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On Private Lunatic AsylumsAuthor(s): An Admirer of TruthSource: Provincial Medical and Surgical Journal (1844-1852), Vol. 16, No. 8 (Apr. 14, 1852), pp.196-200Published by: BMJStable URL: http://www.jstor.org/stable/25493360 .

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196 ON PRIVATE LUNATIC ASYLUMS.

case which forms the basis of the memoir, is that of a

lady, aged 56, who, being at Vichy with her husband,

proceeded, as is the fashion, to take the baths, though there was no necessity for them as regards her general state of health, which, on the contrary, was remarkably

good. It appears that on July 20th, 1850, she took

her second bath at four a.m. She had been over night in her usual state of health. In walking to the baths

she noticed that her breathing was shorter than usual, and the attendant observing her condition advised her

not to bathe that day. She, however, did so, and

remained in her bath half an hour. When she got out

she felt uncomfortable, and in a few 'minutes sunk

exhausted into a chair. Respiration now became very

difficult, and in a few moments she was dead. I M. Durand Fardel, who was on the spot immediately,

found her still covered with her bathing sheet; The

face was pallid; lips violet; no froth on the lips; limbs flaccid; and heart's action completely ceased.

The autopsy was made twenty-two hours after death, the 31st of July, at three o'clock in the morning.

The body presented no appearance of putrefaction, there

being some lividity only on the depending portion of the

trunk and members. The heart was very large; the

right cavities distended with liquid blood, rather violet

coloured than black, syrupy, very frothy; the bubbles

of gas enclosed were some (very numerous) as big as

the head of a pin, others less common, as large as peas, When pressure was applied over the course of the two

venae cavse, the blood which flowed into the right auricle was frothy, like soap and water ; the parietes of

the right cavities of the heart presented a superficial violet colour ; the left side was completely void of blood,

and not coloured; the left ventricle was considerably

hypertrophied; the orifices of the heart did not present

any appreciable alteration, as also the aorta. All the

abdominal venous system was distended with violet

and frothy blood; numerous bubbles of gas were also

found in the blood of the splenic and portal vein. The

lungs filled the chest, presenting a few adhesions, and

some appearances of emphysema; their colour was

reddish outside, but of a deeper tint internally, where

they presented traces of considerable sanguineous con

gestion, without infiltration of blood. There was con

siderable frothy congestion in the more depending parts. The bronchi contained some whitish frothy mucus.

The abdominal organs presented nothing more worthy of notice than a considerable sanguineous congestion of

the liver, spleen, kidneys, and a remarkable congestion of the veins of the epiploon and mesentery. The

epiploon was loaded with fat; the stomach rather

large, and containing about half a glass of clear colorless

mucus. The intestines were not opened. The en

cephalon did not present the same degree of congestion as the other organs; the sinuses of the dura mater

contained only a little liquid blood, not frothy. The

brain and origin of the spinal marrow, examined as

soon as possible, appeared completely natural, a little

injected with blood; no bubbles of gas appeared in its

vessels.

The author publishes this case in all its details, as

science possesses as yet very few cases of this kind. The observations of Morgagni, wanting in details, do not, allow of a positive judgment. M. Reyrolles, in two cases of death by haemorrhage, found the blood frothy in the heart and veins.

Finally, M. Ollivier of Angers, published a case

(Ann. Gen de Med., 1838) which leaves no doubt as

to the existence of the disease which M. Durand Fardel observed in this case. A curious circumstance, doubtless observed before, enabled M. Durand Fardel to state

the existence of gas at the moment even of death. The

bleeding performed at the arm gave issue for more than a quarter of an hour to blood, which, trickling from the vein of a body deprived of life, carried with it numerous

bubbles of gas. To what cause can the origin of this gas be attributed ?

This is a question still undetermined, and whioh may be - perhaps solved at some future time by the chemical

analysis of the gas found in the blood. Whatever it

may be, the observations of M. Durand Fardel tend to

prove that it is owing to a spontaneous exhalation from

the veins, caused by spontaneous alteration in the

crasis of the blood, of which we are ignorant.

[This case is still further important in its connection with those cases of sudden death after delivery in which air has been found in the blood, and is supposed to have entered by the uterine sinuses. May it not in these cases depend, as in M. Fardel's, on a sponta neous generation of gas ??Ed. P. J.]

i

ON PRIVATE LUNATIC ASYLUMS I _

To the Editors of the Provincial Medical and Surgical Journal.

