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that tubercle is never found in the lungs of persons who havesuffered from cyanosis or any mechanical disease, as rachity,curvature of the spine, interfering with the arterializationof the blood; so that if Dartmoor were free from fog andstorm, and if its hill sides were swept by pure, cold, andbracing breezes only, it would be no place for phthisicalpatients; as it is, Dartmoor is no place for invalids of any de-scription. I cannot understand how a day can be longer on ahillside than on aplain,unless the happy mountaineer can perchhis habitation exactly on the summit, or watch the sun’s risefrom the eastern slope and his decline from the western; butwhatever the length of the day may be in Dartmoor, I knowwell that the length of the summer is much shorter therethan on the plain. Winter sets in very decidedly a full monthbefore it is felt down below; and woe to the invalid whobraves a Dartmoor winter!When I say that Dartmoor is no place for any invalid, I beg

to except the class to whom it has been wisely recommended"to live upon sixpence a-day and to earn it." The man whohas been a little unbraced by professional or mercantileanxieties, by dissipation, or city life, may take exercise andfind health even on these misty hills. If he be a Zebedee,let him station himself during any portion of the three summermonths at Brempts, and he will be able to fill his basket dailywith small but fine-flavoured trout, or if he be a very hardyinvalid, and a sportsman, let him locate himself later in theseason at Two Bridges, and he will find plenty of snipeand some cocks and teal in the swamps around. If he be amere lover of nature, or an antiquarian, let him perambulatethe moor in search of the grand and picturesque scenery, or theCeltic remains with which it abounds, but let him not forgetthat the accommodation is indeed " poor and mean," and thathe will do well to make his own special arrangements for thecommissariat department, having reference to a basis ofoperations in the rear. In conclusion, I beg to say thatI am sorry to differ in opinion so entirely with Dr. Radley,and should be more ready to doubt my right to do so, if hehad given any statistical information on the subject, or had,even given a few undoubted cases of phthisis benefited by aresidence on Dartmoor.

I am, Sir, your obedient servant,Teignmouth, Sept. 1850. C. B.

SUGGESTIONS FOR THE ESTABLISHMENT OF ANASYLUM FOR THE INDIGENT INSANE OF THEEDUCATED CLASSES.

[LETTER FROM DR. CONOLLY.]To the Editor of TaE LANCET.

SIR,—I read with great satisfaction, in THE LANCET of Oct. 5,the observations on the present state of Bethlem Hospital. Itsample resources, and the high character of its physicians, areadvantages of great value; and the zeal and activity of itsvery active governors give perfect credibility to the assurancethat every improvement of modern times has been introduced,or is in progress in that noble institution. The statementthat "personal restraint is almost abolished" rests, no doubt,on good authority; and is only less gratifying than would bethe statement of its being never resorted to.My chief object, however, in now addressing you, is to notice

one particular portion of your observations only.Having myself endeavoured, without success, to obtain suf-

ficient assistance towards establishing a public asylum forinsane persons of the middle or educated classes, whose cir-cumstances are very limited, and on whose families the ex-penses of any comfortable asylum fall always heavily, andsometimes ruinously, I should be truly glad if Bethlem Hos-pital supplied this want, or could supply it; as your remarksappear to indicate that it does, or might do.

It is true that insane persons belonging to the learned pro-fessions, officers in the army, artists, clerks, &c., and theirwives, or daughters, are freely admitted to Bethlem; and Ibelieve they are most liberally and kindly treated there. Ihave several times been enabled to secure these advantagesfor patients in such stations of life, by advising that theyshould be sent there; and the immediate relief from all ex-pense has been, in such case, of great importance to theirfamilies. But this relief, except where an early recoveryhas taken place, has always been merely temporary. Therelief does not even extend to the cases in which it is the mosturgently required.

In every case not curable within twelve months, the laws ofBethlem Hospital cause the expiration of one year to renewall the difficulty and distress of the family of the patient.Beyond that period, the support of the charity cannot be

afforded. The parents or relatives are exposed to freshanxiety, and have to decide on some new plan and place at

once, and the poor patient is subjected to the discomfort anddisadvantage of a removal; which is necessarily to some cheapand miserable private asylum, or to an asylum for pauperpatients.

