The discussion which I have been invited to open is on a subject which is new to all of us, and which may, therefore, simply on this account, claim a share of our attention. Indeed, on searching the works of Clouston, Blandford, Savage, and others, as well as the extensive periodical literature which is at our disposal in the “Journal of Mental Science,” the “West Riding Asylum Reports,” and similar publications in France and Germany, the subject of mental affections occurring subsequently to influenza has hardly been mentioned with a single word previous to the epidemics of that distemper which we have recently passed through. Nor is there anything to be found on this subject in the numerous books and papers descriptive of influenza which have appeared before 1890. All that has been written on mental disorders in connection with influenza previous to that date refers to the febrile or initial delirium which may occur at any time during the progress of the feverish attack, and may, indeed, precede all other symptoms, setting in sometimes before there is any rise of temperature. This initial delirium has been described as long ago as 1510 by Sauvages, and later on by Huxham, Ash, Haygarth, Gray, Smyth, Rush; more recently by Lombard, Bonnet, and Pétrequin, and during the last epidemics by Ewald,1 Joffroy,2 Gwynne,3 Creagh,4 Nicholson,5 Van Deventer,6 Mairet,7 and others. In the German Collective Investigation Report, edited by Leyden and Guttmann,8 no less than 276 such cases have been collated. It is, however, not this initial delirium which we have met here to consider to-day, but those better defined psychoses which are prone to occur after the feverish attack is over, during, or some time subsequently to convalescence.

The following notes on expression are supplementary to a paper on the same subject published in this Journal twelve months ago.

Under this heading I propose to make a few inquiries relative to the principal forms under which this disease shows itself, and more especially into the likelihood that it is undergoing some modifications under various influences. This latter possibility has impressed me for some time, and, on addressing several specialists on the subject, I find that no few share the same opinion. So far as the question of modified type is concerned, the difficulty which presents itself at the outset is that it is uncertain whether the older writers recognized general paralysis under the Protean aspects now known to us—supposing them to have existed—and it may be an error to assume that its now varied forms are extensions of, or deviations from, a more concise and specialized group of symptoms. If, on the other hand, we can rely upon the observations of those who have spent a considerable number of years in lunacy practice, and can at the same time by statistics indicate that noteworthy differences are becoming apparent between recent and former cases of general paralysis, some basis for belief in a variation of type may be assumed.

Is the beneficial effect often produced in a case of recent and acute insanity by local inflammation (cellulitis) mainly due to the local disturbance or to a general, systemic disturbance? This question appears to me to have more than a mere theoretical interest, for the following reason:—If the effect noted be due mainly to the local inflammation we may go on applying blisters and equivalent chemical irritants on a sufficiently large scale to the skins of patients; but if the result is to be ascribed solely or largely to the accompanying general disturbance, it will be advisable to consider whether such cannot be evoked with greater certainty and thoroughness than is possible with the means now employed. I much doubt whether local inflammation, the result of chemical irritation, can be compared, from the point of view of influence upon existing mental disorder, with cellulitis∗ of unknown origin, such as occurs in the insane. Upon this point it would be instructive to hear the opinions of experienced observers. No one probably will deny that a more profound general disturbance is associated with idiopathic cellulitis than with inflammation due to chemical irritation. If, then, cellulitis is capable of producing the more striking mental alteration, it seems legitimate to ascribe this to the more profound systemic disturbance referred to. The qualitative difference in the nature of the irritants in the two cases possibly entails some difference in the modes of local reaction; even if this be so one would still, I think, be justified in adhering to the conclusion reached, i.e., that the greater mental effect produced by cellulitis is due to the greater systemic disturbance.

The amount of land originally belonging to the Omagh Asylum amounted to fifty-two acres. This land surrounds the asylum, and is bounded partly by a wall and partly by a river.

