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This is certainly a very encouraging result, says Dr. Watson,and we are happy to put on record the following case, whichwell desers-es to be added to the list :-John ;’1--, aged forty years, was originally admitted,

under the care of Dr. Bence Jones, May 8th, 1853, with all thesymptoms of considerable effusion into the left side of thechest. He stated, on his admission, that he had been ill sixweeks, during which time the cough had been very severe.At that period he had one day fallen down suddenly, pantingfor breath, -whilst engaged at work as an agricultural labourer;but this accident will not appear when we recollectthat the left lung was at that time rapidly becoming useless.The patient was treated in the country, the usual range oftherapeutical means being used- -viz., bleeding, blistering, &c.On his admission, the symptoms of effusion were so marked,

and the distress so great, that Dr. Bence Jones had him

tapped on the following day. Mr. Henry Charles Johnsonperformed the operation, and we shall never forget the unbear-able fcctor which was exhaled by the pus which escaped uponthe perforation of the chest. The usual stimulating and ex-pectorating remedies were used; but the patient became soonmuch oppressed by reacenmulations, and it was found necessaryfor the next three weeks to re-open the aperture made in thethorax. Mr. Johnson subsequently made a large opening,which was covered with linseed poultices ; but the fcetor con-tinued to be almost intolerable. ’

The patient, though still weak, insisted, about three monthsafter admission, on being discharged, when he returned toWindsor, where he was admitted into the Union Infirmary.Here he was affected with occasional severe dyspucea, and

the accumulation of pus (which turned out as foetid as it hadbeen before) became so great, that the parietes of the chestgave way in iive different places at very short intervals. Thescars left after this spontaneous escape of purulent matter arenow visible. These repeated attacks brought him so low thathe was one day looked upon as dead; the shell was preparedfor him, but before he was put into it, the master of the work-house (certainly a very prudent and sensible man) put a looking-glass before the patient’s mouth, and as the glass becamemoistened, means of revival were used, and the poor maneventually recovered. It is needless to say that in the unionand at St. George’s, the man was kept up by medicine, food,and stimulants. When a little better, he tried to work in thefields, but could not accomplish this task, and eventually wasre-admitted into this hospital on the 8th of March, 1854.He looked, on this second admission, considerably better

than when he left, and the intensity of the cough had consider-ably diminished. He complained of some weakness in thelegs; the whole of the left side of the chest was quite dull onpercussion, and yielded no sort of respiratory murmur onauscultation, though the heart was not so forcibly pushed tothe right side. The patient has progressed pretty well sincehis second admission, and we hope that he will graduallyregain that amount of health which is compatible with hispresent state.

Medical Societies.

ROYAL MEDICAL AND CHIRURGICAL SOCIETY.

TUESDAY, APRIL 25, 1854.—JAMES COPLAND, M.D., F.R.S.,PRESIDENT.

ADDITIONAL REMARKS ON THE STATISTICS AND MORBIDAPPEARANCES OF MENTAL DISEASES. By JOHN WEBSTER,Esq., M.D., F.R.S., &c.

This communication consisted of a synopsis of 115 dissections Iof patients dying in Bethlem Hospital, and was accompaniedalso by a careful analysis of the morbid appearances observedboth in the brain and the organs of the body. A paper pub-lished in the Society’s T1"CinsactÎolls for the year 1845 con-tained the post-mortem records of 175 insane patients; andthe 115 cases supplied by the present paper gave 290 dissec-

tions, an epitome of which gave the following result: In 226cases the pia mater was infiltrated; in 207, effusion had takenplace into the ventricles; in 184, turgidity of the blood vesselsin the brain or membranes was observed; in 117, the arachnoidmembrane was thickened and opaque ; in 64, the colour of thebrain appeared changed from its natural hue; in 51, blood-points were large and numerous upon the cut surface of themedullary surface; whilst in 40 instances blood was effused,sometimes even to a considerable extent, within the cranium,and which evidently proved the immediate cause of death in

most of these patients. According to the above data, theauthor desired to repeat the same general conclusions as for-merly enunciated by him when discussing the pathology ofinsanity-viz., 1, intiltmtion of the pia mater; 2, effusion offluid in the ventricles; 3, turgidity of the cranial vessels,were the principal as also the most usual diseased alterationsof structure which pathologists might confidently anticipate inpatients dying whilst suffering under symptoms of mentalalienation.

