the Committee in opposing his election. There could be no personal feeling with regard to himself, but if they had a law, he felt they should adhere to it stringently; a principle which, he was sure, Dr. O'Connor would appreciate.

Dr. THURNAM suggested whether a resolution could be put as to adhering to the recommendation of the Committee as to the list of new members to be elected?

The PRESIDENT: Would any one move an amendment to this effect?

Dr. ROBERTSON then moved as an amendment, "That the recommendation of the Committee, as related to the list of new members, be adhered to.

Dr. THURNAM seconded the amendment.

The question was then put, and on a shew of hands being taken, there appeared:

Majority in favour of the amendment ...

The original motion was therefore lost.

ALTERATION OF RULES.

16

Dr. TUKE said he rose, in pursuance of the notice which he had given last year, to move That the names of proposed honorary members be printed, and sent round with the circular convening the meeting of the Association." The inconvenience of the present practice was, that they were not supplied beforehand with the names of the new members to be proposed. He thought it was a bad compliment which they paid to their honorary members to be in ignorance of whom they might be; and, on the other hand, there was no opportunity to object to persons at the moment they were announced.

Dr. CAMPBELL seconded the resolution, which was carried unanimously.

ACTING SUB-COMMITTEE.

Mr. LEY said he rose to move the re-appointment of the acting Sub-Committee. The matters to which this Committee applied itself were peculiar. Circumstances might arise which would make it desirable that this Committee should act, and summon the general body, when it would be inconvenient to any private member to take that duty upon

himself. Thus, they were likely to have questions sent to them during the session of Parliament, when the Society itself would be incapable of acting. In the course of last year they made the president take upon himself the correspondence with the Committee. A small number of persons thus acted together, and agreed on the mode of proceeding. By this means much more work was done than by waiting to have the concurrence of some 120 or 130 persons who were members of the general body. His proposition was, "That the acting Committee of last year be re-appointed."

Dr. SHERLOCK begged leave to second the motion, knowing, as he did, the admirable manner in which the business of the Sub-Committee was carried on. He sincerely concurred in all that had fallen from Mr. Ley.

The motion was then put. Carried unanimously.

Dr. TUKE having been called upon by the president, proceeded to read the following paper:

OBSERVATIONS ON THE

TREATMENT OF IN

SANITY, WHEN REFUSAL OF FOOD IS A PROMINENT SYMPTOM.

Mr. President and Gentlemen,-It is not without some diffidence that I venture to bring before this meeting, numbering, as it does, so many of the most distinguished practitioners in our department of medical science, views of my own, on a subject that must be so familiar to them; or that I attempt any description of a symptom of insanity that is so often seen, and which all of us are constantly called upon to meet. But I have found in private practice so great a diversity of opinion amongst medical men as to the treatment of this particular symptom, refusal of food-our text-books on the care and cure of deranged minds pass over the subject as one of so little importance; I have found it so impossible to obtain any information on the point, except scattered, through the medical reports of asylums, which our Association may well be proud of, as containing all that is most valuable in the practical treatment of insanity-that I believe I shall be doing a real service to medicine in bringing the question before this assembly. My own practice is comparatively of little importance: my object is rather to elicit and place on record the opinions of gentlemen so well qualified to pronounce judgment; whose dissent from my views would incite me, and perhaps others, to still further

investigation, and whose concurrence in my conclusions would set the matter at rest.

I do not propose in these remarks to bring forward any new theory, or strange method of treatment. My object is to attempt a classification of those cases where refusal of food is a prominent symptom, founded on the real or presumed causes of such refusal; to point out the treatment necessary for each division; to discriminate those in which forcible alimentation is or is not justifiable; and lastly, to point out the various methods that may be adopted for this purpose, and the reasons that have induced me to choose the particular mode of treatment I myself prefer.

I divide those cases in which repugnance to nourishment, or inability to take it exists, into five divisions, more or less distinct from each other. Disinclination to food in the insane may arise from-

1. Simple dyspepsia.

2. Delusion as to food itself, or to their power of taking it. 3. Suicidal tendency, or wound of gullet after an attempt at suicide.

4. Stupidity, inertness, idiotcy.

5. Special organic lesion in the brain or other internal organ.

I shall consider each of these classes separately; and although these divisions may not embrace all the cases that may arise or have been met with, and one may not often occur uncomplicated with some other, I believe such a classification will be found practically useful, and will, by clearly defining the nature of the case I am speaking of, enable me to defend myself against the charge of erring on the side of those who advocate mechanical interference in all cases where food is refused, or with those who think the forcible administration of food usually unnecessary, or even cruel.

