21 MARCH 1874, Page 22

DR. WYNTER'S LAST ESSAYS.*

DR. WYNTER is a "mighty hunter" after details. He likes to tabulate figures and to accumulate facts. He enjoys the kind of labour which most men of letters dislike, and it must be confessed that he turns his toil to good uses. The essays which fill up these two volumes are of the most miscellaneous description. No sub- ject comes amiss to the author that can be reached through personal observation and by the aid of statistics. He knows well what will interest the public, and he can present his knowledge in an attrac- tive form. This kind of workmanship is not without its value. It sometimes assists a busy student, and it amuses and at the same time instructs the reader who takes up a book in order to while away time. There is little connection between the forty-six articles and essays reprinted in these volumes, but among them are three or four of a professional character, which remind us that Dr. Wynter is a physician. The first essay in the book is on non- restraint in the treatment of the insane, and in it we find a number of curious statements which would be melancholy enough, were it not that they belong to the past, and serve to show in the strongest light the prodigious advance of medical knowledge with regard to the management of insane patients.

The monstrous devices once practised upon lunatics almost surpassed belief ; they remind us of the tortures of the Inquisi- tion, and the worst of them appear to have been invented by -German physicians :—" One of these was to entice the sufferers to walk across a floor that suddenly gave away and dropped them into a bath of surprise, in which they were half drowned and half frightened to death. A still more demoniacal plan of treat- ment was sometimes employed. Patients were confined by chains in a well, and the water was gradually made to ascend, thus ex- posing the poor victims to what appeared to them the gradual approach of inevitable death." In England, in the middle of the

• Peeps Into the Human Mae. By Andrew Wynter, M.D. 2 Tole. London • Chapman and Hall.

last century, a physician invented the circular swing, in which monomaniacal and melancholic patients were bound in the longitu- dinal position when it was wished to induce sleep, and in the erect position when intestinal action was required; and this contrivance was praised as an invention " that no well-regulated asylum should be without." Within living memory, as Dr. Wynter points out, the insane were treated more like beasts than human beings.

" Refractory patients were heavily chained, sometimes those who were not violent were fastened like savage dogs to the wall." Thanks to Dr. Gardner Hill, of Lincoln, who, in spite of immense opposition, was the first to establish the non-restraint system in this country, and thanks to Dr. Conolly, who carried out Hill's plan on a far wider scale and with admirable advantage, the proper method of treating the insane is no longer a subject of debate. It took a long time, however, to convince the "mad doctors" that the new system was practicable, but no prejudice could stand out against the fact that Conolly, with eight hundred lunatics in his keeping, flung away strait-waist- coats, had the restraint-chairs cut up, allowed his patients the free use of their limbs, and did all this with impunity. Conolly was not in favour of large establishments, and Dr. Wynter com- plains that the county asylums are growing larger and larger day by day. He does not consider that madness is on the increase in proportion to the population, but asserts that " the very im- posing appearance of these establishments acts as an advertise- ment to draw patients towards them. If we make a convenient lumber-room, we all know bow speedily it becomes filled with lumber. The county asylum is the mental lumber-room of the surrounding district ; friends are only too willing, in their poverty, to place away the human incumbrance of the family in a palatial building at the county expense." Yet he considers that in spite of their attractive appearance, these institutions are not favourable to the cure of patients ; that the monastic system that prevails is injurious, and that it would be far better if the sexes, under proper regulations, were allowed to mix together. Again, the size of these establishments prevents the personal supervision which is the sole safeguard in the removal of mechanical restraint.

" The result is that, as a rule, the patients are at the mercy of the attendants. What that mercy is, let the inquests that have lately been held in asylums on patients who have died through brutal treatment at their hand make the sad answer." Dr. Wynter's view of the present condition of our asylums is a gloomy one, and much that he says on the subject is worthy of careful perusal :-

" It will doubtless surprise the reader," he observes, " to be informed that out of the total number of 24,748 pauper patients in county and borough asylums and in registered hospitals in the year 1867, no 1es3 than 22,257 were past all medical cure; whilst the curable amounted only to 2,491, or a little more than ten per cent. When we consider the pressure put upon the ratepayers for the erection of large asylums throughout the land, this result is so disastrous, that it may be said our whole scheme for the cure of lunatics has utterly broken down As the asylums are extending in size, the very atmosphere within tho walls may be said to be saturated with lunacy. They are becoming centres for the condensation and aggravation of the malady rather than places of cure, just as the crowding a fever hospital makes the type of disease more malignant."

