little or no arterial blood can find its way into the arteries during the convulsion.

"There is, however, one fact which may be thought to show that there is an increased injection of arterial blood into the vessels during the convulsion. Such injection is evidently very imperfect at the onset of the fit-in many instances at least; for upon no other supposition can we explain the corpse-like paleness of the countenance, and the feeble and silent pulse at the wrist. This is evident. But if the finger be kept upon the wrist, it may be found that the pulse may rise during the convulsion, until it has acquired a force and fulness which it never had in the intervals between the fits; and if the hand be placed over the heart at this time, it may be found that this organ is beating tumultuously and with great violence. It may also be found that these signs of vascular excitement will continue for some time after the convulsion is over. These facts are evident and unmistakeable, but they do not show, as they might seem to do at first sight, that more arterial blood is injected into the arteries at this time. On the contrary, they necessitate a totally different conclusion when they are subjected to a strict scrutiny.

"Now it cannot be doubted, that the effect of cutting off the access of air to the blood is to prevent the free passage of the blood through the pulmonary capillaries, and to overload the right side of the heart and the venous system generally, at the expense of the left side of the heart and the arteries springing from it. In this way the right side of the heart may become so much distended that the auriculo-ventricular valves are separated, and the beatings of the ventricle are made to tell as much in driving the blood back into the veins, as in sending it onwards into the lungs. But it is not right to suppose that the arteries are empty. If, for example, the carotid of a rabbit be exposed, and a ligature placed around the windpipe, it is found that the blood continues to flow through the vessel, that the originally scarlet colour becomes darker and darker, until at last it is as black as that of the blood in the neighbouring jugulars. Two minutes to two minutes and a half are occupied in this transformation of the scarlet into black blood. It is found, also, that this black blood will escape from the cut vessel in as full a stream and with as much force at the expiration of two minutes or two minutes and a half from the commencement of the process of suffocation, as it did before the aëration of the blood was at all interfered with: Nay, it is even found that at this time the black blood will escape with greater force and in a fuller stream than it did when it was red; for on fitting a hæmadynometer into the vessel and testing the force of the pulse-wave before and after the tightening of the ligature upon the windpipe, the mercury in the instrument is seen to rise to a higher point than that to which it rose previously. Indeed, at this time it is evident, without the aid of any instrument, that the artery is more distended and more tense than it was before. This phenomenon is explained by the late Professor John Reid, who has investigated the condition of the circulation in suffocation more carefully and successfully than any other observer, as the result

of an impediment to the free passage of the black blood through the systemic capillaries similar to that which prevents the free passage of the same blood through the pulmonic capillaries; and it is more easy to entertain this view, and to suppose that, in consequence of this impediment in the systemic capillaries, a greater proportion of the force of the left ventricle is expended in distending the arteries, than to suppose that the ventricle is 'stimulated' to increased action under these circumstances. And, lastly, as explaining the peculiarity of the pulse in suffocation, it is to be remembered that the blood is sent along the arteries with greater force and increased velocity during violent attempts at expiration, and that the pulse becomes soft, feeble, and less frequent during violent attempts at inspiration; and hence it may be supposed that the increased fulness and force of the pulse during the suffocation of epilepsy may be owing partly to the fact that during the whole of this time the air is prevented from entering the chest by the firm spasm of all the muscles concerned- -a state which may be compared to that which obtains in forced and prolonged expiration.

"Hence, the increase in the strength and fulness of the pulse which may take place during the convulsion of epilepsy is no proof, as it might appear at first sight, that the brain as well as the rest of the system is at this time supplied with an increased quantity of arterial blood; for the black and bloated face and neck, and the absolute su suspension of the respiratory movements, show most clearly that the pulse is then filled, not with red blood, but with black.

"After the convulsion there is little to notice in the circulation. When the convulsions cease, the respiration is speedily restored, and the re-admission of arterial blood into the system may be attended with some transitory and inconsiderable febrile reaction; but this reaction has nothing whatever to do with the convulsion, for when it appears the convulsion has departed, and if the convulsion returns it is not until the reaction has first taken its departure.

