the Nose and Mouth by the Use of the Surgical Engine, after which Dr. George B. Fowler presented one on Intra-Vascular Alimentation: the Nutritive Value of Peptones. Dr. Fowler has recently been making some original investigations in regard to the use of digested meat as an aliment, and his experiments in this direction upon the lower animals have proved so successful that he has been led to the conclusion that peptone is much preferable to either blood or milk as an agent for intravenous injection. He furthermore reports that the results of his researches have been confirmed in a very satisfactory manner in one case in which it was employed in this manner in the human subject.

- At a recent meeting of the Academy of Medicine Dr. Abram Dubois was lected an honorary Fellow of the Academy, in consequence of his having contributed five thousand dollars towards the enlargement of its building, as well as other generous donations to the institution. At the last meeting, May 1st, Prof. Frank H. Hamilton read a paper on Posture as a Means of Relief in Strangulated and Incarcerated Hernia, in which he advocated placing the patient upon a steep inclined plane, with the head inverted, and gave a detailed explanation of the mechanism of reduction.

-The bill providing for changing the State Inebriate Asylum at Binghamton into an asylum for the chronic insane (supplementary to the Willard Asylum), to which allusion was made in the recent article on the New York State Charities Aid Association, published in the JOURNAL, has now passed both houses of the legislature, and will doubtless soon receive the signature of the governor.

Mr. Palmer, the manager of the Union Square Theatre, has given the entire receipts of a matinée performance to the New York Foundling Asylum, no deduction being made for expenses. It was peculiarly appropriate that a representation of the beautiful play, Lost Children, now running at this theatre, should be given in aid of such a charity, since one of the principal characters in it is Vincent de Paul, the founder of the first foundling asylum, and two or three of the scenes are laid in this asylum in Paris.

-Two cases of death from hydrophobia are reported from Brooklyn.

CHICAGO.

-Prof. E. W. Jenks, who has occupied the chair of gynecology in the Detroit Medical College since the organization of that school, has been elected to the place made vacant in the Chicago Medical College by the resignation of Professor Byford. — Prof. Daniel T. Nelson has resigned the chair of physiology in the Chicago School. His successor is not yet appointed.

-The management of the Cook County Hospital is just now receiving an overhauling at the hands of a committee of the board of commissioners, led by Commissioner Fitzgerald, who thinks the warden needs disciplining. The trial does not affect the medical board. It seems to have grown chiefly out of the scandal of an interne, a nurse, and the apothecary surreptitiously using the wash-room and dead-house of the hospital in which to clean the flesh from the bones of bodies they had procured for skeletons. The testimony differs as to whether the warden had given permission for these proceedings and for the use of the bodies of deceased patients.

BOSTON CITY HOSPITAL.

SURGICAL CASES OF DR. GEO. W. GAY.

Popliteal Aueurism; Femoral Artery tied with Catgut Ligature; Relieved. -T. L., laborer, aged forty-six years, entered the hospital September 26, 1878, and gave the following history: Three months ago he first felt a pain in the right popliteal space; a month later he noticed a tumor there of the size of a walnut, which has increased rapidly since that time. The heart is normal, and he has received no injury, although he appears to have been more or less dissipated. He is a large, powerful man, and has generally had good health. The right popliteal space was filled with a firm, elastic, pulsating tumor, which extended from the outer hamstring around on to the inner aspect of the thigh ten and a half inches. The vertical diameter was five and a half inches. The circumference of the right knee was two and three fourths inches greater than that of the left. The thrill and bruit were well marked, and the pain at times was excruciating. The patient was put to bed for a week, to get him accustomed to the confinement before any operation should be undertaken. Large doses of opium were required to procure relief from pain.

October 4th. The circumference of the right knee had increased two inches, and the skin over the aneurism was beginning to look red and irritable. It was now time to consider the different methods of treatment. The tumor not being confined to the popliteal space, flexion could do no good. The patient was too irritable to bear compression of the femoral artery, had it been practicable to employ it. The case did not appear to be a suitable one for any other method of treatment but the Hunterian operation, and that was accordingly done. The patient was etherized, and the femoral artery was tied four inches below Poupart's ligament with a double catgut ligature cut short. The wound was closed with sutures, and dressed with compound tincture of benzoin. The circumference of the right limb at the knee was one inch less after the operation than before it.