In accordance with a resolution adopted by the Irish Branch of this Association in November, 1888, we are now assembled in a District Asylum, and this being our first provincial meeting I need hardly mention what a very great pleasure it affords me to offer a hearty welcome to the members who have been good enough to come to Mullingar to-day.

A discussion on the origin and nature of pachymeningitis hæmorrhagica at the present time is very desirable on account of the remarkable difference of opinion of those who have studied it. Two theories regarding its formation exist, and the best pathologists and neurologists have ranged themselves almost equally on either side. This fact of itself betokens that each view probably has some elements of truth in it, and that neither contains the whole truth. What, then, is greatly to be desired under these circumstances is a new theory that will combine the elements of truth contained in each of the old theories, and supply the deficiencies of both.

The specimen to be described was obtained at the post-mortem examination of a patient in the Northumberland County Asylum.

At the present time, when our fin de siècle knowledge of “general paralysis” enables us to recognize under that generic term many types of the disorder, and when the relation between it and syphilis continues a rather vexed question, little apology is needed for introducing to notice the following cases. They illustrate unmistakably some of the instances in which syphilis is solely responsible for what. Is termed by Dr. Savage” A process of degeneration which ultimately produces the ruin we recognize as general paralysis.”∗ Whatever may be hereafter formulated from the present evolutionary crisis in the history of the disorder there can be but little doubt that syphilis will be one of its most intimate and important relations. The story of its methods is briefly sketched in the following two short life-histories—in one asserting itself in the offspring of its victims by right of impure heredity, in the other carrying death direct into the vital centres by the force of its malignant virus.

The case which, by the kind permission of my chief, Dr. Conolly Norman, I am enabled to bring under your notice to-day, is one of acute insanity occurring in a male adolescent, and marked in its course by the somewhat unusual symptom of sexual perversion.

The subject who presented this anomaly of development of the scalp was M. B., aged 66, a peasant woman from the province of Comasca. Of medium height, regular conformation of body, dark complexion, irides dark chestnut, thick and black eyebrows, hair thick, strong, black, with only a few white ones, notwithstanding her advanced age. Her mother, a brother, and a sister have been insane. She suffered some years ago from puerperal mania, and was finally admitted to the asylum at Como labouring under simple lypemania, on 25th March, 1884. She died suddenly from syncope on the 27th of the same month. The autopsy revealed advanced fatty degeneration of the heart and liver.

Shakespeare so clearly held up the mirror to nature that every special student finds his specialty recognized by the great dramatist. We do not for a moment suppose that Shakespeare made a prolonged study of the insane or of the mental defects associated with senility, yet when he came to portray a weak-minded old man his observation in no way misled him, and we have in his Lear one of the most masterly descriptions of a demented king that any literature, whether special or general, can provide.

The facts of this remarkable and extremely narrow case, which was tried by Mr. Justice Gorell Barnes and a special jury, at the close of last year, are too fresh in the minds of our readers to require or to justify recapitulation at any length, and it may suffice to state that the point at issue was whether certain testamentary documents executed by a Chancery lunatic, Miss Ellen Roe, were or were not vitiated by the alleged mental unsoundness of the testatrix. The evidence was very evenly balanced. On the one hand, Miss Ellen Roe had been found lunatic by inquisition; no supersedeas had been obtained. The Lord Chancellor's visitors were of opinion that she did not possess testamentary capacity at the critical period; the deceased lady had proposed to bequeath her property to the Dean of Norwich, and to leave legacies to the Archbishop of Canterbury and the Lord Chancellor, and a strong effort was made to show that she was under the influence of an insane aversion towards her sisters, and that the case, therefore, came within the ratio decidendi of Dew v. Clark and similar authorities. On the other hand, it was contended, and evidence was adduced to prove, that the only form of insanity from which Miss Roe had ever suffered was temporary alcoholism, and that her aversion to her sisters was at first merely the indifference caused by long absence from home, and afterwards the dislike which the inmate of an asylum is apt to feel to the persons whom she supposes to have put her there. It was also proved that one of the Chancery Visitors had expressed an opinion that Miss Roe might be allowed to make a will—although, of course, without undertaking to say that it would be valid—and that the actual preparation and execution of the disputed instrument were preceded and accompanied by every possible precaution on the part of testatrix's solicitor. In the event the jury pronounced in favour of Miss Roe's testamentary capacity—a conclusion at which we might not perhaps have been able to arrive—but which it was perfectly possible for reasonable men to adopt under the circumstances, and the verdict was received in Court with the popular applause which the judicial obliteration of the stigma of insanity never fails to elicit. The course of this case was seriously impeded by the fact that all the reports of the Chancery Visitors with regard to Miss Roe were presumably destroyed at her death, and, at any rate, were not forthcoming for the purposes of the trial. We trust that Section 186 of the Lunacy Act, 1890, which renders this absurdity possible and lawful, will receive the early attention of the Legislature.

