We are, for obvious reasons, forced to gauge the prevalence of phthisis in asylums by its mortality. Several questions at once present themselves:

What is the mortality from phthisis at the present time in the British Islands ? What is the mortality from phthisis in the asylums of the British Islands ?

Are these mortalities diminishing or increasing ? And what relation do they bear to one another ?

It is easy to propound these questions; it is extremely diffi cult to properly appraise the available data. For, first, if it be desired to compare the mortality from phthisis of asylum inmates with that of the general population, the comparison must be made on the basis of the ratio, in each case, of the annual deaths from phthisis to the average populations in volved. In other words, the phthisis death-rate, and not the percentage of deaths assigned to phthisis, must be estimated.

Dr. Mott.—Before I was intimately associated with lunacy I was astonished to find in my hospital experience that nervous diseases were so frequently due to syphilis. I therefore adopted the treatment of giving mercury and iodide in all doubtful cases. In regard to general paralysis, I agree at first with those authorities which believe that syphilis had little to do with it; but careful examination of the patients and postmortem investigations convinced me that syphilis plays an important rôle in this disease.

The subject of the present paper has occupied my attention for more than two and a half years, and during the whole of that time I have felt deeply indebted to my colleagues both at Bethlem Royal Hospital and at the Lancashire County Asylum at Prestwich for the generous way in which they have afforded me every opportunity of studying the subject. Some of these gentlemen have not only permitted me to examine their cases, but—knowing my interest in the subject—have, at inconvenience to themselves, drawn my attention to cases which would otherwise have escaped notice, and have further assisted and encouraged me by confirming my own observations. I therefore take this opportunity of most heartily thanking all these gentlemen for their valuable help and kindness.

We think it will be generally acknowledged that the problem which the treatment of noisy, destructive, and dirty patients sets to their medical officers is greatest as regards their management at night. It is then undoubtedly that noise, destructiveness, and dirty habits have the greatest chance of getting free play, and it is then that the efforts for reformation have to be greatest. If these efforts are successful considerably more than half the problem will have been solved. It is to this part of the question, viz. the supervision of such patients during the night, that we desire in this paper to direct attention. At the outset it may be stated that our proposals are not theoretical. They are the result of practical experience gained during the past four years in the Sunderland Asylum. The special arrangements we propose to describe were instituted by one of us at the opening of the institution four years ago. At first a few cases were dealt with tentatively, but, as the first results were so encouraging, the number of cases was gradually increased, until all the patients who were restless, noisy, destructive, or of dirty habits came without exception to be dealt with. The asylum, situated at Ryhope, is a small one, containing only 350 beds, and on this account, as well as because it was new, it was conveniently suited for such an experiment. It may be well before going further to describe the arrangements now in existence there. There are 175 beds for each sex, made up as follows:—45 single rooms, one fully padded, and 2 half-padded; 2 small dormitories of 7 each, 2 of 13 each, 2 of 19 each, and 2 of 26 each. In the last two there is a night attendant, and one also in one of the dormitories for 19, which is the hospital ward. There is, in addition, a head night attendant who visits the patients in these dormitories and also all the remaining patients every hour, or oftener when necessary. There are thus 4 of a night staff for 175 patients. Though this is probably a large proportion compared to most public asylums, it is not claimed as a new departure in asylum management, as we are aware that in a number of asylums the advantage of having a large night staff is fully realised and acted on. The essential feature of the arrangements at Ryhope, to which we wish to direct attention, is the selection of cases placed in dormitories under constant supervision. Of course, all epileptics and suicidal patients are placed there. But, in addition, all recent cases of whatever kind, all dirty and destructive cases, and those who sleep badly and are in consequence inclined to chatter or be noisy, are also placed under constant supervision. Looked at from the other side, all single rooms and dormitories not under constant supervision are reserved for quiet and well-behaved patients who do not require any special attention during the night. This plan has been found to work exceedingly well, and since it was organised we have never had occasion to think of adopting any other. Another testimony to its effectiveness is that those of the staff who have the actual supervision of the patients and have had experience in other asylums are unanimous in their opinion that the arrangement is a very decided improvement. This opinion, let it be observed, is not based on the ground that now their duties are lighter than they were, because, as a matter of fact, they are more onerous.