"Arguing, therefore, from the corpse-like paleness and comparative pulselessness of the onset of the paroxysm, and from the signs of positive and unmistakeable suffocation by which this stage of paleness and pulselessness is succeeded, the only conclusion would seem to be that the convulsion of epilepsy is connected with the want of a due supply of arterial blood. Indeed, the whole history of the paroxysm, as deduced from the condition of the vascular system, would seem to show that there is something utterly uncongenial between epilepsy and anything like arterial excitement." (pp. 156-161.)

Nor is the case different in epileptiform convulsion connected with certain diseases of the brain chronic softening, chronic meningitis, tumour, induration, hypertrophy, atrophy, congestion, apoplexy, inflammation-with fevers, with certain suppressed secretions, with irritation in the gums and elsewhere, and with the moribund state. In each case, on examination, the condition of the circulation is always the reverse of what it ought to be, if

the muscles were over-stimulated at the time. In inflammation of the brain, for instance:

"In inflammation of the brain the condition of the circulation is. not uniformly the same at all times, but this condition, as will be seen by reflecting on what has been already said, varies little with respect to the convulsion.

"Simple meningitis begins with paleness of the skin, a feeble depressed pulse, cutis anserina, vomiting, rigors, perhaps convulsion. Then follow rapidly the symptoms of high febrile reaction and cerebral inflammation the pulse becoming hard and frequent, the breathings irregular and oppressed, the skin, particularly the skin of the head, hot and burning. These symptoms of high febrile reaction and inflamma. tion continue for two or three days, and then give place to an opposite state of things, in which the pulse loses its force and becomes weak, small, irregular, and the breathings are interrupted with frequent sighs and pauses. Or if at this time the pulse retains any degree of resistance, it is evident from the dusky colour of the skin and the suspirious and laboured respiration, that the whole of this resistance is not due to the injection of arterial blood into the artery. Now it is in this stage of collapse which follows the period of inflammatory and febrile excitement, or else in the stage of collapse which precedes the febrile and inflammatory excitement, and never during the actual period of excitement, that the convulsion happens. And this rule is constant. Indeed, the history of simple meningitis shows most conclusively that vascular excitement is as incompatible with convulsion as it is with rigor or subsultus.

"In tubercular meningitis the pulse is weak and variable from the very first, now quick, now comparatively slow, rising in frequency when the head is raised from the pillow, and falling upon lying down again; and from the very first, the respiration is irregular, unequal, and interrupted with frequent sighs and pauses. For some time there may be some little disturbance of a hectic character, particularly in the evening; but this soon comes to an end, and the prostrate pulse forgets to put on even this faint semblance of fever. In some cases, there may indeed be a short stage of fever, and something like cerebral inflammation, especially in young children; but as a rule, the symptoms are altogether of a passive, non-febrile, non-inflaminatory character. In any case, however, the convulsion is connected with an extremely depressed state of the circulation, and never with a state of febrile and inflammatory excitement, if there be such a state.

"In rheumatic meningitis, also, there is little or no febrile excitement from the beginning, and the pulse has become feverless and utterly weak before the convulsion happens..

"In general cerebritis, the pulse, at first slow, soon becomes variable and readily affected by changes of posture: the respiration, also, is very variable and suspirious. From the first, indeed, there is scarcely any fever, and little heat of head, except the phenomena of cerebritis are mixed up with those of simple meningitis; but if such symptoms are present, they soon pass off, and give place to symptoms of slow

sinking a state in which hour by hour the breathing is more interrupted with sighs and pauses, and the pulse more powerless, unless it may derive some fictitious power from the difficult circulation of imperfectly arterialized blood, in which case the dusky countenance and the purple lips will show very clearly that the vessel is not altogether filled with arterial blood.

"In partial cerebritis there is even less febrile disturbance than there is in general cerebritis, and at no stage of the malady is there anything like increased vascular action."-(pp. 309–311.)

