now," said he. He laughed derisively when I assured him there was no danger, and that I was determined, by cutting, or by whatever necessary measures might be called for, to thwart his intentions. He speedily recovered from the effects of the laceration; but, for several months, great caution in the arrangements of his dress, his bed-room and furniture, were necessary. The characteristic gloom and despondency gradually gave place to a desire for mental occupation; and his wishes to be supplied with Greek books were complied with. His physical health is now (Feb., 1858) good; and much intelligence, with amiability of disposition, are not unfrequently evinced, although his language is more generally of absurd import, and is characteristic of an irritable, and even pugnacious tendency.

In simple wounds of the trachea, not involving the carotid or its principal branches, the difficulty of treatment is usually not great, nor do I remember any fatal instance.

Eliza R., aged 67, was admitted into the Cornwall County Asylum in Nov., 1850, with an extensive wound, inflicted the previous day, across the throat, involving and laying open the trachea. The ability to articulate was nearly lost, but she hoarsely whispered that "the devil was urging her to destroy herself." She was pallid from hemorrhage, and her melancholy was extreme. On the fourth day she tore away the sutures and dressings of the wound, which was gaping and inflamed, air passing from an orifice in the trachea, and the voice being imperfect and hoarse. It was considered imperative to apply the straight waistcoat. The trachea continued open until the eighth day, after which it closed by granulation, and the wound gradually healed. A month after admission a large lumbricus passed from the bowels. Three months after admission she suffered peculiar paroxyms of excitement, and was prone to beat her head against the wall, apparently owing to cephalalgia; but under a tonic system of treatment these tendencies subsided; and, in the fifth month, she was cheerfully engaged in wool-combing, convalescence having fairly set in. At about the end of the sixth month she was discharged perfectly recovered; the accounts, received some months afterwards, continuing satisfactory.

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John H., aged 43, was admitted into the Cornwall Asylum in March, 1852, with an extensive wound of the throat, penetrating the trachea, and rendering his voice suppressed and indistinct,-air not escaping, however, during respiration. He expressed fear of being injured by those around him, and

was prone suddenly to strike them, the eye having an unsteady and suspicious expression. Under a nutritious and unstimulating dietary he slowly improved, and the delusions subsided five weeks after admission. He was soon usefully occupied in agricultural labor, and was discharged well about three weeks after his admission.

John L., aged 24, whilst under treatment in the Colney Hatch Asylum, in September, 1856, opened the trachea with a piece of glass, air rushing through the wound with a hissing sound. Simple dressings were applied.

On the following day, regret was expressed at having made the attempt, which was not subsequently repeated, and mental recovery ensued in the twelfth month from his admission.

I have met with three determined attempts to pierce the carotid artery, by stabbing with pen-knives in the front of the neck; but, in each instance, the artery was missed, and no inconvenience arose excepting temporary, and somewhat heavy gushes of blood, not requiring further surgical interference than simply dressing the wounds.

On a few occasions I have resorted to amputation of the fingers and upper extremities of insane patients, who wished the operations to be performed.

Thomas P., aged 65, a patient of the Cornwall Asylum, an old sailor of the Trafalgar fleet, received an injury by another patient biting his finger, which I subsequently removed at the metacarpal joint, sloughing and necrosis having rendered that step necessary.

The patient being of very difficult management, as regarded the dressing, &c., an abscess of the palm with subsequent sloughing of the tendons of the fore arm, and disease of the wrist joint, seriously complicated the case. With the patient's willing concurrence, I removed the limb above the elbow, by the double flap operation. The wound was nearly healed by the eighth day, and it was subsequently observed that he became far less liable to excitement, the paroxysms to which he was prone being of shorter duration. He lived nearly four years afterwards, and eventually sank from hydrothorax and general anasarca.

In the following case the ordinary risks of a capital operation were materially enhanced by epilepsy.

William J., aged 40, a powerful and very muscular man of colour, by occupation a luggage porter, in April, 1846, two years after his admission into the Cornwall Asylum, complained of pain in the vicinity of the right elbow joint, which was found to be enlarged. The tumour slowly increased,

and by the end of July assumed an irregularly lobulated form, with elasticity, and other appearances of fungoid disease. On Aug. 3rd., with the patient's concurrence, I amputated the arm above the elbow, adopting the double flap operation. On dissection of the limb, the fungoid growth was found attached to, and radiating from the extremities of the bones forming the elbow joint.

On the third day an epileptic fit occurred, and great care was necessary to prevent injury to the stump.

On the sixth day a most violent and prolonged epileptic paroxysm occurred: the muscles of the stump were powerfully convulsed, and some blood afterwards oozed from the granulations of the wound.

On the seventh day, convulsions having recurred, the process of union was found to be entirely interrupted; the flaps of the wound were torn open, and the adhesive deposit was broken down. On the eighth and ninth days, notwithstanding the use of purgatives, &c., the paroxysms continued; but remitted until the seventeenth day, when severe convulsions again set in, undoing what progress had been made in the healing of the wound. The ligature of the brachial artery came away on this day without any hoemorrhage whatever.

