Gardening and Furming. M. Esquirol speaks in high terms of this species of occupation. There can be no question that experience has decided generally in its favour.

At the Salpetrière, the females are employed in a systematic manner. There is a large room in which some are occupied in sewing, others in knitting. Some perform the necessary domestic offices of the establishment -others cultivate the garden.

It is difficult to occupy individuals of the upper classes in this manner. This interferes with their recovery, and goes far to neutralise the advantages they possess in other respects.

Removal of the Cause of the Insanity, if possible.-M. Esquirol raises his voice against empirical treatment, that is, against any one mode of treating insanity. In this, as in most other disorders, the physician should ascertain if possible the physical or moral cause of the malady, and, if possible, remove it and his treatment should be also regulated by the nature of the existing symptoms.

If there are excitement and plethora, the antiphlogistic treatment and regimen should be adopted. Almost always, at the expiration of 8, 15, 21, or 30 days, an intermission or remission takes place, and then, combined of course with appropriate moral management, the particular indications of the case should be investigated and acted on. Thus, says M. Esquirol, the patient has been long subject to hæmorrhoidal discharges, which bave ceased to flow; the physician re-establishes, or endeavours to re-establish them. Or an ulcer has healed prior to the occurrence of the monomania; the ulcer must, if possible, be re-opened. It is the disposition, on the part of M. Esquirol, to dwell on circumstances of this description, circumstances which, though not unimportant, are erected by him into too great importance, that leads us to deem him a decided Hippocratist. His leaning to the doctrine of critical days, indeed the whole tenor of his observations, would induce us to place him in the category of the followers of the médecine expectante.

But suppose that measures of this description have proved unavailing. The time is come for "empirical remedies."

Water. This has been applied in all varieties of manner.

M. Esquirol thinks that tepid baths, of the temperature of 20° to 25°, (we presume of the centigrade scale,) are most useful. They may be prolonged for several hours in the cases of thin, nervous, and irritable subjects. If there is much determination of blood to the head, bladders filled with cold water may be applied to the head at the time that the rest of the patient's body is kept immersed in the bath.

The cold bath is adapted for young and robust subjects who suffer with heat. Of the warm bath M. Esquirol speaks hesitatingly. He does not appear to have had much experience with it.

The plunging bath and cold affusion are of service to patients who are enfeebled, particularly by masturbation, or by long-continued mental annoyances. The bath of surprise has never been made use of by M. Esquirol, but he is acquainted with fatal results from it. He thinks it would be quite

as rational to prescribe pitching the madman out of a three pair of stairs window, because one or two have been cured after a fall on the head.

The douche is mainly useful in young, strong patients, affected with cephalalgia. It ought never to be intrusted to servants, nor administered shortly after a meal, nor ought it to be continued for more than a few minutes. The primæ viæ should be cleared out prior to its use. It is not totally exempt from hazard.

Ice to the head calms cephalalgia and furor, especially at the commencement of the attack, and when combined with immersion of the feet in hot water, or in a mustard poultice.

If

Pediluvia are of service. They may be composed of hot water with salt, sal ammoniac, mustard, &c. The water should not be too hot at first. it is, the kind of shock occasioned reacts upon the cerebrum. The water should be made gradually hotter after the immersion of the feet in it.

Lavements, the douche by the rectum, and copious potations of cold water by the mouth, have been recommended and employed. M. Esquirol seems to speak seriously of the benefits of drinking cold water freely in cases where there is a tendency to suicide.

Evacuants.-M. Esquirol responds to the general opinion in favour of emetics. Yet he does not think that remedies of the class of evacuants are adapted for all cases. He is of opinion, and no one can object to it, that the particular purgative should be adapted to the case. He remarks that some patients refuse medicine, protesting that their bodily health is very good. A very good plan is to give such patients, without their knowledge, some substance which will disorder their stomach or bowels, and by rendering them uneasy respecting their health, will conquer their indisposition to physic.

