Department, or to furnish the service with a well-informed and efficient body of Staff Officers, capable of giving to the Governor of a Colony, or the Commander of an Expedition, the most judicious advice in all that regards the health of his troops.

I have hitherto, Sir, as you will observe, addressed myself generally to the objections which have been brought in opposition to my views, I would now address myself a little more particularly to you and to the reviewer. I have not presumed to think that these objections embody the sentiments of an experienced Naval Surgeon, more especially of one who has acquired experience on the Indian Station, "who has seen the diversified maladies produced by climate, season, constitution, and co-existing circumstances." I am, indeed, hardly left to conjecture on this subject, for we are told, in a subsequent article, that this reviewer is an accomplished Army Surgeon, of which I make no doubt; but I must be permitted to say, that he has, in my opinion, taken a very limited view of his subject, a view very far short of those lofty conceptions which dictated the Memoir of Mr. John Bell-a memoir which you have seen proper to reprint, and which, although inapplicable at the present day, as regards the general education of our Army and Navy Surgeons, is more than ever applicable to that special instruction which it so forcibly inculcates, and which our enlarged establishments, our extended commerce, and our multiplied possessions demand.

Your reviewer cannot have considered all the important bearings of this question, as regards the collection as well as the diffusion of information on the health of the troops. The pupils of this class have distinguished themselves in all the recent struggles in India. In the first luckless campaign of Affghanistan, no fewer than three of them perished; one of these was Dr. Cardew, whose fate is so feelingly deplored by Lieutenant Eyre, and who had become so great a favourite with the soldiers that, when unable to travel farther, they endeavoured to save him by conveying his almost lifeless body on the carriage of a gun. To this gentleman I was indebted for a communication on fractures when a pupil of the class, and had his life been spared, I might have been in possession of information which is now for ever lost to the world.

I have at this moment lying before me Statistical tables of the sickness and casualties amongst the Queen's troops in China, and returns of Surgical Cases after Sir Charles Napier's recent actions in Scinde, framed for my special use by the Superintending Surgeon of the force, an old pupil of the class. The communications indeed which I have received from my pupils, in the shape of contributions to the Museum, of Returns and reports from distant stations, or of written Essays on subjects discussed in the progress of the Course, are more than I shall ever live to do justice to, or sufficiently to express my gratitude for. Amongst several of these communications which have appeared in print, I may be allowed to notice an Essay on the Comparative Merits of Flap and Circular Amputations by Mr. M'Hardy, and the Essay on the Feigned Diseases of Soldiers and Seamen, by Dr. Gavin. To these I trust I may soon be enabled to add a valuable history of the Medical Department of the British Army, by Dr. Irving. I am said to have failed in making out a case for additional Professorships of Military Surgery. Upon this point, however, I trust there is room for a difference of opinion; I am told by a distinguished General Officer, who has fought and bled in the service of his country, that I have made out "a most triumphant case," and we are told by a spirited and intelligent professional writer," that the Government which reads the arguments of Mr. Guthrie and myself, and does nothing, is as clearly condemned as the man who will persist in denying mathematical axioms."

Will your reviewer now allow me to tell him where I think he has failed? He has failed to see how much the institution of such courses of instruction as I recommend is calculated to raise the character of his department. He has failed to see what influence it is calculated to give to medical opinion in the eyes of those holding superior command; and he has failed to see what a waste of life

and of health it may obviate, by a perfect foreknowledge of what has happened, and what may again happen, in any given circumstances.

