a very hypertrophied condition of the pituitary body. This structure was extensively diseased; its functions are not well understood, but oertain facts which have fallen under my own notice, and the researches of the laborious Wenzels make me believe it to be an organ of greater importance in the due nutrition of the brain, than it is usually supposed to be, and I may probably refer to it again on some future occasion; but the case of M. A. is now referred to, because from the day that inflammation of the lungs set in, until the day of her death from tubercular disease, a period of six months, she never had a single fit, although for years previous to the accession of the pulmonary disease, she had a paroxysm or more daily. These facts, the occasional arrest of epilepsy, by erysipelatous inflammation and by tubercular disease, would seem to teach, that in a paroxysmal malady of this nature, it becomes us to gather the histories of many cases, and to be cautious in our inductions; lest we should regard that as a consequence, which was simply a sequence; or, to use the pithy phrase of the old Logicians, be led to confound the "post hoc" and the "propter hoc," and thus raise expectations which can only end in disappointment and

sorrow.

The Condition of the Insane, and the Treatment of Nervous Diseases in Turkey. By R. F. FOOTE, M.D., Member of the Imperial Medical Society of Constantinople; lately 2nd Class Staff Surgeon, Her Majesty's Service, attached to His Highness Omar Pasha, serving in Roumelia, the Crimea, and Anatolia; formerly Physician Superintendent to the Norfolk County Asylum, England.

Living in what may be said to be in a country which forms the link between civilisation and barbarism, so favored by nature, so neglected by man, where we have constantly so much before us to admire and so much to condemn, we have naturally been led to enquire into the condition of the poor lunatic in this city of the Sultan, into the state of him, whom mental and bodily disease has overtaken in its worst form; whom the public in some countries are

disposed to honour as a gifted being, and whom in others they are inclined to look upon as the especial object of divine vengeance and torture.

As we daily walk the streets of this capital, our view is often arrested by the sight of some wretched demented looking object soliciting alms in such a way that we see at a glance the man or woman is a lunatic.

We naturally enquire whether these poor objects have no friends; are there no asylums in this country whither they can be removed, taken care of, treated kindly, and, indeed, where they can be placed under proper medical care, and be restored to their right mind? What is the economy, organisation, and medical moral administration of such asylums, if they exist?

We have in vain, for more than three years, tried to obtain some information, in a printed form, as to the public and private institutions for the insane in Turkey, but up to the present time have entirely failed. We have, however, been able to ascertain that there are receptacles in this country, and we propose to give a short account of them, and of the treatment of diseases of the nervous system, at Constantinople.

The first cases of insanity, which came under our observation, were two soldiers at Varna, during the late war, whom we found in the barracks, situated at the northern side of the town, just inside the town wall. Both of these men were loaded with chains, an iron collar being fixed round the neck, a bracelet around each wrist and foot; these different iron collars were connected together by means of thick heavy links of iron chains. We asked why the men whom we saw with several other patients in a very dirty room were thus chained, and were informed by the "uze bashy," or captain, that they were "dély," or madmen, and on further enquiry were informed, that if mad persons committed any acts of violence, exhibiting themselves dangerous to other persons, they were chained up, and that if they made much noise they had a pail of water thrown over them, or were severely beaten, which generally made them pretty quiet.

Finding this to be the treatment of the insane at Varna, which during the war was considered the principal and best station for hospital accommodation, we were led to infer that the treatment of the patients in the capital, could be but a little if at all better.

We took an early opportunity of making enquiries as to the treatment of the insane there. Our first and second visits to the asylums of Constantinople, were made in February and July, 1857, our third in January, 1858, and on these VOL. IV. NO. 25.

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examinations we found that receptacles for the insane exist under four different forms of government, which may be thus classed according to their internal government and economy.

1stly. The Turkish Military Lunatic Asylum for the reception of the insane from the army, and such other lunatic Turks, as may be deemed worthy of public charity.

2ndly. The Armenian Lunatic Asylum, for the reception of poor persons belonging to the Armenian (orthodox) church, and such other Armenian persons, whose friends may feel inclined to pay for their sustenance, during the time they may be resident in the institution.

3rdly. The Armenian Catholic Asylum, for the reception of Armenians professing the Roman Catholic Religion.

4thly. The Greek Asylum for the reception of patients, who profess the Greek religion.

We will take them, however, in the opposite order from that in which we have placed them, and begin with that which appeared to be the worst managed, that in which we saw the greatest amount of misery and wretchedness.

The Greek hospital for the insane, is situated in a suburb of Stamboul, just outside the walls of Constantinople, called Tiedy Koly, or the Seven Towers, on a piece of land near the sea; the adjoining country is flat and marshy.

