23 of the amputations were of the upper extremity, of which 18 were cured and 5 died; 33 were of the lower extremity, of which 17 were cured, and 16 died; 6 were amputations at the joints, of which 4 were cured, and 2 died.

Of the 55 patients operated on,

9 were under 20 years of age, of whom 8 were cured and 1 died.
21 between 20 and 30-15 were cured, and 6 died.

From this resumé of seven years' practice at the Pennsylvania Hospital, it

appears,

1st. That amputation is to be regarded as an operation attended with much danger to the life of the individual.

2d. That the chances of success after it, are much greater in persons who have been for some time suffering from chronic diseases, than in those who have it done whilst enjoying robust health.

3d. That amputation of the lower extremity is much more fatal than that of the superior member, and

4th. That the danger increases with the age of the individual operated on." We may here introduce some statistical observations by Mr. Benjamin Phillips, read before the Medico-Chirurgical Society, in November, 1837, and published in the Medical Gazette for June, 1838. To these observations our contemporary, the Examiner, alludes, and we quote from his quotations.

"I have now shown that the mortality succeeding to amputation is very great-23 per cent. I shall therefore proceed to analyse the gross number, and exhibit the proportion furnished by the different countries implicated in the inquiry. They are as follow:

France

Cases.
203..

Deaths. Per Cent.

Here is an average number of deaths, amounting to, as near as may be, 231 per cent. If the several countries be taken separately, we find that France is a fraction below this average; that Germany differs only to the amount of a fraction from France; that America only exceeds the average by a little more than 2 per cent.; and that Great Britain is a fraction below the average.'

The main object of Mr. Phillips is to shew that the mortality after amputation is much greater than is usually believed.

Mr. Phillips justly observes, that if compared with the much dreaded operation of lithotomy, amputation is much more fatal.

Mr. Phillips thinks it proved that there is a large class of cases, in which union by the first intention is attended with more danger, than when suppuration is permitted. This class comprises diseased articulations.

"Of these cases, immediate union was attempted in 117; consecutive union in 96.

Of the 117 cases, 88 only succeeded; the deaths amounted to 29.

Of the 96 cases, in which the treatment was by consecutive union, 76 succeeded; the deaths were 20.

Of these cases, Great Britain furnished 86; the other countries included in the observations, 127.

Of the 86 cases, immediate union was attempted in 60; consecutive in 26, and with the following result of the 60 cases there were 15 deaths; of the 26 there were 5 deaths.

Of the 127 cases, immediate union was attempted in 57 cases; consecutive in 70.

Of the 57 cases, 14 were unsuccessful, the patients died, and 43 succeeded. Of the 70 cases where consecutive union was employed, there were 15 deaths. The results, therefore, attendant upon the practice of immediate union, are a mortality amounting to 25 per cent.; upon consecutive union, of nearly 21 per cent.

And there is a singular uniformity attendant upon the results of these two modes of practice, as shown by the returns furnished by our own and the other countries; and all are strongly confirmatory of the prudence of avoiding immediate union in this large and well-defined class of diseases.”

STATISTICAL REPORT OF THE RICHMOND LUNATIC ASYLUM. By JOHN MOLLAN, M.D. Physician Extraordinary to the Asylum. Octavo, stitched. Dublin, 1838.

The attention of the profession scarcely requires to be directed to insanity. Yet there are many points connected with it, which are understood imperfectly, and so much hinges on a sound acquaintance with its phenomena and management, that medical men cannot study them too closely.

The present report is far from uninteresting. Our brethren in Ireland are beginning to exhibit a degree of zeal and activity which bode the best results to science. The officers of charitable institutions are particularly zealous.

It appears that the Richmond Lunatic Asylum was completed in the year 1814. It was planned not simply for the safe-keeping of the insane, but with a view to their rational treatment and cure.

For many years after its opening, patients were admitted into the Richmond Asylum from all parts of Ireland; but since the year 1830, when the various District Asylums were completed, it has been appropriated to a certain district, which embraces the city and county of Dublin, the counties of Meath, Louth, and Wicklow, and the town of Drogheda. A residence of twelve months within the district is necessary to entitle a patient to be received, and none are admitted without a medical certificate of insanity, and an affidavit on the part of the nearest relative, that the individual is a pauper, by which is understood, not being possessed of sufficient means to pay for maintenance in a private asylum. A few persons have been occasionally admitted, who contributed small sums to the funds of the institution; but the number of such cases at one time in the house, has rarely amounted to eight; and it is right to state, that they are treated in every respect like the general class of patients.

Cases of a manifestly incurable character are not admissible, but this rule can never be strictly enforced. Persons subject to epilepsy are excluded by the same regulation, but they sometimes get admission from the existence of the disease being concealed.

The plan of the building admits the formation of five classes for each sex, and a separate airing-ground is appropriated to each division. An important addition has lately been made of a large piece of ground, and including the gardens originally attached, there are now nearly twenty English acres belonging to the asylum.

The house was planned originally for the reception of 236 patients, but by alterations subsequently made, 288 can now be admitted; and yet, owing to the accumulation of incurable cases during a series of years, the accommodation is found to be inadequate to meet the wants of the district, and the Asylum labours under the disadvantage of not being at all times able to receive patients immediately on their being attacked, a circumstance which has an important effect

on the result of treatment. But this defect is likely to be soon removed, Government having sanctioned the addition to the building of accommodation for 100 patients.

