12; hydrocephalus, 2; facial palsy, 2; neuralgia, 69; sciatica, 14; insanity, 2. Proportion 1 in 58.

In the Native Hospital at Hankow, carried on by Dr. Shearer under the auspices of the London Mission, I find there were 5,668 cases under treatment during the year 1870, of which 165 cases are entered under the head of diseases of the nervous system as follows:-Neuralgia, 15; sciatica, 18; vertigo, 4; cephalalgia, 42; hemicrania, 16; trembling palsy, 2; facial paralysis, 7; head palsy, 1; hemiplegia, 11; paraplegia, 16; hæmorrhagic apoplexy, fatal, 1; epilepsy, 12. Two cases of insanity, and one of suicide by hanging, all of them originating in family quarrels. Proportion 1 in 35.

Dr. Thomson, of Swatow, reports 35 cases of diseases of the nervous system, out of 1500 cases of general disease treated in the Native Hospital, as follows:-Neuralgia, 17; sciatica, 8; hysteria, 1; paraplegia, 1; hemiplegia, 3; epilepsy, 4; œtitis, 1. Proportion 1 in 42.

At Kew-Kiang Hospital for the natives Dr. Shearer reports upon 2,456 general cases under treatment during the year 1871, of which 44 are referred to the nervous system. Among these were 2 of hæmorrhagic apoplexy, fatal within 6 hours; 1 of delirium tremens; 1 of numbness and partial paralysis of right arm and hand, with acute wasting of the muscles; 3 of convulsions in young children; and one of acute mania cured by repeated doses of bromide of potassium, after the ordinary sedatives had failed. Also several cases of opium poisoning with a view to suicide, saved by the administration of strychnia in minute and repeated doses. Proportion 1 in 46.

Dr. Manson, at the Dispensary for the Natives in Takoo and Taiwanfoo, Formosa, reports on 1287 cases, of which 7 only are classed under the head of diseases of the nervous system, as follows:-Hysteria, 1; neuralgia, 2; sciatica, 2; epilepsy, 2. Proportion 1 in 183.

Dr. Reid, in charge of the Mission Hospital at Hankow, for 1872, reports upon some 5138 cases, of which 120 are placed under the head of diseases of the nervous system, as follows:-Chronic hydrocephalus, 2; apoplexy, 2; embolism, 1; inflammation of spinal cord, 2; atrophy of spinal cord, 5; softening of spinal cord, 3; neuroma, 2; paraplegia, 7; hemiplegia, 19; facial paralysis, 5; Scrivener's palsy, 1; infantile paralysis, 10; tetanus, 1; convulsions, 10; epilepsy, 16; shaking palsy, 2; neuralgia, 6; sciatica, 8; hemicrania, 4. This is in the proportion of 1 in 42.

Dr. Manson, of Formosa, reports upon 891 cases treated by him during 1872, of which only 9 were referred to the nervous system :-Hysteria, 3; epilepsy, 1; sciatica, 1; paralysis, 4. Proportion 1 in 99.

During the year 1873, Dr. Reid treated some 3876 cases at the Mission Hospital in Hankow, of which 101 belonged to the class of nervous diseases, as follows:-Tubercular meningitis, 1; apoplexy, 3; sunstroke, 2; hemiplegia, 15; paraplegia, 5; infantile convulsions, 9; epilepsy, 12; neuralgia, 13; sciatica, 16; shaking palsy, 1; locomotor ataxy, 2; infantile paralysis, 5; Bell's paralysis, 4; Scrivener's palsy, 1; anæsthesia, 3; spasm of muscle, 4; mania, 1; idiocy, 2; neuroma, 2. This is in the proportion of 1 in 38.

The only reliable inferences to be drawn from these statistics seem to be the following:-That disorders of the nervous system, in a general sense, are by no means infrequent amongst the Chinese; that we have no sufficient data as yet to enable us to decide the question of their greater or less frequency of occurrence, as compared with European countries, though the probabilities are that the prevalence of diseases of the general nervous system in China bears some proportion to the prevalence of the same diseases in Europe, and other regions, since the proportion is observed constantly to rise with the degree of attention paid to diagnosis, the proportion of nervous cases varying from 1 in 1607 to 1 in 38 at different hospitals; but that cases of alienation of mind, idiocy, lunacy, fatuity, and, generally speaking, insanity, are strikingly few, if we leave suicides out of the reckoning.

Sunstroke, or heat apoplexy, which carried off 10 persons in the foreign community at Shanghai during the summer of 1872, is all but unknown amongst the Chinese.

In confirmation of these remarks, I find Dr. Lockhart, of the Pekin Hospital, who, during the year 1861-2 prescribed for some 22,144 cases, writing thus:

"The number of cases of paralysis of various kinds has been very surprising, chiefly atonic paralysis, the result, in many cases, of excessive study, and of endeavouring to commit to memory the books of the classics; in some also the result doubtless of extreme dissipation. Other cases were clearly the result of effusion of serum, or the extravasation of blood on or into the brain, as in apoplexy. From all that could be ascertained, it would appear that disease of the brain and paralysis in its various forms prevail to a great extent in this city. I am satisfied that one cause of cerebral affections among the Chinese in the North is the practice of living and

sleeping in rooms heated by stoves in which anthracite coal is burned. These stoves have no chimney, and the coal being smokeless, leads the people to suppose that nothing injurious passes from the fire, but of course a large amount of carbonic acid and carbonic oxide is generated, and injuriously affects those exposed to it, causing severe headache, stupefaction, and fever. Many persons have been brought to me semicomatose, who in the cold weather had lighted the stove and then gone to bed, but were afterwards found by their friends to be insensible. Such a state, often repeated, must give rise to cerebral disease sooner or later, and I am sure it does so in many instances.