The case of Morley v. Loughnan is equally interesting to the student of human nature, the lawyer, and the psychologist. The details of the strange and painful story on which it turned are, no doubt, familiar to our readers, but a sketch of the salient features may not be inopportune. The late Mr. Henry Morley, from whom the defendant, Mr. W. H. Loughnan, a prominent member of the Close Sect of Plymouth Brethren, was alleged to have obtained sums of money, amounting to about £140,000, by undue influence, was an epileptic, possessed the exaggerated warmth of sentiment, the liability to alternate depression and elation, and the need for external guidance, which epileptics frequently display, and though not positively insane, passed at least the greater portion of his life on the borderland between the world of sane men and the realm of minds diseased. Conscious of the risks to which his son's mental condition exposed his substantial fortune, Mr. Morley's father had placed him under the friendly control of “companions;” and, when the narrative opens, this desirable appointment had just fallen to the lot of Mr. W. H. Loughnan. In the creed of the Close Sect of Plymouth Brethren the duties of entire dedication of property to religious purposes and sequestration from worldly society hold a cardinal place, and Mr. Loughnan laboured faithfully, and not without success, to imprint them upon the mind of his impressionable ward. At no time, however, was the balance between these great principles very accurately adjusted in Mr. Loughnan's teaching. At first the duty of dedication received excessive prominence, and Mr. Morley was dramatically asked whether the luxury with which he was surrounded was worthy of a disciple of Christ. Then the duty of sequestration became the lesson of the hour, and the imperative claims of dedication were somewhat feebly insisted on. At length Mr. Morley, after having written a letter of farewell to the world, went to live with his protector. Mr. Loughnan lent himself nobly to the task of making his self-invited guest's seclusion from temporalities complete, managing his business, conducting his correspondence, accepting large donations from his superabundant wealth, and drawing around him a close cordon of associations, corroborative of his own influence, from which Mr. Morley was only released by the hand of death. Then it appeared that Mr. Loughnan had benefited by his ward's weak generosity to the extent of £140,000, and the executors of the deceased gentleman properly subjected the nature of the relationship that had existed between Mr. Morley and his “companion” to the searching scrutiny of the Chancery Division. Into the miserable devices by which Mr. Loughnan endeavoured to resist first, the executor's claim, and, secondly, the exposure which its prosecution involved, we need not enter. Suffice it to say that Mr. Justice Wright, sitting as an additional judge of the Chancery Division, held that the gifts from Mr. Morley to the defendant were vitiated by the undue influence of the latter, and that the plaintiffs were entitled to receive the whole amount from him, and even from the innocent subdonees into whose hands part of the spoil had passed. We observe with surprise the statement in the pages of a legal contemporary that “this case presented no new legal difficulties.” The inaccuracy of this assertion is readily demonstrable. There are two classes of cases in which donations are set aside on the ground of undue influence; first, cases in which there is positive evidence that coercion has been brought to bear upon the donor; secondly, cases in which there existed a relation between the donor and the donee, capable of giving, and Calculated to give rise to undue influence, and the donee is unable to prove affirmatively that the donor had independent advice. Mr. Justice Wright held that in the case of Morley v. Loughnan there was positive proof of undue influence having been exercised. But his lordship was also prepared to hold, if necessary, that the relation between Mr. Morley and Loughnan was such a relation as brought the defendant within the second class of cases above referred to, and threw upon him the onus—which he had utterly failed to discharge—of vindicating the voluntary character of the gifts. This, if we mistake not, is a distinct advance upon previous decisions, and it will render the law of undue influence for the future much more difficult of evasion than it has been in the past.

