happen that within a given, but exceptional year, there had been more cures than admissions, and in the event of a severe epidemic, even deaths might chance to be in excess of both.

"Analyzed according to the usual mode, the recoveries during the past twelve months in Irish public asylums would realize 45 per cent., and the improvements, as represented by discharged patients, 3, between both fully 58 per cent. on admissions."

The Inspectors publish the revised code of Privy Council Rules for the management of the several district lunatic asylums in Ireland, and at page 6, give these rules their approval without any qualification. The Journal of Mental Science has already pointed out the following regulation as injurious to the dignity of the medical superintendents of asylums:

"XXXV.-He, the resident medical superintendent, shall never be absent from the asylum at the same time with the matron, nor ever for the night without special leave from a board of governors or the inspectors, and upon every such absence he shall enter in the book the date and period; and inform the consulting and visiting physician, who for the time shall exercise a general supervision over the establishment."

We do not know who originally framed this inquisitorial regulation (they are signed by the Lord-Lieutenant and Privy Councillors); but in order to think well of him, it would be necessary that this was one of the least estimable of his proceedings. Superintendents of asylums are, we believe, a body of honourable men, not requiring any such detective machinery. The pleasure some men feel in controlling the movements of those who may be exposed, in one way or other, to their supervision, should not lead them to inflict useless or unnecessary humiliations.

The tenth regulation seems to us also objectionable :"X.-The general dietary shall be regulated by the board of governors, subject to the approval of the inspectors, and to such alterations as they may think fit from time to time to direct. The medical officers shall be at liberty to prescribe such extras as they may deem necessary."

The boards of managers are, as a general rule, totally unfit to frame a proper diet-roll for an asylum, and when they do so, they should be clearly made to understand that they must to a great extent be made responsible for the mortality; for nothing has a greater effect on the mortality of an asylum than the nature of the dietary. The permission given to resident physicians to order extras is a check upon the evil, and might indeed with a little management nullify it to a considerable degree; but common sense, we think, demands that the diet-roll should be framed by the medical superintendents, subject to the approval of the board of managers and the examination and comment of the inspectors in lunacy. It strikes us that it would not be unworthy of the inspectors of lunacy for Ireland if they were a little more anxious to uphold the dignity

of the medical superintendents. They have to attend to duties of the highest importance, the care and guardianship of hundreds of human beings deprived of reason, and subject to nervous diseases, which require a most attentive study. If they do their duty in this respect, they must always be hard-worked men; hence it is most unwise to subject them to fritter away their time by demanding trifling returns or making their work difficult by complex and vexatious regulations. It appears from the revised code of regulations that a resident superintendent cannot send the gardener out for a package of seeds without gaining the consent of the board of guardians to the said purchase, and furnishing the man with a signed pass to get past the gatekeeper. But regulations like these always in the end become a dead letter. After every meeting of guardians, the Irish superintendent has, within four days, to send a report of the proceedings to the inspectors of lunacy. The quantity of other clerk work he has to do is sufficient to dull the energy which might well be reserved for more important duties. The medical superintendent should be held responsible for the state of the asylum, and he should not have his authority weakened by such rules as might render his decisions doubtful. By these rules, he cannot even dismiss a servant without the consent of the board; he is allowed to suspend only in cases of drunkenness, insubordination, or cruelty; but he must report to the inspectors, within three days, the name of the party and the cause of suspension, and at next meeting of the board of governors lay before them the case for its decision.

The revised code occupies nearly 20 pages octavo, and enters into the most trifling particulars of the duties of the inferior servants. The chaplains have to keep a book at the asylum giving the result of their religious ministrations, to be submitted to the board at its meetings, and to be retained in the office.

It is pleasant to think that the inspectors of lunacy have time to attend to so much; only it may occur to the public some day that as a number of the returns they ask from superintendents are only calculated to make useless work, it would be a relief and a saving to the national treasury if their staff of clerks were reduced, and that a Privy Council which has no better work to do than to print regulations telling the cook of an asylum to keep her pots clean, must be in want of something to engage their leisure time, which, we suppose, like Don Quixote's, comprises the greater part of the year.

Fourteenth Report of the Scottish National Institution for the Education of Imbecile Children, Larbert, Stirlingshire.

We have again received the Report of this most valuable and excellent institution, so well managed by Dr Ireland. In a

scientific and professional point of view, the work done, and observations made by him there, are of extreme value; while, as a philanthropic institution, this asylum deserves all the support, pecuniary help, and influential encouragement that we as medical men can give it. It is doing a great work among the idiot and imbecile children of the country, and affords a model to which similar institutions may look for guidance.

Part Third.

MEETINGS OF SOCIETIES.

MEDICO-CHIRURGICAL SOCIETY OF EDINBURGH.
SESSION LIV.-MEETING VIII.

Wednesday, 2d June.—Dr D. R. HALDANE, President, in the Chair.

EXHIBITION OF PATHOLOGICAL SPECIMENS, PATIENTS, ETC. I. Mr Bell showed-(1.) A beautiful specimen of what looked very like SENILE GANGRENE. The patient, however, was a lady, 49 years of age, young-looking for her age; and the grangrene had resulted from a pathological plugging of the popliteal artery, following attacks of fever and pneumonia. He had seen her seven weeks ago in Stirlingshire, but the line of demarcation had not, at that time, formed. Five weeks afterwards, however, it formed, and he therefore amputated below the knee-joint. The patient was making a good recovery.