Eastward of it is Somatiah, a suburb of Stamboul, inhabited by Armenians and Greeks, where diseases of a zymotic character prevail to a great extent, including diarrhoea, dysentery, remittent and intermittent fevers; and southward is the village of Teitoun Bournum, where are some government works, under the direction of Englishmen. Altogether the situation may be said to be unhealthy.

The building is of stone, its form in a line extending north and south, plain in structure. From it a good view of the Princess' Islands, facing the Seven Towers, and the sea of Marmora, is commanded. Near is a tastefully built church, tended by a grey bearded priest of the orthodox Greek religion, and who, although he vociferated strongly on the duties towards our neighbour, upon visiting the hospital, we felt rather disposed to fancy his doctrine was more a point of theory than practice.

From all we can hear, the general idea disseminated by the Greek priests, who are truly as a rule, a most ignorant and bigoted race of men, is that insanity is inflicted upon men and women through the agency of the devil, and that the best way to get rid of it is by scourging and beating. The asylum is supported entirely by the contributions of the Greek popula

tion themselves; it has around it gardens well filled with fruits and vegetables, to which the unhappy inmates have but little access. We found on entrance, that in no part of the world is the maxim laid down by Celsus, more rigidly carried out, than in this Christian institution, "ubi perperam aliquid dixit aut fecit; fame vinculis, plagis coercendus est. Cogendus est et attendere et ediscere aliquid, et meminisse sic enim ut paulatim metu cogatur considerare quid faciat, subito etiam terreri et expavescere in hoc morbo prodest, ut fere quidquid animum vehementer pertubat."

Insane patients are here received without any medical certificate if the friends are anxious for them to be properly taken care of; and I am informed the plea of insanity, in criminal cases, is a question, never heard of at the Sublime Porte. Indeed, medical evidence on the subject of nervous derangement would be an anomaly before this august assembly scarcely to be tolerated, and very difficult to obtain. This hospital is not only a receptacle for the insane, but also an institution where young Greeks are taught the rudiments of their language, and indigent Greeks supported; it is properly what may be termed a poor house.

It consists of two stories. In the first floor are the sick and aged, and in the second are the children, whilst in the basement are the male lunatics. The insane wards consist of three rooms, and for the sake of making the description easy, we will call them numbers one, two, and three.

Number one ward is a room fifteen feet square, containing ten beds, in each of which is a patient, five of whom on every occasion I found under mechanical restraint. In it are the water closets for the adjoining wards. There is no window or means of proper ventilation. The height of the ceiling is 10 feet, the floor of stone, no fire or stove of any kind even in winter. The bedsteads were generally of iron, some of wood; few of the patients had straw palliasses under them, and three were without anything. The bed covering was very scanty, consisting in four instances of a quilt lined with cotton wool, the others being supplied each with a common thin rug of woollen.

There is one door which opens to the garden, another door to number two, a third opening to the stairs, and a fourth to the water closets.

When we visited this hospital, in July last, we found that the outer door of number one was closed, and that the effluvia in the room was quite unbearable; there was no attendant present; three of the patients were nearly naked; seven were

under mechanical restraint; so bad was the odour of the room, that the attendant who accompanied us from the other wards found it necessary to burn incense to make the place fit to be tolerated by himself.

In January, 1858, we found the external door of number one open, and the temperature of the room only four degrees above freezing point. The feet of one patient under severe mechanical restraint were so cold, that they appeared frost bitten; he was fixed in the recumbent position with nothing beneath him but a wooden bedstead, and scarcely any covering; he had been recently bled twice, and on our enquiries it was stated in answer, that he had been brought thither by the Turkish "Cavasses," or police officers; that he was a very troublesome and destructive patient; that they knew of no other means of keeping him quiet, and that he had not taken any medicine since his admission. We made enquiries if there were single rooms for placing violent and excited patients, but have always been told that such do not exist.

Adjoining number one is number two, in which were twentyfive beds with the same number of patients; the height of the room was 10 feet, the floor of stone, and many of the patients were under mechanical restraint. Number three was of the same size, the beds being only two feet apart.

The under clothing was of cotton, the upper of the same material; but on our last visit, a flannel rug had been added, said to have come from the hospital at Scutari.

There are no apparent means of ventilating the wards, and but a scanty supply of clothing and water; every means however are provided for repressing violence by the large chains and the contrivances for attaching them to the floors.

The only means for warming were by charcoal, which we only saw on one occasion in number two, placed in a kind of brazier, or as they term it in this country a mougal," the smoke from which caused a very obnoxious effect.

The female wards are detached, but near, and consist of a wooden building containing four different rooms, with 36 patients; cheerless and cold in winter; so low was the thermometer, that it was only six degrees above the freezing point. We divide them for the sake of description into four wards.

In number one were the violent and refractory patients, six in number; three of whom on both occasions we saw chained to their beds with thick iron collars around their necks.

There were no means of providing warmth in winter; the