We collect no very precise information of the nature of the maladies to which the insane are most liable, and which prove mortal in British lunatic asylums. As to epidemics, the system of management is happily so improved in these institutions, that they scarcely ever prevail.

In the Lancaster County Asylum, atrophy, hydrothorax, and bowel complaints, chiefly occur. Dysentery is alleged by a late writer to be very common and fatal in that excellent institution; and this effect was said to be produced by the unwholesomeness of the water. But this report has since been disproved by an inquiry which was instituted for that purpose.

In the Cork Asylum, in which a thirteenth part of the patients admitted are reported by Dr. Hallaran to be insane from excessive drinking, -a fever, sui generis, continuing six or seven weeks, and even three months, but eventually giving way, was the most common disease. Affections of the liver are also very rife, inducing apoplexy and palsy, hydropic effusions, and oedematous swellings of the lower extremities. Fever is so constantly prevailing in most of the populous towns in Ireland, that the greater prevalence of this disease in the Cork Asylum, comparatively with others, may easily be accounted for. The large number of habitual drinkers of spirits will readily explain, too, why apoplexy, palsy, and dropsies, should exceed.

The most frequent fatal cases in the Glasgow Asylum, of late years, are from apoplexy, palsy, atrophy, exhaustion, and pulmonary and dropsical affections.

The French commission, with that minuteness of detail which all their reports relative to the insane now embrace, have thus nosographically classed the affections of which the inmates of the Paris lunatic hospitals have died in the years 1822, 1823, and 1824:

The report does not particularise the diseases included in this pathological arrangement; but those of the encephalon greatly preponderate.

It must be objected to these details, that it is quite impossible always to decide by dissection, whether morbid appearances are causes or effects; and it is still more rarely possible to discover from the histories of the cases of lunatics, or from their own description, either the actual seat of disease, or what may be the degree of pain which a lunatic feels. This information is rather to be collected from extrinsic circumstances, which are more or less distinct from their own recognition.

Upon this point Georget remarks, that when we see an insane person become calm, avoid tumult, and rather seek solitude or his bed, and lose his appetite, he ought to be strictly examined, to see whether he be not suffering from some ailment. If weakness increase, and there is a distaste for food, and his features sink, there can be no doubt that his health is declining: either an acute disease is approaching, or already exists. The most common which present themselves in this way are gastro-intestinal diseases. Chronic maladies develop themselves not more insidiously: they appear almost always, and in every individual, with signs of atony only, and general weakness.

Besides the diseases to which I have referred as ter

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minating insanity, the following are common:-1. Atony. 2. Consumption-3. Chronic inflammation of the bowels, dysentery, and colliquative diarrhea-4. Affections of the liver-5. Constipation-6. Sudden debility-7. Mortification of the extremities-8. Scurvy.

1. Atony.

As a general observation, it may be remarked, that there is a state of atony generally accompanying all chronic diseases of the insane. Their physical as well as their intellectual powers deteriorate, and their bodies. waste and become exceedingly attenuated. The colour, nay even the texture, of the skin alters; and it is rare to find an incurable who preserves a healthy tone and appearance. In an atonic condition of the constitution, the features will be changed; but in the atonic state of lunacy they vary so remarkably as to be scarcely cognisable, and the patient always looks much older.

2. Consumption.

Phthisis kills more than half the lunatics in La Salpetrière. This disease is certainly frequent among insane people, and a great cause of their mortality in all countries. It often exists, indeed, in cases where it is never suspected. Whenever extreme emaciation accompanies mental derangement in any form, and there is no reason to imagine that it arises from a diseased state of the mesenteric glands or inanition, latent phthisis may be suspected. In every such case, inquiry should be made of the patient's friends, whether a phthisical diathesis prevails in the family, or whether, before insanity was developed, any pulmonary symptoms had been manifested. Indeed, I have seen many cases of insanity where great extenuation has been exhibited, but not one symptom of pulmonary affection-neither thoracic pains, cough, nor expectoration, till just before dissolution, when

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the two last symptoms have suddenly appeared; and yet, upon a post-mortem examination, the most extensive marks of inflammation of the lungs or investing membrane, or abscesses in the substance filled with pus, have been disclosed.

Perhaps in all these cases, if strictly inquired into, the attack of acute pulmonary symptoms, though only at the time considered as a common cold, might be recollected, and also that they as suddenly receded or were suspended.

This suspension of phthisis I have known continue for many months; and when the symptoms recur, death, may be prognosticated, is near.

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Consumption, however, among the insane, is by no means so frequent a cause of mortality in public or private practice in England, as Esquirol and Georget report it to be in France.

3. Chronic Inflammation of the Bowels, Dysentery, and colliquative Diarrhea.

A chronic inflammatory state of the mucous membrane of the intestines is a common and fatal affection in long-standing insanity. It is generally accompanied by a looseness, and frequent desire of going to stool. This complaint partakes more of the nature of dysentery, and requires a correspondent treatment, always having in view the ever-attendant debility of the patient. There is rarely any pain, even on pressure of the abdomen.

Pure dysentery, however, is not an ordinary affection in lunatic asylums. Whenever it appears, it is generally in the form of an epidemic, and is then produced by some fault in the diet of the patients, or local cause. In such case it generally proves, among the old lunatics, very fatal.

Colliquative diarrhea is a much more common ailment towards the close of ancient cases of insanity. At

first, the attacks perhaps are slight, and easily checked by the ordinary remedies; but soon they become more violent, and the evacuations more frequent and abundant. In the latter stage, the patients are quickly carried off by it.

All these affections of the bowels are more rife, and will prove more fatal, in asylums where poor lunatics are received than elsewhere. Possibly, to a certain degree, they are always epidemic; certainly, sometimes endemic.

4. Affections of the Liver.

Organic lesions of the liver proved mortal, according to Esquirol, in 35 out of 277 deaths, or 1 in 8.

That cysts, tubercles, chronic inflammation, induration, &c., of this viscus, have frequently been detected in the dead, when neither pain, jaundice, nor other indication, while living, had excited a suspicion of hepatic disease, is a well-known fact. Equally well known is the influence which this organ and the brain reciprocally exercise on each other. We cannot, therefore, question, especially among the poor, many of whom have been addicted to the abuse of spirituous liquors, that a morbid condition of the liver is a frequent termination of life in lunatics.

I am not, however, disposed to consider, when organic lesions of the liver are discovered in the bodies of insane persons, that death, in the proportion Esquirol infers, is the consequence of that condition. Diseased hepatic function may originate diseased cerebral function, and the latter may persist, when the former has entirely ceased. Therefore, if a lesion in either organ be detected, we still cannot decide which is cause and which effect. The same difficulty always presents itself when the corpses of insane persons exhibit morbid appearances.

If, however, death be not often the immediate effect of a lesion or disease of the liver, yet, among the insane