Dr. SUTHERLAND said, he thought that we were muchindebted to Dr. Webster for bringing the subject of themorbid appearances in cases of insanity so frequently underthe notice of the Society; that its importance was recognisedmore and more every day, because greater attention was paidto the subject, and because there were greater facilities of in-vestigating it than formerly prevailed. Chemistry, the

microscope, and the balance, added much to the accuracy ofour knowledge, but still it must be confessed that we hada very imperfect notion of the connexion of symptoms withthe morbid appearances of the brain. That there was nothingcharacteristic of the brain of insanity; that it was true somedeviation from healthy structure was generally found, but thatwhen it was considered that insanity was not only idiopathic,but also sympathetic and symptomatic, dependent uponfunctional and organic disease of the brain, as well as upondisturbances existing in a comparative state of health. When,for instance, on the one hand is met with every gradation ofsymptoms between encephalitis and delirium tremens, and, onthe other, symptoms analogous to dreaming and somnambulism,it could not be a matter of surprise, not only that no charac-teristic appearances were found in the brain of insanity, butalso that in some few cases nothing abnormal was discovered.Dr. Sutherland said that he could have wished that thesymptoms had been given in Dr. Webster’s paper, so as tohave enabled the fellows of the Society to have connected thepost-mortem appearances with them, as this would haveadded greatly to their importance and their interest; that hewould not speak of the morbid appearances so commonlyfound, as these had been ably pointed out in the paper, but hewould observe that minute anatomy had taught us to lookmore particularly into the state of the cortical structure, tosee whether any distinction could be drawn between acute andchronic cases, and into that of the fibrous structure, toelucidate the symptoms of that imperfect state of palsy,known as paralysis of the insane. That in acute cases, theconvolutions were found well-developed, the cortical structureof normal thickness, and gorged with blood, and Foville’sbands were distinctly marked; that in chronic cases the con-volutions were atrophied, the ganglion globule was more orless devoid of pigment, and that Foville’s bands were nowhereseen. That the fibrous structure, as seen under the micro-scope, varied much both in size and in consistence ; that inacute cases little change was perceptible; but that in chroniccases it frequently partook of the general atrophy of the brain;sometimes that the minute fibres were softer, and more easilybecame varicose, while at other times they were together, andmore elastic than in health; that, in certain cases, there wasadhesion between the fibres, giving rise to hardening of thebrain; that the softening of the brain was caused generallyby want of nutrition, dependent either upon poverty of theblood, as in starvation, or upon congestion in the capillaries, asin cases of maniacal excitement, or upon a diseased state of thearteries. He would not detain the Society by alluding tothe morbid appearances found in the other viscera, whichwere mentioned in the paper, as they corresponded with hisexperience in these matters; but he must conclude by con-

gratulating Dr. Webster upon the valuable addition which hehad made to his former papers upon this subject.

Dr. COPLAND, after speaking of the importance of connectingthe symptoms observed during life with the morbid appearancesafter death, remarked that the cause that was assigned forinsanity was not always the real one. There was no doubtthat secret vices in both sexes were the most common causesof insanity, though their influence was rarely known. Thiswas particularly the case in unmarried persons. There was noclass of diseases, moreover, in which there was so frequentlya combination of causes at work to bring them into action.

