tained. The institution is without a nightwatch now, however. the Insane was so generally acknowledged and understood, as to render it almost supererogatory to say anything in its favour. In Dr. Nichols replied, that to his predehis own experience a fire had been disco-cessor at Bloomingdale, Dr. Pliny Earle, vered by the night attendant, and the alarm was due the credit of having originated a given, which, without this means of detec-night-watch there. He (Dr. N.), feeling tion would, undoubtedly, have wrapped the convinced of the utility of the plan, had building in flames. He considered a night- maintained a night watch there; he also watch extremely useful in keeping up the concurred in the views expressed in Dr. police of an institution. He had also derived Kirkbride's paper. much benefit from the night watch in curing filthy habits among a certain class of patients. Dr. Curwen employs a night-watch, andfess that he was not prepared to admit the fully coincides in Dr. Kirkbride's views as to the advisability of having a more extended care of the Insane at night. Dr. C. dwelt at some length on the very great benefits derivable from the night-watch in the cure of filthy habits in chronic cases; instancing several cases in his experience where a radical cure had been effected. Dr. Bell said, that to keep an outside watchman to guard against fire was a debt paid to public sentiment. He must con necessity or utility of an in-door watchman as much as the tone of the paper seemed to imply. After the catastrophe at the Maine Hospital, it had been tried at the McLean Asylum, but gradually fell into desuetude. A watchman seemed to keep the whole house in an uproar-patients would fancy themselves seriously unwell, and having a Drs. Smith, Stewart (of Blockley), Pat-messenger at hand would insist on seeing terson, and Stribling, concurred in the utility of the night-watch. In the institutions under their charge a night-watch is regularly employed. the Doctor immediately. As to the watchman being able to prevent suicide, that he thought almost impossible, for the chances were as 100 to 1 against his being on the spot where, and at the moment when sui Drs. Tyler, Walker, and Bullock were much pleased with the paper. No night-cide was being committed. The care of watch is employed in their institutions. suicidal patients was so important that he Dr. Ray dwelt at some length upon the thought it should not be intrusted to the - merits of the paper, and upon the general casual visits and divided attention of a watchquestion involved. He thought that there man. Attendants are watchmen; and they was a proneness to prefer our own indivi- should be impressed with the necessity of dual ways, without giving to other plans disciplining themselves to sleep lightly; that mature consideration which was desira.this is quite possible; cases are plenty in ble, and a trial, which alone would enable which persons have so accustomed themus to find out whether the same objects can selves to sleep lightly that the least unnot be attained by other, and less objection- usual noise awakens them. Homicidal and able means. He employs no night watch, suicidal mania are so often coexistent that and thinks himself better off without them. he thought no two patients should ever be Dr. Jarvis said that, having private at-put together; no attendant even should be tendants for each patient under his charge, put to sleep in a room with a suicidal pa who also sleep with them, he did not keep tient, but an open latticed door should diup any night attendance, other than wasvide them. Persons in whom it was not necessary in case of sickness. known that a propensity to suicide existed Dr. Kendrick said that a watchman was employed at the institution at Columbus, who passes through the halls. He, how-of filthy patients by the watchman might ever, relied much upon putting two patients have a good effect in cases of dementia, but together for their mutual safety. not in mania. Dr. Brown stated that for thirty years Bloomingdale Asylum had been without any regular night-watch, but he believed that during Dr. Nichols's time, who has so recently discharged the duties of Superintendent there, that a night-watch was main Dr. Kirkbride explained some points treated of in the paper which had formed grounds of remark. He said he was cognizant of two cases of suicide having been successfully prevented by the night-watch. and nothing but the constant vigilance of He Dr Jarvis had used injections of tepid water with very beneficial effects, not as coercionary, but as medical means of treatment. Dr. Bell said that some little favours and of which would be considered a punishment; farther than this he could not go. The use of injections in a medical point of view he was quite prepared to admit, but to use ice water injections as a coercionary means he thought inadmissible, and in the present age censurable. Modern and ancient attentive persons can prevent suicide. past age, and which he thought had long been thought that the noise caused by the watch exploded from our Institutions, were still in man, which Dr. Bell made a ground of ob- existence. He protested against any such jection to the use of a night-watch, might coercionary means, and against the inference be easily remedied by having the duties that the gentleman had conveyed that either fulfilled by a careful person; he had known shower-baths or any other coercionary these duties performed with so much quiet-means were permitted, or were in use ness that the patients were actually not among us. aware that the watchman passed through their halls. He