able and impressive text for any one who may not go to the full extent of the non-restraint principle in treatment. From the account given, it appears that the patient was a tall, powerful man, labouring under acute mania, with symptoms of general paralysis. "Three, four, and even five men had great difficulty in controlling him. In the course of the four days of his residence in the asylum several desperate conflicts took place between him and his attendants, during which they frequently fell down together, and over the bedstead which I was in his room. At four o'clock in the morning of the day upon which he died . . . a most violent struggle took place between him and the attendants, by whom he was then fastened to the bed with a sheet and towels." Death took place between ten and eleven o'clock that same morning, and on examination of the body, various bruises and abrasions were found, and three ribs "fractured on the right side and six on the left. The heart was also extensively diseased." In the inquiry before a jury no undue violence could be proved to have been used, but "the Commissioners could come to no satisfactory conclusion with regard to" the conduct of the attendants, although the two senior of them were requested to resign. The Commissioners' couclusion was, that the treatment "had not been judicious, and that there had been a want of proper care and supervision;" for it appears that the superintendent did not see the case until making his ordinary round. at half-past ten in the morning.

Death is attributed to the heart-disease and the fractured ribs consequent on the struggle in the early morning of the day on which the patient died; and the Commissioners evidently disapprove even the final expedient of confining him to his bed. He must be a thoroughgoing partisan of non-restraint, and willing to sacrifice everything to it as a universal principle of action, who will not regret that some means of mechanical coercion had not sooner been resorted to-supposing always that seclusion was found inapplicable or ineffectual, rather than that such a terrible struggle for mastery, and indeed for life, should have gone on from day to day in a room between the infuriated maniac and his attendants. It will be generally admitted as unfair to attendants to be so exposed to maniacal violence, and to have their passions so tried by prolonged resistance and desperate assaults; while it must be also granted that such conflicts are necessarily attended with danger to the life and limbs of the unfortunate patient. In hinting at mechanical restraint as expedient in the case, we necessarily assume that all other means of calming excitement had been tried in vain, and that seclusion, drugs, baths, and moral influence had failed.

This was just one of those cases which foreign physicians, in their criticisms on non-restraint as a universal expedient, represent as inevitable, and therefore a sufficient reason against such an extreme principle. To this objection it has generally been replied by our English advocates of non-restraint, that such cases were purely problematical, and that in the experience of the many asylums of this country in which that principle is fully acted upon, no maniacs not amenable to firmness and kindness-in short, to moral treatment as 65-XXXIII.

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understood and practised in England-were met with, and that if such did occur in foreign countries, it was because coercion was not wholly laid aside, and because the true system of non-restraint was not comprehended. There is much truth in this reply, for none can deny the extraordinary extent to which the non-restraint principle can be carried out in well-ordered asylums; but that struggles between patients and attendants are comparatively frequent, the annual reports issued attest by the yearly catalogue of patients whose ribs have been found fractured before or after death, not to speak of slighter injuries. We must, however, not be understood to imply that such struggles are the consequence solely of restraint not being used; on the contrary, we are perfectly persuaded that they will unavoidably happen, for insane patients are prone to violence, and attendants have not always moral control, and that in almost all cases where maniacal violence does occur, mechanical coercion should not be employed to control it. We argue therefore on the same side with foreign objectors to non-restraint as a universal principle, only so far as the recognition of very exceptional cases of maniacal violence is concerned, believing that humanity will be best served in such supposed instances by a departure from so inexorable a rule of management.

The State Criminal Lunatic Asylum is ready to receive patients, but the Commissioners find that a removal of all the registered criminal lunatics to it is unnecessary and undesirable. The number to be removed bears a small proportion to the aggregate, on account of the trivial nature of the offences of the majority, and other circumstances with regard to them mentioned. The Commissioners indeed

"Have been forcibly impressed with the impropriety and absurdity of treating a large number of the patients confined under Secretary of State's warrants as of the criminal class, or otherwise than as ordinary lunatics, from whom they cannot, on any sound principle, be distinguished. We think it most desirable that the Secretary of State be empowered to transfer such patients from the criminal to the ordinary pauper class."