Sirs,?In conversation with various intelligent mem

bers of Society, lay as well as professional, I find the

I above subject has attracted considerable attention, and

is invested with an interest at the present time, which

j calls for a more extended discussion, and if your pages i be still open to such a theme, I solicit another portion

S of your space in one of your earliest issues.

I When my former letter, published in your journal of

! the 21st of January, was penned, I was not prepared to

\ believe that the noble Chairman of the Commissioners

; in Lunacy could possibly have made use of such a

: statement as has been attributed to' him by the public

j press. It is reported that Lord Ashley, at a late meet

ing in one of the midland counties, said that " he hoped

| to live to see the day when every private asylum in the

I kingdom would cease to exist." Now, Lord Ashley, I

should suppose, notwithstanding his official relations, is

at liberty to fully express his opinions on this subject,

I freedom of discussion being the birthright of every t inhabitant of this realm, and constituting, indeed, one of

I its main glories; but I think you will agree with me, that it specially behoves an individual holding the con

I spicuous position he has hitherto done in public esti

I mation, to be cautious as to the grounds on which he

I allows his actions to be determined in any public move

| ment. I do not think any one does or can suspect

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ON PRIVATE LUNATIC ASYLUMS. 197

Lord Ashley of any but the most honourable motives |

in his philanthropic career, but his judgment is equally liable with that of all others to be impugned; and it is

my opinion that the above bold and rather radical

statement, like the recent dictum of a celebrated lawyer, "that no lunatic not dangerous to himself or others, should ever be confined in a lunatic asylum," would

have been better unsaid. But we have not yet to

learn that great men may, and do err, and we must

leave his lordship to answer for himself. It is necessary to observe, however, that such an asseveration coming from such a quarter, and in such an age, is rather

startling and significant, and ought to awaken from

his slumbers every party who has an interest at stake in

the existence and maintenance of a private asylum. Whether intended or not, we seem to have no alterna

tive left, than to look upon it as the sounding of the

tocsin, and we can no longer with safety lull ourselves

in our fancied security, otherwise our strongholds may be taken by surprise, and we shall be left to mourn

over our fate without sympathy and without redress.

Coming events are apt to cast their shadows before

them ; and, depend upon it, the day is portentous, and

it is high time to put on our armour for the fight, and

if we can show that we have any measure of right and

justice on our side, let us resolve to act in concert, and

not fail, when called upon, " to die hard." If public

feeling, goaded on by notions of mistaken philanthropy, shall determine the extinction of private asylums, it will

be well to prepare in time to make out our case for

compensation, (for our right to this, we presume, will

be as clear as that of the West Indian planters ever was

to their twenty millions,) but as I only fear that such

feeling has not yet been wrought up to this pitch of

warmth and fanaticism, that it may be still oscillating and perhaps halting between two opinions, it seems

better, in the first instance, that we, the proprietors of

of these asylums, should take some pains with the com

munity in order to give them a proper insight into the

nature of private institutions as well as into the "arcana," should there be any, of their general management. As

matters at present stand, and as I have shewn in my

former letter, the reformers have certainly had every

thing their own way, the people having been admitted

to only one side of the picture, but notwithstanding all

this one-sidedness, if the numerous charges against us cannot be rebutted?cannot be met by counter

statements which may annihilate or at least weaken

their power; and, further, when we call to mind that

our detractors are active and we are passive, I repeat, our extinction is nothing more than a legitimate con

sequence of our own supineness and lethargy, and our

tacit acquiesence in it will be regarded in no better

light than as an evidence of our guilt and self-convicted

criminality. Now, it is hardly to be expected that Lord Ashley,

with his acknowledged character for caution, would

venture upon so general a condemnation of private

asylums solely on the strength of his own experience, and it is an inquiry of some interest to us?the proprie

tors, to learn how his Lordship has been led to this

conclusion ; for there is undoubtedly involved in it the

negative inference that, in his estimation, the very prin

ciple of a private asylum is essentially defective, that

the system is incurably wrong, and admits of no remedy but thorough extinction. Certainly, on the part of his

Lordship, this is very bold doctrine to broach, but the

fairness of our inference is undeniable. The most ex*

treme reformer in general politics could not exceed it; indeed the latter goes no further when he contends that

the evils and power of an hereditary peerage are so

great that they can never be counteracted by present

contrivance, and that there can be no true liberty for

the people without its total extinction ;?when he con

tends that the union of Church and State is accom

panied with such fearful consequences, that it is useless

attempting their reform without first entirely breaking off their alliance, &c, &c, &c.; but as these views are

not participated in by the mass of sober and reasonably minded men, so in like manner I fancy the radical

notions of his Lordship in respect to the irremediable

nature of the evils of private asylums, will be liable to

share the same fate with the community in general.

