which counsel decides to be legal, that registered hospitals may receive voluntary boarders, upon some sort of bond or agreement, such boarders not being actually insane, but "conscious of a want of power of selfcontrol, or of the addiction to intemperate habits, or fearing an attack or recurrence of mental malady, and being in all respects free agents.' This privilege will be a great boon to many such much-to-be-pitied individuals, who could or would not enter an asylum as registered lunatics subject to the restrictions necessary for the insane.

The Scottish Commissioners remark on the greater proportion of female pauper lunatics than of male, but instead of inferring therefrom, as is commonly done, the greater proclivity of the female sex to insanity, they go into the question, and show that the excess of female pauper lunatics is due simply to the larger source from which the supply of such lunatics is derived. "When the inquiry is restricted' to private patients, this opinion derives considerable support, as it is then found that the proportion of male to female lunatics placed in asylums is as 100 to 106: the proportion of males to females in the general population being 100 to 111."

Both the English and Scotch Commissioners still concur in condemning workhouses and workhouse lunatic wards as places of detention for the insane, and in exposing the fallacies of Boards of Guardians respecting the great economy of such accommodation; and we wouldespecially recommend for perusal the remarks of the latter Board on the whole question of its expediency and supposed pecuniary advan-' tages, at p. 47 et seq. of their Report.

We shall conclude our notice of these Reports by briefly analyzing the general statistics of lunacy in the two divisions of the kingdom, during the past year.

The summary of the English Commissioners shows that there were:

Comparing the totals of the two years, we find an increase of 1140 among those placed in asylums, of which by far the largest proportion, viz. 927, has taken place during the year 1862 among the pauper inmates of county and borough asylums. The number of pauper lunatics has also increased greatly in metropolitan licensed houses, viz. from 695 to 826, or a total of 131; and in a less degree in hospitals, viz. from 262 to 306, or 44; but on the other hand, there is a diminution of 53 pauper lunatics in provincial licensed houses. The total increase of pauper lunatics during 1862 was, therefore, 1049 of the whole increase of 1140 that had taken place in all the establishments,

public and private, for the insane in England, or within 91 of that number.

The mistake is often made of quoting these totals of the summary in the Commissioners' Reports, as representing the actual number of the insane in England, whereas they represent only about one-half of those coming under the cognizance of public officials. Thus, the Commissioners tell us, at p. 22, that on the 1st of January, 1862, there were 8803 pauper lunatics in workhouses; and from a foot-note to that page, we gather that there were also 4463 others living as single patients with relatives, or boarded out with strangers. By adding, therefore, these numbers to the 20,949 enumerated as present in recognised establishments for the insane, we obtain a total of 34,215 pauper lunatics known to the Lunacy Commissioners and the Poor-Law Board on the 1st of January, 1862. To compare the total numbers of the insane in England with those reported by the Scottish Commissioners, we have to add to the 34,215 pauper lunatics found in England the number of private cases at the same date, viz. 5250, which gives a total of 39,465 insane inhabitants in England and Wales on the 1st of January, 1862; and to make an approximative estimate, we may assume this total to have reached 42,000 on the 1st of January, 1863. Turning to the Scotch Report, we have the statement of the whole number of lunatics in Scotland, put before us at a glance in the table appended below; and this, we may observe, is compiled from more careful and accurate returns than we possess in England; for on comparing the returns of the English Commissioners with those of the Poor-Law Board, we find many discrepancies between them, and there is an evident want of concurrence and harmony between those two public offices, or otherwise we should not be able to point to the discreditable fact, that in a country like England we cannot state with accuracy even the actual number of chargeable pauper lunatics. To return, however, to the table setting forth the state of lunacy in Scotland on the 1st of January, 1862, there were—

The Scottish Lunacy Commissioners make no return of the number on January 1st, 1863, and we cannot therefore ascertain the increase of lunacy in Scotland during 1862, as we were able to do for England. However, the increase is given during 1861, the Commissioners showing it to have been only 39 in the case of private patients, and of 32 in that of paupers-a remarkable contrast to what we have found to take place in England. "To what cause," say the Commissioners, "this comparatively slow growth of pauper lunacy is to be ascribed, we are not prepared to offer an opinion; but we scarcely venture to hope that the result of future years will be found as favourable.”

