places, and cases of mania, when they occur, are treated with iron handcuffs and hempen rope, and tied up like wild beasts till the fit is over, or nature sinks under the strain. As Dr. Lockhart remarks, "The condition of the insane in a country like China, where there are no asylums, is truly pitiable." A certain, though I must believe an inconsiderable, number of cases of lunacy and insanity are seen year and year at each of the various Mission Hospitals throughout the Empire, and these have been in some instances of so striking a character as to have impressed the opinion on the minds of some physicians that mental maladies are not less prevalent amongst the Chinese than they are amongst Europeans. Undoubtedly suicides (mostly by opium) are notoriously frequent, and from causes (such as disappointed love, injured pride, sudden fear) deemed ridiculous amongst Europeans. Yet my impression is very strong that the proportion of cases requiring restraint, surveillance, and, generally speaking, the care of an asylum, is infinitely smaller than we find in any part of England or Scotland. The statistical notes which follow will, I think, bear me out in this statement:-Diseases of the general nervous system are by no means infrequent amongst the Chinese, but cases of alienation of mind are comparatively few. Of course, if we include cases of anesthesia and leprosy under diseases of the nervous system, we shall increase the former class; and if we include the suicides or attempted suicides by opium-poisoning, drowning, &c., under the latter head, we shall swell the number of insane cases. I have so arranged them in the abstracts which follow, and yet the proportion will be found to fall far below what might be looked for in European communities. Two causes in chief operate towards this result.

1st.-The Natural Character of the People.

The Chinaman is naturally a smooth, placid, unmartial, steady, easy-going, unexcitable being, with a large share of common sense, and self-control, and philosophy "to bear the ills of life." The mass of the population is engaged in agricultural pursuits, and leads a life of arcadian peace and felicity. Amongst business men there is nothing like the same jealous competition and rivalry, sharp practice and under-selling, which occur amongst European merchants and tradesmen; trade prices being regulated by guilds and corporations. Nor is there the same "living for appearances," and "beyond one's means," so common in England. The

style of living even on the part of wealthy merchants is simple and unpretentious, so that when calamity overtakes them the fall from the pinnacle of fortune is much less precipitous and injurious to one's pride and self-respect than it would be with us.

He that is low need fear no fall.

They do everything quietly and methodically, without the slightest exertion or fuss. They have few ups and downs in their world. Fate regulates everything, and they are content with their lot. If they have wealth, they use it; if none, they do without it. They live on in one regular routine. Worry is unknown. None of the causes, such as competition in business, speculation, religious controversy, and party politics, which in the west undermine health and increase the mortality, are found here. General indolence and ease, disinclination to be troubled about matters, and a desire to let things take their course, trusting that all will come right, are their characteristics. This state of feeling, partly inculcated by their various religions, and occasioned partly by the climate, conduces most effectively to the permanence of their institutions, and indisposes them for any changes in their customs.

2nd.-Their Temperate and Abstemious Habits.

The Chinese are a sober, temperate people. One physician writes-" During eight years' residence in Pekin, I have seen but two cases of intoxication." Another, "During six years' residence in Hankow I have seen but two cases of intoxication and one of drunkard's liver." Another, "During seven years' connexion with a public hospital I saw but eight cases of intemperance." Yet a good deal of raw coarse spirits, or "shamshoo," is consumed, distilled from the Sorghum, or Barbadoes Millet, and containing a large quantity of fusel oil, which renders it impossible to be drunk in large quantities. Tea is the only beverage which is not used in moderation, and to this circumstance is attributed the general prevalence of dyspeptic and gastric disorders. A mild, native tobacco is commonly smoked by men and women by means of the waterpipe, and within the last forty years the opium-pipe has become the indispensable and baneful luxury of an enormous and growing proportion of the population. How far the habit of opium smoking tells in the development of mental

diseases I know not, but of all luxuries it is the surest destroyer of health, property, position, and life.

At the Shanghai General Hospital during the year 1855 there were 12,237 cases, surgical and medical, under treatment, of which 16 were entered under the heading paralysis, 20 of epilepsy, and 16 of attempted or successful suicide by opium. Proportion 1 to 235.

During the year 1854, at the same institution, 12,181 cases were treated, 20 of which were cases of paralysis, 15 of epilepsy, six of suicide by taking opium. Proportion 1 to 297.

In 1856 there were 11,495 cases entered, of which 10 were cases of paralysis, 16 of epilepsy; attempted suicide by the use of opium, 8; successful ditto, 4. Proportion 1 to 302.

During the year 1863, out of some 20,000 cases, there were but 14 of insanity, and this is stated by Dr. Henderson to be "more than double the number observed during the three preceding years. Insanity, though reckoned exceedingly rare amongst the Chinese," he goes on to say, "may not be really so, as we shall probably find on a better acquaintance with the people." In the majority of cases the friends ascribed the disease to the influence of sudden terror, as from fire, incursions of Imperialist soldiers, pirates or robbers, pecuniary losses, disappointment in love or marriage. Two were examples of erotomania; one was perfectly quiet and inoffensive, and left the hospital perfectly cured within three months; the other showed his disappointment by savagely attacking everyone who approached him. He was carried in by four men, heavily ironed with a chain weighing 4lbs. around his neck, and his hands and feet firmly tied together. He recovered within 42 days.

