floor was of stone; there were no single rooms or other means of seclusion; no opportunity of exercise in the open air.

The organisation appears to be as follows: a few of the chief Greeks are appointed by the community as governors, some of these gentlemen in fine weather go to Tiedy Koly; at other times the patients are left to themselves, or to the ignorant man who has been by interest and chicanery placed in the position of what is vulgarly called governor; he has formerly been a servant to one of the members of the committee, subsequently a keeper or attendant of the asylum, and thus has gained a sufficient knowledge in the estimation of the directors to rule and govern the establishment. He is a civil, respectful, and apparently an honest man. He knows how to regulate the internal economy of the asylum, to see that the patients shall not be too well fed or clad, so as to increase the current expenses. He knows how to feed the attendants, especially those who may be the creatures of the committee. His wife is the chief attendant of the females, for whom there is only another servant, the laundress, to whom the duty of nursing is left.

The doctor lives several miles off, and pays his visits twice a week, chiefly, however, to see those whom he considers sick, and not the lunatics, consequently this responsibility falls upon the governor.

Hence violence, disease, and neglect occur, from the absence of any well-regulated medical authority present.

On leaving this place of torment, we were led almost to think with Byron, that

"The Leech was sent, but not in mercy, there To note how much the life yet left could bear; He found enough to load with heaviest chain, And promise feeling for the wrench of pain ;" We feel certain that any one visiting this horrible place, could alone think that such must be the vocation of the physician attendant thereon, for little else could he be said to the mind of a western, to perform.

We look upon it as a tolerably well received fact, that where it is necessary to give administrative power in the government of a hospital, the head must be a resident person. In the carrying out of his duties, he must not be interfered with by any one but the parties, who are invested with the authority under which he acts. Give him high responsibility, and you may expect from him efficiency equivalent to the responsibility therein placed. All subordinates must be placed entirely under his control. Most especially in the govern

ment of a hospital is this necessary. We may take for example the hospital for sailors at Constantinople, which was formerly under the direction of the physician to the embassy; the consequence was that the duties were very much neglected, because his avocation called him constantly from the hospital to Therapeia, Scutari, Buyukdere, Stamboul, &c., he was necessarily obliged to leave his patients to any one he could find willing to attend the sick in the hospital; whereas lately the hospital has been placed entirely under the direction of a resident surgeon (with a proper remuneration) Mr. Hoyland, and there can be no doubt that its management is satisfactory. We can say that from a recent visit to it, we found the condition of the wards very creditable to the medical authority, under which they are placed.

(To be Continued.)

The Medical Treatment of Insanity; by M. H. RANNEY, M.D., Resident Physician of the New York City Lunatic Asylum, Blackwell's Island.

A Report read before the Association of Medical Superintendents of American Institutions for the Insane at the Annual Meeting, 1857. From the American Journal of Insanity.

In presenting my views relative to the medical treatment of insanity I shall be very brief, tracing only the general outlines of the course pursued by me in a few of the best-marked forms of this disease.

The object of the report is to obtain an expression of the views of the different members of the Association on this subject, to attain which it is necessary that there be no misunderstanding as to the particular disease described. The treatment of insanity is the great desideratum, although in fact subjects of secondary importance are much more frequently discussed. The peculiar ideas entertained by the members as to ventilation, the construction of water-closets, &c., are generally understood; but I am unable to say that there is an unanimity of opinion as to a mode of practice

in any one of the various forms of insanity. It may be, perhaps, impossible to determine the exact treatment which should be pursued in a particular case, but the general principles, at least, that govern our course in a certain defined form of mental derangement, can be given as well as in the treatment of physical diseases generally. I assume that there are conventional terms, which convey to the mind definite ideas of certain forms of disease, which, when referred to, suggest a group of associated symptoms that, taken collectively, constitute a distinct variety. It is only to a few of such well-known and recognized forms that reference will be made.

In insanity no new faculties are created, but those already existing are modified by the conditions of exaltation, depression, or perversion. The type of the different varieties of disease may be found in the normal state of the mind. This consideration affords important aid in distinguishing one form of mental disease from another.

I shall first refer to Acute Mania. The physiological type of this disease is given more nearly in anger marked by violence than in any other state of mind. The leading characteristics are, impassioned moral and intellectual exaltation (the one exhibited by perversion, the other by delusion), the rapid flow of ideas, violent gesticulation, disposition to overthrow or destroy the furniture of the room, sleeplessness, and wild expression of the eye and countenance, betraying great disquiet of mind. Undoubtedly the term acute mania recalls a certain grouping of symptoms, and conveys more accurate notions of the condition than would the minute description of an individual case, since by abstraction the essentials in particular instances have been selected and combined to form the general idea. Taking it as granted that the form referred to is fully recognized, the medical treatment will be briefly considered. A careful examination must be made into the general condition of the system, as well as of the functional disturbance of any organ that might affect the brain. The success following treatment depends much upon the care exercised in the duty. The patient should, as far as possible, be excluded from all excitement. In most cases the condition of the stomach and bowels is disordered, to correct which an active cathartic should be prescribed. For this purpose the combination, hydrarg. sub. mur. gr. x, pulv. jalap. gr. xx, may be administered, and if the patient be of full habit a grain of tartarized antimony may be added. The skin is often dry and unclean, requiring, after catharsis, a warm bath, and pulv. ipecac. c. gr. x, the following night. On the succeeding day, if the patient be plethoric and there seem to be a determination of blood to the brain, commence with ant. et potass. tart., gr. ss. ter in die, which should be gradually increased until nausea follows; cold applications may be made to the head, and spts. ammon. acetat., or spts. æth. nit. to act upon the secretions. If there be unnatural rapidity