After having been so freely questioned by the reviewer I shall not I trust be accused of anything rude or uncivil, in asking whether this gentleman has served any considerable portion of his time in the East or West Indies, if so, I have only to observe that he differs very widely in opinion from others similarly situated. Hear the opinion of one of the survivors of the mortality at St. Domingo,one who subsequently served through the Peninsular war with the elevated rank of a Deputy Inspector of Hospitals, one who, a second time, served in the West Indies, as Chief of the Medical Staff in the Windward and Leeward Islands, and who now lives respected and esteemed by every man who knows him. “I ought," says this voice from St. Domingo, "to have thanked you before now for the little brochure you have sent me, in every word of which I thoroughly agree, and only wish that your arguments may make a suitable impression upon the authorities who have power to give them effect. Your quotation from Mr. John Bell is singularly apposite and good. The most experienced campaigner could not have written better." Hear again the opinion of another gentleman who retired as President of the Medical Board after seven and thirty years' experience in various parts of India;-under all circumstances and situations of intertropical service; in charge of large general hospitals at fixed stations; in field hospitals on actual service; in regimental hospitals moving over various countries, and through different climates; amongst Europeans as well as Natives; and among men, women and children; "I am very much obliged to you for your kind letter and enclosures, I sincerely hope you may be successful, and I think it very probable you will, as the importance of what you recommend must be obvious to every man who thinks at all, and particularly those who have any knowledge of soldiering, or the important duties devolving upon medical men on Foreign service. You have already done so much to benefit and improve the studies of Military Medical Officers that nothing is left but to follow up your plans; which, if adopted in London and Dublin, by the nomination of competent Professors, there cannot be a doubt that the public will be great gainers."

Both the gentlemen above alluded to have written much, and have written well, on the diseases of the troops, and on military hygiene, and their cordial approbation of my views would seem to shew, that they concur in opinion with another talented and experienced Army Surgeon, who, with reference to the very article on which I am now commenting, observed that "the reviewer might as well propose to supplant the Commissariat of an Army by Dr. Kitchener's work on Cookery, as to supply the purposes of so great a School by a book." But it were endless to multiply such quotations, suffice it to say that I am now in possession of six-and-forty letters to the same effect-all these letters, be it observed, wholly unsolicited. One from the Director-General; seven from Inspectors of Military Hospitals, or of Naval Hospitals and Fleets, eighteen from gentlemen holding the rank of Staff, Regimental, or Naval Surgeons, and the others from Professors in English Universities, from private practitioners, or from General and Field Officers in the Army-the last a class of men whose evidence I am inclined to rate very highly in a question of this kind. A medical man does not, I believe, consider it necessary to acknowledge every pamphlet which may be laid upon his table, and when so many gentlemen of talent and experience have stepped forward to volunteer their opinion in support of my proposal, I may well sit at ease under the strictures of my reviewer.

I conclude by observing that it is from respect to the established reputation of your Journal, from respect to your own character, personal and professional, and from respect to your position as a Naval Surgeon, that I have been mainly induced to enter into this detail. Believe me, Sir, that in what I have now written I am much more solicitous about the promotion of a great public object, than about my personal vindication, or my private interest. I have now been employed for nearly forty years in the study, in the practice, and in the teaching of Military Surgery. I have submitted to the Government, from an imperious

sense of duty, my sentiments on this important question, valeant quantum valere debent. Gratified by the approbation of my seniors and cotemporaries, both Military and Medical; strong in the rectitude of my purpose; and feeling, personally, but little interested in the result, I shall not again be easily drawn from that quietude which best befits my habits, my present state of health, and my time of life. I remain, Sir,

Your very faithful and obedient Servant,

GEO. BALLINGALL.

WYKE HOUSE ASYLUM FOR NERVOUS INVALIDS OF THE UPPER AND MIDDLE CLASSES. It is only among the Poor that the benevolent views of a more advanced Science, in the treatment of the Insane, can be said to be reduced to practice. Among the middle and upper Classes they are still unapplied, at least to any satisfactory extent. Persons of moderate means, or who are not too rich to disregard expense, are debarred the advantages of the well-organized Pauper Asylum, and are too often made over in consequence to the care of men destitute of any notions of medical or psychological science. We have laid aside the means of force, but in how many forms do neglect, harshness, and abuse still prevail! We have ceased to regard these poor creatures as brutes; but have we yet begun to treat them as men? The alienated invalid is but too often abandoned to the care of a keeper, without employment, recreation, or personal consideration. He is cast out, because he is stricken; and hence his restoration is rendered more uncertain, and often hopeless.

It is to meet this want that Dr. Costello, long the pupil and friend of the illustrious Gall, has opened Wyke House, Osterley Park, not with the pretension of forming a model Establishment, but to aim at least at making better arrangements for these classes of patients than have hitherto been brought within their reach.

