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amongst the insane, and careful observation of the practice ofmany large and well conducted asylums, I am more than everconvinced of its efficacy as a means of cure. ( Vide last report ofBethlehem Hospital, on the treatment of insane persons at theirown residences, or at all events, out of a regular establishment.)Having been entrusted with many private cases, (two of them

of the higher classes,) I will offer a few remarks on their manage-ment. Last autumn I went to reside with a gentleman, agedtwenty-nine, who had been attacked with insanity a few monthspreviously: the symptoms at first sight were those of incipientdementia. The pulse was feeble, circulation languid, extremitiescold, and he could not to be induced to talk ; the bowels habituallycostive, and he passed his urine in bed. On taking charge ofthe case, I first turned my attention to the subject of warmth,and procured for him stockings, drawers, &c., of fleecy hosiery,at the same time substituting woollen clothing for his lightsummer dress: his sitting room was kept at a regular temperatureby means of radiated heat, and he took short carriage drivesevery day, as often as the weather would permit. Viewing thecase as one of physical as well as mental debility, I suggested tothe family surgeon, who was in attendance with me, the pro-priety of allowing a pint of porter and a glass of sherry daily.Under this treatment he improved very rapidly, and began tonotice his friends. However, it was deemed advisable that heshould be removed from home, and he was placed under thecare of Dr. A. Sutherland, and eventually recovered. In thiscase, no mechanical restraint was employed, further than securinghis wrists with a silk kerchief during the operation of shaving,which he usually resisted most strenuously. My only assistantwas the butler. Had this case occurred in a properly constructedbuilding, with suitable attendants, no restraint would have beenrequired. One thing particularly struck me. During his violentparoxysms, which were neither few nor far between, he invari-ably displayed the greatest violence towards the butler, showing,as I think, that he felt keenly the degradation of being coercedby his former servant. Is not this a strong proof in favour ofremoval to a proper building? So thoroughly convinced am I ofthe almost absolute necessity for employing restraint in the treat-ment of private cases, that I have determined upon not taking anymore patients, though I have been fortunate enough to be recom-mended by one of the most talented physicians now practisingamongst the insane. On this account I have ever looked uponprivate establishments with extreme jealousy. Within closeddoors, without vigilant supervision (in many instances, I fear) onthe part of the proprietor, and deprived of that most powerful ofall checks upon ill treatment, the free admission of the public eye,I dread to contemplate the doings in many asylums, (improperlyso called,) even in the present day. Why is it that the publicasylums have ever taken the lead in correcting abuses? Whathave the learned commissioners in lunacy been about for thesemany years? Is not the fact of their having lately discovered somany abuses in the different asylums a very strong proof of theirprevious neglect or incompetency ? Will any man who is practi-cally acquainted with these matters take upon himself to say that ’’,abuses have not existed for many years? Were the commis- isioners young, active men, practically versed in the treatment ofthe insane, we should speedily have a thorough reform in theseprivate establishments. What was it that brought to light thedreadful doings in the York Asylum, some years ago? I answer,public inspection. It has been ably remarked by a writer on thesubject, " Let us not hear of inspection interfering with otheravocations, when it is obvious that no avocation can be paramountto this. In truth, it is the trouble and difficulty of keeping thewhole establishment at all times in order for review that are thesecret causes of the dislike entertained, and the pleas against in-spection of the institution and the condition of the patients."With these sentiments I most cordially agree, as also with thoseof the talented Samuel Tuke:—" I believe that I am not too san-guine when I say, that for one evil arising from accidental visita-tion, ninety-nine will be prevented. The evils of visitation arespeculative bugbears, to which practical men have too often foundit convenient to give the character of reality." ,

How would it have fared with the non-restraint system at Lin-coln and Hanwell if the public eye had been excluded from theirwards ? I firmly believe that the system would have failed. Inboth these establishments it underwent a most rigorous and ’,searching inquiry, and in both it had to encounter great diffi- ifculties-a difference of opinion amongst its officers, and the stoutopposition of the attendants, who naturally preferred that systemwhich gave them the least trouble. The question is now fairlyset at rest, and although the practice is occasionally contested, bya reference to extreme and exaggerated cases, the theorv is uni-

versally acknowledged. Compare the state of Bethlehem Hospitalnow, as shown by its recent report, with that of old Bedlam inthe palmy days of strait-waistcoats, leg-locks, &c., when the

keepers could enjoy their whist and beer, undisturbed by theyells and blasphemies of the poor wretches confined in restraint-chairs, and other abominations, happily, now almost explodedfrom our national establishment.December, 1845.

