Mr. Presidentand Gentlemen,–Inthe annual report of the resident physician of Bethlehem for 1864 the following observations on the comparative statistics of Bethlehem Hospital and the English County Asylums occur:–The attention of the Governors and of all those interested in obtaining accurate information on the important question of the cure of the insane is earnestly requested to the following statistics collected by Mr. James Ellis, Medical Superintendent at St. Luke's Hospital, from the admissions into forty-four public asylums in the united kingdom, and from actual returns from each asylum. It shows the total number of patients received into each institution, and distinguishes those which would be from those which would not be admitted into Bethlehem Hospital. It also shows the numbers and per centage of the cures and deaths of such admissible patients during the first year of residence. [Here follows Mr. Ellis's table.]

The prognosis in mental disease involves two separate questions. In the first place, does the existing disease endanger life? And in the second place, if life be continued, whether, and to what extent, may recovery from the mental derangement be hoped for?

The present seems to be a favorable moment for directing the attention of the profession to the condition of those insane paupers who are confined in workhouses. A general disposition to criticise the management of these establishments exists in the public mind, and the profession has given unequivocal evidence that it shares in this feeling and is determined to carry out the inquiry thoroughly. If may be safely affirmed that, if this is to be done, there is no part of the subject which demands earlier attention than the condition of those workhouse-inmates who are insane; for the circumstances which call so loudly for reform in the management of “indoor” paupers, especially those who are sick, exist in an extreme degree in the instance of the insane. The upshot of all careful inquiries into these matters, and notably of that inquiry now proceeding in the columns of ‘The Lancet’, is to make prominent the fact that those workhouses which are situated in populous cities are rapidly becoming great hospitals, instead of refuges for tired or lazy vagrants: while, as yet, the guardians who manage them cannot (or will not) understand that this is the case, but persist in treating the inmates as much as possible on the old system, by which the workhouse was a penal residence intended to disgust and repress the applicants for public relief. Under such a régime it has been shown that numbers of acutely sick persons suffer great hardship and have their chances of recovering health and strength materially interfered with; while as for the patients suffering from chronic disease and debility, it can hardly be said that they receive any proper care at all; and it is my purpose in the present paper to show particularly that the insane are the most deeply injured of all classes of indoor paupers by the system usually followed.

“On en est même vena aujourd'hui admettre que tons les épileptiques, sans exception, presentent, à certain degré, des perturbations de l'intelligence ou da caractère, et qu'aucun d'eux ne peut être considéré comme absolument sain d'esprit, [p. 661.] ∗ ∗ Cependant tous les auteurs sont d'accord pour reconnaître que la plupart des épileptiqnes présentent, à divers degrés, des troubles de I'intelligence et du caractère dans le cours habituel de leur existence, en dehors de leurs attaques convulsives.”–“De l'Etat Mental des Epileptiques,” par le Dr. Jules Fahret; ‘Archives Générales de Médecine,’ t. ii, 1860, p. 668.