Two years ago, when the toxic theory of the causation of insanity was attracting attention in this country, I made a series of observations on the blood of acute recent cases of insanity with the object of ascertaining whether organisms were ever present. In no case, with the exception of one of general paralysis, did I ever find an organism in the blood. It occurred to me, however, that if I could make an aseptic necrotic area subcutaneously, the serum and pus in such an area would be a suitable nidus for the growth of organisms circulating in the blood, and that by aspirating the serum and pus and placing it in suitable nutrient media one should be able to grow such organisms, if present. Acting upon this theory, I took a case of acute mania—an adult woman—and, with antiseptic precautions, injected into the soft tissues of the flank 2 c.c. of turpentine.(1) An abscess formed, and on the third day after the injection I aspirated some fluid, consisting of blood-serum and pus. A couple of drops of this fluid were then added to each of four tubes containing 8 c.c. of sterile nutrient broth. These tubes were incubated for forty-eight hours, when they showed slight turbidity, and upon microscopical examination the broth was found to contain a pure growth of a small diplo-bacillus.

The case here dealt with is that of a man æt. 35, now a patient at Carmarthen Asylum, formerly a ferryman. He was admitted from prison, where he was undergoing a sentence of twelve calendar months with hard labour, having been convicted at the assizes of unlawfully attempting to have carnal knowledge of a girl under thirteen years. He was imprisoned on March 24th, 1902; the trial was on May 30th, and he was removed to the asylum on July 1st, symptoms of certifiable insanity having been first observed by the medical officer to the prison on June 26th. The total term of imprisonment was therefore rather over three months.

I have ventured to suggest that we should now consider what we are going to do about the classification of mental disorders. Lately, the Royal College of Physicians of London decided to revise the Nomenclature of Diseases, and publish another edition. The President of this College is on the Committee; as is also Dr. Savage, our colleague in London, who has taken much interest in this question. I was somewhat surprised the other day when I asked for a copy of the Nomenclature of Diseases in the Royal Medical Society of London, to find that they did not have a copy in their library—a book which is supposed to guide the profession in the statistical registration of diseases. In 1896, for the third edition, an attempt was made to reform the nomenclature of mental diseases, under the direction of Dr. Hack Tuke and Dr. Savage. In its present state it is still unsatisfactory. The classification with which we have to deal is as follows:—First, there is “idiocy (cretinism), and then mania (acute or chronic), delirious, hysterical, puerperal, epileptic, traumatic, syphilitic, gouty, from either acute or chronic disease, alcoholic, plumbic, or other poisons.” Acute is an absurd word, because we specially want to mark the duration. Acute should be rendered Recent. Then there is “melancholia (acute or chronic), delirious, hypochondriac, climacteric, puerperal, epileptic, syphilitic, acute, other diseases.” Then there is “dementia (primary or secondary), senile, climacteric, puerperal, epileptic, traumatic, syphilitic, acute, other diseases.” Then there is “mental stupor, anergic, delusional.” Then there is “general paralysis.” That is not a mental disease. Lastly, there is “delusional insanity.”

My paper to-day is the natural outcome of the address by Sir William Gowers upon “Sanity and Insanity, Lunacy and Law, the Views of a London Hospital Physician, particularly in regard to Private Patients,” given at our last general meeting in London. The discussion which followed was hardly worthy of the subject. Most of the earlier speakers, although eminent general physicians, had had little or no experience in the care and treatment of the insane; therefore, when the turn came for those practically acquainted with mental diseases to speak, the hour was advanced, the audience was weary, and an all too exacting brevity resulted.

It augurs well for the success of the action taken by the Conjoint Committee of the British Medical Association and this Association with regard to the amendment of the Lunacy Law, to enable cases of recent (incipient) insanity to be legally treated in private care, without being certified as lunatics, that the Lord Chancellor inserted into his proposed Lunacy Bill a clause to meet our requirements, in the very terms I advocated at the annual meeting of the British Medical Association in 1896.

The cases of clinical interest in our asylums must be very numerous, and there can be no doubt that much valuable information is buried in asylum case-books with little hope of ever reaching the notice either of the specialty or the profession.

The Derby meeting of the Association did not pass without reference to the unfortunate report of the Tuberculosis Committee. The President explained that the whole matter had been considered by the Council, that they had obtained the opinion of an expert of the highest eminence, and that it was desirable to proceed further in order to have the statistics corrected and published in this Journal. As we have previously indicated, the errors in these statistics do not vitiate the important conclusions set forth by the Committee. Of that the Council has been definitely assured; and, as Dr. Yellowlees remarked, it is the duty of the Council to protect the honour and dignity of the Association. The whole of the materials accumulated and dealt with by the Tuberculosis Committee in the production of their Report will be submitted to a searching expert inquiry, and the results will be made known. Nothing less could be regarded as satisfactory in the circumstances; the members of the Committee are just as desirous of having mistakes corrected as the Council or the Association at large. The Chairman of the Committee has taken a course which is absolutely unassailable; having consulted with the members of his Committee, he laid the matter before the Council and gave every possible assistance towards the amendment of the errors into which the Committee fell. We may therefore await with confidence the result of these deliberations.

The suffocation of fifty insane persons, as the result of a fire in an English asylum, constitutes a tragedy that might have been hoped to be impossible. Yet, despite the magnitude of the loss of life, there is much reason to be thankful that it was not greater.

The Annual Meeting of this Association was held at the house of Sir William Church, the President of the College of Physicians, who presided.