LIABILITIES OF THE MUSCLE IN DISEASE.PARALYSIS.

THERE is now, in the York Ward of this hospital, A. D-,a young Scotch baker, of whom, since his admission on the25th of October, it is observed that he is always in bed, andnever off his back ; and this is his case:-Though young, and ofactive make, he can neither walk nor work. The case is common,and yet of special interest. It is palsy, the result of poison. Sevenweeks ago, while under great moral depression, this young mauswallowed, by his own report, half a teaspoonful of white arsenic,mixed with a smaller quantity of verdigris. There is matter ofexcellent study in the primary operation of this compound poisonon the system; but it is not in our present purpose to mark thesymptoms in detail. There was no vomiting until six or sevenhours after the deleterious mess had been swallowed; at whichtime, the patient informs us, "he felt excessive pain in the sto-mach." Eight days subsequently, on October llth, he becamefuriously delirious, and remained so for about forty hours. Itdoes not appear that he suffered much at any time from pains inthe abdomen. On the second day after taking the poison, hefound a difficulty in buttoning his clothes, and in drawing off hisboots: here was the beginning of the paraplegia, which, in thefeet and hands, is now complete. And this is our use of the case.Had the fact of a special poison been suppressed by the patientor his friends it is probable that, in our explanation of the symp-toms, we should have taken but little account of any prejudicethrough the circulation to the locomotive organs. In routinepractice, we should have been content to refer this doubleparalysis to a supposed condition of the brain or spinal marrow.Under the great prevailing error of our modern pathology, it iswell to be reminded, that in disorders of the muscle, the nerve isnot exclusively, and in all cases, responsible for the impairedfunction of the fleshy fibre. Great crimes are still abroad, and,in forensic medicine, from palsy of the limbs, there is an occa-sional inference of poison in the blood. J. A. W.

St. George’s Hospital, Nov. 25th, 1845.

REJOINDER OF DR. COPLAND.THE PHYSIOLOGY OF THE NERVOUS SYSTEM.

To the Editor of THE LANCET.

SiR,-My remarks on your article in THE LANCET of the 6thinstant, shall be very brief, as I have -very little time, and stillless inclination, for controversy; and as I shall have occasionhereafter of showing that many of the phenomena, both func-tional and pathological, which your reviewer and Dr. M. Hallascribe entirely to the spinal cord, belong essentially to a differentpart of the nervous system, the nerves proceeding from the cordonly at most reinforcing, and otherwise influencing, that verydifferent part of the nervous system and its functions, as morefully stated in the articles on Irritability and Irritation in mywork and elsewhere. In your reply to my observations, aftersome general reflections, you state-" There is, indeed, a vastdifference between the views of Dr. M. Hall and Dr. Copland ;and in a work professing to reduce physiology to its pathologicaland practical uses, whether he believed them or not, Dr. Cop-land should have given a fair epitome of Dr. Hall’s real doctrines,while he attempted to refute them." (LANCET, p. 617.)Of course there is a vast difference between our views; for

much of what Dr. Hall refers entirely to the spinal cord, Iattribute, essentially and chiefly, to the ganglionic and sympa-thethie system. I have nothing to do with the reduction of Dr.Hall’s physiology to practical uses. He must undertake thislabour for himself, and accomplish his task as he best may. Ihave had to deal with his doctrines, whilst treating of palsy, only,in as far as they have been used by him and others, in explainingcertain of the phenomena of the disease. I had no o"casion foran examination of his views in extenso, and indeed, it would havebeen difficult to have stated them with the precision requisite forsuch a purpose, as they have either varied at different times, orhave been differently stated by himself and followers. Your re-viewer proceeds to notice certain points in the diagnosis of cere-bral and spinal hemiplegia, which he considers that I have eitheroverlooked or not sufficiently insisted upon; as he believes, withDr. Hall, that they are of importance’ and he concludes withthe question-" Has Dr. Copland pointed them out for the benefitof those engaged in practice ?"