Since experimental observation has established the fact that inflammation of the central nervous system is easily induced by infection of the ascending lymph stream of nerves, it would seem that the views regarding the ætiology of inflammatory lesions of the cerebro-spinal axis must undergo considerable revision, and that an insufficient degree of importance has so far been attributed to the rôle and wide-reaching results of lymphogenous infection. That the spinal cord and brain are exposed to infection along this path cannot be doubted. This view is based upon both clinical and experimental data; and its value in connection with the elucidation of the ætiology of some nervous lesions may now receive more recognition, seeing that the range of application of the hæmatogenous theory is becoming more limited. To take one example: acute anterior poliomyelitis is no longer regarded by neurologists as a hæmatogenous infection of the spinal cord, with a special selectivity for the motor nuclei. Recent work shows conclusively that the inflammatory phenomena can only be the result of a lymphogenous infection.

A considerable number of men are received annually into Brixton prison remanded, or committed for trial, on a charge of attempted suicide. They are all specially examined as to their mental condition, and a large number of them are remanded for that purpose. From the plentiful clinical material thus studied these remarks were prepared whilst I was on the medical staff of that prison, and I have to thank the Prison Commissioners for their permission to publish them.

At the present time when the Mental Deficiency Bill is before Parliament a discussion on the above subject may be of some interest to the readers of the Journal of Mental Science.

In dealing with any subject in connection with the burning question of the care and control of the feeble-minded, some reference will be expected to the second Mental Deficiency Bill recently introduced into the House of Commons by the Home Secretary. For the purposes of this paper it is unnecessary to do more than quote the Clause, which defines the classes of persons who are mentally defective and deemed to be defectives within the meaning of the Act. Taken all round, it is a much better Bill than its predecessor of last year, but it should be noted that in the present measure no allusion is made to the undesirability of procreation of children by defectives, or to any intention to penalise persons wittingly bringing about a marriage between defectives. These proposals, which were likely to arouse uncompromising disapproval, may be the less regretted, as their inclusion might doubtless have been instrumental in the blocking of the Bill as a whole. Their effacement, it is hoped, may do away with the opposition which is at present invariably evoked by any attempt to infringe upon the so-called liberty of the subject, and may also give opportunity for educating public opinon, so that in time it may be clear to all that the prevention of amentia can only be attained by life segregation on the one hand, and by the prohibition of marriage on the other. The promoters of the Bill have gone as far as they possibly could in the face of uneducated public opinion, and those of us who were present at the discussion of last year's measure in Standing Committee cannot but admire the courage and resourcefulness of Mr. McKenna in presenting the new Bill after the repeated discouragement which he had to face in connection with his first effort last year.

The object of this short paper is to direct attention to certain clinical cases illustrating the effect of physical illness on the mental state in insanity, and to discuss some points in connection therewith.

When I was invited, during my last summer holiday, to read a paper on this subject, I agreed with a light heart; but on more mature reflection the glow of satisfaction at being so honoured has paled before the spectre of responsibility in addressing a body of experts on a subject peculiarly their own and remote from the paths of my usual work. I can only ask your indulgence, and—negative though most of the conclusions are—hope that they may suggest certain points in the treatment, and especially in the pathology of these conditions.

If, in this the ninth annual letter of your correspondent to the Journal, he should leave out the usual introductory plaint as to the impossibility of crowding the important psychiatric news of the year, even in shortest form, into the allotted space, the patient reader—if there be such—might welcome the change of style. Some vindication, however, is due the writer if he seems to supply a parcel of fragments rather than a true epitome.

Two Bills presented to the Chambre des Députés, recognising insanity as a ground for divorce, have not yet been debated. According to the motion of M. Maurice Violette, detention in an asylum during three consecutive years is necessary, and the applicant must submit, with an interval of one year, three requests for the nomination of two physicians for the purpose of examining the patient and attesting incurability. The writ has to quote the three reports, and divorce cannot be granted unless the signers unanimously certify that such insane person no longer presents any prospect of recovery. The Bill of M. Maurice Colin requires also as an indispensable condition a detention of three consecutive years in an asylum and a certificate of incurability; but even subsequently to the divorce, the successful applicant remains responsible for the maintenance of the lunatic. M. Maurice Colin gives as a characteristic mark of incurable insanity the disappearance, without any possible return, of intellectual and moral personality. But he repels the plea for divorce when this condition is a consequence of senility.

F. Siemens (Lauenburg in Pomerania), at the annual meeting of the German Society for Psychiatry at Kiel, in May, 1912, made the proposition, which received unanimous support, that the Empire might be called on to establish a biological institution for the investigation of the physical basis of mental diseases. He said that the building of expensive establishments and the discovery of new methods of accommodation cannot in the long run satisfy either physician or people. Neither was it of any value to continue the diligent grouping of mental symptoms into types according to the fancy of the alienist. There were only two kinds of symptoms in mental disease: (a) The elementary, caused by physical disease such as anxiety, hallucinations, emotionalism, stupor, catatonia, and delirium; (b) symptoms of a purely mental kind, arising out of the misinterpretation of those elementary derangements by the psyche. The study of the action of the internal secretion of glands encouraged the hope that in the investigation of mental diseases much also will be gained by this means. The individual provincial asylums were not in a position to accomplish the task of so comprehensive an inquiry, nor were the individual clinics at the universities, but the Empire must establish an institution on a large scale for this purpose.