Now, in the absence of positive information, we must

briefly speculate as to the mode in which Lord Ashley has been led to these extreme conclusions. Of course he

is very familiar with the news of the day, as well as the

literature of the age, and no doubt, he may have had a

small share, by virtue of his office, of even personal

experience; but I should say that the representations, derived from these various sources, highly coloured

though they have been, would hardly have emboldened

him to come out so strongly, and we are driven to

the unwilling alternative of suspecting (and we may be

surely excused suspecting, as suspicion seems the order

of the day in these things) that the Commissioners

themselves have been reporting unfavourably of us en

masse behind the scenes. However, this may be, the

noble Chairman seems to have come to a decision on the

question, and to say the least, probably more may be

due to the Commissioners for having aided in the result

than we would fain believe.

The question, however, must not rest where it is at

present; there must be a more thorough understanding on this point; and Lord Ashley, on consideration, must

feel himself called upon at once to speak out more

distinctly the meaning and scope of his observation.

This much, at least, is due to the proprietors of private

asylums; for really such an announcement, if it have

its legitimate effect, is culculated to paralyze all their

energies, and seriously interfere with the further in

; vestment of capital in this department of science. I

fear, also, it may come to have another and perhaps

more serious effect; for it may be the means of throw

ing additional impediments in the way of the Commis

sioners exercising their usual supervision with efficiency

and#satisfaction, for Lord Ashley's experience of man

kind must, or ought to have taught him, thrt laws may

be rendered so exacting as to goad people on J. rebellion;

that the sense of right and wrong, and we m~y, perhaps,

be excused saying, even honour, small though this

latter may be in the breasts of proprietors of private

asylums, may be wounded, suspicions and jealousies

I may be engendered, and the respectful feelings hitherto

i subsisting between the supervisors and the supervised

may be greatly interfered with. I believe it is a

general fact and rule, admitted from Grotius downwards

to Blackstone, that to ensure ready, and willing, and

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198 ON PRIVATE LUNATIC ASYLUMS.

obedient compliance to the laws, the framers must take

care that they accord, as far as possible, with that sense

of common justice and fairness, naturally inherent in

mankind. The law of lunacy, strange to say, in more

senses than one, appears destined to be rendered per fect and infallible; seems singled out for special ex

periment. Because insanity refuseth to be bound in by strict definition;?because the shades of sanity and

insanity are so fine that the most copious and expressive

language faileth to mark out their respective bounda

ries ;?because a " Nottidge Case," will now and then

occur on the scene;?because, forsooth, these rare and

exceptional instances have happened o?\ a subject con

fessedly the most difficult and abstruse in the whole

range of medical or legal science, has the whole system of

management, each time of their occurrence, to be stirred

up afresh to its very foundation, and triumphantly paraded as an argument showing the irremediable abuses

of private establishments. We admit that painful cases have come to light, and we profess to have

humanity enough left to lament them; but we at the

same time are equally sure that such cases will occur

again, despite of the most refined statutory enactments, and we demur, "de toto," to the conclusions which

appear to have been drawn from them. I appeal again to your readers whether, with the view of preventing the recurrence of these things, it is wise?it is necessary to abolish private institutions for the insane. By

parity of reasoning we should be called upon to abolish

the office of judge and trial by jury, because many innocent men, as has been afterwards proved, have

suffered imprisonment and even death at their hands;

further, shall we abrogate the Poor-Law because many instances have come to light where parties have been

hungered to death through the difficulties attending its

satisfactory administration ? Again, why is the office

of union-surgeon not extinguished, when it can be

shown that in some few instances men have died with out being able to obtain his services owing to excessive

engagements ? The reason is pretty obvious to men of

experience. In all human affairs it is a good thing to ?im at perfection, but there is no reason in becoming desperate when we fail to attain it. Let abuses as

they arise be reformed, but in accordance with the dictates of cool and sober experience. We repeat, it would be very uncandid to deny that certain cases

have occurred which were calculated to arouse public attention, or that many useful reforms in the law of

lunacy have resulted from the attention of the

community having been so directed. To deny this would be tantamount to disbelieving in the possibility of human progress; but public feeling soon tends to

right itself and come to a due equilibrium, when the facts of any case awaiting its decision are truly and

faithfully represented, without colouring and without

distortion; but who can say that such has obtained with regard to the subject of lunacy; indeed, who can

deny that a great amount of pseudo-sentimentalism and mawkish sympathy has been unnecessarily expended upon it.