In some of the county asylums there is a limited but farfrom adequate provision for such cases, and at Stafford a specialasylum is now building for them, by subscription; but there isno such institution in or near London, and families of great re-spectability are often, after much reluctance, and pain, andsorrow, compelled to solicit the interference of the parishofficers for the admission of some dear object of their affectionto the county asylum, on the footing of a pauper.The expenses attendant on a case of insanity of sudden

occurrence can in many instances be borne for a time, if notwithout inconvenience, at least without ruin, even by familiesof the middle classes who are not wealthy. For a few months,or for a year, they contend with this new demand. Theymake many sacrifices cheerfully, in the hope of the earlyrecovery of their relative. Friends help them. Charitablepersons having the disposition of funds assist them. If re-covery follows in a few months, the loss incurred is not veryconsiderable, and is eventually made up.But we must keep in mind the melancholy fact that even

at Bethlem, where no cases are admitted except recent cases,and of them none but such as are deemed to be curable, one-half of the patients admitted prove to be incurable by anyhuman means. For these, Bethlem is professedly not anasylum. All of them must leave it, at a fixed time, and bereturned to their friends, who have now to bear for many along year the heavy expense of a private asylum, uncheeredby any hope of the patient’s restoration to reason.Moreover, the paralytic and the epileptic are inadmissible

at Bethlem. Yet among the most distressing cases in theireffects on the circumstances of families are those in which thefather of a family is attacked with paralysis, and at once im-paired, in various degrees, and for life, in his intellectualfaculties. These cases are-of frequent occurrence; and whenthey occur, the results are, generally, an immediate diminu-tion or total suspension or loss of income, and at the sametime increased expenses. The remote consequences are, toooften, hopeless poverty, and at length utter destitution.

It must be remembered, too, that many young persons, aftera violent attack of mania, fall at once into a state of incurableunsoundness of mind; and that many others, in consequenceof epilepsy, become gradually and hopelessly imbecile. Theseunhappy patients become a perpetual burthen to their parents,who perhaps strive for a time to pay the expenses of a privateasylum. The patients survive them, and are friendless; and,although perhaps retaining the impressions of early care andrefinement, are either doomed to spend a long life in placesand among companions not to be described without a suspi-cion of exaggeration, or, if less unfortunate, are sent to acounty asylum for paupers.

These, Sir, are among the many cases, for the expense andburthen of which assistance is extremely needed; and I shouldbe rejoiced indeed, if the governors of Bethlem Hospital pos-sessed the means of providing for them, or for a certain pro-portion of them. But supposing that there were funds at thedisposal of that great charity, for this most charitable object,they could only be efficiently applied to the comfort of suchpatients by the institution of a supplementary asylum, a fewmiles out of London, and placed in the midst of cheerfulgrounds and gardens. Whatever advantages the localityselected for Bethlem Hospital may have been supposed topossess five-and-thirty years ago, are certainly not discernibleat present. It is obviously objectionable in almost everyimaginable respect, being such as not only to exclude all op-portunities of occupation, or even of recreation out of doors,but almost every hygienic influence, and everything cheeringto the senses, or the heart. The kindness and ability of themedical officers must find a continual antagonism in the cir-cumstances which surround them; and their patients, many ofwhom are persons of cultivated intellect, and capable of en-joying the beauty, and feeling the influence, of externalscenery, and of being benefited by the more diversified re-sources of a well-placed asylum, are, in these respects, lessfavourably situated than the pauper lunatics of any countyasylum in the United Kingdom., A healthful, cheerful asylum, for the indigent insane of the

educated classes, furnished with every appliance that experi-ence or ingenuity could suggest for the comfort and improve-ment of patients of this particular description, and the termsof admission to which should be moderate in every case, and

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gratuitous in many cases, is still among the charitable institu-tions wanting in this country, and the hope of seeing which Ido not yet abandon.

Trusting that even these observations may attract some newattention to the subject, and contribute to an attempt beingsuccessfully made, at some time or other, to establish such anasylum, I remain, Sir, your obliged and obedient servant,Hanwell, Oct. 8, 1850. JOHN CONOLLY, M.D.JOHN CONOLLY, M.D.