October 7th. Patient has been very comfortable, with the exception of a chill last night. Sutures removed. Wound closed by first intention throughout its whole extent. The ligature was never seen after the operation. October 30th. There has been more or less pain in the right foot since the operation, but it could be readily controlled by opiates. The foot has been warm, and although the wrappings have been seldom disturbed there has been very little, if any, swelling. No signs of gangrene. The circumference of the knee is two inches less than at the time of the operation. The tumor was firmly bandaged. Ordered blisters and poultices.

November 30th. The tumor has diminished considerably since the last report, so that now, although the patient has been walking about for a week, the right knee is only about an inch and a half larger than the left, whereas it was four inches larger prior to the operation. The tumor is now soft, painless, and devoid of pulsation. Although much smaller since the operation, yet it has never shown any tendency to become firm and hard, as is usually to be expected in these cases. This result may take place in the future should a complete recovery be obtained. There is pulsation in the right femoral, one

inch below Poupart's ligament, and also in the anterior and posterior tibials. The foot is warm, free from swelling, and the pain not severe enough to require opiates. The great size of the aneurism, its rapid growth, and the happy results following the use of the catgut ligature are points worthy of notice. It is hardly possible to get a wound with ligatures hanging from it to unite by first intention. In many operations primary union would be obtained were it not for the silk with which the vessels are secured. Torsion in these cases is tedious and uncertain. But good catgut, carefully tied by three square knots, and the ends cut short, allows the wound to be closed throughout its whole extent. This material has been in use over two years in this hospital, and thus far it has always been satisfactory.

Wound of External Iliac Vein; Ligature; Death. Mr. N., aged sixtyfour years, was stabbed in the right groin with a common pocket-knife. He bled until he fainted, and on reaching the hospital was in a state of collapse; almost pulseless, surface and extremities cold and clammy, face pallid, and respiration slow and sighing. On applying warmth and giving stimulants reaction came on to a moderate degree. The hæmorrhage being controlled with two fingers thrust deep into the wound, the latter was enlarged two inches, and after much trouble, owing to the depth of the vessels and the profuse hæmorrhage when the pressure was relaxed, the vein was secured by ligatures above and below the opening. The knife had passed upwards and backwards beneath Poupart's ligament, and made a lacerated wound an inch long in the external iliac vein. A smaller vein was afterwards tied, and no more bleeding took place. But the patient never rallied beyond that stage of great restlessness which John Bell says is an almost infallible sign of death, and died the next day, about thirty hours after entering the hospital.

LETTER FROM LONDON.

The Care of the Insane in Great Britain.

MR. EDITOR, - One of the results of the free communication between nations which is so striking a feature of the present age is that social reforms are instituted almost simultaneously in several different countries. In my last two letters I dwelt upon the English contribution toward the solution of a problem which, after having lain dormant for centuries, is being closely and practically studied in many countries at the present time, namely, the disposal of sewage. In my present letter I intend to deal with another subject which is claiming the attention of reformers on both sides of the Atlantic; I refer to the question of insanity in its legal and medical aspects. For a good many years the public in England, as a whole, and the profession had alike remained quiet in the belief that matters were pretty satisfactory as touching the guardianship of insane persons; but signs have not been wanting during the past three or four years that public confidence was becoming shaken, and this feeling of uncertainty has been growing so rapidly of late that the government, after issuing a royal commission to collect evidence and report upon the subject, is about to take steps to alter the existing state of things.