On the evening of the following (sixteenth) day, however, arterial blood was observed by the attendant flowing abundantly between the dressings; and, on my arrival, I found that a large quantity (four or five pounds) had escaped, deluging the bed, a copious arterial jet being still propelled from among the dressings. Having removed these, I found that the stream proceeded from a fistulous orifice, of the size of a large quill, in the immediate direction of the brachial artery. Into this orifice I immediately passed, on the point of a catheter, a portion of lint to the distance of an inch or more in the direction of the artery, pressing up folds of lint, and then placed a dossil, supported by adhesive plaster, over all, holding myself in readiness, in case it should become necessary to ligature the brachial artery below the axilla.

Fortunately, however, there was no return of hemorrhage, or, immediately, of epilepsy.

The plug of lint was gradually forced to the surface by new granulations and deposit, and eventually came away with the dressings. There was a recurrence of epilepsy on the 7th, 8th, and 9th days after the haemorrhage, but with no further effect on the, now superficial, wound than slight oozing of blood from the granulations. Owing to occasional bruising of the stump, the wound was not perfectly cicatrized

until the eleventh week from the amputation, when a suspicious swelling was found to be developing itself at the extremities of the bones of the left or remaining fore arm.

His general health was, however, good: he slept well, took exercise, and enjoyed a good appetite. The disease at the wrist was gradually developed; and, instead of a fungoid, assumed a strumous character, with tendency to ulceration of the integuments, and destruction of the bones of the joint.

In March of the following year, seven months after the amputation of the right arm, the left wrist was found dislocated, and wholly destroyed by necrosis and ulceration: the health was rapidly declining from pulmonary phthisis, and diarrhoea had set in.

On April 6th following, he died, immediately on my being summoned to him, in an epileptic paroxysm, blood in large quantity being thrown from the mouth.

On the autopsy, the lungs were found occupied by tubercle and cavities, from which the expectorated blood proceeded. The liver was pale, and studded with small cysts, containing a yellow, or greenish bile-like fluid. The cranium was of small capacity, and the arachnoid sac, and subarachnoid cellular tissue, contained abundant fluid.

Besides the diseases which occur in the ordinary practice of surgery, the insane are liable to accidents peculiar to their physical condition, and mental suggestions.

In one instance, a maniac, at Colney Hatch, by occupation a barge-man of the Thames, manufactured with a piece of wire, a minute model of a grapnel, having about an inch of shank, which he passed deeply into his urethra, tamping it down with a small stone, and a small piece of coal. The latter substances were easily removed, but I found it necessary to lay open the urethra upon a director, and so extract the grapnel downwards.

Occasional deaths from suffocation by choking have occurred among the paralytics at Colney Hatch, but numerous patients have been rescued from the impending danger.

In one instance an epileptic inhaled into his trachea, during a deep inspiration on the commencement of a fit, a mouthful of masticated food which blocked up, and took the form of the tube, fatal asphyxia being the immediate result.

If the finger can reach the lodged morsel of food, at the bottom of the pharynx, it is perhaps the best instrument for extracting it, but the sliding hair probang, and the probang with a blunt hook, have been found efficient in some cases, the former where bodies more or less globuluar, as a small

potato, were lodged, and the latter when the foreign body was flexible, as a portion of blanket, handkerchief, &c. The sponge end of the probang has generally passed by foreign bodies, unless they occupied the whole diameter of the œsophagus, distending that tube.

These casualties I have found much reduced in number, since I have more imperatively insisted upon the attendants' vigilance at table, which they are required, not upon any account whatever, to leave before the completion of the meal.

Fractures and dislocations have always done well, so far as my observation has yet extended, notwithstanding the occurrence of convulsions in those most liable to these casualties, viz., the epileptics.

In a recent case of fracture of the tibia and fibula, at Colney Hatch, the bones are united, and in a very fair line, although, during the latter part of the treatment, the patient, in a fit, broke the foot-piece of the outer splint.

In the treatment of abscess and superficial sores, Iodine, in the form of Tinct. Iodinii Comp., has been found valuable at Colney Hatch; and in some bad cases of the patients picking, and so keeping up ulceration of the integuments, the Iodine has been found to beat their efforts by its power of stimulating the granulation and cicatrization of the wounds. (To be continued.)

On Mental Physiology; or, the Correlations of Physiology and Psychology. By ROBERT DUNN, F.R.C.S., Eng. (Read before the Medical Society of London, February 6th, 1858.)

Mr. PRESIDENT,-I need not tell you, Sir, nor the Fellows of this Society, that the study of the human mind is a subject which has occupied the attention of the greatest philosophers of every age; nor need I remind you how long that study was enveloped in the shades of mysticism, bewildered in the mazes of metaphysical subtilty, amid the dogmata of conflicting systems. It is to Locke that we are so much indebted for dispelling the mysticism of the schoolmen. Unshackled from the tyranny of ancient names, and regardless alike of Aristotle and his categories, Locke discarded the syllogism, and instituted a searching analysis of the phenomena of thought.