ON THE MEANS OF RAISING THE POSITION OFTHE MEDICAL PROFESSION.

THE OPEN-SHOP AND SURGERY QUESTION,

Are we to be tradesmen, or are we to be gentlemen ?—" That isthe question."

To the Editor of THE LANCET.

SIR,—The writer of the article from the Observer, reprintedin THE LANCET of the 21st of September last, is no less a truthfulthan a generous exponent of the case of members of the medicalprofession; and, at the same time, has displayed a conception ofour real pretensions to public esteem, which argues a perfectacquaintance with the subject he has taken in hand.

But, Sir, while I feel, in my own person, the liveliest indigna-tion at things that be-and I hope that no man amongst us, ofgentlemanly feelings and a well-organized mind, can be insensibleto the same—while, I say, I have a keen sense of the public andprivate wrongs we suffer-from the nature of our mission, thenoblest order, with one exception, upon earth—I feel an irresistibleimpulse, at such a moment, to turn round upon my brethren, andtwit them for the ample room which, in one large particular,they have afforded to the public for the origin and spread of thosedegenerate notions which it is pleased to associate with our"craft," and with ourselves. I allude not to the dissensionswhich are conspicuous among us, nor to the nnholy alliancewhich many of the " master-workmen" of our calling acknowledgewith quacks and impostors; still less, to the public flirtationwhich other (once respectable) members of our body carryon with divers forms of jugglery and divination-but, Sir, Iallude to our intolerable and (to myself) incomprehensible adop-tion of the character of shopkeepers and tradesmen - to our

intimate association of ourselves with the trade of this our pro-fession ! When every street in every town shall display a

"doctor’s shop," cheek by jowl with the tinker’s and the tailor’s,and that, not in modest diffidence of its Intrusion, but flauntingits wares upon the public gaze with all the pomp and circum-stance of a public sign, in the form of green and red bottles-when, in a row of shops, we are introduced to the baker, thegrocer, the "doctor," the candlestick-maker, each and all owninga community of action, of purpose, of tactics, and of tastes, it isabsolutely ludicrous to divert ourselves with a crusade upon thepublic neglect of our pretensions-of its narrow estimate of ourproper status in society-of its slowness to recognise our title torank and honours &c.!

Now, Sir, in these observations I by no means wish to be un-derstood as confining my strictures to the "Members of the

Royal College of Surgeons" and 11 Licentiates of the Apothecaries’Guild," whose street-windows are adorned with coloured bottlesand tooth-brnshes; but I intend them likewise to apply to everymember of the profession who dabbles with duugs-in a word,who dispenses his own medicine in a shop within his house-inplain English, who still keeps a shop on his premises, though theoutward and visible indications of it may be kept out of sight !I am not insensible to the animadversions to which such senti-ments may expose me on the part of the immense majority ofpractitioners who dispense their own medicines. Neither am Iignorant of the arguments paraded in support of the assertednecessity for such a system. I have them at my fingers’ ends;but will demolish them, en masse, in a few words-as thus: if a

single instance can be cited of a medical practitioner pursuinghis profession in a locality, divided by many miles, or by a singlemile, from a town or village, I am ready to recognise thenecessity which in his case exists for an amalgamation ofthe trade with the profession! But the fact is, no suchcase does exist, and for these two simple reasons-first, thathe would be removed altogether from the sphere of his use-fulness, and that nobody would or could turn his services to

account ; and, secondly, that no man who is anxious forpractice, or to whom practice is his bread-and-butter, couldafford to place himself in a position so unpromising. Henceit follows, that the medical man is essentially a gregariousanimalcule, the denizen of the town and village. This being so,it is of equally universal application, that no town or village inthe United Kingdom is without its chemist or druggist-or if

there be such an exception to the rule, that none would be with-out it, were the doctor interdicted from turning tradesman to thedisadvantage of the legitimate vender! But, then, it will beargued, if the general practitioner cease to dispense, whence theguarantee for wholesome drugs, and for protection to the publicagainst the dangers attendant upon the compounding them by un-skilful hands? Bah! ’tis pure moonshine, this!

