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pital, under the care of Mr. Liston. I re-gret that the opinions I advanced in myremarks, should have appeared rather cu-rious to the reporter of the above case, for,far from belonging to myself, they were buta repetition of opinions professed by one ofthe greatest surgeons that ever existed,Baron Dupuytren, and are those of manysurgeons of the present day renowned forsurgical knowledge.

In objecting to the accuracy of the termdislocation, being applied to an accidentevidently consisting of fracture of the in-ferior extremity of the radius, I by no

means wished to impugn the professionalskill of the house-surgeon, who no doubt isperfectly deserving of the situation he holds,gained as it was by his " mental trial ;" but,however "capable of distinguishing the na-ture of the accident," he may appear to beto the reporter of the case in question, inmistaking a fracture of the inferior extremityof the radius for dislocation of the wrist,Mr. Taylor stands not alone; it is an every-day occurrence ; and many persons, not stu-dents or young surgeons, but professors,hospital-surgeons, men celebrated for know-ledge and talent, have similarly erred. In

proof of this let us take the following cases,nearly thirty years ago, when Pelletan andDupuytren were surgeons of the Hotel-Dieuof Paris ; a mason was brought to the hos-pital, having fallen from a considerableheight ; together with several wounds, anda fracture of the cranium, he presented atone of his wrists a displacement, having allthe signs of dislocation of the carpus back-wards ; Mr. Pelletan diagnosticated dislo-cation ; M. Dupuytren, fracture of the in-ferior extremity of the radius. At the post-mortem examination, so strikingly similarto a dislocation was the accident, that it wasonly on exposing the joint that the fracturewas evident, with the articulation un-

touched.Many years afterwards, another case oc-

curred at the Hopital Beaujon. At thistime Dupuytren had publicly announcedthat,without absolutely denying that dislo-cation of the wrist could result from falls onthe hand, he denied that any case existed ;and that in every case, published as dislo-

cation, a fracture of the inferior extremity ofthe radius had been taken for dislocation.He further defied any one to show him asingle case of real and well-established dis-location. A man died at Beaujon, with allthe signs of dislocation of the wrist back-wards : glorying in the opportunity of refut-ing him, Mr. Marjolin sent for Dupuytren;on laying bare the parts, a comminuted frac-ture of the inferior extremity of the radiuswas found. Since then, Mr. Marjolin be-came a convert to the opinions of Du-puytren.These are recorded and well-authenti-

cated facts, and unfortunately they are not

uncommon. How many persons have been

deprived of the use of their hands by similarerrors ? Daily practice shows their fre-

quency ; and if such men as Pelletan,Bozer,Marjolin, have erred, surely it is possiblethat Mr. Taylor, even 11 with a guide on theopposite side," might have been mistaken.

In asserting that one of my objections tothe accuracy of the diagnosis was, "that noprecedent had occurred in the practice ofFrench surgeons, and therefore, that it wasnot likely to occur here," the reporter toyour Journal has unfortunately made aslightmistake. The words I made use of were:" that no well-authenticated case had as yetbeen published ;" meaning, not only inFrance, but even in England.

For the present, I must content myselfwith the above remarks. In a future com-munication I will endeavour to show that,notwithstanding the 11 mention of the charac-teristic signs of the injury by all Englishsurgical authors,’’ dislocation of the wrist-joint, from falls on the hands is an exceed-

ingly rare occurrence, and that probably ithas never existed. I remain, Sir, yours, &:c.

July 26, 1841. E. S.

GLOUCESTER ASYLUMPROPOSITIONS.

RESTRAINT OF LUNATICS—IMPORTANT REASON

FOR PREFERRING LARGE TO SMALL AND

PRIVATE PLACES.

To the Editor of THE LANCET.SIR :-The statement of the visiting com-

mittee of the GLOUCESTERSHIRE LUNATICASYLUM for the year 1810, has accirlentallyfallen under my notice. It contains four

propositions of the medical officers,-too im-portant, notwithstanding the lapse of timesince the’ publication of the document, tobe passed over in silence. They are as fol-lows :-

" 1st, That to avoid personal restraint, sofar as may be considered compatible withsecurity, has always been a standing andperemptory rule of the institution, andstrictly attended to under all circumstances.