Such is a free sketch of the argument by which Dr. Radcliffe attempts to show that convulsion in all its forms-tremor, convulsion proper, and spasm-must be looked upon in a very different light to that in which we have been in the habit of regarding it. The subject is one of great importance of special importance in psychological medicine; for is not convulsion a most common symptom of disorder of the brain? The subject is one also which claims immediate, as well as serious, attention; for if Dr. Radcliffe is right, the natural conclusion is, that the more appropriate means of treatment will be, not those which are calculated to calm excessive stimulation, but those which will sustain and rouse the powers of a flagging system.

ART. VII. ON THE STATE AND CONDITION OF LUNACY IN IRELAND.*

IN 1856 a Royal Commission was appointed to inquire into the state of Lunatic Asylums and other Institutions for the custody and treatment of the Insane in Ireland, and into the present state of the Law respecting Lunatics and Lunatic Asylums in that part of the United Kingdom. The Report of the Commissioners has now been made public, and it is unfavourable, not only as regards the condition and management of both public and private institutions for the insane in Ireland, but also as regards the existing state of the Irish Law of Lunacy. From several omissions, however, and also from not a few imisappre-hensions of the Commissioners, it appears to us that the unfavourable aspect of their Report has been unnecessarily, although, without doubt, unintentionally, heightened, and that,

Report of the Commissioners of Inquiry into the State of the Lunatic Asylums, and other Institutions for the Custody and Treatment of the Insane in Ireland. (Blue Book.) 1858.

Observations on the Report of the Commissioners of Inquiry into Lunatic Asylums, &c. (Ireland), in a Letter to the Right Honourable Lord Viscount Naas, M.P., Chief Secretary. By J. Nugent, M.D., Inspector of Lunatic Asylums. (Her Majesty's Stationery Office.) 1858.

in consequence, the Report does not present a correct notion of the actual state and condition of Lunacy Legislation and Manage ment in Ireland.

The returns laid before the Commission show that, on the 1st of January, 1857, the number of insane poor in Ireland amounted to 9286, of whom 5934 were maintained at the public charge, and 3352 were at large. The returns made to the Commissioners do not correspond with the returns of the Inspectors of Lunacy for the same period. These returns give the total number of insane in Ireland, exclusive of epileptics at large and in workhouses, as being 11,452, of whom 5441 were at large. The inspectors estimate that, of the total number of insane at large, as recorded in their returns, 600 lunatics and idiots were not: paupers. Thus, according to this calculation, the insane poor would amount to 4841. The returns upon which the Commissioners' enumeration is founded distinctly specified that the "poor" alone should be included; the inspectors' estimates were founded on returns obtained irrespective of social condition. The Census returns show that the total number of insane in Ireland on the 31st of March, 1851, was 9980. A comparison of the Census and of the Lunacy Inspectors' returns, " made at an interval of between five and six years, and obtained through the same sources of information, shows a considerable increase in the amount of insanity in Ireland."-(p. 2.)

It is to be regretted that the Commissioners have not given an estimate of the proportion of insane to population in each of the two periods referred to, and also of the probable rate of increase in the amount of insanity.co

The insane poor, who are maintained at the public charge, are. distributed in the District. Asylums (sixteen in number), the. workhouses, the gaols, and the Central Criminal Asylum.

Concerning the District Asylums, the Commissioners report that the rules which exist (themselves imperfectly conceived) for the government of those institutions are frequently imperfectly carried out, disregarded, or altogether violated; that the books which are required to be kept for recording, at regular periods, the condition of the inmates, are either not kept, or if kept, there is a want of uniformity in the mode in which the entries are made; that the Governing Boards of the institutions do not, as a rule, meet sufficiently often; that there is great diversity in the rules of admission; that the hygienic arrangements of both the old and the new asylums are not satisfactory, particularly the ventilation and warming; that in several asylums there is an inattention to cleanliness; that the provision for the recreation of the inmates is deficient, if not altogether wanting; that the wards have commonly a bare and uncomfortable aspect;