distinctly perceived, by manual examination of the abdomen, the course of many inches of the colon which was filled with stones and angular pieces of porcelain, all of which were passed without injury. The mode in which nature operates in defending the interior textures of the body, is by coating with the solid contents of the intestines the foreign bodies, and thus rounding off their inequalities and angles. They then in their passage through, and by the movements of the intestines, assume an ovoid figure, the lower bowel becoming for the nonce, the ovipositor.

In many instances, however, at Colney Hatch, life has been placed in jeopardy, and in some, lost by foreign bodies, or large unmasticated pieces of food lodging in the pharynx, œsophagus, or respiratory passages. In the case of a demented patient, I extracted a portion of blanket, and a considerable part of a handkerchief from the oesophagus, by the hooked probang and forceps, imminent suffocation being averted. In other instances, small potatoes and portions of meat have been removed with the sliding and hair cupped probang, (manufactured by Mr. Bigg); and I doubt whether success would have attended the use of any other instrument, undoubtedly a valuable acquisition in the lunatic hospital. The tube of the instrument is, towards the lower extremity, and an inch above the sponge, partly composed of stout hairs or bristles, and when introduced into the oesophagus and depressed upon the stilet, the bristles form a cup-like expansion which, when withdrawn, carries upwards with it the morsel or foreign body. In instances of failure I have minutely examined the mucous surfaces, and found them uninjured by the passage of the instrument. Two instances have occurred of large and solid portions of food, probably of cartilaginous or ligamentous character, lodging, during meals, firmly in the lower part of the oesophagus, far below the larynx, so that no difficulty of respiration resulted. In both of these cases, the first attempts to force the substances into the stomach failed, and liquids attempted to be swallowed were forced back through the nose. On the second day, (not without persevering efforts, and such firm pressure of the probang, continued for ten or fifteen minutes in the axis of the œsophagus, that the whalebone handle of the instrument on being withdrawn remained bent,) the efforts were successful, and the masses were reduced by the stomach and digested. The immediate freedom with which liquids were swallowed indicated, in each of these instances, the clearance of the oesophageal tube from obstruction.

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By far the more frequent cause of danger from suffocation has occurred to the subjects of general paralysis, and has arisen sometimes from their tendency to voracity, as well as from the nervous inefficiency of the muscles concerned in the process of deglutition. In the male department we have generally forty, or about seven per cent. of patients who are the subjects of this intractable affection. On the female side the proportion is much less. Not unfrequently the attendant has succeeded in extracting with the finger the lodging morsel, all danger being at once removed.

I have already adverted to the great vigilance at table requird upon the part of the attendants, who are not allowed to leave their places on the entrance into the wards of visitors or magistrates, who fully concur in the necessity of such discipline. In one instance recently, the attention of an attendant was attracted by a visitor, and fatal asphyxia, probably preventible by instant attention, resulted to a paralytic patient. In this case, I succeeded in extracting a portion of meat from the upper part of the oesophagus with the haircupped probang, but too late to be of avail. Great care is also enjoined to attendants having the charge of paralytics, to cut up finely the food, and administer it, if necessary, in a semi-liquid form. The little mills, used at the Devon and some other asylums, for the comminution of animal food, no doubt assist in diminishing the tendency to asphyxia from accidental suffocation.

Dislocations of the shoulder joint have not unfrequently occurred at Colney Hatch, as many as three happening on the female side in one year; these casualties having been occasioned by falls. No unusual difficulty occurred in the reduction, and the subsequent treatment of those injuries.

Dislocation of the jaw has occurred to three patients, two being men, and one a female. One of the men was an epileptic, and the accident did not recur after the reduction. The other man was a paralytic, a native of India, and the dislocation occurred repeatedly during the forty-eight hours preceding death. It was easily reduced, and appeared to

result from a loss of muscular balance between the elevator and depressor muscles of the lower jaw, the result of the paralytic affection.

A painfully interesting case, in which the patient, an elderly female, with a view to self-destruction, laid open with a razor a large umbilical hernia, was for some years under the observation of my colleague, Mr. Marshall. A coil of the protruding colon was severed by the instrument, and artificial

anus was the result. This patient eventually sank from general disease; and upon the post-mortem examination, it was found that the portion of lower intestine between the artificial and the natural anus, had become contracted, and assumed a rudimentary character.

The apparent exemption from pain, and even material inconvenience, of the insane under certain surgical injuries, is very remarkable. A blind maniac, during his violent and plunging movements in a padded room, recently received a fracture of the left clavicle, at Colney Hatch. He certainly winced somewhat under the necessary examination, but continued to use the arm of the injured side without great inconvenience, the scapular and pectoral muscles of the joint acting vigorously; the elevation of the arm by the deltoid being evidently the most difficult movement.

Another patient in kicking at the door of a padded room, during the night, fractured transversely the left patella. It was impossible to keep the limb in position, and in a day or two, with a straight and stiff movement of the limb, he walked about with a certain amount of facility.

