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ployed at agricultural operations, or in thEvarious trades." It is unnecessary at present to enter into

the particulars of each disease, and of thevarious injuries to which youths are subject,as these will be given when the diseases ofthe colliers come under observation ; but Imay here mention that these young peoplesuffer much from inflammatory affections ofthe chest, from irritation in the bronchial

passages, arising from exposure to cold, andfrom the inhalation of an impure atmosphere ;that their growth in vigour and health anddue proportion is very much deteriorated byexcessive labour, irregular hours, and bynight employment; and that many of thembecome maimed, or are deprived of life, bythe various injuries to which they are sub-ject in their employment, viz., contusions,fractures, wounds, and lacerations.

" The diseases of the pectoral organs areso very common among colliers that scarcelyan individual above the age of twenty years,who has been employed for a considerabletime at coal-work, will be found, in whom theseorgans are in a healthy condition. Chronicbronchitis, or inflammation of the air-tubes ofthe lungs, is one of the most common diseasesof colliers, and is generally found superaddedto every other disease, either of the lungs orof other parts, from which the collier maychance to suffer." For the first few years chronic bronchi-

tis is usually found alone and unaccompaniedby disease of the body of the lungs. The

patient suffers more or less difficulty of

breathing, which is much affected by changesof the weather and by variations in the

weight of the atmosphere; he coughs fre-quently, and the expectoration is composed,for the most part, of a white frothy and yellow-ish mucous fluid, occasionally containingblackish particles of carbon, the result of thecombustion of the lamp, and also of minutecoal-dust. At first, and indeed for severalyears, the patient, for the most part, does notsuffer much in his general health, eatingheartily, and retaining his muscular strengthlittle impaired in consequence. The diseaseis rarely, if ever, entirely cured; and if thecollier be not carried off by some other lesionin the mean time, this disease ultimately de-prives him of life by a slow and lingeringprocess. The difficulty of breathing increasesand becomes more or less permanent, the ex-pectoration becomes very abundant, effusionof water takes place in the chest, the feetswell, and the urine is secreted in small quan-tity, the general health gradually breaks up,and the patient, after reaching premature oldage, slips into the grave at a comparativelyearly period with perfect willingness on hispart, and with no surprise on that of hisfamily and friends." So seldom is this disease entirely cured,

that many individuals who have in youth worked a few years only at coal-work, and i

have then left it for some other employment,have continued during the remainder of lifesubject to cough, and to expectoration, whichhas occasionally been black. I have metwith many individuals who have returned toEast Lothian after an absence of many year -during which they had been employed indifferent capacities, as soldiers and trades-people, who have continued to cough and toexpectorate blackish or bluish mucus."

METROPOLITAN COMMISSION OFLUNACY.

To the Editor of THE LANCET.

SIR,—The following results of the Metro-politan Commission of Lunacy during the -

last five years, as set forth in the returns or-dered to be printed by the House of Com.mons, on Feb. 3, 1842, may not be unin-teresting to your readers.

Number of Houses under the Care and lin-spection of the Commissioners.

Pauper and private patients ...... 4Private patients only............ 32

Total.................... 36

Expenses of Commission.;f s. d.

Fees to two barristers .... 2920 00Ditto to five physicians .. 6498 0 0Salary of secretary ....... 2000 00Chaise hire, and other ex-

penses ............... 2165 17 10

Total............13,583 17 10

Average cost of inspecting each house,f388.

Results.Licences refused.............. 1

Ditto, suspended.............. 0Ditto, revoked................ 0

Total.................... 1It further appears that of the thirty-two

iouses for private patients-5 are kept by resident medical proprietors.4 situated respectively at Clapham, Upper

Clapton, Chelsea, and Fulham, by phy.sicians resident in London.

.6 by resident proprietors, not being medicalmen.

7 by non-resident proprietors, not being me-dical men.

2It also further appears that of the counties

nder the joint jurisdiction of the commis-ioners and the quarter-sessions, 14 containo licensed houses, and the remaining 26ntain 87 only, and these 87 houses do notlclude above 2500 patients of all ranks.

