face, we shall proceed naturally to observe the attitudes, gestures, movements, and general conduct. The facility, suppleness, and co-ordination of the movements must be noticed. The attitude of the old man with his head inclined to his chest, his back bent, and his knees giving way under him, is not more characteristic of a state of senility and exhaustion, than is the position of an unfortunate human being seated on the floor, with his chin resting on his knees, motionless for hours, and entirely unmindful of all that is passing around, indicative of incurable dementia. The gestures alone often indicate the passion which predominates. In insanity from disappointed love, airs of languor are often affected; in that from religion, great humility and attention; in that from sexual excesses, a downcast appearance, an evident desire to avoid notice, and an inability to look one in the face. The various gestures and actions of the insane, however, from the happy easy movements of the man who believes himself a monarch, or the excited violent ravings of one suffering from acute mania, to the sad torpid listlessness of the incurably demented, require to be drawn in stronger colors than I have the art of employing, in order to produce truthful portraits.

The Conversation of the Insane.-In endeavoring to gain information from this source, we must first seek to obtain, by kindness and a sympathizing manner, the confidence of the patient; for since it will frequently be necessary to ascertain his thoughts on the most varied subjects, so—unless we do so-and succeed in interesting him, he will often become suspicious of our motives, sullen, and uncommunicative. Lord Erskine, in his defence of Hadfield, referred to the case of a lunatic from whom he could draw no indication of insanity in the course of an examination in a court of law, until Dr. Sims entered, when the man addressed him as the Lord and Saviour of mankind. In many cases of madness, the reasoning faculties not being wholly lost, we are not surprised at finding that the patient can discourse correctly on many topics, until some accidental observation leads him to break out into the most imbecile extravagance, or makes him confide to us plans of revenge, or proposals for performing the most impracticable achievements.

The Memory of the Insane.-Evidence may generally be obtained more easily upon this point than upon most others. A few quiet questions addressed to the patient as to his name, age, and address, the members of his family, the nature of his occupation, the day of the week, the name of the reigning

monarch, &c., will often suffice; or where there is evidently mental weakness, we may ask him to shut his left eye, give his left hand, put out his tongue, show his right leg, and so on. An examination of the letters written by such an one will often also give us information upon this head, while they at the same time teach us his intimate thoughts. - These letters are often rambling and incoherent, and a very frequent characteristic of them is that they are full of wants. The following copy of a paper given to Dr. Conolly, by one who said that he had "received a commission from God Almighty," is a good example of this :-"In the name of the most High, Eternal, Almighty God of Heaven, Earth, and Space-I command you to procure me the following articles immediately:— a Holy Bible, with engravings, &c., a Concordance, a Martyrology, with plates. Some other religious books. A late Geographical Grammar, a Modern Gazetteer, Newspapers, Magazines, Almanacs, &c., of any kind or date. Musical instruments and Music; Large Plans, Maps, Guides, Directories, and Histories of Edinburgh, Glasgow, London, Dublin, Paris, Rome, Naples, &c.; Histories of Rob Roy; Riley's Itinerary, and his other works. Histories and Memoirs of George the Third, Queen Charlotte, Princess of Wales, Princess Charlotte of Wales, the Regent and Court, Prince Cobourg, Marquis of Hastings, Lords Sidmouth, Castlereagh, Bonaparte, the Beast, &c. Wines, fruit, lozenges, tobacco, snuff, oysters, money, everything fitting to Almighty God. Answer this in three days or you go to hell. P. S.-A portable desk and stationery, and a dressing case."

In connection with this subject it remains to say that the practitioner should, as a rule, be introduced to the patient in his proper character, and that he should bear in mind that the object of his examination is not only to determine whether the individual is of unsound mind, but if so, the treatment that must be adopted, especially with reference to the necessity for restraint, and the degree to which it may be called for. Should the circumstances require him to give

A Certificate of Insanity, he must remember the stringent rules with respect to it, enforced by the Act of Parliament, which came into operation on the 4th of August, 1845. According to Section 45, no person (not a pauper) can be received into or detained in any licensed house or asylum, without an order from some responsible person, and two medical certificates, which must be signed by two physicians, surgeons, or apothecaries, not in partnership, and having no interest

directly or indirectly in the house or hospital in which the patient is to be confined. They must each separately examine the alleged lunatic, not more than seven days prior to his reception into the asylum; and they must severally sign and date the certificate on the day of examination, and state the facts on which they form their opinion. The following is the form of certificate in the case of a private patient :

I

being a

() hereby certify that I have this day, separately from any other medical practitioner, visited and personally examined the person named in the accompanying statement and order, and that the said and a proper person to be confined, and that I have formed this opinion from the following fact (3) viz. :—

Signed,

is a (2)

Name.