"Amaurosis is also very common, the consequence of unremitting application to reading, and also of dissipation and excess. Many of the Buddhist and other priests are subject to this malady.

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Insanity.-Many cases of insanity and idiocy were seen, but they were for the most part quiet and easily controlled. In one case of acute mania, the young woman had been tightly bound with cords by the wrists till mortification set in, which, spreading up the arms, caused her death. The condition of the insane in a country like China, where there are no asylums, is truly pitiable. The unfortunate sufferers are usually bound fast, sadly neglected, and subject to hard and cruel treatment, in order to precipitate their death, which is urgently desired by their friends and relatives.

"Many epileptics were seen, and deaf mutes are from time to time brought to the Hospital.”

It is quite evident that no satisfactory conclusions can be drawn from the statistical method as applied to these returns, which, in most cases, are rather a simple record of the rough and ready treatment of a general hospital, by men engaged in private practice, than a careful analysis and classification of cases for scientific purposes. But it will be remarked that, whereas the proportion of nervous diseases to general maladies varies thus:-1 to 235, 1 to 297, 1 to 302, 1 to 345, 1 to 316, 1 to 319, 1 to 246, 1 to 103, 1 to 90; it is stated to be so rare in one hospital as 1 to 1607, and so frequent in others as 1 in 59, 1 in 58, 1 in 48, 1 in 42, and even 1 in 35. This enormous divergence can only be attributed to the greater nicety of diagnosis practised at some hospitals than others.

Still it may be interesting to compare with these returns of the native hospitals a few which I have by me of the maladies prevalent amongst foreign communities in China, from

which it will be seen that the percentage of nervous disorders is much greater, though, as a rule, the residents in our foreign settlements are young, hale and hearty-in fact, generally speaking, people in the prime of life. For this excess of nervous affections the climate is generally blamed. Dr. Scott, of Swatow, for 1870, reports upon 361 cases of general disease amongst the foreign population, of which 12 belong to the nervous class, or 1 in 30.

Dr. Somerville, of Foochow, returns a total of 496 cases for 1872, of which 19 were classed under the neuroses, or 1 in 26, as follows:-Heat apoplexy, 1; sun malaise, 13; tetanus, 1; sciatica, 1; neuralgia, 3.

Dr. Wong, of Canton, makes a return of 204 cases of disease amongst foreigners during 1872, of which 12 were nervous cases, or 1 in 17, thus:-Sunstroke, 2; neuralgia, 6; paraplegia, 1; cerebral exhaustion, 2; hysteria, 1.

Amongst the foreign community of Shanghai, numbering between 2000 and 3000 souls, during the half-year ending September, 1872, there took place in all 63 deaths, 16 of which, or nearly one-fourth, were from affections of the nervous system, as follows:-Disease of the brain, 1; heat apoplexy, 10; spinal arachnitis, 1; delirium tremens, 1; infantile convulsions, 3.

During the succeeding half-year (cool winter season), 50 deaths occurred, of which only 6, or 4th were from affections of the mind and brain, thus:-Suicide, 1; brain disease, 4; epilepsy, 1.

On the Family Care of the Insane in Scotland. By PROFESSOR FRIEDRICH JOLLY, of Strasburg.*

The treatment of the insane in families, and the system pursued at Gheel, are generally regarded as identical. The experiment which has been going on for centuries in the little Belgian town appears to satisfy all the requirements of a crucial experiment; and it is supposed that it furnishes in its results a demonstration of the worth or worthlessness of the family system of treatment. Friends and foes have long

*It seldom happens that any portion of our lunacy, administration is discussed in detail by foreign writers. As such discussions when they do take place ought to be specially valuable to the readers of this Journal, it has been thought a translation in full of this interesting paper would prove acceptable, The original appeared in the Archiv. für Psychiatrie, V Bd., 1 Heft, 1874. -TR.

1875.] On the Family Care of the Insane in Scotland.

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been accustomed to investigate the matter at Gheel, and to found their respective verdicts on the system which they may have observed there.

As one glances over the copious literature which is devoted to the subject, it almost appears as if there was an ever increasing conviction in regard to at least one point, that the Gheelese system is suitable or desirable only in the country of its origin; and that there can be any considerable development of it in other places, which have not been prepared for it by centuries of usage, appears to be inconceivable.

Indeed, the imitations of the system which have been attempted in various parts of England and Germany have nowhere had any special success. In England these attempts have generally been given up, and the family treatment of the insane has neither there, nor with ourselves, been adopted to any great extent. The general belief has been that the experiment made in Scotland for carrying out the family system had no greater significance than the others; and it was prophesied that its fate also was to fall rapidly into oblivion. Even among the English members of the profession, though nearer than we are to the locality, the Scottish experiment is generally looked upon as nothing more than a personal whim of the Scottish Commissioners, and as having already within it the seeds of dissolution. An illustration in point will be found in the ironical remarks which the reviewer in the "Journal of Mental Science" makes on the Fourteenth Scottish Report when dealing with this question. (January, 1873, Vol. xviii., p. 549.) In the summer of last year (1873), after a short visit previously made to Gheel, I arrived at Edinburgh, holding views very similar to these; but while there I found occasion to modify my ideas essentially. By the friendly services of Sir James Coxe, one of the Commissioners in Lunacy, I made an excursion, in company with an Inspector of Poor, to one of the lunatic colonies. This visit, and the information furnished by these gentlemen, as well as a more careful study of the Scottish Reports and their appendices, convinced me that it is no "Gheel in the North" with which we have to do, but an organisation which rests on a quite different and much sounder basis.

I may now give a short description of the "colony" which I visited. It was the village of Kennoway, situated in the upland which stretches to the north of the Firth of Forth, and easily reached from Edinburgh. It lies in a pleasant