Mr. HoLMEg COOTE concurred with the remarks of Dr.Sutherland as to the importance of connecting the history ofthe case with the post-mortem appearances. Dr. B1’ ebster,however, could not be blamed for au omission on this point, asno complete record was kept of the symptoms presented byeach patient in the hospital. He (Mr. Coote) believed, how-ever, that a better system was now in operation. With regardto the dissections, many of which he had made, he could not

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connect the appearances observed with the previous symptoms.The microscope and chemistry, by assisting ns in more accurateexaminations of the fibres of the brain and of the blood, mightmaterially aid us in these inquiries. With respect to the cir-cumscribed mortification of the lung, which had been men-tioned, he would remark, that it was so frequently observedin the examinations which he had made, that it might be re-garded almost as epidemic in mania. The chief appearancesobserved in the head were in the various cases a smaller thanusual size of the cranium, an imperfect state of the tissues, anunusual thickness of skull, &c.Mr. BROOKE, in relation to the sphacelus of the lung con-

nected with insanity, inquired if any differences had beenobserved in the medullary structure of the medulla oblongatain these cases?Mr. CooTE replied that he had frequently examined this

structure, but could not detect any change in it.Mr. Bossy inquired whether there was any connexion be-

tween malaria and insanity ? Medical practitioners in marshydistricts saw more of the disease than those located in morehealthy districts.Dr. GUGGENBUHL observed that cretinism, to which he hadmore particularly directed his attention, was observed chieflyin the marshy districts of the Alps. He believed that malariahad a great influence in its production, but was not the exclu-sive cause either of cretinism or idiotcy. This influence ex-tended to other animals, for even the calves and dogs in onevillage which he had visited were idiotic and emaciated. 1-1 e

thought, however, that the malaria must be of a special kindto produce these effects, for both in Holland and Hungary,where intermittent fever was prevalent, idiotcy was not

frequent, and cretinism very rare. With regard, however, tothe causes of mental affections, as the President had observed,these could not be confined to one or two, as many might be inoperation.

Dr. M. SciiULHOF remarked, that in Styria idiotcy andcretinism were remarkably frequent, and inquired if Dr.Guggenbuhl had formed any opinion as to the cause of thisprevalence. He also inquired if Dr. Webster could give anyinformation on his own authority as to the increase or decreaseof lunacy. ,

Dr. O’Cowo, inquired if the urine had been examined inany of the cases that had been brought before the Society ?Mr. COOTE had had nothing to do with the treatment of the

case whilst in the hospital, but might mention that a diseasedcondition of the kidneys was very commonly found after death.

Dr. GARROD had a few years since attended a patient whodied in a few days from a violent attack of delirium tremens.Most extensive gangrene of both lungs was found. Thisdisease seemed to have some relation to the state of the brainat the time, the case he had related being a recent attack ofdelirium tremens, the patient having never been afflictedbefore with insanity.Dr. COPLAND had many years since referred insanity to the

ganglionic system, which, being disordered, would affect theblood and the organs of nutrition in a manner which couldscarcely be determined by after-death appearances. It was

proved that in insanity the nutrition of the brain as well asits chemical condition was affected.

Dr. WEBSTER felt gratified that the remarks contained in thepaper just read to the Society coincided with the experienceof so good an observer as Dr. Sutherland, in all questions con-nected with the statistics and pathology of mental diseases.He admitted readily, with that physician, the defects his com-munication exhibited respecting the previous symptoms mani-fested in the various dissections detailed. Such an inquiry iscertainly of the highest importance, although little has hithertobeen accomplished in order to localize, as stated in his paper,the different phases of insanity, or to connect them with par-ticular morbid appearances in the brain and membranes,whereby pathologists could be able to foretell, from the par-ticular phenomena usually noticed during a patient’s mentaldisease, the changes of structure which might be confidentlyanticipated after death. This can often be prognosticatedwith confidence in ordinary maladies affecting sane persons;and great attention being now paid to the pathology of mentaldiseases at numerous public asylums, to which members of theprofession had often free access, the above desideratum woulddoubtless be in due time supplied. Dr. Sutherland had re-ferred to the frequency of paralysis amongst lunatics, butespecially respecting its fatal character. Only recent cases

being received into Bethlehem Hospital, excepting criminals,and as all patients labouring under any form of paralysis areexcluded from the institution, very few instances of that

variety of insanity hence fall under observation, unless in

patients who become so affected after their admission. Dr.Webster, however, fully agreed with Dr. Sutherland as to

