The first and one of the most important questions to be determined in dealing with the subject of insanity is the meaning which we ought to attach to the word insanity itself. The condition which the word is supposed to indicate has most important relations, both social and scientific. It is a frequent subject of popular discussion, and it forms an important element in many enquiries—philosophical, medical, and juridical. Speaking generally, it may be said that it invariably signifies a marked abnormality of mental condition. But it is frequently necessary that we should be able to form a much more precise idea of the degree as well as the kind of abnormality that it implies. And a very superficial examination is sufficient to show that the degree and the kind vary greatly, according to the point of view from which the subject is regarded.

Criminal Lunacy is a many-sided subject: but I have no intention here of entering upon it from any special standpoint, whether social, legal, or medico-psychological. I merely wish to recount, briefly and without detail, such general matters of interest connected with successive methods of dealing with criminal lunatics as can be linked together in the form of a historical sketch, which does not pretend to be a criticism.

It has long been well-known that the curability of cases of insanity diminishes rapidly as the duration of the disease increases. In this respect it follows a parallel course to all other diseases, and indeed to every other evil under the sun. I do not propose in any way to object to this fact, or to dispute the accepted measure of the relation between duration and curability. The object I have in view is to call attention to one or two very grave fallacies of almost equally wide acceptance in the supposed application of this well-known relation. One meets everywhere with the statement that a large proportion of the patients sent to our County Asylums suffer from mental disorder of considerable duration, say over twelvemonths—so far true—but it is added that these cases ought to have been sent to the asylums when recent, in which case a large proportion of them would have recovered, and the accumulation of chronic cases in asylums would be largely or completely checked. All this sounds very logical, but as I propose to show, it is quite untrue, and to those who are well acquainted with the fact, must be so obviously incorrect, that one is surprised to meet this statement in various forms in a very large proportion of the reports of Medical Superintendents of Asylums, in Medical Journals, and elsewhere; nor do I recollect seeing anywhere a hint as to the erroneous use of statistics on which it rests. I cannot, perhaps, give a better view of the remarkable and erroneous opinions to which this error leads than by giving in full a recent instance from a leading Medical Journal of the deductions drawn from it.

In this communication it is proposed—

(I.) To relate three cases of general paralysis in which localized copious perspiration affected one side only of the face and head, and to mention a fourth case in another insane patient.

(II.) Next to refer to some other cases of unilateral sweating mentioned by authors, but not occurring among the insane; and

(III.) Lastly, to speak of the pathology of this symptom. I. By reference to the subjoined notes, it will be seen that the unilateral perspiration of the face occurred under dissimilar conditions in the three cases of general paralysis; in one, without any local paralysis or convulsion, but associated with old-standing disorganisation of the eyeball of the same side; in another, occurring sometime after a peculiar change in the mental state, and at first with very slight and very transitory unilateral facial paralysis; while in the third the unilateral perversion of secretion accompanied unilateral convulsions and hemiplegia of the corresponding side. All these patients were soldiers.

The occurrence of transient hemiplegia is so unfrequent in nervous affections, and the pathological conditions causing the symptoms are so obscure and uncertain, that any additional information regarding the nature of the lesions in such cases is of importance, and so I venture to bring before the Society the following case:—

A. M., æt. 73. Widow. From Edinburgh. Was admited into the Royal Edinburgh Asylum on October 10th, 1873.

The urine of the insane has been hitherto comparatively seldom the subject of minute examination, because, independent of the numerous opposing difficulties, no special importance was attached to it. And yet, more exact observations of the quantity of urine secreted by this class of patients should claim our interest on several grounds. This subject, moreover, cannot be ignored if we desire to penetrate the darkness which surrounds, especially in the insane, the complicated processes of chemical change; for it is in them that such peculiar and obscure phenomena of vital chemistry and nutrition occur. We see how other internal maladies, injuries, and wounds, without any treatment, are cured surprisingly quickly; how the insane, independent of the amount of food consumed, often undergo in a very short time, an astonishing increase or decrease of weight, and endure total abstinence from food incomparably longer than other individuals. Cases in point are recorded, which almost exceed belief. Thus, Wigand (Ueber Wahnsinn. Kempten, 1839), relates the detailed history of a lunatic who ate nothing for 62 days, and died in the hospital at Kempten, on the 63rd of starvation. In Henke's Medical Jurisprudence there is a similar case, where death occurred on the 64th day under violent convulsions.