I have no intention of tracing the history of tuberculosis in asylums through the official obscurity of the past fifty years. This point has already received careful investigation at the hands of Dr. Crookshank in the admirable essay he has recently published; nor are we here concerned with any comparison between the mortality from tubercle among asylum inmates and the mortality from tubercle among the general population, inasmuch as deductions drawn therefrom are liable, among other errors, to those fallacies which occur when two communities whose environment and susceptibility differ are compared as regards the mortality of any particular disease.

In the Revue Philosophique de la France, tome xlv, 1898, there are three articles filling eighty-seven pages on this subject, by Dr. G. Dumas. In order to appreciate their importance it may be well to give a short review of what was previously made known of the mental aberrations of that philosopher by his friend and biographer, M. Littré.

Considering the closeness of the ties which the existence of such bodies as the Medico-Psychological Association have created between alienists throughout the world, it is surprising that so little attention has been paid to the comparative side of the medical jurisprudence of insanity. In the spring of 1898 there was published in New York a treatise by Dr. Clevenger and Mr. Bowlby, an American barrister (Medical Jurisprudence of Insanity, or Forensic Psychiatry, 1898, Lawyers' Co-operating Publishing Company, 2 vols., pp. 1356), in which excellent work in this direction, so far as England and the United States are concerned, was done. The book is a monument of labour. Every conceivable branch of forensic medicine is discussed with learning and ability, and an admirable index, both of cases and of subjects, renders fairly accessible to the reader the otherwise bewildering mass of legal information which the editors have so industriously accumulated. It is not, however, specially of efforts of this kind that it is desired to speak in this paper. The problems of lunacy law and lunacy administration with which civilised countries have to deal are, to a great extent, similar. It would obviously be of immense international importance if the solutions attempted of these problems in different parts of the world and the results of such experiments were systematically chronicled from time to time, so as to give the lunacy authorities, lawyers, and experts of the chief countries of the globe the benefit of each other's experience. It may be of interest to select some instances of the manner in which different countries have dealt with questions that are constantly arising. Take first interdiction and curatory. The voluntary and judicial interdiction of Scots law is sufficiently familiar to alienists (for full information on the subject see Stair, i, 6, 37; iii, 8, 37; Bankt., i, 7, 118; Ersk., i, 7, 53; Bell, Com., 139, Prin., S. 2123; Fraser, P. and C., 554).

It is disappointing to anyone trained in modern clinical methods, and accustomed to hear alienists urge with so much insistence that insanity is a brain disease, to find so little apparent attention paid to what may be called the physical signs of insanity.

It would be quite impossible during the few minutes at my disposal to deal in an exhaustive manner with the numberless varieties of skin affections met with in asylum practice. I have therefore selected from an immense mass of material a few of the rarer affections, and shall deal with them in such a way as to call for your experiences and criticisms rather than make any personal attempt to lay down the law with regard to any of them.

The object of this paper is to briefly consider the various forms of insanity which are complicated by epilepsy, and for convenience we shall discuss them as they occur during infancy, puberty, adolescence, the climacteric, and the senile periods.

During the sixteen years I have been at York 206 cases of acute mania have been admitted, inclusive of 29 relapsed cases occurring in sixteen individuals. Of these 206 cases, 171 have recovered, 8 have died during the attack and because of the mania, and 3 have died during the attack from intercurrent bodily diseases, 12 have been discharged relieved to the care of friends, 7 were transferred to other asylums, and 5 remain under care.

The term hysteria among the ancient Greeks had reference to a disease primarily due to some abnormal state of the female generative organs. Even yet we assign a foremost place to the sexual elements in hysteria, but more as a symptom than as a cause of the disease. We find that the greater the number of cases we investigate the more we shall be impressed by the fact that a marked element of sexual perversion generally exists, at times so dominating the reasoning powers of the patient that he becomes firmly convinced that unless his sexual desire is indulged the community will suffer in some inexplicable manner. In a recent case I found this symptom strongly marked in connection with the habit of masturbation. As a rule the “delusional errors” of these patients are vague. They generally can be brought to admit that their ideas are erroneous; and their ability or otherwise to do this should, I think, bear much weight with regard to prognosis.

“The recovery of the curable, the improvement of the incurable, the comfort and happiness of all the patients, should steadily be kept in view by the architect from the moment in which he commences his plan.”—Conolly, Construction and Government of Lunatic Asylums, p. 1.

IN the present day the great increase in the number of certified lunatics has raised the question of asylum architecture to one of primary importance. New asylums are being built and planned in all parts of the country, and the managing authorities are keen to provide the best possible accommodation for the suffering ones under their care.