" 2nd, That the combined and corre-

sponding evidence of several large lunaticestablishments has clearly shown that per.sonal restraint may be avoided to a muchgreater extent than was formerly consideredeither possible or advantageous in the treat-ment of the disease." 3rd, That they dissent from the general

proposition that personal restraint is, underall circumstances, prejudicial ; and are ofopinion, that notwithstanding all that hasbeen said upon the subject, the experimenthas not yet been virtually and really triedin any large establishment, the confinementof refractory patients in their cells being notonly an obvious personal restraint, but most

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inimical to the future recovery of the pa- resorted to in some cases in which patientstients. were accustomed to strike others, were found

"4th, That the moral restraint of exam. to possess so many of the disadvantages ofple, that is to say, the disposition of lunatics restraint, that they were discontinued after ato fall into the habits of a large asyil1m, in short trial."compliance with, as it appears, and in imi- I had hoped that this absurd fallacy hadtation of, the examples of those with whom been banished from all philosophic andthey associate, is a most influential agent in scientific discussions, and was now limitedthe treatment of the disease, and gives to in its use to such superintendents as are ini-large establishments a power of avoiding mical to the moral treatment of the insane ;personal restraint to an extent which can but who have, nevertheless, to deal withwith difficulty be accomplished in smaller troublesome, though inexperienced, commit-institutions, and has always been found im- tee men, to whose pertinent inquiries somepracticable in private families." plausible answer must be returned.From the first proposition I entirely dis- But the medical oflicers go on to report

sent; for if the rule therein stated had -always that the seclusion of refractory patients inexisted in this asylum, and been strictly their cells is most inimical to the future re-attended to under all circumstances, the rapid covery of the patients. This is a bold pro-diminution of restraints, upon the appoint- position, and so directly at variance with thement of the present medical attendant, could commonly-received opinion upon the subject, -

not have taken place. that it ought not to have been hazarded, un-From the second proposition it is impos- less upon great experience and most unan-

sible to dissent; but a more accurate defini- swerable data. I know of no authority intion of the establishments alluded to than its favour, save that of the president of Beth-the vague epithet" large" is desirable. lem, who once declared, according to ° Phi-Is it intended to include or exclude Glou- lanthropos," that seclusion was most impoli-cester by that term ? The asylum there is tic, and would not be permitted in that hospi-not smalle1’ than the Northampton asylum, in tal. Dr. Mayo and Dr. Southey, however,which personal restraint has been wholly who are both commissioners for the metro-abolished with the happiest effects, and politan district, thus contradict this state-which is a pattern of excellent management. ment in their report upon the treatment ofBut it is with the third proposition that the criminal lunatics there confined :—" We

the " Looker-on" would deal, and espe- found (say they) the officers (that is to say,cially with that part of it which somewhat Dr. Monro and Sir A. Morison, both prac-dogmatically states that " the experiment of titioners of great experience and celebrity,)non-restraint has not yet been really and well aware of the advantages of solitaryvirtually tried in any large establishment, confinement ;" and unless the " Looker-on"the coufinement of refractory patients in their is greatly mistaken, the annals of that ho,3.cells being not only an obvious personal re- pital will show, that whatever diminutionstraint, but most inimical to the future recovery may have taken place, as regards bodily re-of the patients." straint, since the attention of the public

Confinement in a cell an obvious personal was first directed to the treatment thererestraint ! Well, so it undoubtedly is, in pursued, the quantity of seclusion amongstone sense of the word, but in the same sense, the patients has not, to speak in the leastconfinement in a ward, or, indeed, in an favourable terms, been decreased ; and theasylum itself, is a personal restraint. The practice of this hospital is in this respectrestraint intended to be abolished is not re- most important, for Bethlem is essentiallystraint in its general sense as contra-distin- devoted to crerable cases. In like manner, Dr.guished from freedom, in which sense it is Conolly states, that" all the substitutes forapplicable to prisons, not asylums ; but re- restraint are like restraint itself, liable to bestraint taken in the limited sense to which abused ; but none cau be made such instru-it is applicable as regards the treatment of ments of cruelty by abuse. All are also

lunatics, in which sense it is confined to the liable to great misrepresentation ; and noneabolition of such instrumental restraint as more so than that which is of all the mostcoerces the body or impedes muscular ac- useful, the most simple, and the most ap-tion. "During the past year," says Dr. proved of by the highest medical authorities;Conully in his valuable report, "not one in- namely, seclusion. By seclusion is meantstance has occurred in which the resident temporary protection of the maniac from thephysician has thought it advisable to resort ordinary stimuli acting upon the senses into any of the forms of bodily coercion for- the refractory wards of a lunatic asylum.merly employed. The use of the strait- He is abstracted from noise ; from the spec-waistcoat, the muff, the restraint-chair, and tacle of a crowd of lunatics ; from meetingof every kind of strap and chair designed to those almost as violent as himself; and fromrestmin muscular motion, was discontinued every object likely to add to his irritation.on Sept. 21, 1839, and has never been re- * * * But the mode in which seclusion issumed. * * Even the stuffed gloves effected is also important to securing the benefitsmentioned in the physician’s last report as of it. If resorted to with violence; if acoompa,.