paralysis of the insane being now more common than foimerlythroughout England, as it seemed to be likewise in France;whilst the attack almost always proves fatal, and was muchmore prevalent amongst men than women. Respecting thecauses commonly assigned by relatives to have produced mania.,Dr. Webster concurred with the President, that it verydifficult to obtain correct information on such points; whilstreally not one but often various infliied-ccs actually producedinsanity, the reported cause being only the most prominent.Secret vice, to which Dr. Copland had also alluded, wasunfortunately much more commonly the real cause of insanitythan parties would often admit or could be ascertained. InFrance, on the Continent, and especially in the southern portionsof Germany, as for instance at Vienna, this was certainly thecase; and he remembered, when visiting the lunatic asylumof that capital, the above fact was so stated to himself.In England the same demoralizing influence acts frequently asthe chief exciting cause of mental alienation, although it is

always difficult to obtain correct information on such subjects.Drunkenness proved a common, and at present was verypowerful cause, in reference to the production of insanitythroughout the general population; especially in Scotland,where whisky-drinking was assigned in numerous cases as

having produced madness amongst a large proportion of patientsunder treatment in the public institutions of that country.Tobacco-smoking was likewise, in his opinion, a much morefrequent exciting cause of mental maladies than many personsperhaps supposed. The excess to which this filthy custom, soinjurious to the bodies and minds of enslaved votaries, hadbeen of late years often pushed, seemed certainly an increasingevil, and therefore produced serious consequences to a greaterextent than formerly. In the United States of America.,medical men considered it as often a chief source of insanity innumerous individuals admitted into asylums, and the physiciansof several establishments for the insane in that republic,mention the fact, and even prohibit all tobacco-smokingamongst inmates, believing such practices protract their re-covery. Dr. Webster next adverted to certain modern systemsof education now pursued in some seminaries of England, andwhich he believed often tended to produce insanity amongstjuvenile persons, through too great exhaustion of their mentalfaculties; as, for instance, in young men at college, whenstriving to obtain prizes or become wranglers, and so forth:as also amongst nervous girls whose feelings and animal tem-peraments are sometimes over-excited by giving what are oftencalled accomplishments, instead of cultivating their intellect.This seemed a great mistake, and he would appeal to Dr.Sutherland, if victims of that system were not met with inprivate asylums. Reference had been made in the paper read,as also by several Fellows, as to the marked frequency ofgangrene of the lungs amongst lunatics, compared with itsrarity in ordinary patients. That peculiar feature was unequi-vocally demonstrated by the facts contained in the synopsis nowbefore the Society, besides being likewise fully borne out by theexperience obtained at various asylums, both English andforeign. Upon the latter point, allusion might be made to thelarge institution for lunatics at Prague, where, out of 335 dis-sections of insane patients, 25 exhibited marked gangrene ofthe lungs, making 1 case in every 13 individuals; whereas,amongst 3102 autopsies at the general hospital, only fifty-five cases of the same description were observed, or one

example in fifty-six persons who died from bodily diseases.Nevertheless, Grissole mentions, in his work on Pneumonia,when alluding to gangrene of the lungs as exceedinglyrare, that he had not met with one instance amongst the307 cases of thoracic affections constituting the data uponwhich his various deductions were founded. Dr. Websterfurther remarked, in illustration of mortification of the lungsbeing uncommon amongst ordinary patients, that at the publicinstitution to which he was many years one of the attendingphysicians, only a single case of the kind had been met withby his colleague, but not one by himself, although pectoralmaladies were always very numerous. Locality had certainlysome influence in the production of insanity, as stated by Dr.Habershon. For instance, in flat countries, mental diseasesseemed less frequent than in mountainous or hilly districts, asshown by the fact that more lunatics were found in Wales andScotland than throughout England, in proportion to thenumber of inhabitants. But one of the most remarkable

examples of this peculiarity, with which Dr. Webster was: cognizant, existecl in the dominions of the King of Sardinia, ac-, cording to a recent statistical statement he had perused. Thus,in the plains of Piedmont, which extended from the Alps to

