“Il n'y a point de parité entre la responsabilité d'un médecin et son pouvoir; l'une est grande et l'autre petit, et c'est justement à cause des limites oò ce pouvoir est resserré que, bien qu'il soit facile d' en laisser perdre une parcelle, la moindre parcelle perdue cause une poignante anxiété.”

While the condition of the blood vessels in General Paralysis has been a subject of discussion by many observers, and the state of the pulse, including sphygmographic tracings, has engaged the attention of Thompson and others, I have been unable, in the literature to which I have had access, to find reference to any observations on the state of the blood in this disease.

The question of the relation between Uterine Disease and Insanity is one which, though at different times it has attracted much attention, is yet very far from being thoroughly elucidated. On the one hand the subject is mixed up with so-called “Hysterical Insanity,” and on the other with “Amenorrhœal Insanity,” concerning the former of which it may be said that but little evidence has been advanced to prove its dependence upon distinct physical disease in the internal organs of reproduction; and, as regards the latter, it needs but little observation in an asylum to show that in the majority of cases in which Amenorrhœa is associated with insanity, the suppression of the menses is merely a symptom, and in no sense the cause of the disease.

At the last moment I have been asked to fill up a gap in the programme of to-day, and if my paper be short and uninteresting, I must crave your indulgence.

My object in this paper is to elicit the opinions of asylum superintendents in regard to the use of some form of alcohol in the ordinary dietary of institutions for the insane, and to state at the same time what I already know in respect to this question, thanks to the very general replies I have received from medical superintendents to a troublesome circular which I recently issued. It was not without much hesitation that I sent round these queries, well aware as I am of the multitudinous duties already devolving upon the heads of asylums; but the importance of the subject induced me to overcome this reluctance, and I take the earliest opportunity of expressing my appreciation of the kindness of those gentlemen who have taken the trouble to fill up the circular. As to those who have not done so, I readily take the will for the deed.

Annie P., æt. 35 years, had been an inmate of Rainhill Asylum for 12 years. She was subject to attacks of recurrent mania, in the intervals between which she would be quiet, orderly, and rational; the attacks usually lasted some months, and were attended with great restlessness and loquacity, but not with much incoherence. She was at these times very mischievous and destructive, and was indeed a very troublesome patient — generally appearing to have a very good notion of what she was about, and seeming to commit many of her destructive acts on purpose to give trouble, though this apparent capacity for self-restraint was doubtless illusory. In April, 1883, she had been for upwards of 18 months in a maniacal condition, which attack had thus been not only unusually prolonged, but had also been in some respects exceptionally severe. On May 1st following she did not appear very well, but exhibited at that time no special symptoms beyond a little mental dulness and some delay in responding to questions. These symptoms gradually increased, and though there were no physical signs of disease, patient called out at times when moved; she took her food fairly well, but had to be fed, and her bowels were freely relieved after medicine. At 2.15 p.m., on the 5th inst., a great change was observed in her; her face was noted to be livid, conjunctivae insensitive to touch, pupils much dilated, being each about 6 mm., and did not respond to light; respirations slow; pulse 80, full; temp. about 95° (the index did not rise at all, and the thermometer did not register lower); limbs flaccid; plantar reflex, very slightly marked, as also were the knee jerks. She was, in fact, deeply comatose, and presented all the symptoms of cerebral hæmorrhage, a diagnosis of which was, with some confidence, made. Two drops of croton oil were given, and an enema, but neither had any effect. At 5 p.m., in addition to deepening coma, there was distinct drawing of the angle of the mouth to left. The eyes were directed straight forwards, or with a very, slight external deviation in each. At 10 p.m. every muscle in the extremities appeared absolutely flaccid, and the reflexes were completely abolished. Pupils as before. Respirations irregular, with mucous rattling in throat. Pulse 110, bounding. Temp, about 95° (the index, as before, would not rise at all). 11.45 p.m., died.

The rarity of cases of Addison's Disease, and the want of accurate knowledge alike of the clinical features and of the pathology, justify the record of the following case.

This report, which is no less voluminous than its immediate predecessors, contains a large amount of interesting and valuable material.