Eight hundred and seventy-seven criminal lunatics are enumerated as detained in asylums, hospitals, and licensed houses in England; but the number of those confined in convict prisons and gaols, the Commissioners are unable "to state, even approximatively." This last is a remarkable admission on the part of a Board which, if properly constituted and empowered, should, from its single special function in the State, be charged with the supervision of all lunatics in the kingdom.

In Scotland the only criminal lunatics alluded to by the Commissioners are those confined in the general prison at Perth, and only thirty in number. We cannot, in face of the large number enumerated in England, suppose those thirty to be the whole of the criminal lunatics in Scotland, yet no notice is given of any such inmates in the very complete lists of patients in asylums of all sorts, and we presume therefore that their existence is either not taken into account, or else that the Scotch criminal law operates in a different manner on the destiny of those guilty of crime who are at the same time of unsound mind. The English Commissioners have arrived at the conviction,

which counsel decides to be legal, that registered hospitals may receive voluntary boarders, upon some sort of bond or agreement, such boarders not being actually insane, but "conscious of a want of power of selfcontrol, or of the addiction to intemperate habits, or fearing an attack or recurrence of mental malady, and being in all respects free agents." This privilege will be a great boon to many such much-to-be-pitied individuals, who could or would not enter an asylum as registered lunatics subject to the restrictions necessary for the insane.

The Scottish Commissioners remark on the greater proportion of female pauper lunatics than of male, but instead of inferring therefrom, as is commonly done, the greater proclivity of the female sex to insanity, they go into the question, and show that the excess of female pauper lunatics is due simply to the larger source from which the supply of such lunatics is derived. "When the inquiry is restricted to private patients, this opinion derives considerable support, as it is then found that the proportion of male to female lunatics placed in asylums is as 100 to 106: the proportion of males to females in the general population being 100 to 111."

Both the English and Scotch Commissioners still concur in condemning workhouses and workhouse lunatic wards as places of detention for the insane, and in exposing the fallacies of Boards of Guardians respecting the great economy of such accommodation; and we would especially recommend for perusal the remarks of the latter Board on the whole question of its expediency and supposed pecuniary advantages, at p. 47 et seq. of their Report.

We shall conclude our notice of these Reports by briefly analyzing the general statistics of lunacy in the two divisions of the kingdom, during the past year.

The summary of the English Commissioners shows that there were:

Comparing the totals of the two years, we find an increase of 1140 among those placed in asylums, of which by far the largest proportion, viz. 927, has taken place during the year 1862 among the pauper inmates of county and borough asylums. The number of pauper lunatics has also increased greatly in metropolitan licensed houses, viz. from 695 to 826, or a total of 131; and in a less degree in hospitals, viz. from 262 to 306, or 44; but on the other hand, there is a diminution of 53 pauper lunatics in provincial licensed houses. The total increase of pauper lunatics during 1862 was, therefore, 1049 of the whole increase of 1140 that had taken place in all the establishments,

public and private, for the insane in England, or within 91 of that

number.

The mistake is often made of quoting these totals of the summary in the Commissiouers' Reports, as representing the actual number of the insane in England, whereas they represent only about one-half of those coming under the cognizance of public officials. Thus, the Commissioners tell us, at p. 22, that on the 1st of January, 1862, there were 8803 pauper lunatics in workhouses; and from a foot-note to that page, we gather that there were also 4463 others living as single patients with relatives, or boarded out with strangers. By adding, therefore, these numbers to the 20,949 enumerated as present in recognised establishments for the insane, we obtain a total of 34,215 pauper lunatics known to the Lunacy Commissioners and the Poor-Law Board on the 1st of January, 1862. To compare the total numbers of the insane in England with those reported by the Scottish Commissioners, we have to add to the 34,215 pauper lunatics found in England the number of private cases at the same date, viz. 5250, which gives a total of 39,465 insane inhabitants in England and Wales on the 1st of January, 1862; and to make an approximative estimate, we may assume this total to have reached 42,000 on the 1st of January, 1863.

