The perusal of Dr. Savage's most interesting article in the July number of this Journal has suggested to me, as no doubt to all who read it, some important reflections. If I venture to submit my own thoughts on the subject, it is mainly in the hope that their consideration may lessen the “abstract metaphysical difficulty” (to which our President confessed in his address) “of conceiving moral as distinct from intellectual insanity.” I may say at once, that I believe the difficulty chiefly arises from our disregarding the number and complexity of the mental processes involved in even the simplest moral acts. Let it be remembered that all recent physiological psychology has gone to show how numerous, almost beyond belief, are the factors of even the most rudimentary perception. The ground, indeed, seems almost to fail from under one's feet when one realizes how such an apparently elementary act has been shown to be the sum of numerous observations and differences, of which many are, perhaps, unsuspected, and all are unknown to our direct consciousness.

6. In 1630 Alexander Hamilton confessed to having met the devil in the likeness of a black man riding on a black horse. He renounced his baptism, and engaged to become the devil's servant, on receipt of four shillings sterling. The devil instructed him how to be revenged of his enemies, and further gave him a spell by which he hilled the Lady Ormestone and her daughter in revenge of the lady's having refused him the loan of a mare, and having called him nicknames. Lastly, he declared he had many meetings with the devil, from whom he once got a severe drubbing for not keeping an appointment.

In attempting a description of the School System as carried out in this institution, I am undertaking a task the accomplishment of which I feel at the outset must be very imperfect indeed; but considering how often I have had to answer such questions as the following—“What is the use of a school for lunatics?” “What can you possibly teach them?” I think it is due to my position to describe as well as my abilities permit our system, inviting at the same time all interested in the welfare of the insane to come and see for themselves its beneficial influences.

In the next place we arrive at the consideration of—

B. The supposed cortical auditory centre. (First temporesphenoidal convolution.)

I wish in the first instance to lay clearly down what are the objects to be attained in regard to alleged insanity in criminal cases; in the second place I shall speak of what is the course pursued in England to reach those ends, and point out its inadequacy and inconvenience; and, thirdly, I shall suggest certain modifications, or rather radical changes in our present system, which I submit will act beneficially in securing the objects I lay down as those we ought to have in view. I am not, of course, speaking here of the duties of the Expert; his rôle is much more limited in its range; but I am placing myself in the position of one who heartily desires to answer the question: Can the present method of ascertaining Criminal Responsibility in our Courts of Law be improved ?

J. C., a mason's wife, æt. 26. First admitted to the Montrose Asylum 6th March, 1855, labouring under acute mania. No special cause alleged, except a feeble constitution inherited from a mother mentally and physically weak. Had been ill for some days before admission. Imagined that God ordered her to mutilate herself. Attempted to pull out her tongue, and on being restrained, she pushed it out of her mouth, and suddenly clenching her teeth, bit a large portion off.

The following two cases of so-called “Rheumatic Insanity” have recently been under observation in Rainhill Asylum, and I am indebted to Dr. Rogers, under whose care the patients were, for permission to publish an account of them.

The high place assigned by Dr. Ringer to atropine as a sedative and hypnotic has lately suggested to me to try it in the cases which are so much relieved by hyoscyamine. My experience has so far been too limited to pronounce definitely on its value; but it may be sufficient to induce other observers with more ample opportunities to give it a trial, and come to some definite conclusion as to its value. I have given it only in three cases: two of chronic mania with considerable violence and destructiveness, and the third of chronic insanity, characterised by vivid terrifying auditory hallucinations, which caused constant screaming and excitement. All three had been previously treated with hyoscyamine, and with the result of greatly quieting them. Two have now been taking the atropine for three months, and one for two months, in doses I shall presently mention, with occasional intermissions to test the action of the remedy. Comparing its action with hyoscyamine, it seems to me that it is less powerful than that alkaloid. The patients are less completely subdued and helpless: there are occasional outbursts of violence and excitement, though by no means so great as when atropine is not taken. Its effects seem to pass off more quickly, so that it needs to be given two or three times in the twenty-four hours. On the other hand, the patients are decidedly in a more natural and healthy condition; there is less stupor, oppression, and heaviness than under hyoscyamine. The pupils need generally not be dilated, but there is often much dryness of throat before the dose is reached, which quiets the patient. I ordered a solution of atropine in glycerine, of the strength of the liquor atropiæ P.B., on account of the risks from evaporation of the officinal preparation. I began with m. ij of this in each case, and have now pushed it in two cases to m x, and in the third to m vj twice a day. One case I treated for a while with belladonna, giving 3j of the tincture; but the atropine seems more uniform and convenient, especially as it can be administered without the patient's knowledge if necessary. I may remark that hyoscyamine is about fifteen times the price of atropine, which would be a matter of some importance in a large practice, if the action of the two drugs is not very different. I regret that I have had no acute case in which the alkaloid might be suitably tried since its use occurred to me. It might be worth trying whether the persistent use of atropine in full doses might not be useful as a curative agent in chronic mania, as it has sometimes been found to cure that cognate neurosis, exophthalmic goitre.

Although Hyoscyamine in some shape or other has been used now for some time, but little is known of its chemical constitution, and one is, therefore, glad to notice that at the Pharmaceutical Conference, held in London, in August, 1881, a communication was read from E. Merck, of Darmstadt, the now famous producer of this drug, on the “Present State of our Knowledge of the Proximate Constituents of Henbane.”

The persistence of auditory hallucinations is generally admitted to be good evidence of an incurable condition among the insane, and I, therefore, think it may be worth putting on record the following case, in which such symptoms were followed by recovery:—

A married woman, æt. 33, was admitted into the Cambs. Asylum in May, 1874, in a state of acute mania. She was raving, violent, and destructive. She was treated with bromide of potassium, digitalis, chloral, &c., for two months, but got no better. She got better at times, but in December was reported as full of mischief, dirty and untidy, and does a little scrubbing at times.

Localized destructive lesions of cerebrum, basal ganglia, pons, and cerebellum, and secondary descending disease; also cornual atrophy.

Speaking generally, the permanency of the subordinate staff may be taken as an indication of the efficient administration of an asylum. Few things can be worse for the patients, and more demoralising to the discipline, than frequent changes amongst the attendants and nurses. Some such idea must have been in the minds of the English Commissioners during their recent inspections, as they have generally reported on the condition of the staff, stating how many attendants and nurses had seen less than a year's service. For facility of comparison we subjoin a list giving (when possible), 1, the name of the asylum; 2, the total number of attendants and nurses; 3, the number who have not been a year in the service. The Scotch Commissioners do the same thing in a better way. At each visit they note the numbers who have left in the interval and the reason, e.g., voluntary resignation, discharge for drunkenness.