M. Esquirol strongly reprobates the abuse of bleeding-an abuse which has been productive of much mischief to the insane. He has seen a madman bled thirteen times in forty-eight hours. Yet moderate bleeding is occasionally both rational and serviceable, and the local abstraction of blood by leeches, or by cupping, is, in cases of cerebral determination, of undoubted benefit.

Tonics and Antispasmodics.-Of great use in particular cases, in which there are indications for them.

Narcotics.-M. Esquirol reprobates them.

Counter-Irritation.-Not serviceable in the majority of cases, in which it only torments.

Electricity and Galvanism.-M. Esquirol has only in one or two cases seen the former of benefit.

The Circular Swing.—It is universally abandoned.

We shall return to M. Esquirol's work, and select particular subjects for notice. Our readers will be put in possession of his vast experience on one of the most important of human maladies.

STATISTICAL REPORT ON THE SICKNESS, MORTALITY, AND INVALIDING AMONG THE TROOPS IN THE WEST INDIES. From the Records of the Army Medical Department, &c. Presented to both Houses of Parliament, 1838.

Ir such records as these had been made and preserved during the tumult, carnage, and destructive sickness of the late war, medical statistics would have been vastly enriched. But the past cannot be recalled; and great credit is due to the Army and Navy Medical Departments for the accuracy and authenticity which they have infused into the reports transmitted to them from all parts of the world. The volume before us is among the first fruits of this energetic system; and the labours of Mr. Henry Marshall, and Captain Tulloch, who compiled this report from upwards of 160 folio volumes of returns, accumulated at the Army Medical Board since 1816, are above all praise. These gentlemen have had a most laborious and difficult task to perform, but the result is a highly interesting and valuable document; especially to all those who are destined to visit the pestiferous but beautiful Isles of the Antilles. From such condensed documentary reports, filled with numerical details, it is no easy matter to draw up an analysis-indeed it is next to impossible; but we shall be able to introduce to our readers a great mass of information respecting the West Indies, which cannot fail to prove interesting even to the practitioner of the remotest village in England.

The Windward and Leeward Islands extend from 6 to 17 degrees of North latitude, and from 56 to 63 degrees of West longitude-stretching in a chain across the great Gulf of Mexico, and differing greatly in climate, aspect, and salubrity. Thus Tobago, Trinidad, St. Lucia, and Dominica, are mountainous, covered with dense forests, and intersected by deep ravines, impervious to the breeze, and where the rains stagnate among a mass of decaying vegetation. On the other hand, Antigua and Barbadoes are comparatively low, barren, and rocky, with dry climate, and agreeable tempera

ture.

Some other islands possess a kind of intermediate character, while the coast of British Guiana is totally different from all-being an immense tract of level country, scarcely above the surface of the sea; presenting, during the rainy season, an endless succession of swamps and marshes, with an exceedingly humid atmosphere, though a not very variable temperature. The following leading characteristics of these interesting regions are worthy of

note.

"1st. The first peculiarity which distinguishes the climate of this Command is a high temperature, a necessary consequence of proximity to the equator. The mean height of the thermometer throughout the year is, however, rather under than above the average of similar latitudes, being only about 8010. In none of the islands is it above 82° or under 79°, and any slight difference in this respect results more from their geological features, or extent of cultivation, than the mere difference of latitude; as the mean temperature of British Guiana in latitude 6o, is but 80°, while that of St. Kitt's, more than 12 degrees further to the North, is 81°.

2d. The next peculiarity which extends to this, as well as most tropical rcgions, particularly of insular situation, is great uniformity of temperature. The difference between the highest and lowest mean range of the thermometer, is, even in the most variable of the islands, only 13", and in some it is not more No. LIX.

E

than 4o throughout the year; whereas in Britain it is, in most years, upwards of 30°.

3d. In this, as well as other tropical climates, there is but little change in the elasticity or pressure of the atmosphere. The extreme range of the barometer is not more than from a quarter to half an inch throughout the year, and it is not materially affected even by hurricanes; whereas, in this country, its range is from two to three inches, and it varies with every slight change of weather.