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nied with expressions of anger or contempt;if stigmatised, as a punishment, and if fol-lowed by neglect, it may produce all theevil moral effects of restraint itself. If in-

judiciously persevered in, in very recent

cases, it exasperates instead of calms," &c.*The limits of this letter exclude the residueof this extract, which occupies several pagesof the Report; but enough has been givento make the reasoner pause before he giveshis assent to this novel and unsupportedproposition of the Gloucester medical officers.Upon what data is it founded? By whatproofs is it supported ? What substitute hasbeen provided ? And under what circum-stances has it been tried ?The fourth proposition contains a profound

truth with which the public is unfamiliar,but which is ’daily becoming more apparent,and must ultimately produce importantchanges in the treatment of the insane :" The examples of those with whom they(the patients) associate, is a most influentialagent in the treatment of the disease, andgives to large establishments a power ofavoiding personal restraint to an extent whichcan with difficulty be accomplished in smallerinstitutions, and has always beenfound imprac-ticable in private families." Hear this, yemen of wealth, who have relatives inclosedin small establishments! Hear this, yelegislators, who permit private families totake charge for hire of a single patient,without licence or inspection ! The systemof medical treatment hitherto pursued isshaken to its foundation-stone, and cannotlong survive the daily inroads made upon it.Private establishments must not be permit-ted to exist; and the remuneration of thesuperintendents (liberal as it ought to be)must cease to be dependent upon the conti-nuance of the disorder. When these happychanges are effected, but not until that time,the blessings of the humane system will beas fully enjoyed by the wealthy as by thepauper-patient; and the relatives of thesmall tradesman and industrious artisan willcease to pauperise the unfortunate objects,of their solicitude, as the most effectualmeans of securing to them comforts, andcontributing to their cure. I am, Sir, yourobedient servant,

A LOOKER-ON.July 27, 1841.

P. S.—From the continued silence of SirA. Morison, I fear he does not intend to re-

ply to my letter. I am sorry for it : itcreates an unpleasant impression as regardshimself, and places me under the necessityof reverting to the subject on some futureoccasion.

* The visiting justices of the Hanwell iAsylum are entitled to the thanks of the me- I,dical world, for their liberal distribution ofthis Report. It is forwarded, upon appli-cation, to every medical institution in thekingdom.—ED. L.

LETTER FROM DR.W.B.CARPENTER.

To the Editor of THE LANCET.SIR :-It can scarcely, I think, be reason-

ably expected, that I should reply to theanonymous attacks made upon me in theletter signed " JUSTITIA," which appearedin your Number of last week. Any state.ments which I have publicly made or

avowed, are of course open to equally publiccomment ; but I deny in toto the right of" JUSTITIA," or any one else, to fix upon methe authorship of reviews, which I havenever acknowledged, and for which theEditor of the Journal in which they haveappeared holds himself responsible. If" JUSTITIA" has a right to attribute this tome, on the ground of a supposed correspond.ence of style, or similarity in the mode oftreating the subject, I might with at leastequal justice attribute the composition ofhis letter to Dr. M. Hall, since its resem.blance in general character to the preface ofthat gentleman’s last work must be apparentto any reader of the two; and since thereare many parts of the review in question, ofwhich the style is so palpably superior tomine, that I esteem it a great compliment tobe regarded as capable of writing it.There is one statement, however, in the

letter of " JUSTITIA," to which, as it affectsmyself and not the author of the review inquestion, I shall step out of my way to ad-vert ; more especially as it may be taken, Ibelieve, as a fair sample of the veracity ofthe rest. It is, that I have at last avowed_myself to be the author of the " completeanticipation" paragraph. I most distinctlyand unequivocally deny that I have any-where avowed myself to be the author ofthat paragraph ; and I further inform " Jus.TITIA," that it is impossible that I could havewritten it, since (as I can easily prove, ifmy veracity be openly impugned by yourcorrespondent,) I did not see the paragraphin question until it was in print.

In conclusion, sir, I beg to say, once forall, that no charges brought by anonymouscorrespondents against me, as the supposedauthor of reviews of the works of Dr. M.Hall, or any other gentleman, will againcause me to trespass on your columns; andI feel confident that every person of honour.able feeling must perceive that I am justifiedin this course. I am, Sir, your obedientservant,

WILLIAM B. CARPENTER, M.D.Bristol, July 19,1841.

WILLIAM B. CARPENTER, M.D.

DR. MARSHALL HALL.

THE following is the passage in the articleof the " British and Foreign Medical," towhich "Justitia" referred in a formerLANCET :-

" No lover of physiological science canread Dr. Hall’s present work, notwithstand.