(2.) A very well-marked specimen of ENCEPHALOID CANCER growing from the dorsum of the foot. Owing to the stupidity of the patient, the history could not be accurately made out. He had received an injury of the foot about two years ago, which was not followed by any bad results until six months afterwards, when a cystic tumour appeared. This was excised entirely by his medical attendant. Within the last six months, however, this large growth, of which they saw a section, had appeared. As it bled profusely, the patient when admitted into hospital was very anæmic. After the operation he did well at first; unfortunately, secondary hæmorrhage occurred twice, for which he could only account by the general poverty of the man's system. He was now, however, doing well.

(3.) A TUMOUR weighing three pounds, which he had removed from the popliteal space of a young gentleman in Linlithgowshire. The tumour had been growing for some time, as the patient had been two or three years in Canada since its first appearance. When seen by him along with Dr Kirk of Bathgate, he was unable to straighten his limb; and there was swelling extending from the middle of the calf to the middle of the thigh. As it was

evidently not adherent to the bone, he made a free incision over it, and after a careful and prolonged dissection removed it entirely. He then found that it had pressed so much on the vessels that the sheath was thinned, and the artery and vein, lying side by side, were seen for about four inches flattened and separated. The external popliteal nerve was embraced in the tumour, and had to be carefully dissected out of the groove which they now saw. This explained the pain suffered by the patient. Fortunately there were no strong adhesions. The patient made a good recovery, and five weeks after the operation came a considerable distance to show himself. Microscopic examination showed that the tumour was a soft fibrous sarcoma, with few symptoms of malignancy, except a somewhat disorderly grouping of its cell elements. The long time during which it had been growing was in favour of its not being malignant.

II. Mr Annandale showed-(1.) A child on whom he had performed a new operation for aggravated KNOCK-KNEE. The result of the operation had been to completely cure the deformity. (See page 18.)

(2.) A man who had suffered from a COMPOUND DISLOCATION OF THE ASTRAGALUS. The case had been treated by division of the tendo Achillis, and antiseptic dressing. Recovery had taken place, with a movable and useful foot.

(3.) A man aged 42, whose KNEE-JOINT he had excised successfully three months before. The operation was performed on account of acute inflammation of the joint, the result of a sloughing external wound which had opened into the articulation.

(4.) The HEAD OF A FEMUR, and portion of ACETABULUM, excised from a case of hip disease.

(5.) HALF A TONGUE, removed for epithelial disease. patient operated upon was quite well three weeks after.

The

(6.) The ASTRAGALUS, and lower end of the TIBIA and FIBULA,

excised from a case of ankle-joint disease.

(7.) A GLANDULAR TUMOUR, with cartilaginous structure in its substance, removed from the anterior triangle of the neck.

(8.) A TUMOUR OF THE UPPER JAW, which he had removed, together with the jaw, floor of the orbit, and masseter muscle, which had become involved in the disease; sloughing of the cornea had followed the operation on the affected side.

(9.) A NEW APPARATUS for the treatment of fibrous anchylosis of the elbow-joint.

III. Mr Chiene showed a PATIENT suffering from a simple malady, but whose case illustrated the organization of a blood-clot in an open wound. He believed that this was the first systematic attempt to fill a cavity with a blood-clot. The patient suffered from a corn on the heel, which he had removed along with a triangular piece of skin, each side of the triangle being 1 inches

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long. He had then cleared out all the tissues down to the os calcis, thus making a cavity half an inch deep. He next applied protective and a gauze dressing before removing the tourniquet, in the hope that blood would ooze from the sides and fill the cavity with a blood-clot. This operation was performed on the 18th of April. Six days after, the cavity was filled with a dark jelly-like substance. On the twelfth day, this clot was of the same colour, but firmer in consistence. On the sixteenth day, it bled when scratched. On the twenty-sixth it was evidently organized and red in colour. Epidermis began to cover it on the thirtieth day; and on the thirty-fourth, it was completely covered and entirely healed, without any contraction. This organized blood-clot was therefore half an inch deep, and like an equilateral triangle, each side being an inch and a quarter in length. It was still a point of clinical interest whether the contraction would ultimately take place. On this point he would satisfy the Society by showing the patient in July. He only wished further to state, that no retentive apparatus had been employed, as he had no proof when he operated that there would be contraction. The case was treated antiseptically.

IV. Dr Keith showed two bottles containing twenty-four ounces of RED SERUM AND BLOOD-CLOT drained from the pelvic cavity within forty-eight hours after the removal of an ovarian tumour. He had no doubt but that septicemia would have resulted if the fluid had been allowed to remain. The operation was severe and tedious, and after tying many vessels, he was compelled to close the wound with some oozing still going on. The tumour removed was also shown. It was very semi-solid, and its attachments to the abdominal wall and pelvis were unusually firm.

V. Dr Watson showed-(1.) An UPPER JAW which he had, on the previous day, removed for epithelioma.

The patient had previously suffered from neuralgia of the infraorbital branch of the fifth nerve; afterwards an epitheliomatous growth, which was supposed to have originated in the antrum, appeared on the hard palate. He therefore removed the jaw by an incision from the edge of the eye to the ala of the nose, and then the upper lip, continuing this into the nasal cavity. He then raised the soft parts by a periosteum scraper, and, by means of a narrow saw, cut through the bone obliquely below the orbit, and also at the palatal plate. He then found that the antrum was not involved, and that there was no occasion for interference with the floor of the orbit.

(2.) A SMALL PELLET like a No. 2 shot which he had removed from beneath the eyelid of a patient. While working in a metal manufactory, a damp hook falling into the metal caused a spirt of the molten mass to enter his eye. On examination, Dr Watson found it below the eyelid. The cornea was blanched, but he did