We next approach one of the most important parts in this discussion. Supposing Lord Ashley succeeds in his attempt to annihilate private asylums, it is very

necessary to inquire what he proposes to substitute in

their place. Does he intend to remove private lunatics to the county establishments ? or is he about to restore the cottage system, and store them up and down again amongst farm houses ? or rather, does he not purpose to erect special institutions by means of charitable

subscriptions, and in the event of these failing, by the aid of county-rates or the consolidated fund, something on the principle of the Northampton and Manchester

Asylums; and when all this has been done, to go out

into the highways and hedges, and compel them to come in. We must presume that his Lordship at least

imagines he sees his way clearly on this point, and

possibly he may be gifted with a more extended vision

than ordinary mortals, but he must bear with us taking the liberty of cautioning him as to the very delicate

ground on which he here treads, and of expressing our

deepest conviction that he is about to undertake a task

which will prove too great for him.

We believe it is a general rule, as we have attempted to show in a previous letter, that there is a constant

tendency in mankind to be jealous of all establishments

officered by salaried superintendents ; and for one main

reason, amongst many others, that it is generally diffi

cult to fix upon a responsible head. The public prefer to deal with individuals rather than a Committee of

Governors; and we must repeat our impression that

should the Commissioners succeed in inducing the

Legislature to refuse to license any longer private institutions, they indulge themselves in a delusion when

they anticipate the day that persons of means, or those

who have any option in the matter, will consent, as a

general rule, to send their friends to public asylums. No doubt exceptional instances may now and then occur, where the Governors can meet with a Tuke, or a

Conolly, or a Pinel, to act as directors, whose high moral and well-established characters would at once

inspire sufficient confidence. But in a great under

taking of this kind, intended to be adapted for the

whole community, it must be recollected that their

main management, after all, will have to be entrusted

to men of average attainments and average feelings ;? in short, to common fallible humanity.

Having entered so far into the general argument, and

having ventured to express our great misgivings as to

the success of the institutions which it is proposed to

substitute for those whose existence time-honoured

custom has long tolerated, if not sanctioned, it seems

necessary that we should now clearly and explicitly state some of the probable reasons which induce the

public to prefer private asylums. In a former letter we

slightly glanced at this subject; but we propose now to

enlarge upon it. And, in the first place, we affirm

that the public prefer them because there is generally one

recognised responsible head, supreme in control, and

amenable to no other authority, and who is influenced

by motives of self-interest to be affable and approach

able, prompt and business-like in his habits;?one who

is dependent for his daily bread on his daily exertion;? one who is dependent for success on the candour and

good faith which he observes towards his patients and

their friends;?one who has time and opportunity to

pay individual attention to individual cases.

In the second place, the public prefer private

asylums because they are, comparatively speaking,

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ON PRIVATE LUNATIC ASYLUMS. 199

private;?because they are more limited in extent, and

that, therefore, their friends can receive more special

attention;?because they believe that a greater variety of diet is practicable in them;?because they leel that

they can make it worth the while of the proprietor to

grant a greater number of little nice indulgencies, which

they conceive will contribute much to the invalid's

comfort;?because they can more freely and oftener

correspond respecting their friends;?because they feel

more at liberty to visit (whether judiciously or not is

another question) whenever their feelings prompt them

to such a course. And, contrast all these privileges and advantages with those of an asylum containing from 300 to 500 inmates, and perhaps the public will

shew themselves not very undiscerning in imagining that a private asylum will suit their tastes and views better, and prove more acceptable to their feelings.

That the above is no factitious representation?no coloured exaggeration to gain an object, we appeal to

every medical man of experience in these matters;

indeed, to any one who has studied mankind, and who

knows something of the impulses and emotions which

determine the springs of human actions. Not a year

passes over our heads but we receive parties into our

establishment who might have obtained admission into the county one {and if our fees were less, we feel that

we should receive many more) ; but the friends prefer to try them for a few months with us previously to their

adopting this, in their opinion, extreme course, and

they make great exertions to maintain them; and the reasons assigned on their part are embodied in the

statements above made.

We cannot well conclude this letter without briefly alluding to the proposals recently set forth by Dr.