The question of legislation for the insane is one of comparatively recent origin, for the first legislative enactment for the protection of lunatics does not date further back than the year 1744. Up to that time their treatment had been of the most barbarous description. The present Earl of Shaftesbury, in introducing a bill to amend the lunacy laws in 1845, said in his speech, "the whole history of the world until the era of the Reformation does not afford an instance of a single receptacle assigned to the protection and care of these unhappy sufferers, whose malady was looked upon as hardly within the reach of medical aid. If dangerous, they were incarcerated in the common prison; if of a certain rank of society, they were shut up in their houses under the care of appropriate guardians; chains, whips, darkness, and solitude were the approved and only remedies." At the time of the Reformation, however, Henry VIII., in abolishing monasteries, seized upon one which had been founded in the thirteenth century, in the city of London, and presented it to the city, with all its revenues, as a residence for lunatics. The prior of this monastery had been directed by its founder to receive and entertain the Bishop of St. Mary of Bethlehem and all belonging to that order whenever they should be in England. The name Old Bethlehem became attached to the monastery; it clung afterwards to the asylum; in its abbreviated form, Bethlem, or Bedlam, it is still applied to this celebrated hospital, and has passed into a household word in all English-speaking communities. It is doubtful whether the condition of the unfortunate lunatics was much improved by this new foundation; for, more than a century afterwards, we find that it was necessary to pass a rule to the effect that "no keeper or servant in Bethlehem Hospital should beat or ill treat a lunatic without he considered it absolutely necessary for the better governing of the lunatic." The statute of 1744, to which I have referred as the earliest act of Parliament in which the social treatment of insane persons is dealt with, provided that two justices of the peace could issue a warrant for the arrest of any person who was furiously mad, or so far mentally disordered as to be dangerous if left at large. The lunatic was to be locked up in a secure place, and, if necessary, chained. The way in which at this time the inmates of lunatic asylums were treated is depicted with horrible realism in Hogarth's celebrated picture. In 1763 a committee was appointed by the House of Commons to inquire into the condition of the insane, and it was proved beyond all possibility of doubt that numerous persons who were perfectly sane were enticed away from home by relatives under false pretenses and placed in asylums. It was ascertained that in one asylum the great majority of the inmates were persons of this kind; no medical man ever visited the asylum, and the inmates received no medical treatment. As the result of this investigation the first lunacy act was passed in 1773, by which a great reformation was effected, and the foundation was laid for our present enactments. By this act a board of five commissioners was appointed, who should be Fellows of the College of Physicians. No one might receive into his house more than one lunatic without a license from these commissioners, and they were to have the power of visiting all places where lunatics were detained at any time, each commissioner being bound over by oath not to reveal to the proprietor of an asylum the date of a proposed visit. This act remained in

force without further inquiry until 1813, when the attention of the House of Commons was again called to the unsatisfactory state of everything which had to do with the treatment of lunatics. It was proved beyond question that many sane persons were still incarcerated in asylums; and it was found that in one of the licensed mad-houses the patients were confined in cells on the ground-floor nine feet long, the ground wet, the only furniture consisting of a box which contained straw to be used as a bed. A select committee was appointed to investigate the whole matter, and their report contained frightful accounts of the way in which these establishments were carried on. So strong, however, was the influence which was brought to bear upon members of the legislature by those who were interested in maintaining the status quo that it was not till 1828 that any measure could be carried through Parliament to amend the law which had permitted such gross abuse. Up to this time any person could be committed to an asylum on the certificate of one physician, surgeon, or apothecary, under the latter term being included all who dealt in drugs, whether they had obtained a diploma or not. By the new act every certificate was to be signed by two medical men, who had separately to visit and examine the patient, and to state that he was a fit person to be confined in an asylum. Neither of these medical men was to be in any way connected with the asylum to which the patient was to be sent. The number of commissioners was raised to fifteen; their appointment was taken out of the hands of the College of Physicians and placed in those of the government. Each asylum was to be visited four times a year by a committee consisting of three commissioners. Whenever a new patient was admitted into an asylum notice had to be sent to the commissioners within seven days, and there were special regulatious as to the frequent visitation of all lunatics by medical men. The commissioners were, moreover, given full power to revoke or refuse any license they might think proper, or to order the liberation of any person from an asylum.

It is a strange comment upon the state of public opinion in the early part of this century that one of the most prominent movers in the introduction of these most necessary regulations was the present Earl of Shaftesbury, then Lord Ashley. Were it not a matter of history it would be almost incredible that such a horrible system as before existed could have been allowed to remain unaltered until so recent a date that one who is still among our foremost social reformers was able to take an important part in its abolition. Under the new law the condition of the insane was much improved; but so deeply rooted was the system which it was designed to abolish that for many years complaints of ill treatment and wrongful detention made themselves heard. At length, in 1844, the commissioners themselves drew attention to the mismanagement and ill treatment of patients, which were still unhappily only too common, and which they felt themselves powerless to prevent; and as a consequence of their representations Lord Ashley again took the matter up, and passed through Parliament the celebrated act of 1845, which has been in force with the exception of slight amendments, ever since.

The system which was inaugurated under the act of 1845 may be briefly described as follows: Any registered medical practitioner is qualified by law to sign a certificate of lunacy. In the case of all patients who are not paupers,