thought that in justice to the attendants who are employed in the harassing care of insane patients they should be relieved at night from the responsibility which attaches to their duties. Many at-privileges might be granted, the withdrawal tendants would sink under the weight of the thought that the responsibility of suicidal patients rested upon them when retiring at night. This idea would also prevent their having a sufficiency of sleep, than which nothing was more injurious, as it tended to make them irritable. He thought that it should be impressed upon attendants to ac-hospitals are distinguished from each other custom themselves to sleep through all by this axiom, “Patients, nowadays, are noises, as it was thus only that they would not responsible." A dose of senna or aloes be able to take that amount of sleep which would distress and gripe a patient very was essential to the due performance of much; but if a medical man was to call a their duties. An occasional watch was patient aside and tell him: "You have done worse than useless; and, in his opinion, aso and so, which is wrong, and now to regular night-watch only was to be tolerated. {punish you for this I am going to give you Filthy habits in eight or nine chronic cases, a dose of something which will gripe you with which he is acquainted, have been en terribly," this he (Dr. Bell) thought was tirely cured in less than a twelvemonth by equally wrong as to use the lash, the showermeans of the night-watch. One night-bath, or the ice-water injections, although watch, that is, one of each sex, should always be employed; two, and in some institutions, four, might be employed with advantage. at the same time it might be, that the patient stood in need of, and would be benefited by, a strong cathartic. He would wish to reiterate what had been already said by Drs. Kirkbride and Benedict, and have it widely and distinctly known that the views and sentiments of this Association are directly and emphatically adverse to any penal or coercionary means being used or permitted in our Hospitals for the Insane. Dr. Kendrick said that the cure of filthy habits having formed rather a prominent subject of remark in the present discussion, he would take the liberty of throwing out a suggestion on this point, that the members of the Association might, perhaps, consider useful. He had known very advantageous results follow the use of injections of ice-Galt, water into the rectum. It was a mode of treatment adopted by him for the cure of filthy habits. The effect of the injection was to cause intense pain for a few moments, but he had never found it to fail in the desired result. Dr. Kendrick also alluded to the use of shower-baths. Dr. Kirkbride would wish to raise his voice against the use of any means of tor ture. Dr. Benedict was much surprised to learn that any means partaking of the usages of a Dr. Nichols then read a paper by Dr. "On Pledges by the Insane." A short conversation ensued on the subtolph and Kirkbride, took a part. ject matter of the paper, in which Drs. But On a motion that the paper be laid on the table, Dr. Bell said that no one, perhaps, in the United States, had given more attention or had made greater or more frequent trials on this subject than the late Dr. Woodward. But Dr. Woodward's views had very materially changed on this question, a few years before his death, adversely to the accepting views of the argument, but who appeared to of pledges from the insane. The paper was then laid on the table for future discussion. [The press of other matter subsequently, however, prevented this discussion being resumed.] After an interval of ten minutes, be, however, largely in the minority, the Association adjourned to 34 P. M. Afternoon Session. The Association having met at the hour appointed for its afternoon session, and intimation being given that the carriages to convey the members to the Mount Hope Asylum were then in waiting, it was agreed Dr. Jarvis read a paper "On the Effects of over or perverted Action of the Brain or Nervous System on Mental Health." A communication from the Business Com-that the Association be farther adjourned to mittee relative to the visit of the Association 6 P. M. to the Maryland Hospital having been made, Dr. Kirkbride said, that he thought Dr. Jarvis had conferred a favour upon the com munity by the production of the paper just read by him. Dr. Ray fully indorsed the views advanced in the paper, and the principles of education, modes and manner of life recommended by Dr. Jarvis. The paper was farther discussed by Drs. Fonerden, Bell, Smith, and Jarvis. During a rather desultory conversation that arose, casual reference was made to the phrenological doctrines of the agency of the brain in the action of the mind. On this point very different views and opinions were held among the members of the Association. Dr. Bell said he was not prepared to say that the brain is the sole organ of thought; he had no reason to believe otherwise than that it is the whole, and not any one part of the Nervous System that performs this function, and in which the faculty exists. Autopsies generally present no material lesion of the brain; changes, indeed, there are to be seen, but which may have occurred in articulo mortis. What symptoms have we seen that can lead us to infer that the brain is the sole organ of the mind? How rare it is for our patients to complain of pain in the head, and how entirely inefficient have all counter-irritants hitherto proved in diseases of the brain! He fully admitted the great importance of education as having reference to phrenology-educating