256 patients. It is the expenditure of this sum which has excited the ire of the Guardians of Bolton. We cannot believe that the Justices of Lancashire will permit any delay in carrying out the recommendation of their committee. At the present time there are 150 pauper lunatics chargeable to the parishes in Lancashire, in the private asylum at Haydock Lodge, at which the charge for their maintenance is 13s a week; the charge at the Rainhill County Asylum being 8s 9d a week. There are 900 lunatics and idiots confined in the union workhouses in Lancashire, many of whom are known to be most improper objects of such places of detention, and urgently in need of the care and treatment of an asylum. It appears most desirable that these pauper lunatics out of asylums should be placed under the immediate inspection of the Magistracy, and that legislative powers, should, without delay, be given to the Justices of the Peace, extending their powers over all the pauper insane whether in asylum or not. It is only by placing all the pauper insane under one authority, and that authority the most responsible and trustworthy, that the care and treatment provided in the county asylums can be extended to all proper objects, and that the best arrangements can be made for tranquil and unimproveable cases for whom the safeguards and appliances of an asylum are not indispensable.

J. C. B.

BIBLIOGRAPHICAL NOTICES.

The Circulation of the Blood. By G. ROBINSON, M.D., Physician to the Bensham Asylum, Gateshead, &c., &c., 8vo. (pp. 273.) Longmans.

A very able treatise on the physiology and pathology of the blood, and the nature and treatment of inflammation. Dr. Robinson has long been a careful and original investigator of the phenomena of inflammation, and of vascular action; and his present work is a valuable contribution to physiological science. We regret that the press of other matter has prevented a purpose of pillage we had formed on his valuable pages, in transferring his short but important chapter on "The Peculiarities of the Cerebral Circulation, and their connection with the Phenomena of Epilepsy and Apoplexy." He throws out the important suggestion that a contracted state of the foramen lacerum posterius may render the brain liable to these diseases. His statement of the grounds of discussion between Dr. Burrows and the Edinburgh pathologists, on the physical conditions of the cerebral circulation, is exceedingly well given, and his decision on this moot question the most judicious with which we are acquainted.

The Medical and Legal Relations of Madness, shewing a Cellular Theory of Mind, and of the Nerve, Force, and also of the Vegetable Vital Force. By JOSHUA Burgess, M.D., 8vo. (pp. 283.) Churchill.

It is delightful to see the physiological theory of mind, gaining ground day by day, even in this age of spirit-rapping madness. "It is," the author says "opposed to the dilettantism and spiritualism prevalent, masculine and hopeful, opposed to an effete reliance, upon chance, nature, and expectation. Dr. Burgess's best chapter is on "The Legal View of Insanity;" it displays considerable knowledge of his subject, and is written carefully and agreeably. At page 96, the author gives from his personal knowledge, an account of a most interesting case, that of the Rev. W. Brooke, the curate and friend of Dr. Parr, who shot his servant maid at Warwick, in 1812, under the delusion that she was stealing papers from his writing desk. In his ravings he strongly reminded the