In order to carry out a plan based on the accommodation of numbers, without which the advantages of a judicious classification are unattainable, the first desideratum was an extensive range of buildings in a favourable locality, with pure air and water, and a sufficient extent of land to afford facilities for exercise, varied occupations, and quiet seclusion. These conditions, indispensable to a well-combined plan of general treatment, are united in Wyke House, almost to a degree unequalled by any Establishment in the kingdom.

The House is situated on Sion Hill, one of the most elevated and salubrious spots in the vicinity of London, from which it is distant 74 miles. The buildings consist of a large mansion, fronting to a woody lawn, with two wings extending from it, and enclosing a spacious court, 200 feet long. The facades, front and rear, extend 270 feet. The flower and walled gardens, and ornamental grounds, cover an area of nine acres, and, inclusive of the farm lands interspersed with finely-timbered groves, the range extends over 30 acres The command of prospect is extensive: Harrow, Hampstead, Richmond, and the Surrey Hills, are in the distance: while Ealing, Hanwell, and the winding valleys of the Brent and Thames, form the fore-ground. It is thus the centre of some of the most attractive drives in Middlesex, viz., Osterley, Sion, Ealing, Kew and Richmond Parks, Isleworth, Twickenham, Hampton Court, Bushy, and Sunbury. Within wholesome bounds, there are still many enjoyments, in which, either for cure or comfort, the nervous invalid ought to be made to share. This being a leading principle, the Establishment for all who are capable of social relaxation forms but one family, of which the Director and his lady are the heads. Influences opposed to the morbid fancies of the patient are thus brought into activity, at table, and in the evening circle, by music, conversation, books, and the numberless offices of kindness and attention of an uninterrupted intercourse. By such means he is gradually strengthened to shake off his wayward imaginings, and to feel that he is not in a prison, but in a home. The medical and moral treatment embraces all the modern improvements-baths, douches, padded rooms, chair and carriage airings, &c. The out and in-door occupations and recreations comprise the culture of plants and flowers, the management of hot and green houses, of domestic animals, the farm yard, and horsemanship; billiards, tennis-court, skittles. The airing-grounds are large and dry; and there are spacious rooms for exercise in wet weather.

For particulars, application to be made at No. 10, Golden Square, in London; or at

Wyke House, Sion Hill, Middlesex,

CIRCULAR ADDRESSED TO THE MEDICAL OFFICERS OF THE EAST INDIA COMPANY'S SERVICE, BY THE MEDICAL BOARD AT CALCUTTA. Dated 20th October, 1818.

To the Editor of the Medico-Chirurgical Review.

Oriental Club, 31st May.

Sir,-In your number for April last, you published an interesting but visionary letter from the late Mr. John Bell, to the late Earl Spencer, in relation to the means of promoting Military Medical Science. Will you be so kind as to find a place in your forthcoming number for the accompanying appeal to the Medical Officers of the East India Company's Service, by the Medical Board at Calcutta, on a similar subject. The " Circular," which was obviously much called for, is dictated by sound sense and great practical experience.

I am, Sir, &c.

ORIENTALIS.

Sir,-In conformity with the orders of Government the Medical Board have directed me to submit to you the following considerations, relative to a proposed plan for the collection, and accumulation, of professional information, relative to this country, and its more extensive diffusion, amongst the medical part of the service under this Presidency.

It has been a frequent subject of regret to the medical world, that, wide and rich as is the field in India, for the cultivation of physical science, and the study of pathology, the labour hitherto employed in it, even in comparison with what has been bestowed on far less promising spots, has been negligent and irregular, and the product presented to the public, scanty, and in the extreme unprofitable. Whilst in almost every other portion of the civilised world, scientific objects have been pursued with energy and success, and every successive year has largely added to the previous general stock of medical knowledge; India has scarcely given birth to a single important discovery, or publication of acknowledged merit, on professional subjects, since the first establishment of the British interests in this quarter.