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the valley of the Po, there was only one insane person in every5812 inhabitants; whereas, throughout Savoy, although thelatitude, laws, customs, and people were nearly similar, onelunatic was recognised in every 1306 individuals, the ratiobeing therefore four times gTeater in this mountainous district,contrasted with the more level provinces of Piedmont. Further,in hilly countries, more lunatics were even found on the northernsides of mountains, from being hence deprived of the vivifyinginfluence of sunshine and warmth, than on their southern orwestern declivities. This peculiar feature Dr. Webster statedas the result of his own observation and inquiries; whilst itwas also borne out by other observers: as, for instance, Dr.Eubertz, of Copenhagen, who had only recently written a veryinteresting work respecting insanity in Denmark. Dr.Guggenbuhl having adverted to cretinism and g6itre, althoughthese maladies were not specifically noticed in the author’spaper, he would nevertheless remark, that the improved phy-sical stccttcs and advanced civilization of the inhabitants oflocalities where such maladies usually prevailed, alwaystended to diminish their frequency, and might even ultimatelyeradicate them altogether. In proof of this influence, Dr.Webster alluded, first, to a singular instance of the kind whichwas mentioned in the recent report made to the SardinianGovernment by the Commissioners appointed to inquire re-

specting cretinism and goitre in the Alpine districts of thatkingdom. At a village or small town situated in a valley nearthe Alps, where cretins were formerly very numerous, thosegentlemen found, that ever since a high road had been madethrough the locality in question, whereby much traffic, with itsattendants of increased employment, better remuneration, andgreater physical comforts, became disseminated amongst thenatives of this hitherto poor and almost è1llcivilised community,a considerable diminution in the number of cretins had taken

place; in fact, this disease seemed almost to have disappeared,very few cretinous children being born since the inhabitantsenjoyed better food and were more prosperous. The other

example cited by Dr. Webster occurred in a district of thecanton of Valais, in Switzerland, which he had himself visitedsoon after the great inundation of 1818, whereby, from thebursting of a mountainous lake, several villages, as also a

large tract of country near Martigny, had been flooded, andmuch damage inflicted. The soil of this district, formerly wet,marshy, insalubrious, and unproductive, in consequence ofmuch new vegetable matter having been brought from themountains by the overflowing waters during the inundation,and left on the adjacent land, had become more fertile; so thatthe inhabitants were fully occupied, better fed, and had con-siderably advanced in material civilization;-the consequencesof this change being, that recently no new cases of cretinism orgoitre have appeared in a particular commune of this previouslyunhealthy district; whilst the former malady was now almostunknown where it seemed formerly so common. Dr.Guggenbuhl was doubtless well aware of both these interestingfacts, and he would like much to hear his opinion on thesubject now mooted. The question having been askedduring the discussion, whether insanity was now more

prevalent in England than formerly, he would reply,that, in his own opinion at least, mental diseases were lessnumerous in reference to the aggregate population than atprevious epochs. No doubt, a larger number of individualswere at present recognised as insane compared with the amountascertained twenty years ago, or at the commencement of thepresent century; but then many lunatics were left to roam atlarge, generally neglected, or even wholly unknown; whereas,much greater care was recently taken of these unfortunatefellow-creatures, whilst their number is more accurately regis-tered than in bygone periods. Seeing it had been proved thatcretinism, idiotcy, and goitre were diminished in frequency,through advanced civilization and augmented physical com-forts, Dr. Webster therefore now believed, although such anopinion was disputed by various authorities, that insanity didnot really appear at present an increasing malady throughoutthis country, notwithstanding the number of new asylumswhich were constructed or in course of erection, and the greaterattention consequently directed to such important matters.Allusion having been made to the advantage of microscopicand chemical investigations, respecting the nature or composi-tions of various fluids and secretions of lunatics, he would justremark, that such inquiries were of great utility, and aidedin diagnosing the different types of mental disease. Someattention had been given to these subjects; but as the datahitherto obtained were very limited, no conclusive deductionscould yet be founded thereon. However, as the medical staffof Bethlehem Hospital was now more numerous, it was hopedfurther progress would be made in this department. Before