the faculties, and not the organs. . All knew, too, that functional diseases eventually became organic. In conclusion, he (Dr. Bell) thought that it was false philosophy to assume that the brain, only, is the seat of mind; nor will any examination that can be made, show us the seat of mind-neither the mind nor its seat being visible to physical examination. After a few words from Drs. Smith and Buttolph, who favoured the phrenological The Mount Hope Institution is pleasantly situated within a short distance of Baltimore; indeed, so near is it, that the extension and improvements of the city, and the opening of new streets so far encroach upon its privacy, that but a short time can elapse before its removal to a more retired location will be necessary. The eighteen acres of land belonging to the institution are tastefully laid out in pleasure-grounds, walks, gardens, &c. &c. It is entirely under the control of the Sisters of Charity, Dr. Stokes, its excellent physician having charge only of the medical department, and who bears warm testimony to the high and efficient qualifications of the Sisters for the duties they fulfil. The very neat order and thorough cleanliness maintained in every part of the establishment, the general appearance of the patients and their freedom from restraint reflect much credit on all concerned with it. The members having examined every part of the house under the guidance of Dr. Stokes, sat down to a very elegant cold collation prepared for them. The Association then returned to the Eutaw House much pleased with their visit, and with the kind and hospitable manner in which they had been received by the Sisters. Evening Session. The Association assembled at their Session Room in the Eutaw House, at 6 P. M. Dr. Ray read a paper " On Undescribed Forms of Acute Maniacal Disease." On motion of Dr. Tyler, the discussion of this paper was deferred for the present, and the Association adjourned to 9 A. M. The remainder of the evening was passed by the members of the Association at the hospitable mansion of Dr. Steuart, President of the Board of Directors of the Maryland Hospital, whose name is intimately blended with all the improvements made in the condition of the Insane of Maryland. charge during the past, than in any previous Third Day—Morning Session. The Association having met at the hour appointed, proceeded to discuss the paper) read last evening by Dr. Ray, "On Unde.} in the patients under his charge, presenting scribed Forms of Acute Maniacal Disease." More fully to elucidate the discussion which followed, and to explain the bearing of some of the arguments advanced, we extract and condense some portions of this very interesting paper, which will appear in full in the next number of the Journal of Insanity. the types or symptoms of the disease described. Doubtless cases did occur in the section of country where he resided, but the probability was that they were kept at home, where they died. Patients are not conveyed early to the asylum in his State. Dr. Walker had met with one case in which the symptoms had assumed such a character that it was deemed advisable to have a Coroner's inquest to inquire into the matter, as strong suspicions were held in the community that the deceased had come to his death by foul means; this, however, was not the verdict of the jury, and he felt that class of cases described by Dr. Ray. Dr. Kendrick appreciated the full value of the paper; he had not himself witnessed any cases bearing a resemblance to those described, probably for the same reasons assigned by Dr. Patterson. Dr. Ray describes seven cases that he had received, of which six terminated fatally. The Doctor then proceeds to state that though "examples might be multiplied, enough had been given, to justify the doubt, whether all the anomalous cases of acute maniacal disease, which are now so fre.no hesitation in saying that it was one of quently witnessed in our hospitals for the insane, can be properly referred to that form of it which has been described by Dr. Bell." "From the discussion which followed the reading of this paper (Dr. Bell's, in 1849), it appeared that, with one or two exceptions, no one felt sure that Dr. Stribling said, that from the location he had met with the disease in his own prac- of the Asylum under his charge, he had not tice. At subsequent meetings of the Asso-had any experience in cases of the nature ciation, however, several members have described by Dr. Ray; he would not say spoken of its having been recognized by that there were none to be met with in Virthem; and at the last meeting a paper deginia, but if there were the distance might scribing several cases was read by Dr. Worthington." "Dr. Benedict, of the Utica Asylum, in his last report, includes in his admissions, eleven of what he terms 'exhaustive mania,' and in the discussion which followed the reading of Dr. Worthington's paper, Dr. Benedict expressed the opinion that the form of disease here indi cated was identical with that of Dr. Bell. Dr. Brown has had four cases which very The only fact mentioned in his report re- much assimilated to those described by Dr. specting it, is that they all recovered; after Bell. He would much wish to see the paper making every allowance for diversity of read by Dr. Ray printed, as it would enable treatment, this fact alone would throw much gentlemen to prove to their own satisfaction doubt on their identity, since nearly all Dr. whether a case they might have under treatBell's cases proved fatal." Dr. Ray thenment formed one of the class described by alludes to the class of cases described