4th. One of the most marked of the atmospherical peculiarities of these regions, is the large quantity of rain which falls annually, being, on the average, at least three times as much as in Britain-a necessary consequence of rapid evaporation under a tropical sun. The quantity, however, varies materially in the different colonies, according as their surface is mountainous or level, clothed in wood, or cleared and under cultivation. We have, in a subsequent portion of this Report, stated the fall of rain in each colony, so far as it has been ascertained by measurement; the average quantity, throughout the whole Command, has been estimated at from 60 to 70 inches annually.

The rain of these regions is, however, of a very different character from that of Britain, being confined principally to two seasons of the year, termed the Spring and Autumnal rains, and then falling not in gentle showers, but in torrents, which, unless in a very dry soil, or where there is free drainage, speedily inundate the surrounding country.

5th. The four seasons of temperate climates are therefore represented by two wet, and two dry seasons; but, as the rains follow the course of the Sun, it is obvious that the period of their commencement and duration must vary according to the proximity of the settlements to the equator. In Guiana, the most southerly, the Spring rains generally extend from December to January, the Autumnal from May to August, while in the most northerly of these settlements, the former does not commence till April or May, and the latter extends from October to December.

In many of the islands, particularly the less hilly ones, there is scarcely any deposition of dew, and in the others it is generally scanty, except in densely wooded districts.

6th. In regions exposed to such a high temperature, it is fortunate that the heat of the day is generally modified by a sea-breeze, not of that variable character which prevails in temperate climates, but which blows with nearly uniform force, and from one direction, during nine months in the year. It is termed the Trade Wind, and generally comes from the East and its collateral points, except from August to December, when it veers round, and blows slightly from the South and West, with frequent calms at intervals.

While this Trade Wind prevails during the day, a land wind, in all the large and mountainous islands, blows with almost equal regularity at night; for as soon as the sea-breeze dies away, the hot and rarified air of the plains, ascending to the mountain tops, is there condensed by the cold, and flows in a steady current towards the ocean, to supply the equilibrium of the atmosphere. In the smaller islands, and those in which there are no mountains, there is either no land wind, or it is very slight. The sea-breeze generally sets in between 10 and 11 A.M., blows with increasing force till 3 P.M., and dies away about sunset, when, after a short interval, the land wind commences, and continues till sunrise.

In these and some other tropical regions, in similar latitudes, hurricanes are occasionally experienced between the month of August and latter end of October, hence denominated the hurricane season. Trinidad, Tobago, and the settlements to the South, have hitherto been exempt from them, but they sometimes fall with dreadful violence on the other islands. Barbadoes, in particular, has suffered very severely from their ravages.

During the rains, particularly at their commencement and termination,

thunder and lightning are very common, but seldom occur at any other period of the year. Unfortunately little has been done to investigate the electrical condition of the atmosphere in these parts of the world, and therefore we can only estimate the presence of that agency from its visible effects at these periods." 4.

From several statistical tables inserted here, it appears that, among every 1,000 white troops, there have been annually admitted 1,903 into hospital, so that, on an average, every man must have been under medical treatment, about once in six months and a half. In the United Kingdom the proportion is about one in thirteen months-or just one half. There is a still greater difference in the ratio of severity. In the West Indies there is one death in every 24 admissions, while at home there is only one death in every 67 cases treated. The following table is very curious, and we shall insert it here.

The reader will not fail to remark on the frequency of pulmonary affections, as compared with hepatic diseases or disorders, even in a tropical climate, where the biliary system is supposed to bear the brunt of the malignant influence of such portions of the globe. Affections of the lungs are nearly as 8 to 1 compared with affections of the liver-and the ratio of mor tality is nearly the same. Now in the East Indies the proportions would be very different. Hepatic would far outnumber pulmonic complaints. The great proportion of fevers to other diseases is very striking. Sixty-two in every 164! Two-fifths of the fever admissions were intermittents-few of which proved fatal. In the low marshy settlements of Demerara and Berbice, the number attacked in each year being frequently equal to the whole