In the year 1890 the late Dr. Henry Monro sketched the following suggestions for a petition to Parliament on the subject of habitual intemperance.

It has hitherto been the rule in this country that epileptics should qualify as lunatics before they could find a home. The usual charitable institutions were for the most part closed against them, and, save a few special hospitals, no other place of rest could be found for them. Those “subject to epileptic fits” are, by the rules of many homes, excluded from them. Want of employment and the consequent worries of poverty aggravate their malady, and the utter helplessness of their condition leads to despondency and hastens their descent towards dementia. According to Edith Sellers, in a paper in “The Medical Magazine” for February, who quotes the recently published statistics of the Charity Organization Society, there are nearly 78,000 epileptics in Great Britain, and 39,000 of these are still in the full possession of their reason. Now it is a fact that the condition of life most calculated to ward off epileptic attacks is that of healthy occupation, and, under ordinary circumstances, this is the most difficult to obtain. Thus the scheme so ably advocated at the Mansion House, at a meeting∗ presided over by the Lord Mayor, for the purpose of founding a home for those necessitous epileptics who are able and willing to work, meets an urgent and ever-growing want. The importance of such a scheme it would be difficult to over-estimate; it is a reasonable one, and it is based, to a great extent, upon the successful colony established at Bielefeld, in Westphalia. It is proposed to secure an estate of 100 acres within fifty miles of London, easy of access, where additional land may be procured when required, and to erect upon it appropriate buildings. Through the munificence of Mr. Passmore Edwards, the necessary funds for the purchase of the land and erection of the buildings are promised, and an encouraging amount of support from other quarters has been given.

During a holiday visit to the Auvergne last autumn we visited the quaint little town of Riom, which has, as we shall see, a certain interest for the alienist. It has always been a rival to the more flourishing city of Clermont Ferrand, and although it has had to give place to Clermont as capital of the district, it still retains the Courts of Appeal for the whole neighbourhood. By this means the town continues to hold its own and keeps some of its past importance, although at the present time it can only boast of a population of some ten thousand persons.

Any publication proceeding from the Physician of the Hartford Retreat, Connecticut, is certain to be welcomed by all who are acquainted with his conscientious work in the field of medical practice to which he has devoted his best energies for so many years.

This is a translation of Prof. Ziehen's “Leitfaden der Physiologischen Psychologie” (published in 1891), and we may say at once that to some extent it fills what is, or should have been, a long-felt want of the alienist. Unless we take into account Ladd's large and in many respects excellent work, there was no book in English which presented in a concise and handy form any statement of that general science of experimental psychology of which medical psychology is but a branch. Dr. Ziehen's book is well fitted to fill the void for two reasons—he is in sympathy with the English associational tendencies in psychology (in opposition to Wundt's doctrines), and he was moved to take up the general study of physiological psychology by the problems that came to him in the course of medico-psychological work. Although not appealing exclusively to the physician, this book is especially intended for (as the translators call him) the “psychiater.”

This is a large book, but it cannot be said that there is much unnecessary padding in it. From first to last it is filled with facts and observations drawn, not only from the stores of an erudition singularly rich with the ancient and modern science of many countries, but especially from the experiences of a clinical observer who has had ample opportunities of studying the physiology and pathology of emotional states.