This question of the punishment of the insane is one which has gone through certain stages. You will remember that in Edinburgh I read a paper in which I laid down three propositions. The first was that no insane person should be punished with the same severity as a sane person; the second was that some insane persons ought not to be punished at all; and the third was that the majority of insane persons ought to be punished for a large number of their wrong-doings. To these I added a fourth as a rider, that, as a matter of fact, punishment is already largely used in the treatment of dealing with insane persons. To this it was retorted that certain measures are taken with respect to insane persons, which, if they were taken with respect to sane persons, would be punishment, but as taken with respect to insane persons they are not punishment. In other words, we do punish the insane, but we shrink from acknowledging that we do so. Now there is one aspect of this question which I have put several times, and regarding which I have never yet been answered in any way, and I desire to put it again, and in order that there may be no mistake about it I will put it in a very concrete form. Our excellent Treasurer is entrusted not only by us with the finances of this Association, but he is also entrusted by his county with a share in the management of the county affairs, and it is within the bound of possibility that Her Majesty might entrust him with the Commission of the Peace, if he has not already been so entrusted. It may happen that at the trial of a prisoner—we will say supposing a man has thrown a pint pot through a pane of glass—he will come before our Treasurer, and he will be fined a certain sum of money, or, in the alternative, will be awarded certain imprisonment; we will say he is fined 5s. or seven days. Then our Treasurer quits the bench and goes back to his own institution, and finds there a patient who has thrown a mug through a pane of glass, and he says to that patient, “You have destroyed this pane of glass, you will have to pay for it;” or “your pocket-money will be stopped for the amount.”

There are several causes which may induce refusal of food, and these have to be carefully considered before attempting to forcibly feed an insane patient.

Anorexia is one of the earliest and most common symptoms of general bodily disease. It is always present in anæmic conditions and severe affections of the stomach. It may arise from nausea, the food not being properly digested, fœtid eruc–tations are produced, and so the patient loathes the idea of food.

In giving advice concerning the marriage of a person who has had an attack of insanity or who belongs to a family with a hereditary predisposition to insanity, on what considerations should our opinions be based? Firstly, on the welfare of the individuals who are about to marry and of their families present and prospective. Secondly, on the welfare of society. Our advice might have far-reaching consequences if we were only agreed on common principles.

Sulphonal has been extensively used in the Royal Manchester Hospital during the last two years. We have found the drug prepared by Bayer to be constant and trustworthy in action, converting noisy and turbulent patients into comparatively quiet and manageable cases.

The spiritualist was and still is the orthodox criminal jurisprudent. He believes in original sin, and when he sees a crime attributes its commission to the inherent wickedness of its author. The médecin-légiste looks first, not at the crime, but at its author, and brings an open mind to bear upon his inquiry into the reason for so strange thing having been committed. The former, therefore, starts with the assumption that each offender is responsible, and excuses him only upon pressure, as in the clear case of the lunatic, the child, and the idiot, when the evidence of irresponsibility is overwhelming, even to his prejudiced eye. On the other hand, the horizon of the man of science is less bounded and grows wider year by year. He knows the moral disabilities of the general paralytic in the first stage, of the epileptic and of the true degenerate, and he is usually able to recognise their respective disorders. Magnan and Serieux tell us that between 1885 and 1890, seventy-six general paralytics were transferred from prison to the Asylum of St. Anne within a very short time of their condemnation by criminal courts. Monod (Conseil Supérieur de l'Assistance Publique, fascicule 47) says that within the same period about 700 persons were sent to prison in France who were subsequently received into French asylums, and who were, in his opinion, undoubtedly irresponsible at the time of the commission of the offence for which they were severally condemned.

It is just two years since the attention of the Association was directed to the condition of Indian asylums and the defects in their management. Since that time the subject has not been lost sight of, and it is now most gratifying to find that the Government of India has taken it seriously in hand. It was a fortunate occurrence that before Lord Curzon left England to assume his duties as Viceroy the requirements of Indian asylums were brought under his notice. He promised to look into the matter immediately on his arrival in India. Through a mutual friend Dr. McDowall was able to bring his presidential address under the notice of Lord Curzon. Whether owing to that fact or not, we now see the beginning of the reforms so urgently required.