in the pulsations of the heart still persisting, tinct. verat. virid. gtt. v, ad. x., bis in die, may be substituted for the tartar emetic. If for several days the patient continue violent, ol. tiglii. is to be applied to the back of the neck and behind the ears; selecting for this a proper time in the advance of the disease, a full eruption is usually followed by marked improvement. As soon as the prominent symptoms of violence yield, morph. sulph., gr. ss. ter in die, is substituted for the remedies before specified, or if, at the time of admission, the patient be emaciated and apparently prostrated, either morphia or opium is given directly after the warm bath. Under these circumstances a full diet is urged, and if with restlessness and high excitement an anæmic state of the brain is believed to exist, a supply of meat rich in fat is liberally furnished. Beer and milk-punch take the place of other drinks. Tonics, such as ferri carb., potass. iodid., &c., have a favorable action, and even quinine is occasionably admissible. When violent paroxysms are separated by lucid intervals, as in recurrent mania, quinine, in doses three times a day during the quiet period, has been found highly beneficial.

My attention was first called to the use of this article by a paper read before this Association three years ago, by Dr. Tyler. Since then I have often used quinine in cases of the recurrent form of insanity with decided success. In many the lucid interval was prolonged, the paroxysm less severe, and in a few instances complete recovery was the result. If masturbation was suspected as a cause, free applications of croton oil were made to the penis and scrotum.

Amenorrhoea is a frequent cause of mania in girls between the ages of 15 and 25, while in later life menstrual disturbances usually produce melancholia. Mania from this source yields rapidly to proper treatment. The tr. al. et myrrh. to remove constipation, Lugol's solution, or some other form of iodine, with stimulating applications to the mammæ, effect, ordinarily, a cure in two or three months. In that form of mania in which little violence exists-the patient seeming like one inebriated, yet moved by that same mischievous propensity that is found in a variety of nymphomania, opium in large doses controls quite effectually the undue exhilaration of spirits. The common course is to commence with tinct. opii., 1 dr. ter in die, which is doubled at the expiration of the first, or even increased to three drachms, if found necessary, at the end of the second week. From the peculiar state of the brain and nervous system, these large doses are not only tolerated, but produce little sensible effect aside from allaying the excitement and occasioning active emesis and catharsis. These last conditions render it often necessary to omit the medicine for a day.

Melancholia, the lypemania of Esquirol, is another form of mental disease readily recognized. The elementary type is found in fear, sorrow, or grief, as exhibited by a mother in the loss of her child, or in impending calamity. The peculiar marks which distinguish this affection are exaltation of the sentiment of sorrow,

entire concentration of mind on one idea or class of ideas, and an inability to direct the attention to any thing not immediately connected with that which wholly absorbs the mind. It is frequently dependent on some bilious or uterine derangement, and in the selection of medicines attention should be directed particularly to this fact. To correct the secretions mass. hydrarg., or the hydrarg. cum creta. may be used. Where a sufficient alterative effect has been produced, opiates in small doses are indicated. The object is to partially remove the intense grief or fear which characterizes this form of disease. Morphia in small doses may for a long time be continued. During its administration gentle laxatives will be required; for, aside from the effect of the opiate, there is a tendency to constipation. The patient generally refuses a proper amount of nourishment, leaving the vital powers greatly reduced, and requiring tonics and stimulants, such as ferri carb., porter, &c. If a propensity to commit suicide exist, the occasional application of blisters, or ung. antimon. to the back of the neck, lessens much the danger of such an occurrence. It may afford benefit, in part, by relieving congestion of the vessels of the brain, but principally from the substitution of a real for an imaginary trouble.

Of the remaining forms of insanity Dementia alone is that which I now shall consider. Its fundamental type or analogue exists in natural dullness of intellect. The leading characteristic is an enfeeblement of the intellectual faculties, or even a complete obliteration of their manifestations. Dementia is usually a sequel of mania or some acute affection of the brain; rarely an idiopathic disease. Moral treatment is of much more importance than in mania or melancholia, yet a judicious use of medicines will aid much in the restoration of reason. To relieve anæmia, nutritious diet and the free use of chalybeates are requisite. The object is to supply the brain its proper stimulus by enriching the blood, and thus arousing its dormant excitability. As the muscle loses its contractile power from long inaction, so may the brain, although unchanged in structure, cease to perform its proper functions, from previous longcontinued disease. The phosphates of iron and manganese become valuable in this disease by furnishing the necessary amount of phosphorus for generating the nervous force. In a few instances rapid improvement has followed the use of cannabis indica, which seems to have a special tendency to stimulate the senses, and excite the moral qualities. Those cases in which dullness of intellect depends on a congestive condition of the brain are benefited by counter irritants, such as blisters, ung. antimon., or ol. tiglii applied to the back of the neck. The most favorable results occasionally follow accidental sloughing from the application of tartarized antimony, while the same effect may occur from an extensive abscess.

Such are my views in regard to the ordinary course to be pursued in treating the foregoing forms of insanity, each individual case requiring, however, modifications of treatment corresponding to the