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Brunswick it runs its fearful course of corruption and mutilation, bringing with it a merciful, though scarcely human, insensibility, till the insensibility of death itself supervenes. Nor is it necessary in order again to meet the leper to turn to Arabia, where, however revolting the form of the disease, it does not render the victim, as in so many other instances, legally impure. For, passing northward from Ceylon, the vast continent of India stretches before us. And "India continues to be, as it has been for ages, one of the principal seats of leprosy in the world." Though the awful scourge in India is heaviest among the poor, every race and rank is subject to it; rich and poor, Christians and pagans; Europeans and natives; Rajahs and Newabs; Brahmins and Pundits; Pariahs, the low-caste Hindoos, Mussulmans and Parsees, all are numbered among the despised and hated class of lepers. Abhorred by every one, the leper in India is often ruthlessly driven by his own flesh and blood from house and home, literally to perish by the roadside; while in some places Government interference alone has put a stop to his being buried alive-the father burying the son, the son burying his father. And not only the leper himself, but also his relatives and friends, lest in multiplying their kind they should transmit the disease to distant generations. Though no law restrains him from intercourse with other people, caste steps in and takes the place of law. The man of high caste, once a leper, from that moment is turned out of his caste; he may not sit in the same room or house with the sound and pure; his own kith and kin will not eat what he has touched, or drink or smoke .with him. If his wife eat with him, she is put out of caste. None will marry his daughters, even though there be no slightest sign of leprosy in them, and they can never be readmitted into caste. There is no pity and no hope for him. And when he dies abhorrence follows him to the grave; all religious ceremony is withheld from him, and his body, given up to the low caste of sweepers and such like, is subject to the greatest indignity the Hindoos can show their dead. Lepers are met with in every stage of misery in India. They flock to the borders of the Ganges to end their hopeless lives on "holy ground." Pilgrims, they crowd to Pooree to make prayers and propitiatory offerings to the idol Lokenauth; and then, failing of their cure, they continue to haunt the neighborhood, and form fresh centres of vice as vile and detestable as the foul
corruption that pollutes and makes havoc of their bodies. Often herded by themselves at night, they are scattered during the day along the roadway and in the bazaars begging of the pitiful, and filling with horror the unaccustomed stranger. Special hospital accommodation is provided for them here and there; but in all India, with its millions of people and its over a hundred thousand lepers, the asylums for the leper can be almost counted on one's fingers; they are not a fourth, nay, not a fourteenth part of the Lazar houses that England in the Middle Ages built for the despised "children of St. Lazarus." But even India does not terminate our rapid survey of the leprous districts of the world. Nor can we yet quit
the boundaries of our own empire to trace its path to the end. The latest official document that comes to us from India is dated March 5th of this year. It is a memorandum by Dr. Vandyke Carter" On the Prevention of Leprosy by Segregation of the Affected." Dr. Carter says: "The following brief memoir is the third I have compiled for submission to the authorities of British India; and, like its first predecessor, it is based upon unique experience acquired through the enlightened proceedings of the Government of Norway." The statistics he quotes prove the truth of his assertion that the methodical isolation of lepers, which has been carried on with unremitting effort, has resulted in a decided diminution of their number during the past twenty-five years. Isolation he acknowledges to be a costly measure; but the State, recognizing from the first the incurability of leprosy, limited its attempts to opposing the hitherto continuous reproduction of disease, and such anticipatory sphere of action admits only of radical rather than showy achievements. How much longer these somewhat costly measures may have to be maintained cannot yet be said; but it has been learned that restrictive means ought, if possible, to be extended, and could be remitted only at imminent risk of renewed spreading of disease." In finally urging the adoption of segregation for India Dr. Carter says that it is the only method likely to check and lessen leprosy; it has, in Norway, proved to be beneficial in both these directions, as well as by awakening the people to a sense of rational self-help and a willingness to co-operate further. Such a cogent and attractive stimulus is much needed in India, where the foundations of public hygiene have yet to be laid."-Nineteenth Century.