The Summary Jurisdiction Act, 1899, effects several salutary changes in the law as to the treatment of juvenile offenders. By the first section of the Act the first schedule to the Summary Jurisdiction Act, 1879 (which sets forth the indictable offences which can be disposed of summarily under that Act), is extended by the inclusion of two additional offences: (1) obtaining money, & c., by false pretences (Larceny Act, 1861, sect. 16); (2) setting fire maliciously to any wood, heath, & c. (Malicious Damages Act, sect. 16). It will, therefore, now be competent for courts of summary jurisdiction to dispose, with the consent of the accused, of any charge against an adult of obtaining by false pretences, where the amount of the money obtained does not exceed 40s. Where the accused is an adult pleading guilty, or a young person who consents to be dealt with summarily, the court can deal with the case, whatever may be the amount of money, & c., obtained. In order to prevent any misunderstanding as to what is necessary to constitute “false pretences,” the Act provides that where a court of summary jurisdiction proposes to deal summarily with a charge of obtaining by false pretences, the court shall, after the charge has been reduced to writing and read to the person charged, “state in effect that a false pretence means a false representation by words, writing, or conduct that some fact exists or existed, and that a promise as to future conduct not intended to be kept is not by itself a false pretence, and may add any such further explanation as the court may deem suitable to the circumstances.” By the second section of the new Act, section 11 of the Summary Jurisdiction Act, 1879, which gives power to deal summarily with young persons by consent, is extended to all indictable offences other than homicide. Sir Matthew Ridley trusts that this provision will remove some of the difficulties felt by justices in dealing with youthful offenders. The number of such offenders committed for trial will no doubt be materially reduced; and whenever a boy under fourteen consents to be dealt with by a court of summary jurisdiction, and is convicted of any indictable offence (other than homicide), the court will now have the option of ordering a birching—a means of punishment hitherto available only in the case of larceny and certain other specified offences. Several juvenile offenders have, in London, already received practical object lessons on the new régime that has come into force.

It seems impossible to resist the conclusion, in view of the latest report of the Commissioners in Lunacy, that the burden of insanity in the United Kingdom is increasing out of all proportion to the increase of the population. When first the scare of increasing lunacy was raised it was met, as was natural and, in some sense, proper, by much expert and official incredulity. Cases were better classified than hitherto; chronic cases were counted again and again, and so on. These views were put forward not only with characteristic caution by such experts as the late Dr. Hack Tuke, but also in a special report issued by the Commission in Lunacy itself. The question arises, how is the difficulty to be coped with from the legal side? The main problem undoubtedly is how to get incipient cases of insanity brought under immediate care and control, and here two desiderata present themselves. In the first place, some means must be found of inducing patients and the friends of patients to invoke curative treatment in time. Cannot the principle of voluntary committal established by the inebriates be utilised? In the second place, cannot the medical profession have greater immunity from harassing legal proceedings guaranteed to it than even sect. 330 of the English Lunacy Act confers? If this latter problem cannot be solved, we shall have to face official certification.

It is a principle of English law, at least as old as the year 1799 (Merryweather v. Nixon, 8 Term. Rep. 186), that, upon grounds of public policy, one wrong-doer cannot have redress or contribution from another in respect of the joint wrongdoing. A Divisional Court have recently held in Burrows v. Rhodes (1899, 68 L.J.Q.B. 545), a case arising out of Dr. Jameson's raid, that this rule does not apply where an innocent person has, by the fraudulent misrepresentation of others, been induced to take part with them in the commission of a criminal offence which is merely malum quia prohibitum, and for which he has been neither tried nor convicted, and that probably the case would have been the same even if he had been so tried and convicted. In the course of an extremely able judgment in this case, Mr. Justice Kennedy raised an interesting point under the Lunacy Act, 1890. A person who receives two or more lunatics into his house, not being a registered house or licensed house or asylum, commits an indictable offence, even if he acts under a bonâ fide and reasonable belief that the persons so received are not lunatics at all (Queen v. Bishop, 1880, 5 Q.B.D. 259). Suppose that in such a case the belief had been induced by false and fraudulent representations on the part of the person bringing the patients, would he be liable to an action for damages at the instance of the proprietor of the house? Mr. Justice Kennedy thinks that this question should be answered in the affirmative. It certainly ought to be.

The recommendation of a coroner's jury that additional medical assistance should be given in these asylums is one that should command the immediate attention of the Government of South Australia.

The New York Herald (June 11th) devotes its front page to a report of the Pathological Institute, with head-lines on the “reversal of the treatment of the insane,” and the statement that “asylums may be totally abandoned.” The pictorial illustrations, including a portrait of Dr. Ira van Gieson, although large, are not as startling as the head-lines.