I need not dwell on the first of my divisions; the symptoms are those familiar to the general physician. It is, however, most important that we should recognise the symptom, having the treatment of patients who are so often unable to explain their wants, or justly describe their sensations. Dyspepsia, superadded to chronic mental disorder, will frequently change for a time the character of the disease, induce new delusions, or add strength to old ones. The forcible administration of remedies in these cases may sometimes be necessary, but of food scarcely ever; and it is terrible to think that we may ignorantly inject into the stomach of an invalid suffering from headache, mania, or

gastrodynia, an indigestible meal that will probably add to his sufferings, or even induce severe constitutional disturb

ance.

I shall not now enter on the treatment of dyspepsia, superadded to chronic insanity, a subject I hope to have the honour of bringing before you on a future occasion. It is of frequent occurrence in private practice. It may sometimes induce repugnance to food, endanger life from exhaustion, and require mechanical feeding, but I have never seen such a case; and those practitioners make a grand mistake who sedulously pour gruel or beef-tea down the throats of those unwilling to eat, without investigating the causes of their reluctance. Much mischief may thus be done, and I believe to this indiscriminate use of the stomach-pump the objections that some of our first physicians have to its employment is mainly attributable.

The second group of cases, those in which food is refused under the influence of specific delusion, is the most ordinarily met with, and, fortunately, the most amenable to treatment. Such delusions are not often persistent, and the repugnance to food may usually be overcome by gentle and patient persuasion. Stratagem will often succeed, where you have any clue to the nature of the delusion. Medical treatment will frequently overcome such fancies, and of course obviate the necessity for further interference.

The delusions giving rise to refusal of food are sometimes most ridiculous-more often painfully distressing. The idea of poison being administered is, perhaps, the most common. Patients under my care have frequently refused food for this reason; and would thus, as it were, starve themselves to save their lives. Metallic taste, especially that of copper, is not unusual. There is, probably, always dyspepsia present in those cases, and the deranged secretions should be appropriately prescribed for. I have seen great mischief arise from drugging or tampering with the food of insane patients, a practice too frequently resorted to. A patient so treated will lose all confidence in those around him. In some cases it gives rise to an entire refusal of sustenance; in many it is the origin of these illusions of taste. Of course, I do not mean that such treatment is not sometimes useful. The stomach or the intestines may be the seat of disorder giving rise to this form of delusion. A patient now under my care believes that his stomach is turned inside out. Sometimes this idea will prevent his eating for twenty-four hours; but such abstinence relieves the uneasy sensations, and the use

of bismuth and vegetable tonic infusions prevents the symptom becoming more severe. The delusion itself has existed

for ten years.

The idea that voices are heard warning them against food is a frequent and dangerous symptom in deranged patients, often ushering in or attending suicidal mania. In all these cases active medical treatment is most essential. A lady very recently under my care was, at the commencement of her attack, obstinately bent on suicide, requiring the constant presence of an attendant. She was fed with a spoon for several days, but with great trouble and difficulty. She would give no reason for her abstinence. A great amount of nervous tremor, want of sleep, fits of weeping, marked one of those cases, which Dr. Hitchman, of Derby, our last president, has pointed out to us as being so especially benefitted by opium. After taking it in the form of Battley's solution for a few days, the repugnance to food ceased. Under the persevering use of this remedy, her melancholy disappeared. She is now rapidly recovering, and tells me that her objection to food arose from imaginary voices thundering in her ears warnings against her taking it, and telling her it was "bathed in human blood."

I need not, before my present hearers, enlarge upon the various recorded plans by which patients have been seduced, or surprised into taking food. Dr. Conolly, in his " Clinical Lectures at Hanwell," used frequently to mention the case of a man who had persisted in refusing food for a dangerous length of time, but at length eat heartily of a mighty seed cake, which the steward, with the view of tempting him, caused to be cut up and distributed in his presence, without any apparent wish that the patient also should share it. This is a useful hint to the practitioner; in such cases too much anxiety defeats our object. An affected indifference will often disarm the suspicions of a patient, and induce him to give up his intended abstinence.

Esquirol pretended to flog a patient of his who obstinately refused food, telling him that if he persisted in acting like a naughty child, he must be treated like one. The expedient for the time succeeded. The Bourbon prince, who imagined himself dead, and was induced at last to eat by an invitation to meet some distinguished pretended ghosts, who assured him, by precept and example, that eating was quite compatible with his and their position, is familiar to us all. I question the wisdom of such a plan; and I believe it is recorded, that the poor prince, undeceived as to his com