If we search for the causes which have given rise to this strange anomaly, and placed these Settlements apparently so far behind the other scions from the parent Country in point of professional zeal and intelligence: we shall not find that it can be fairly attributed to the faulty constitution of our Medical Establishment; or to the apathy and incapacity of those belonging to it. The individuals composing this respectable class, have ever been remarkable for the diligent and able performance of their duties. They would seem to be, by previous regular education, and by subsequent large acquaintance with the diseases usually prevalent in hot climates, peculiarly qualified to impart useful information to their less experienced brethren.

The evil, then, is to be traced to another source: and will be readily discovered in the total want of any eligible means of communication between them and the profession at large. Removed as they are, to an immense distance, from Europe, they cannot venture on the risk, or undertake the superintendence of printing a large work; and, in this remote spot, they have not, as in London, and other great cities, periodical journals exclusively devoted to professional subjects; and affording facilities for publishing, without expense or trouble, such short essays, or individual facts, as they might deem worthy of general notice.

These peculiarities of exclusion, to which the Medical Staff of this country are necessarily exposed, have been productive of very serious disadvantages. They have affected equally the reputation of the individual, and the character of No. LXXXI. X

the profession at large. The fruits of each person's experience have, unavoidably, been confined within the narrow sphere of his individual knowledge, or uselessly deposited amongst the records in office, and thus, whilst the medical world has been deprived of the principal end and use of past observations,—that of serving as a guide to practitioners for the future, the younger branches of the profession have been shut out from benefiting by the fund of knowledge acquired by their seniors.

Strongly impressed with the truth of these remarks, and fully convinced of the expediency of removing the injurious barrier, at present existing between the medical observer and his brethren, Government has lately resolved upon collecting and printing at the public expense, all communications of interesting facts and particulars connected with the diseases of this country, and the modes of treatinent best adapted to their removal. Instructions have accordingly been issued to the Medical Board, to make the substance of this resolution generally known throughout the Medical Department of the Service, and to carry the subordinate arrangements for the success of the plan depending on it into early effect. It is in compliance with these instructions, that I have now the honor to address you.

After mature reflection, it has appeared to the Board, that the most ready and effectual means of fulfilling the liberal intentions of the Most Noble the GovernorGeneral in Council, is to hold out an invitation to all officers borne on the medical list, to prepare and transmit to this office, such papers, whether comprehending a general description of any disease, or set of appearances, or confined to the relation of single cases or remarkable facts, as they may be willing to lay before the public.

The nature of the projected compilation, and of the materials of which it is desirable that it should be composed, may be readily conjectured from the foregoing remarks. It will thence naturally be supposed that the greater portion of it will be devoted to subjects of a strictly professional nature. It is by no means the wish of the Board to exclude from it essays, or single observations on chemistry and its dependent arts, natural history, botany, or others of the sister sciences. One of the most gratifying effects indeed contemplated by the Board from the successful operation of the scheme under consideration, would be the direction of a greater share of attention than has been hitherto given to these very interesting departments of science; the investigation of which, besides the important uses to be derived from it, affords a copious source of rational enjoyment to an inquisitive mind.

On the choice of subjects for publication, the medical observer must therefore, in a great measure, be left to himself, and each individual will, of course, on this point, follow the bent of his own inclination: the Board are convinced that he can never be at a loss for fit points of inquiry. The true nature and treatment of fevers, bowel complaints, and the other great classes of disorders common to India, with other regions, are yet very imperfectly understood. And their investigation, while it lies peculiarly open to practitioners in this country, would be hailed by their brethren in Europe, as opening a path that must lead to conclusions important and interesting to all. The various species of cutaneous diseases, elephantiasis and other maladies almost peculiar to warm countries, present a wide and nearly untrodden field to the curiosity of future investigators, whilst much room for experimental research still remains in ascertaining the real powers of such articles of the materia medica of the natives as seem to possess virtues peculiar to themselves, or as might be occasionally substituted with advantage for medicines imported from Europe.

So soon as a body of manuscript, sufficient to form a sizeable volume shall have been collected, the Board will proceed to digest and prepare it for the press. The Board understand it to be the present intention of Government, that copies of each successive volume, shall be distributed to every medical officer through