Such an objection sinks into less than nothingness, when weask to be favoured with an enumeration of the difficulties attend-ing the passing of an Act of Parliament, to render it compulsoryon every druggist to prove his acquaintance with his business byexamination, antecedent to his opening a shop. Let this be theproper sphere of action for the operations of the trading companyat Blackfriars. Let the dirty connexion between a scientific pro-fession and that association of shopkeepers cease for ever. Scandalenough that it has ever existed ! So that they do their dutyrighteously towards the public, an ample field will be left themin the direction I have indicated. " But our patients will notcome into the arrangement!" exclaims a numerous section of thebottle-worshippers. To this I answer, the fault is with ourselves.Let us associate for an object so respectable, and what becomesof the popular caprice in such a matter? It would not be amongstthe least of the advantages resulting from the decline and fall ofthe dispensing system, that the medical practitioner himselfwould be spared (in many cases) the inconvenience and anxietyof domiciling assistants and apprentices beneath his own roof;whilst the latter, if engaging themselves at all, would escapefrom the dignified occupations of washing and carrying outbottles, and of tending the "surgery" door, as well as have sometime for, and prospect of, devoting themselves to, the cultivation oftheir minds. But, Sir, the truth must be spoken-we have aninnate love for the thing, and cling to it from a gusto inseparablefrom the charms which it holds out! We love to grovel on astradesmen, while the interests of our pockets are at stake, in pre-ference to claiming our proper status in society as gentlemen andas members of almost the noblest profession on earth. This beingthe case, let us cease to whine over the low esteem in which we areheld by the public, and pocket the agreeable consciousness thatthe general practitioner is scarcely known or seen in society,-bywhich I mean, in that sphere of society to which every edu-cated gentleman has a right to aspire-the best. I know thatthese are unpalatable truths; I feel them so, keenly, myself;but still they are truths for all that, though I shall in all proba-bility be denounced as a libeller of my own order in the common-wealth. It is inconceivable, to my own mind, that this funda-mental starting-point for the elevation of our order in society hasbeen so little insisted upon by those influential members of it,who must be most keenly alive to the influence which this customof "making up" our own medicines in reality has in keeping usdown in the public esteem. As Wolsey, after his fall, exclaimedof ambition, so do I exclaim of this our abominable fraternitywith trade-" There was the weight that pulled us’ down."

I do earnestly entreat you, Sir, to turn your attention in thisdirection, and to insinuate your broom into this dirtiest corner ofour Augean stable : it needs cleansing sorely.

I cannot close these remarks, without giving utterance to thesurprise and disgust with which, some months ago, I observedour once respectable Quarterly Reviezv (of medicine) recommend-ing the continuance of, and perseverance, on the part of the pro-fession, in this association of itselt with trade-this vending ofits own drugs. But the subsequently open alliance of this rene-gade journal with quackery, and its entrance upon a most sus-picious and degenerate line of action, (for, its editor or editorshave never yet denied the charge brought against them in THELANCET, that they are not only themselves employed by commer-cial speculators to write, but that their very articles have to besubmitted to those interested gentry antecedent to publication,)sufficiently account for that act of degradation, which recom-mended to the general practitioners of this country a course ofpolicy, an adherence to which could not fail effectually to keepthem down with the world.

I do entreat my medical brethren, how little soever they mayagree with me in these remarks, to believe, that in deliveringmyself of them I am actuated alone by a sincere anxiety for thehonour and respectability of our common calling-that we may"bring medicine to wisdom, and wisdom to medicine, so that thephysician should be a divine philosopher," (Hippocrates, " DeDecent. Habit.;") and that they will co-operate with me, in thedesire at least, that this long-continued incubus upon our properstatus in the world’s eye may soon come to be,

" Like the lost Pleiad, seen no more below."I remain, Sir, your obedient servant,

Woolwich, Oct. 1850. M. BROKE GALLWEY,Assist. Surg. Royal Regt. of Artillerp.

M. BROKE GALLWEY,Assist. Surg. Royal Regt. of Artillery.