Henry Munro, although we feel that we might safely leave him in the hands of your correspondent E. B.,

who, if not so wordy, has at least shewn himself

greatly his superior in experience and wisdom. We have really no wish to impugn the purity of motive, or suspect the disinterested nature, of the benevolent

aspirations which seem to have actuated Dr. Munro in his present course; but he should recollect that in a

movement of moment it is as necessary to use the head as the heart, otherwise we shall be apt to make very

poor and profitless advisers. He might also have been induced to act more cautiously by recollecting that he is the scion of a family long distinguished in this

department of knowledge, and that there devolves upon _im the maintenance of the honour of a character so well and so richly earned. His reasons for increased

supervision are, in our opinion, of the most flimsy and

gratuitous description, and make us disingenuous enough to stamp them at once as the concoction of the cabinet, and not the offspring of calm and sober experience.

Your space will certainly not permit of our entering into detail; but, like E. B., we beg to give an unquali fied contradiction to each and every one of his four

propositions; and we cannot restrain ourselves from

saying that the appointment of any Assistant-Commis sioner in Lunacy would be a piece of the most jobbish,

meddlesome, and unnecessary legislation, in a small

way, that was ever palmed upon an unsuspicious and

industrious people; and we sincerely hope that not a

sixpence of our hardly earned income-tax will ever be

misappropriated to such a purpose. We have super vision enough. Tf six or seven clandestine visits in the course of a year, by parties endowed with such tremendous powers as the present Commissioners, are

not adequate to regulate and keep in respectable order lunatic asylums, and prevent the creeping in of exces

[ sive abuses, the sooner the extinguisher is applied the better. The public, we believe, if let alone, are

sufficiently satisfied with the protection afforded to the I liberty of the subject by the last Act of Parliament.

We never recollect an instance in which any party to

whom we have been called upon fully to explain the

safeguards established by law to protect Her Majesty's subjects from improper confinement, has considered

them inadequate; but we have a very distinct remem

brance of a case (for it happened very recently) where an affectionate brother of high moral character, and of

considerable mercantile notoriety, whilst performing the

painful duty of consigning a near relative to our care, observed that he thought such extreme supervision

must be unnecessary in private asylums, but perhaps called for in public institutions. On requesting him to

state his reasons for this conclusion, which we informed

him was opposed to that of many very humane men

at the present day, he replied " that a regard for char

! acter and worldly success should do much towards

ensuring proper and humane treatment of private

patients." We shall dismiss for the present this part of the

subject by candidly observing that our experience inclines us to the belief that the inspection of lunatic

asylums will always prove a rather difficult as well as

delicate task, and will probably never be rendered so

perfect as fully to meet the whims, and caprices, and

fastidious tastes of certain gentlemen who sit at home

in their easy chairs, and who are seldom seen on the

field of battle ; and this difficulty will attach whether

the establishments be private or public; for we profess to know even something of the internal management of

the latter, and therefore would warn our detractors in

pointing them out to us as paragons of perfection. Much will always have to depend on the good sense

and moral attributes of the medical superintendent; and the public have penetration enough ,?0 see this.

But we have certainly our doubts as to the soundness

of the principle of inspection which is pursued at the

present day. We believe that inspection is necessary, and if properly executed cannot fail to do good. We

believe that all reasonable suggestions of the Commis

sioners will be received in a proper spirit by proprietors of these houses;?that they will be thankful for any novel plans which may be submitted to them to assist

them in the discharge of their onerous duties; but why allow themselves to be egged on to anything even

approaching an undignified course by the current

fashion of the day of making molehills into moun

tains ??why come down upon us predetermined to find

fault ??why plant themselves in different departments of the house and cross-question our domestics, with the

obvious intent of eliciting inconsistent reports ??

why deny the superintendent credit for some few

grains of conscience and integrity of purpose? We

question either the fairness or philosophy of this

system; and we are glad to say that we cannot yet go

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200 ON UTERINE HEMORRHAGE.

this length in our belief in the depravity of human I

nature. The banker trusts his clerks with bags of i

gold;?the money-receiver at the entrance of a restau- j rant, entertaining hundreds, takes your word and state- i

ment; and experience seems to warrant a continuance j of the plan. But, lo! the proprietor of a lunatic

asylum must not be entrusted with even the honour and confidence awarded to the frequenter of a pot house.

Before we conclude you will perhaps indulge us with one word in reference to Dr. H. Munro's scheme for

establishing asylums for the middle classes; and we are

sorry that we cannot consider him here any more happy than in his arguments for increased supervision. Dr.