Turning to the Scotch Report, we have the statement of the whole number of luuatics in Scotland, put before us at a glance in the table appended below; and this, we may observe, is compiled from more careful and accurate returns than we possess in England; for on comparing the returns of the English Commissioners with those of the Poor-Law Board, we find many discrepancies between them, and there is an evident want of concurrence and harmony between those two public offices, or otherwise we should not be able to point to the discreditable fact, that in a country like England we cannot state with accuracy even the actual number of chargeable pauper lunatics. Το return, however, to the table setting forth the state of lunacy in Scotland on the 1st of January, 1862, there were—

The Scottish Lunacy Commissioners make no return of the number on January 1st, 1863, and we cannot therefore ascertain the increase of lunacy in Scotland during 1862, as we were able to do for England. However, the increase is given during 1861, the Commissioners showing it to have been only 39 in the case of private patients, and of 32 in that of paupers—a remarkable contrast to what we have found to take place in England. "To what cause," say the Commissioners, "this comparatively slow growth of pauper lunacy is to be ascribed, we are not prepared to offer an opinion; but we scarcely venture to hope that the result of future years will be found as favourable.”

The totals arrived at enable us to compare the relative prevalence of lunacy in England and Scotland. The population of the latter country was 3,002,294, and that of England 20,061,725, according to the Census of 1861. The relative proportion of the population in the two countries is therefore as 3 to 20; and the number of lunatics in England should, supposing lunacy equally prevalent in it as in Scotland, have been on January 1st, 1862, at least 6 times greater, or 6341 × 6.5= 41,216.5; whereas we found it 39,465. After allowing for the more accurate enumeration in Scotland, lunatics would still appear to bear a somewhat larger proportion to the whole population in that country than in England.

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In the returns of the Poor-Law Board there is a separate column for the enumeration of idiots, as distinct from lunatics. It would be very desirable for the Lunacy Commissioners, both of England and Scotland, to prepare tables indicating the number of idiots, whether placed in asylums or elsewhere, as well as to exhibit the number of idiots added to the population annually. The much-needed statistics of idiocy might then be determined, and the relative prevalence of idiocy and lunacy in England, and in England as contrasted with Scotland, be ascertained. Some conclusions, moreover, could eventually be arrived at on the question of the mental degenerescence of the people. Similar statistics are collected in various continental States, and it would be only creditable to collect them in this country, where social science pretends to so much cultivation and patronage.

REVIEW V.

On the Nature and Treatment of Gout and Rheumatic Gout. By ALFRED BARING GARROD, M.D., F.R.S., &c. Second Edition, enlarged and carefully revised.-London, 1863. pp. 618.

WE were glad to see a second edition of Dr. Garrod's work on Gout announced, affording proof that the great ability and original research displayed in the first have been well appreciated by the profession for whom it was written. Doubtless there are other circumstances quite apart from the merits of the publication which have promoted the demand for the book, as we know, and as is so well known, that mere originality of research and ability in an author will rarely insure success to his writings unless there be some elements in them distinct from science to render them attractive.

Now, of all the diseases to which man is liable, gout has peculiarities which have always made it one of more than ordinary interest. It is the special disease of man, and of civilized man, and is unknown, as far as we are aware, to the brute-animal, and to races of our own kind leading a rude life, but little different from that of the brute. Moreover, as far back as authentic history extends, now more than two thousand years, we have a certain knowledge of the occurrence of this disease, of its attacking persons in the same condition of life as at present, whether Greek or Roman, fixing on the rich, the highly