Dr. Wynter is strongly in favour of the cottage system adopted at Gheel ; he makes out pretty plainly that some such system must be adopted, and considers that at least thirty per cent. might be withdrawn with advantage from asylums and thus boarded out in private families. He is equally earnest in his protest against the evils arising out of great city hospitals, with regard to which he observes that either their hygienic condition must be wholly revolutionised, or the performance of dangerous operations within their walls must sooner or later be abolished. In one of the most interesting papers entitled, " Medicine and Surgery," Dr. Wynter declares that the larger our hospitals grow the larger will be the per-centage of deaths as compared with the smaller establishments. In this essay, which abounds with interesting statements, the writer explains in a style adapted to the general reader the wonderful progress made in surgery within the period of a life-time. Probably in no branch of human knowledge has more decisive advance been made, and every year adds something to the discoveries and to the skill of the surgeon. There are men living amongst us whose achievements in this respect place them in the highest rank as benefactors of their kind, men who have reduced to an extra- ordinary extent the sum of human misery. Dr. Wynter points out that there is scarcely an operation that marks this advance in surgery within the last fifty years that had not been successfully tried previously, but which, owing probably to the want of favour- able circumstances, had passed out of the minds of practical men. The operation of ovariotomy, for example, is said to be only a re-discovery of an old method of cure, under better auspices and in more intelligent hands :— "In 1838, Mr. Lawrence denounced attempts to treat diseased ovaries by surgical operation as dangerous to the character of the profession, and the review of which Sir John Forbes was the editor said that whenever an operation so fearful in its nature was performed a funda- mental principle of medical morality was outraged.' It was under these discouraging circumstances, therefore, that Mr. Spencer Wells began to perform the operation in 1858. At that time it had only been performed once successfully in any of our large Metropolitan hospitals, and no case of complete success had ever occurred in Scotland. Yet now Mr. Spencer Wells' operations amount to more than 500; the mortality among the whole of the private cases is 24.23 per cent., though in a series of 100 cases it was only 14 per cent; and the mortality on tho total of Samaritan-Hospital cases is 26.66 per cent. Dr. Keith, of Edinburgh, has been equally successful; and the late Dr. Tyler Smith, Dr. Bird, and others have also performed good service, and done their part in adding to the stores of our knowledge. The operation is now of frequent occurrence, and is recognised as perfectly legitimate."

The achievements of modern surgery, however, are not without serious drawbacks, and it is a dismal fact that a disease has sprung

up "purely of man's creation, which has swept away the greater portion of the fruits of hospital surgeons' scientific advances." Foul hospital air is the cause of more than half the deaths that take place in our large metropolitan hospitals after the great operations. Dr.

Wynter therefore, like most of the faculty in our day, is strongly in favour of cottage hospitals, in which dangerous cases might be treated. It is needless to say that he musters a large array of statistics in favour of his views.

A paper on "Imbecile Children" gives some useful statements, and another on "The Museum at the College of Surgeons" comes also in some degree within the line of the writer's studies as a

medical man. By far the greater number of these essays are, however, non-professional in character ; and some are of the lightest order, pleasant enough to read, but thin in substance, and hardly worthy of being transferred from the newspaper column. Articles on Sewing Machines, Co-operative Stores, Bad Boots, Ladies' Tresses, Railway Season Tickets, the Zoological Gardens, the Art of Advertising, and an account of valentines called "Love Manufactured," are well fitted for the columns of journals that require gossipy matter of this kind, but when reprinted in a volume their insignificance becomes evident. Such essays are produced every week of the year, but happily the writers do not think it necessary to put such "unconsidered trifles" into a book. Dr. Wynter has, we think, made a blunder, and one which a writer so capable should not have committed. Some of his longer essays contain a large amount of valuable information compactly arranged ; his short papers read like the work, good and true, no doubt, in its measure, of the daily journalist.