by Drs. Bell and Ray. Drs. Williams and Ranney (see vol. vii. p. 43, and vol. viii. p. 145), and which, as being distinguished from other forms of maniacal excitement, has been termed typhomania. Dr. Kirkbride made some remarks on the paper, and in conclusion stated that in this form of disease, stimulants had been much more freely used in the institution under his have been so great as to deter their friends from attempting their removal at the first onset of the attack, and they might have died whilst waiting such a measure of strength as would justify the friends in bringing them to the Asylum. He, however, used stimulants in other forms of disease, and with very pleasing success. Dr. Benedict said, that it was with much diffidence that he ventured to differ with Dr. Ray, whose reputation and great experience were were so widely and deservedly known. The eleven cases towhich reference had been made in Dr. Ray's paper, called in his (Dr. B.'s) last annual report, exhaustive mania, he confidently believed to be well marked cases of the form of disease described by Dr. Bell. They were certainly not cases of the ordinary acute mania described in books, and generally met with in asylums, neither were they cases of that form of disease re ferred to by Drs. Williams and Ranney, and which is termed Typhomania. He (Dr. B.) had had large experience in a General Hospital where emigrant fever abounded, and where typhomania was frequently met with, so that he had no excuse if he had failed in discriminating between the one and the other. The classes in community in which the two diseases occur are very different; the mode of attack-many of the symp. toms, and especially the character of the delusions-the progress and termination of the two diseases are widely at variance from one another. That the gentlemen from Indiana, Ohio, and Virginia, had not seen this form of disease, he thought very possible from the facts adduced by them-that the locations of their institutions were such that patients might die at home. It was very different, however, in New York Dr. Bell thought that the great facility of State. The asylum at Utica was so easy access to the asylum at Utica made it easy of access, and the facilities of travelling for this class of patients to reach there. were so great, that even from the farthest The cases Dr. Benedict had mentioned point of the State to reach it was within the were cases of that description he had not compass of a few hours' ride. The feeling the slightest doubt. He had lately made that the asylum is the only place to treat freer use of stimulants in the treatment and an insane person was so widely dissemi- with commensurate success. This disease nated through the community, that patients differs widely from typhomania, and is a were hurried there in some cases with too disease sui generis. When the Association much rapidity. This had formed a ground held its meeting at Boston, some three of caution from his predecessor, Dr. Brig-years since, there was a well-marked case ham. If the cases he had men- of this form of disease then under treatment tioned last year did not come under the at the McLean Asylum, which was recogsame category with those described by Dr.nized without difficulty by two of the memBell, then he was mistaken; but he feltbers of the Association on the occasion of convinced that his judgment had not erred their visit there. in classifying them with those; if they were not, however, then possibly they might be a form of disease still undescribed. To the great facilities for travelling to which he had already alluded, and to the treatment adopted that of stimulants-he attributed the recovery of the eleven cases. form of disease described by him was about ten per cent. of the admissions.] Dr. Benedict then went on to state that, taking into consideration the number of admissions at the Utica Asylum-which was equal to the aggregate admissions of several of the New England Hospitals-and the great similarity between the habits, modes of life, and general character of the people of New England and those of the State of New York, it was scarcely proba{ble that a disease to which one were so subject should not be met with in the other. It was certainly possible; and if that was the case, and that this disease should be one coming under that class, and from which the people of New York State are exempt, then he (Dr. B.) had never seen the disease described by Dr. Bell. He shared in Dr. Brown's desire to see the paper put on record, and trusted Dr. Ray would permit its insertion in the Journal of Insanity. In reply to Dr. Stribling for information as to typhomania, Dr. Benedict described the symptoms, progress, &c., of that disease. Dr. Ray said that the paper read by him had been prepared rather hurriedly, and he possibly might have failed to mark sufficiently plain some of the symptoms indi Dr. Bell said there was a difficulty occa [In answer to an inquiry by Dr. Bell, Dr. Benedict said that he gave stimulants verycated by Dr. Bell. freely; in some cases, as much as twentyfour ounces of the best brandy in twenty.sionally met with in discriminating between four hours.] That the recovery of these eleven cases was an unusual coincidence he admitted, but the next three terminated fatally. [In reply to Dr. Benedict, Dr. Ray here stated that the proportion of cases of the meningitis, passing rapidly through its various stages, and mania; but with this disease it was wholly different. He had found no difficulty in classifying it; a few days affording ample time for that purpose. The symptoms on admission are different |