The totals arrived at enable us to compare the relative prevalence of lunacy in England and Scotland. The population of the latter country was 3,002,294, and that of England 20,061,725, according to the Census of 1861. The relative proportion of the population in the two countries is therefore as 3 to 20; and the number of lunatics in England should, supposing lunacy equally prevalent in it as in Scotland, have been on January 1st, 1862, at least 6 times greater, or 6341 × 6.5= 41,216.5; whereas we found it 39,465. After allowing for the more accurate enumeration in Scotland, lunatics would still appear to bear a somewhat larger proportion to the whole population in that country than in England.

=

In the returns of the Poor-Law Board there is a separate column for the enumeration of idiots, as distinct from lunatics. It would be very desirable for the Lunacy Commissioners, both of England and Scotland, to prepare tables indicating the number of idiots, whether placed in asylums or elsewhere, as well as to exhibit the number of idiots added to the population annually. The much-needed statistics of idiocy might then be determined, and the relative prevalence of idiocy and lunacy in England, and in England as contrasted with Scotland, be ascertained. Some conclusions, moreover, could eventually be arrived at on the question of the mental degenerescence of the people. Similar statistics are collected in various continental States, and it would be only creditable to collect them in this country, where social science pretends to so much cultivation and patronage.

REVIEW V.

On the Nature and Treatment of Gout and Rheumatic Gout. By ALFRED BARING GARROD, M.D., F.R.S., &c. Second Edition, enlarged and carefully revised.—London, 1863. pp. 618.

WE were glad to see a second edition of Dr. Garrod's work on Gout announced, affording proof that the great ability and original research displayed in the first have been well appreciated by the profession for whom it was written. Doubtless there are other circumstances quite apart from the merits of the publication which have promoted the demand for the book, as we know, and as is so well known, that mere originality of research and ability in an author will rarely insure success to his writings unless there be some elements in them distinct from science to render them attractive.

Now, of all the diseases to which man is liable, gout has peculiarities which have always made it one of more than ordinary interest. It is the special disease of man, and of civilized man, and is unknown, as far as we are aware, to the brute-animal, and to races of our own kind leading a rude life, but little different from that of the brute. Moreover, as far back as authentic history extends, now more than two thousand years, we have a certain knowledge of the occurrence of this disease, of its attacking persons in the same condition of life as at present, whether Greek or Roman, fixing on the rich, the highly

gifted intellectually and bodily, and sparing the poor and hard-working class of society and then, as now, having so much the same symptoms, the same hereditary tendency, that there is no room to question the identity of the malady; and so far tending, collaterally, to prove that the constitution of man within the limits of the time specified has undergone no change. And when we consult the literature of the subject, which is vast, beginning with the writings of Hippocrates, we have further a proof, if proof were required, in the great similarity of reasoning on the morbid phenomena of gout in the several authors who have treated of it, that the mind, like the constitution of man, is much the same in quality and in power of thought in all ages; for it is curious to observe how nearly allied is the pathology of the disease as discussed of old in the infant stage of medicine, and at the present time in its advanced state, such as we find it in this work of Dr. Garrod.

These are a few reflections which have occurred to us whilst reading our author's introductory chapter, in which he gives a brief historical sketch of the labours of his predecessors.

Dr. Garrod informs us in his preface that this second edition is enlarged as well as carefully revised, and that the additions are chiefly of a practical character derived from a wider experience. After a careful perusal, we are satisfied of the correctness of the statements, and that, compared with the first, the work now before us is in every way of enhanced value.