THAT our existence, in a physiological sense, may be regarded as consisting of alternating periods of activity and repose is an axiom which requires no very deep reflection or research for the demonstration of its truth. The waking hours of the day are succeeded by the resting hours of the night. The work of life is followed naturally by the repose which, in its turn, is equally a part of our normal existence; and there are too many obvious indications that this succession of events is part and parcel of nature at large, to leave room for doubt that sleep and wakefulness are simply the evenly balanced ends of the vital see-saw. It appears to be a rule of physical life that, even in its most intimate and less apparent phases, an alternation of rest and repose should be constantly exemplified. The work of life means, of course, the dissipation of energy. The wear and tear insepaNEW SERIES.-VOL. XL., No. 5
rable from the mere act of living and being necessitates proportionate repair. This much is contained in the first pages of the scientific primer; whilst a succeeding and equally primitive study discloses the way of repair in the many processes of nutrition which tend to preserve the form of the individual in its stable aspect by counteracting the inevitable waste of life. But there are other processes and functions which seem to contribute to the latter end, and, amongst them we may legitimately number the influence of rest and repose. is by no means paradoxical to assume that the very act of nutrition or that of bodily repair, involving as it does a large expenditure of energy, is in itself a source of bodily wear and tear. The pulsations of the heart, directly concerned in the distribution through the body of the products of nutrition, represent, apparently, an amount of exertion
and work which well-nigh induces the belief that we subsist on a veritable peau de chagrin,"" and that even the gains of the body of necessity imply a loss. From the physiological side of things, however, there comes a gleam of comfort in the declaration that the nutrition of rest serves to counterbalance the wear and tear involved in the mere fact of existence. In repose is found, we are told, a highly perfect source of bodily repair. And it is further impressed upon us that this cessation from labor may occur in ways and fashions undreamt of by the casual observer of the lives of men. Take as an example the heart itself. Next to the brain, which is credited with being the scene of a never-ending bustle and traffic in ideas, the heart may be thought of as an organ whose duties permit of no cessation or repose. Even in the ordinary undisturbed performance of its functions, the rhythmical routine of the great pumping-engine strikes us as resembling that of the galley-slave chained to the oar, and as exhibiting day by day the same unflagging, stereotyped way of life and action. The question of rest for such an organ might at first sight appear non-existent. Its nutrition likewise would seem to be a matter in arranging for which, conformably with its perpetual round of duties, nature might experience some difficulty; since, like the through railway guard on an extended journey, it must feed as it runs.
But the dilemma in question is solved through the simple consideration of the manner in which the heart's work is performed. The action of the organ, as every one knows, is not continuous. Its work is intermittent in character, as may be proved by listening to the sounds its makes. It has its periods of repose, short as these may be, between its strokes of work. It takes its rest in short alternate naps; and if we sum up its life history, and calculate its working hours, we shall find that, in truth, the heart has rested for a longer period than it has worked. Thus although the snatches of rest be short, in the case of the heart they are really as frequent as its working moments, and in the intervals betwixt its pulsations it may be said to gather energy for its succeeding strokes. The case of the muscles used
in breathing-and it may be borne in mind that the heart itself is simply a hollow muscle-is equally interesting, and certainly not less typical than that of the central organ of the circulation. The periods of work, so to speak, are longer in the case of the chest-muscles, just as the intervals of repose are more protracted than in the business of the circulation. And if the idea of rest alternating with work be extended to other departments of bodily activity, we shall find that the practice in question prevails throughout the living organism. The chief differences between the action of one set of muscles and that of another set consist in the varying duration and succession of the periods of work and rest. In absolute cessation from labor, then, we find a profitable source of repair of the body. Then it is that the materials derived from the food can be perfectly applied to the necessities and wants of the frame. The true justification of sleep is found after all in the value of rest as a reparative measure. And the after-dinner nap of wellfavored humanity, equally with the somewhat prolonged post-prandial inactivity of the boa-constrictor, are procedures separated, it may be, by an infinity of differences, but which, perchance, derive much of their reasonableness from the physiological considerations besetting the question of
As a knowledge of the nature of sleep becomes a necessity for the understanding of the why and wherefore of dreaming and allied conditions, we may in the next place endeavor to gain some ideas respecting certain curious states which in one way or another may be said to border the "land of Nod." Such are the remarkable cases of producing insensibility or of feigning death at will, and those which relate to the production of unnatural states allied to sleep, and which in some measure aid our understanding of dreams and their causation. As in many other acts and phenomena connected with brain and mind, the phenomena of sleep and dreams do not stand alone or unconnected with other mental states. On the contrary, it is possible to trace well-marked gradations leading from the day-dream to the reverie, and from these common in
stances of abstraction to the somnolent condition itself. Nay, it may also be said that the full understanding of dreaming, in so far as that is possible at present, can only be arrived at from a knowledge of the facts which a study of the waking dream or the automatic patient teaches us. Through morbid and unwonted conditions, as in so many other instances in the search after knowledge, we arrive at a comprehension of the ill-understood affairs of common life.
That there exists a power of producing at will conditions allied in nature to sleep, or even extending to deep insensibility with apparent cessation of the physical processes of life, is a wellknown fact of physiology. A condition approaching that of coma or insensibility thus appears to be occasionally induced in man by an effort of the will. In many animals a prolonged and periodical suspension of the activities of ordinary existence normally occurs and is designated under the term hybernation. The bear, squirrel, dormouse, and bat exemplify this condition, in which, however, respiration is unimpeded, although its frequency is reduced; and the animal, retiring to its winter quarters fat and well favored, emerges in spring in a lean condition. The nutritive principal which was accumulated in the preceding summer has, in fact, been converted into an account-current and used in the maintenance of the slumbering organism. In such a case there is simply deep somnolence and suspension of all ordinary activity and of the exertions and waste attending the wakeful state. But a step further brings us to the domain of pathology (or the science of disease) with its unwonted states, depending on disease or on conditions which approach those of abnormal existence. Celsus speaks of a priest who could separate himself from outward existence at will, and lie as one dead. But the case of Colonel Townshend, related by Dr. George Cheyne-in his quaint book entitled The English Malady; or, Treatise of Nervous Diseases of all kinds, as Spleen, Vapors, Lowness of Spirits, Hypochondriacal and Hysterical Distemper, etc., London, 1733"justly exceeds in interest any other
known case of the kind, not merely for the abnormal nature of the phenomena, but also from the exact account of the events in question, related by accurate observers trained in the scientific methods of their day.