A maniac who had just attempted to commit suicide by drowning was brought to the hospital by two policemen, who found him a most troublesome subject to manage. He endeavoured to destroy everything within his reach, stripped himself naked, and was constantly vociferating at the pitch of his voice, day and night. He steadily refused all food and medicine, and was fed with the stomach pump for eight days, but in the end he died of exhaustion.

Another case of acute mania died of inanition.

A third, in a lad 18 years old, seemed due to injury about the head, received during a severe beating from his master, and was an extremely violent one. For seventy hours he never slept, nor ceased yelling, notwithstanding large doses,

frequently repeated, of tartar emetic and opium. Aphonia at last put an effectual stop to the uproar, and at the end of fifty days he was perfectly well.

Of the 14 cases of insanity, 11 were cases of acute mania, with excited pulse and obstinate insomnia, and three were cases of dementia.

The same year 44 cases of attempted suicide by opium were treated, of which 14 were fatal. Proportion 1 in 345.

In the year 1860 (total, 16,111), dementia, 6; epilepsy, 5; paralysis of face, 23; hemiplegia, 4; paraplegia, 13. Proportion 1 in 316.

During the year 1865 the entire number of cases amounted to 15,000; there were two cases of suicide by hanging, and 43 of attempted suicide by opium-34 being successfully treated and nine proving fatal. There were two cases also of acute mania. Proportion 1 to 319.

During the year 1870, Dr. Johnston reports a total of 12,823 cases, of which six were cases of insanity (one only remained uncured), 38 of epilepsy, 48 of paralysis, 31 of facial paralysis, and four of locomotor ataxy. Cases of poisoning with opium 48, of which 12 died; ditto with arsenic, 2: both recovered. Proportion 1 to 72.

During 1871, 22,496 general cases were treated, including one of paraplegia, ten of attempted suicides by swallowing opium, of which two were fatal, and one of suicidal melancholia, alternating with attacks of acute mania. Proportion 1 to 1607.

During 1867, 13,078 general cases were under treatment, of which five were cases of hemiplegia; 40 of epilepsy, four of mania, 24 of facial paralysis, four of cut throat, 44 of opium poisoning, of which ten died. Proportion 1 to 108.

During 1872, the total was 12,378, of which 12 were cases of epilepsy, 24 of hemiplegia, three of acute mania, and 38 of opium poisoning (all suicidal), of whom nine died. Propor

tion 1 to 160.

At Swatow Native Hospital there were treated during the years following :—

At the Hankow Hospital of the Wesleyan Mission, Dr. Porter Smith reports that during the year 1864-5 he treated a total of 18,764 cases, of which 182 came under the denomination of diseases of the nervous system, as follows:Epilepsy, 5; apoplexy, 2; paralysis, 60; neuralgia, 113; aphonia, 2. Proportion 1 to 103. He remarks-" Diseases of the nervous system are remarkably infrequent. How far this depends on the apathetic, peace-and-quietness loving character of the people, we cannot tell. In keeping with all their physics and philosophy, they certainly do not use their brains to any very wasting or wearing extent. Apoplexy is very rare. Palsy is generally hemiplegic, coming on in no very definite or sudden manner, and almost always recovered from to a considerable degree. Paraplegia, general paralysis, softening of the brain, and chorea have not been observed. Bell's paralysis of the face occurs with tolerable frequency. Dentition is easy amongst children, and seldom attended with convulsions, palsy, &c. Water on the brain is uncommon. Insanity has not been seen or heard of amongst persons applying for relief. Three cases of idiocy have been noted amongst children, and four instances of imbecility amongst adults. Considering the alarming character of mental maladies, on the one hand, and the exaggerated notions entertained by the Chinese of the powers of Western Art on the other, it is probable that if cases of insanity were numerous in proportion to other diseases and the population, they would be found in far greater numbers at the hospital."

During the year 1865-6 Dr. P. Smith treated 8,941 cases at the Mission Hospital, Hankow, of which 152 were classed under the head of diseases of the nervous system, as follows Apoplexy, 1; epilepsy, 25; paralysis, 44; neuralgia, 55; sciatica, 28. Proportion 1 in 59.

:

During the year 1866-7 Dr. Smith treated 11,557 cases at the hospital, of which 141 are referred to the class of diseases of the nervous system, as follows:-Apoplexy, 2; epilepsy, 28; paralysis, 36; hydrocephalus, 3; neuralgia, 49; sciatica, 20; facial paralysis, 3. Proportion 1 in 82.

During the year 1867-8 Dr. Smith treated at the hospital a total of 6,661 cases, of which no portion is classed under the head of diseases of the nervous system. Proportion nil.

During the year 1868-9 Dr. Smith treated in all 6,935 cases, of which 120 are referred to the nervous system. Thus-Epilepsy, 14; infantile convulsions, 2; hemiplegia,