Dr. M.'s Report embraces a period of five years, commencing January, 1833, and ending December, 1837.

The population of the district, according to the census of 1831, amounted to 803,396, and each county being charged with the expense of the patients received from it, Dr. M. is enabled to compare the numbers with the population of each division respectively.

The large number of patients admitted from the city and county of Dublin, as compared with the other divisions, shews the much greater prevalence of the causes of insanity in cities and thickly populated neighbourhoods, than in the rural parts of the district. The town of Drogheda is rather an exception to this rule.

The medical certificate required with each patient contains a query as to the probable cause of the disease, where such could be assigned. From this source Dr. M. has arranged a table of causes.

"This table shews a greater proportion of physical causes amongst men, and of moral causes amongst women, not exclusive of those peculiar to the

marriage

0 1

latter sex. Besides the large number of cases attributed to intemperance, I have no doubt that the same cause operated remotely in many others, by leading to those circumstances from which the disease was supposed more immediately to proceed. Of the cases denominated religious, I believe but a very small number could fairly be attributed to religion as a cause; religious enthusiasm and religious despondency, though often mistaken for the causes, are much more frequently the consequences of insanity. The puerperal cases occurred either during pregnancy or very soon after delivery; in some few of them, other causes may have been combined with the puerperal state, such as fright and family disagreements. One woman who was attacked immediately after the birth of her first child, had been insane before marriage. In addition to those cases stated as hereditary, wherein this was the only cause assigned, nineteen others were noted, one or other of whose parents had been insane; and in forty-four more, insanity had shewn itself in collateral blood relations. Amongst the cases for which no satisfactory cause was assigned in their certificates were two young females, aged sixteen years, in whom the catamenia first appeared after being admitted into the asylum, and they speedily recovered on the establishment of this discharge. One was readmitted at the end of eight months, and the other after an interval of more than three years, both being affected with suspension of the catamenia. Suitable means being employed for the restoration of this evacuation, every symptom of insanity soon disappeared. In many other cases, irregularities of the menstrual function existed; in some, perhaps, the consequences, in others, very probably, the cause of their insanity; but in none was the connexion of the two affections so strikingly exhibited as in the two first mentioned."

Dr. Mollan earnestly and properly presses on those gentlemen who sign certificates of insanity, the necessity for accuracy in filling up answers to the queries they contain. Those answers are to form the basis for generalizations. How requisite their truth must be.

The occupation or condition in life of each patient is shewn in the table following.

The class of labourers, the lowest, most numerous, and most likely to furnish tenants to a pauper asylum, only gives a fourth of the cases. Insanity prevails more in the middle and upper, than in the lower classes.

"In my inquiries respecting the condition in life of the females, I was suiprized to find so small a number of prostitutes, as the contrary might be expected, on considering the excesses to which they are addicted, and the moral and physical evils to which they are exposed. Only three have been admitted

within the last five years; and I learn that the average number in former periods was not greater. It is right to anticipate an objection that may be made, by stating, that women of this class, when proper subjects for the asylum, find as ready admission as any others. I should not have alluded to this circumstance, but that it is at variance with reports of lunatic asylums elsewhere, particularly in Paris. It has been stated by Esquirol, that at the Salpêtrière, the great hospital for insane females, one-twentieth of the whole number had been prostitutes. And Parent Duchatelet, in his extraordinary work on prostitution in the city of Paris, states that 105 cases of insanity had occurred amongst prostitutes in the course of five years. Why women of this description in Dublin should be more exempt, I can assign no satisfactory reason. The peculiar manners and habits of the same class in the French capital, as described by Parent Duchatelet, will probably account, in some degree, for their greater liability."

Of the men, 126 were married, twelve were widowers, and 134 were unmarried. Ninety-eight of the females were married, twenty were widows, and 115 were unmarried. The state of the remainder was not ascertained.

"An account being kept of the religion of the patients; of the 608 under consideration, 146 were Protestants, and 462 Roman Catholics, being in the proportion of one of the former in every 4; which is greater than that of the respective numbers in the population at large, wherein, according to the census, Protestants constitute one in every 5. But as all classes are included in this calculation, a fairer comparison would be of the patients in the asylum with the admissions into a general hospital indiscriminately open to the lower classes. I have, accordingly, procured returns from two of the hospitals connected with the House of Industry, of the patients admitted in one year, and I find the Protestants to have been one in every seven. I am, therefore, warranted in saying, that relatively to the respective numbers in the population, there are more insane Protestants than Catholics. This difference I conceive to have very little connexion with religious belief, but is mainly, if not entirely attributable to the fact, that the great disparity in the numbers of Protestants and Catholics in this country exists in the lowest classes of society, and that in ascending the scale, the numbers approximate; and as it has already been stated, insanity is least prevalent in the lowest classes. It is not meant by these observations altogether to exclude religion as a cause of insanity; and perhaps cases of a purely religious origin may be more common amongst Protestants, than Catholics; they are, however, only of rare occurrence."

TABLE OF AGES.

Under 20 years.

20 to 30. 30 to 40. 40 to 50. 50 to 60. 60 to 70. Above 70.

487 were admitted in the first attack, seventy-eight in the second, twentyfour in the third, fourteen in the fourth, four in the fifth, and one in the sixth attack of insanity.

The duration of the disease before admission is shewn in the next table.