The peculiar feature of Dr. Garrod's treatise, that which imparts to it so much interest and value, is the theory which it develops of the nature of gout, using the term theory in its best acceptation-that is, as an induction from, or a generalization of facts. Before he entered on his researches, the idea, the hypothetical idea, was common, handed down, as we have before observed, from a remote period, that gout has its special materies morbi, and that its morbid matter and the matter of urinary calculi are similar. Thus Sydenham threw out the conjecture that "calculus itself may be a part and parcel of the morbific matter" of gout; and later-viz., in 1793-Mr. Murray Forbes, as noticed by Dr. Garrod, made the happy conjecture that uric acid exists in the blood. He says, "Its frequent deposition in different parts of the body affords indisputable testimony of its being contained in the general fluids," and grounded on this, he asks, seeing that its deposition occurs in gout, whether gout may not be a consequence of its redundance. The notion of the analogy of the two diseases, gout and gravel, was not a barren one; it had a practical issue, and support was given to it by the results of treatment, some of the favourite remedies in their day for the one ailment being in repute for the other, especially the alkalies and magnesia. A further step in advance was made when Dr. Wollaston, in 1797, ascertained by the analysis of gouty concretions that they, in common with that kind of urinary calculus which is most frequently met with, are formed of uric acid, differing only from the matter of the calculus in being united with soda, one of the ingredients of the blood. After this discovery,

the opinion more and more prevailed, that uric acid is essentially connected with gout. Dr. Garrod refers to Sir Everard Home, to Dr. Parkinson, and Dr. Wollaston, as holding this view, and to Cruveilhier and Dr. C. Petit among foreigners as maintaining it. Yet, however in genious and plausible was the doctrine, it did not compel assent; it lay open to objection, and by some pathologists was considered erroneous. Thus, Dr. Durand-Fardel, writing in 1854, when he appears not to have been acquainted with Dr. Garrod's researches, denounces Cruveilhier's hypothesis, that the urate of soda is the material cause of gout, as a grave error in pathogeny, adding:

"Admettons que la goutte soit une maladie cum materia; la matière y doit être considérée, ainsi que dans tant d'autres affections, comme l'effet et non point comme la cause de la maladie. L'urate de soude n'est pas plus la cause de la goutte que les mucosités ne sont la cause du catarrhe, l'exsudation plastique la cause du croup, les pustules la cause de la variole."*

It was in 1847 that Dr. Garrod ascertained, by chemical examination, that uric acid, in the form of urate of soda, is contained in the blood, normally in a minute quantity in healthy blood-abnormally, in excess in the blood of persons labouring under gout. And all his after inquiries have proved that the excess of this salt in the blood is an essential circumstance of the disease, a sine quâ non; and so much so, that in doubtful cases, its presence or absence has enabled him to make a true diagnosis, one he holds to be infallible.

We owe to Dr. Garrod's chemical skill an easy method of detecting uric acid when in any excess in the blood. This method having been already described in our notice of the first edition, need not be repeated here. Fortunately for diagnosis, it is in the serum that it is to be looked for, and the serum produced by a blister will answer the purpose.

It is on this central fact of the presence of uric acid, and in excess, in the blood in gout, that Dr. Garrod's theory hinges. Its discovery is a striking example of the connexion of the sciences. Were we to make choice of an instance to show how pathology may be benefited by chemistry, we should have difficulty in finding a better. This theory, like every sound theory, is, we think, consistent in itself, and adequate for the most part, so far as the subject of morbid action is concerned, to account for the phenomena, and more than that, to afford a principle of rational medical treatment. It is interesting to see how science, how exact knowledge, of which theory is a representa

* Traité des Maladies des Vieillards, p. 838.

+We may here observe that, like Dr. Garrod, we have been unsuccessful in detecting uric acid in the blood of the common fowl, the urine of which consists mainly of urate of ammonia; affording thus, as he points out, proof of the great eliminating power possessed by the kidneys of the bird; and, we may add, we have sought equally in vain for it in the blood of the viper, the urinary excretion of which is of the same kind as that of the fowl.

In the fluid effused from the action of a blister applied to a part with gouty inflammation, Dr. Garrod states he could detect no lithate of soda, and he attributes its disappearance to its destruction by the inflammatory action. May it not have been owing to another cause--the deposition of the urate in the part affected?