Some years since a male patient died somewhat suddenly from collapse. On making a manual examination of the thorax, I found that several ribs were fractured, the injuries being afterwards clearly traceable to the patient having, in his reckless movements, thrown himself over chairs and a fireguard, a day or two previously. Subsequently to the accident, I saw this man in his ward, walking about with his hands in his pockets, with occasional half rotary movements of the thorax and shrugging of the shoulders; movements no doubt intended to place the broken bones in less inconvenient positions; but he made no complaint whatever, nor was any injury suspected up to the period of his death. Extensive fractures of the ribs on both sides, with injury to the pleuræ and lungs were disclosed at the autopsy, the cause of the injuries being elicited at the coroner's inquest.

Previously unsuspected fractures of the ribs having been sometimes discovered in autopsy rooms, some superintendents have, in their reports, adverted to these cases with a view to call attention to the periods of their occurrence, the asylum having sometimes unjustly borne the onus of the casualties. Such instances have been occasionally witnessed at Colney Hatch, and the injuries have been traced to periods long antecedent to the admission of the patients. The total absence of reparative union in the fractured ends of the bones may have, in some cases, led to the suspicion of the injuries being recent,

but the absorption of the first resulting blood coagula, the polished or semi-carious aspect of the broken extremities of the bones, which have been sometimes seen to be floating in old cavities of pus, and the denudation of the periosteum, indicated injury long inflicted. The lack of reparative union may be ascribable to want of early care and rest, or possibly to the blood-dyscrasis inaugurating the outbreak of insanity.

The occurrence of emphysema of the integuments of the neck and thorax led to the discovery of fractured ribs in one case, the result of a violent assault by another patient. The case did well.

The dexterity with which the insane, homicidally disposed, prepare, secrete, and sharpen weapons of attack, should never be lost sight of; large spike and mop-nails being easily converted into dangerous daggers. The recent homicide of Dr. Sylvester, by a lunatic of France, with the blade of a pair of scissors, was a deplorable event.

At the Cornwall Lunatic Asylum, in the year 1845, a homicidal patient attempted the lives of three persons, one being a patient, and the others attendants. He had, on my ordering him to be secured, already provided himself with a long mop-nail found in the grounds, and which, after sharpening it, he concealed in his pocket handkerchief, some folds of which he bound about the blunt end of the instrument to give a secure hold. He first made a thrust at the abdomen of an attendant, who fortunately wore a thick leather belt, upon which the point of the instrument impinged, rendering the man, however, for some moments breathless and helpless. He then turned upon a harmless patient, and, in aiming at the heart, perforated "with the instrument the left upper arm, and instantly afterwards the glutei muscles" down to the os ilii. A second attendant then closed upon the patient, who instantly stabbed him in the left thorax, below the heart, the instrument entering the lower lobe of the left lung. Extensive emphysema, with collapsed lung, immediately resulted, with great distress and other alarming symptoms. Under the rather liberal use of the lancet, and much care and quiet, this man fortunately, (as the others,) recovered perfectly. Further efforts on the part of the lunatic were happily frustrated by the quick sight and hand of a third attendant, just returned from the war in China, who had suspicion of a concealed instrument, which, enveloped in the handkerchief, he struck out of the hand of the patient. Seven years afterwards, the lunatic died of that frequent associate of homicidal and other violent propensities, phthisis pulmonalis.

Notice of a Form of Window; by Dr. HUXLEY.

A form of window which is believed to be very suitable for asylums has been invented, and the pattern may be seen at the Kent Asylum, where the superintendent will be most happy to submit it to the examination of any of his professional brethren.

It is made wholly of wood, consists of two sashes, and in appearance differs in no respect from a common house window. It is opened and closed with the same ease, in the same manner, and with the same noise, and the fastening is within reach, efficient, and safe. It possesses the peculiar feature of a double action, by means of which both the bottom and top sashes are opened by one and the same movement, and they are spontaneously closed. chanism by which this is effected is simple, cheap, and durable, and not likely to get out of repair. The window would be less costly than an ordinary house window, because those parts upon which the movement depends are of less cost than the pullies, weights, and cords, in common use. These parts, also, are placed entirely out of sight and reach.

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The object of the double opening is one conducive to a better ventilation; for when two openings are made, two currents of air are commonly established, passing in opposite directions, and twice the area of opening is obtained, without an aperture large enough for a person to get through.

Both the sizes of the panes of glass and the extent of the opening may be optional. The latter may be, if desired, half the casement, the same as in a house window.

This window was contrived about two years ago, and is now about to be used in some additional building at the Kent Asylum.

The Eleventh Report of the Commissioners in Lunacy to the Lord Chancellor. Ordered by the House of Commons to be printed, 7th July, 1857.

The pressure of other matter has compelled us to postpone the consideration of this State Paper until the present time. Its importance is too great to permit us any longer to