H. Munro must really suffer from a morbid, overflowing of benevolence. The sum and substance of his appeal amounts to this,?that it would be a good thing to erect asylums for the middle classes, because their limited resources render it difficult for them to main tain their friends at private ones; and it wounds their

feeling of pride to be accommodated at the expense of the county. Now, abstractedly considered, we dare

scarcely deny the truth and reasonableness of these

propositions; but we think we are safe in contending that it would be equally a good thing to subscribe a

large fund to assist the middle classes to pay their

ordinary doctors' bills, their lawyers' bills, and their Government taxes;?to assist the bereft widow in

bringing up her fatherless children, and keeping them from the workhouse;?in short, a fund to assist every man, woman, and child in this kingdom who have the usual worldly difficulties to contend with. But we would ask, is there no danger that such a fund is calculated to strike at the root of our national great ness, and undermine its very essence, namely,?self reliance and independence of feeling; for who, with such resources at command, would long impute these noble principles as virtues? Nay, would not the inevitable result of such a fund be reckless dissipation

and hopeless improvidence. We are here reminded of a sentiment, to which at times we are half inclined to subscribe, the remark of a celebrated foreigner, who, on having had pointed out to him our numerous

hospitals and benevolent institutions, as specimens of our national greatness and pride, replied, that he should rather look upon them as evidences of national disgrace, for they indicate one or other of three things,?either that the people are very idle, or very improvident and

dissipated, or the rewards of labour are very unfairly and unequally distributed amongst them.

To say the least, our Saxon blood recoils at the very idea of pauperising the middle classes of England for this purpose, and rendering them recipients of charity.

True benevolence, Dr. H. Munro may rest assured, will

always find abundant scope for exercise. Too many objects, we fear, for its gratification are constantly falling out in complicated societies like ours, without

devising means fdr their artificial creation; and it has

really become a question with us whether indiscriminate

almsgiving or unlimited selfishness be attended with

greater evils to society. We feel that the best and soundest part of benevolence consists in readily adopting all those political expedients which tend to

beget industry and exertion amongst the people, and to

ensure a proper and equable distribution amongst them of the fruits of their labour; and that excessive alms

giving is only a very secondary ingredient in the philo

sophy of social improvement. To conclude, our task has been a very ungracious

one of having to set ourselves in seeming opposition to

principles and practices which, when properly carried out under the guidance of reason and judgment, reflect

infinite credit on our very race, and constitute, indeed, some of the great redeeming traits in our fallen nature.

But the sense of duty not unfrequently works in

antagonism to the feelings of the heart; and we have

only enunciated what we believe to be based on equity and truth.

I remain, yours, very obediently,

AN ADMIRER OF TRUTH.

ON UTERINE HEMORRHAGE.

To the Editors of the Provincial Medical and Surgical

j Journal.

j Gentlemen,?I was much interested in the perusal of the paper on "Uterine Haemorrhage" by Mr. King, contained in your journal of the 31st ultimo, but was

somewhat surprised he made no mention, amongst other

means for the treatment of internal uterine haemorrhage, of the injection of cold water into the cavity of the

uterus, for the purpose of inducing permanent con

traction of that organ, after the expulsion of the

placenta. In three cases of internal haemorrhage I

have applied cold water in this way, with the most

complete success, and unattended with any unfavour

able symptoms afterwards. In one of them napkins, saturated with cold water, placed on the abdomen and

pubes, and pressure with the hand over the fundus

uteri, had been applied for some time, but with the

effect only of retarding, not stopping, the gradual increase of the organ. Having sent for a syringe, I

injected a quantity of cold water into the cavity, and

immediately perfect contraction ensued. It is imma

terial whether a common enema syringe or an elastic

bottle be used for the purpose, provided the tube be

sufficiently long to be carried completely within the os

uteri; by this method the uterus is thoroughly emptied of its contents, not leaving, as is frequently done after

the application of cold externally, a large coagulum

within, which, undergoing decomposition, causes offen

sive lochia, and not infrequently uterine phlebitis; and

it is also less likely to be followed by serious conse

quences than the introduction of the hand within the

uterus, as recommended by some authors, although Mr. King says

" the only contracting power in this

case (internal haemorrhage after delivery) is cold water."

With regard to the action of the secale corrmtum, I

think it has certainly the power of originating uterine

action, not merely of stimulating it, but the dose

requires to be frequently repeated, and is undoubtedly more efficacious when combined with biborate of soda

recommended by Dr. Rigby. I am, gentlemen,

Yours very truly, F. P.-C.

April 3, 1852.

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