Place of abode.

one thousand eight hundred

Medical Case-book.-In the same Act of Parliament a section has been introduced requiring that a medical casebook shall be kept in every asylum throughout the kingdom, in which the history, treatment, &c., of all patients shall be from time to time recorded. The following is the plan adopted by Dr. Stevens, at St. Luke's Hospital for Lunatics :Name? Age?

Married, single, or widowed?
Number of children?

Physician, surgeon, or apothecary, duly authorized to practise as such. Lunatic, or insane person, or an idiot, or a person of unsound mind. 3 Or facts.

The knowledge required by a medical man in "the life office" is somewhat different from that necessary in the private consulting-room. In the latter the patient is full of complaints, anxious to acknowledge all the pains and symptoms of disease which he may be suffering from, and ready to communicate the cause and history of his malady; in the former he generally acknowledges no uneasiness, and does his best to appear constitutionally strong and free from disease. In the consulting-room no information is withheld, and it is only necessary for the practitioner to weigh the value of the evidence laid before him, reject that which is worthless, and act upon that which is to be relied on; in the assurance office the tendency is to withhold and keep back everything which the assurer may deem calculated to make his life appear bad. The duty of the medical officer, consequently, resolves itself into looking out for and detecting any hidden diseases, malformations, or conditions which may threaten to shorten or endanger life; as well as to observe upon the effects of any previous disorders which may have tended to vitiate the constitution.

In most life offices the medical officer is required to fill up a printed form of questions, which in many instances is unnecessarily long and complicated. Indeed, it would be much better for every office to select their physicians and surgeons with care, and then be guided implicitly by their advice, without also rendering it necessary for the practitioner to submit to the directors the evidence upon which he founds his conclusions. The points to which the medical man should chiefly direct his attention are these:

1. The age, apparent age, occupation-and exposures attending it, and general appearance.

2. The family history, especially as regards scrofula, phthisis, insanity, gout, apoplexy, epilepsy, and renal diseases, occurring either in father, mother, brothers, or sisters.

3. Illnesses gone through since childhood, especially as regards small-pox and vaccination, gout, rheumatism, spitting of blood, asthma, pulmonary complaints, and fits of any kind.

4. The general habits and mode of living, inquiring as to the employment of exercise, early hours, and the use of intoxicating drinks, opium-eating, &c.

5. The character of the pulse and respirations.

6. The height, weight, and vital capacity-as ascertained by the spirometer.

When an examination has been made in the above order, the practitioner must proceed or not to make further investigations as he may deem necessary, and in the manner his judgment will suggest. In deciding upon a life, the recollection of the following aphorisms may lead to a correct decision.

If in doubt about the propriety of accepting a certain life, consider whether it would be advisable for the office to have one hundred such cases on its books.

Paucity of evidence in the family history must lead to increased care in the personal examination of the applicant.

Decline the life of a person who is not sober. Even if he has been given to drinking, and has reformed two or three years, yet his life should be declined, since permanent reformation is so very rare.

Tavern-keepers and such like, must be most carefully ex

amined.

When there is consumption in the parents, decline the case. The parents being well, but two or three of the brothers or sisters having died from phthisis, the life may be accepted, provided the applicant be strong and healthy, of proper weight and vital capacity, and of good habits. Should there be any flaw in the weight or vital capacity, decline.

If a man has had hæmoptysis, decline.

If a woman has had hæmoptysis, especially in early life, we may accept after a careful examination.

If a man or woman be above the normal weight, and the weight be rapidly increasing, decline; since such a person is quickly making fat, and may convert tissues whose integrity is necessary to life into the same material; especially in such is there a tendency to apoplexy, fatty degeneration of the arteries of the brain being often a cause of this disease.

Look with suspicion upon an applicant who has fatty degeneration of the margin of the cornea (arcus senilis), since a