859

It further appears, also, that in 25 of theseg6 counties, the returns of licences refused,suspended, and revoked, is nil; in the re-maining county, viz., Dorset, the return is-Refused, 1 ; suspended, 0 ; revoked, 0.Extract from the Annual Report of theMetropolitan Commissioners for 1838 :-It appears from the returns already

mentioned, that the total number of licensedasylums within England and Wales, exclu-sive of the metropolitan districts, is only’about eighty, and that in a large majority ofthese the number of patients is extremelysmall; it further appears, that in several ofthe largest counties in England, and in thewhole of Wales, not a single licensed asy-lum was to be found, a circumstance whichthe commissioners can hardly reconcile withfacts that have otherwise come to their know-ledge. It would seem to be a not unfair in-

ference, that besides the houses for whichlicences have been taken out, in conformitywith the Act of Parliament, there must existin different parts of the country other andunlicensed establishments in which personsare confined as insane patients (perhapseven without medical certificates) in con-

tempt and defiance of the law. To what ex-tent this practice prevails the commissioners 5have no means of forming an opinion, but itis one which may obviously lead to the mostglaring and dangerous abuses, and which,therefore, strongly calls for a searching in-

vestigation and an effectual remedy."Ditto. f{)1. IR.11 --" With the view of rescuing persons, as

far as may be, from unnecessary discomfortduring their residence in these asylums, andin order to promote their liberation as soonas it can be effected with safety, the commis-sioners have issued express direction (quere,when ?) that a sufficient number of keepers ’,shall in all cases be employed, so as to obvi-ate the necessity of personal restraint, exceptin extreme cases; and they have also endea-voured to establish some system of classifica-tion, in order that the convalescent patientmay neither be confounded with the others,nor his recovery be retarded by associatingwith persons labouring under violent or con-firmed mania." It is satisfactory to add, that these en-

deavours have been seconded by the pro-prietors and superintendents of the three

large houses, where classification is chieflynecessary. The commissioners feel bound to

report, that those persons have lately be-stowed much attention on this subject, andhave, in fact, incurred considerable expensein carrying into practice the recommendationsof the commissioners."The above extract is the first allusion made

in any of the reports to this most importanttopic.

I wish I could have added the amount othe expenditure in the twenty-six countiesbut the returns are so complex and con

fused as to be unintelligible: it seems,however, enormous. I am, Sir, your obe-dient servant,

DETECTOR.March 15, 1842.

REPLY OF MR. HILL TO DR.COOKSON.

To the Editor of THE LANCET.

SIR,—The following account of the " dis-closures of a gentleman" alluded to by Dr.Cookson in his letter published in yourJournal last week, I have since received ina written communication from the gentlemanhimself :-

" Mr. I., of D-, one day came intothe yard after the death of Mr. M., and saidhe (Mr. M.) was soon finished ; he askedme if I knew anything concerning him, Itold him I thought he was roughly handled ;but. Sir, at that time mv word was not to betaken, as you all well know ; I was not inthe room with them, neither did I find anyreason to say so from the treatment I receivedfrom the keepers, as nothing of the kind wasused towards me; but I heard an unusualnoise, and at that time I was ready to setforth fancies for realities. I should be sorryin saying anything against the institution, asI am well convinced from what I have seenand experienced of it, that it is deserving ofmy highest prai,4e."

In the course of an examination at theboard of the Lincoln Asylum on Mondaylast into the said disclosures, the house-surgeon stated, that he had questioned allconvalescent patients, previous to theirleaving the house, as to any ill-treatment ofthe other patients observed by them from theattendants ; and that the allegement in ques-tion was the first complaint which had beenmade.The following is an extract from an entry

by Dr. Cookson as house-visitor, March.7th,1841 :—

" The dismissals of attendants for crueltyhave ceased, and the patients who leave thehouse speak well of the treatment they have

- received."- With regard to the sentiment attributed by3 Dr. Cookson to yourself, on the subject ofrestraint, the following more honest quota-tion of your words than he has given maylead your readers to conclusions different1 from those which Dr. Cookson has intended,e and honourable to yourself:-s , The only question that admits of contro-

versy is, whether, when coercion of somee kind is required, and applied by all parties,

bauds, instrumental restraint, and mechani-cal advantages, should be altogether dis-

)f carded, and replaced by the force of the, keeper’s hands and arms ? Under whichi- treatment does the patient suffer least, and

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