Dr. Cheyne's account of this case bears that Colonel Townshend had suffered from some internal malady, of ascertained and well-understood nature, and that he came in a litter from Bristol to Bath in autumn for the purpose of obtaining medical advice. Attended by a Dr. Baynard, a Mr. Skrine, his apothecary, and by Dr. Cheyne himself
all three despairing of the Colonel's recovery-the patient sent one morning for his medical attendants, and intimated that he had made his will and set his house in order; 'his Senses, cording to Dr. Cheyne, being " clear, and his Mind calm." Colonel Townshend next informed his doctors that he had sent for them that he might give them details of an odd Sensation he had for some Time observed and felt in himself which was," continues Dr. Cheyne, "that, composing himself, he could die or expire when he pleased, and yet by an Effort, or somehow, he could come to Life again, which it seems," adds the author, 'he had sometimes tried before he had sent for us."
On hearing such a recital, the: doctors were naturally astonished. As men of science, their natural scepticism. of the unusual, until proved by experiment to be likely or true, exhibited itself in Dr. Cheyne's declaration that his hearers" could hardly believe the Fact. as he related it, much less give any Account of it, unless, adds the narrator, "he should please to make the Experiment before us, which we were unwilling he should do, lest, in his weak. Condition, he might carry it too far." The Colonel, however, insisted on the trial being made, the preliminary duty of feeling his pulse being duly performed, when it was found to be " distinct, though small and threedy": whilst his Heart had its usual Beating."
Dr. Cheyne may now be allowed to relate the sequel in his own words: "He composed himself on his Back, and lay in a still posture some time; while I held his right Hand, Dr. Bay
nard laid his Hand on his Heart, and Mr. Skrine held a clean Looking-Glass to his Mouth. I found his Pulse sink gradually, till at last I could not feel any, by the most exact and nice Touch. Dr. Baynard could not feel the least motion in his Heart, nor Mr. Skrine the least Soil of Breath on the bright Mirror he held to his Mouth; then each of us by Turns examined his Arm, Heart, and Breath, but could not by the nicest Scrutiny discover the least Symptom of Life in him. We reasoned a long Time about this odd Appearance as well as we could, and all of us judging it inexplicable and unaccountable, and finding he still continued in that Condition, we began to conclude that he had indeed carried the Experiment too far, and at last were satisfied he was actually dead, and were just ready to leave him. This continued about half an Hour. By Nine o'clock in the Morning in autumn, as we were going away, we observed some Motion about the Body, and upon Examination found his Pulse and the Motion of his Heart gradually return ing; he began to breathe gently and speak softly we were all astonish'd to the last Degree at this unexpected Change, and after some further Conversation with him, and among ourselves, went away fully satisfied as to all the Particulars of this Fact, but confounded and puzzled, and not able to form any Rational Scheme that might account for it." Thus far Dr. Cheyne. The sequel relates that after calling for his Attorney and adding a codicil to his will, Colonel Townshend "received the Sacrament, and calmly and composedly Expir'd about five or six o'Clock that Evening.'
In addition to all the signs and symptons of sleep, we have added in Colonel Townshend's case the power of intensifying the conditions of somnolence to an extent comparable only to the extinction of vital action itself.
A case reported in the Medical Times and Gazette and British Medical Journal for 1863 may interest us as presenting us in some measure with a case comparable in man to the hybernating habits of lower forms, and which may also serve as a connecting link between such a case as the previous one and the phenomena of ordinary sleep. A man, aged forty-four years, began in 1842 or 1843, after a severe cold, to exhibit a tendency to indulge in deep and prolonged sleep. The affection returned in 1848, and again in 1860 and in 1866. During the attack his appearance was natural, but the face and ears were pale, feet often cold and livid, perspiration scarcely perceptible, and pulse feeble. The account adds that on awakening, the patient felt refreshed. The longest period he passed in sleep was five days and five nights. Frequently a period of three or four, days was passed in sleep, the average duration of the attacks being two days, whilst he was awake during four or five hours out of the forty-eight. He did not dream during the period of repose. These remarks apply to his history up to 1860. In 1866 the curious phenomena were again noticed. The patient slept from about 11.30 P.M. on January 2d, 1866, to 2 P.M. on January 6th. At 12 P.M. on February 4th another period of repose began, which lasted until 4 P. M. on February 8th; when after a wakeful interval of seven hours he dozed off again until the 11th, when he remained awake for nine hours, but thereafter slept for four days. From February 16th till February 26th he slept continuously, save for an interval of five hours; and beginning to sleep on March 9th at JO A.M., he slept until the 15th at four o'clock in the afternoon. Nothing remarkably abnormal or in the least sufficient to explain the anomalies of this patient's existence was revealed by an examination of the brain after death, which occurred at the close of the year last mentioned. Here the tendency to sleep was a matter of abnormal action