sitting down, Dr. Webster referred to the influence whichatmospheric changes sometimes exerted in producing attacks ofinsanity, as alluded to by a previous speaker during thatevening’s discussion. On this question he would quote a verycurious illustration, stated by Sir Woodbine Parish in his lateaccount of Buenos Ayres. At this capital, when the " vientonorte," which blows from over the extensive and insalubriouspampas of South America, prevails for any great length oftime, it produces an irritability and ill-humour in some peoplethat, even at times amounts to almost temporary mentalderangement, and disorder of the moral faculties. Amongstthe lower orders this effect is so well known to the police, thatcases of quarrelling and of bloodshed are much more frequentduring the existence of this peculiar north wind than at anyother season. Indeed, it has been even said by anotherauthority, that, in a late case of murder, tried in the criminalcourt of Buenos Ayres, the culprit’s advocate actually advanced,as an extenuating plea in his ’client’s favour, the prevalence ofthe "viento norte " at the time when the crime alleged wasstated to have been committed.

Dr. Gu&GENB’JnL, with regard to the increase and decreaseof idiotcy and cretinism, remarked, that in some mountainousdistricts and villages where sanitary improvements had beenmade these diseases were decreasing. In other parts, how-ever, where these reforms had been neglected, these diseaseswere on the increase. In one village which, in 1800, containedonly one idiot, there are now thirty-two of these unfortunatepersons. He (Dr. Guggenbuhl) could find no cause for thisincrease in the climate or other circumstances connected withthe locality, but had found that the inhabitants were muchaddicted to drunkenness, and swallowed large quantities of animpure brown brandy. The increase, he believed, was con.nected with this fact, more particularly so as some of thechildren of drunken mothers spoke and walked exactly as

though they were drunk without having taken anything tointoxicate them. In other parts of the Alps, again, thenumbers of idiots and cretins remained stationary. Sanitaryoperations, tending to ameliorate the condition of the peopleand improve their physical state would have much influence onthe control and removal of cretinism. The influence of avitiated state of the atmosphere, dependent on some electricalor other cause, was very marked in this affection, and he men-tioned a town badly situated in regard to atmospheric in.fluences, in which not one person out of the 6000 inhabitantswas regarded as fit for military service, and another of 3000inhabitants in which there was not a man of sufficient capacityto fill the office of mayor. There was much cretinism both inAustria and Styria, but he had not inquired into the causes ofsuch prevalence.

MEDICAL SOCIETY OF LONDON.

SATURDAY, APRIL 29, 1854.—MR. HEADLAND, PRESIDENT.

Dr. WINN related the following case ofSUBCUTANEOUS EMPHYSEMA OF THE TRUNK AND NECK, OCCA-

SIONED BY RUPTLTRE OF THE PULMONARY AIR-CELLS,OCCURRING IN AN INFANT FIFTEEN MONTHS OF AGE.

The patient, a delicate, unweaned infant, had been under hiscare for a severe bronchial affection, which had supervened onan attack of hooping-cough. The latter affection, however,had not been clearly developed, inasmuch as the mother in-formed him that the child had not hooped more than threetimes during the whole period of its illness. A remarkablefeature in the case was the subsidence of a violent coughtwenty-four hours before the accession of the subcutaneousemphysema, and forty-eight before its death. On the accessionof the emphysema, the child’s breathing became greatlyoppressed, and, as collapse appeared imminent, he substituted It

stimulant plan of treatment for the antiphlogistic remedieswhich had been previously used. The child, however, receivedno benefit from these measures, and she gradually sank.-Post-lnortnn examination: The whole of the cellular membrane en-circling the trunk and neck was completely emphysematous.The lungs presented extensive signs of disease; interlobular em.physema was diffused throughout the greater part of their struc-ture ; the lower portion of the upper lobe of the right side wasdensely carnifiect; in the upper lobe of the left lung there wereseveral small cavities; isolated tubercles were also scatteredthroughout the left lung; the cellular membrane of the pos-terior mediastinum was distended with air. He need scarcelyadd that the minute rupture whence the air escaped could notbe detected. During a practice of between twenty and thirtyyears he had only met with two cases of this kind. The first