Argyll and Bute (1889-90).—As the result of the discharge of all out-county private and pauper patients, it has been necessary to increase the weekly charge from 8s. to 9s.

The use of cocaine is so widespread that a few words of caution against its indiscriminate employment may not be superfluous. From time to time cases in which alarming symptoms have followed the use of cocaine are noted, but they do not attract much attention. Dr. Edmund Falk, of Berlin, is the more to be thanked for having collected and tabulated 176 cases of poisoning by therapeutic doses of cocaine. The dose employed, with its method of employment, and the results following the use, are carefully set down. Dr. Falk excludes from his table not a few cases of syncope which have been set down to cocaine, but which he considers may be referred to the operation itself. He is also of opinion that a majority of cases have not been published, and further that a large number of cases of insanity are to be found in the asylums, which have arisen from the prolonged use of cocaine. The 176 cases which he has tabulated will, therefore, fall very short of representing the real toxic dangers of cocaine. Ten fatal cases are to be found in the list. Two of these fatal cases followed the use of a four per cent, solution of cocaine applied to larynx or pharynx. One case followed the injection of 0·06 gramme (10 grain) beneath the mucous membrane of the gums; another, the subcutaneous injection of a little over three grains. The smallest dose causing death was 0·6 grain (0·04 gramme) injected subconjunctivally. Short of death, very alarming symptoms are frequently noted, such as pallor, cyanosis, vertigo, fainting, collapse, unconsciousness, more or less prolonged, delirium, hallucinations, diminished general and special sensibility, impairment of vision, deafness, etc., etc.

The chief feature in the psychological literature of Italy since my last report has been the multiplication of periodicals devoted to it. Thus we have received copies of the following new journals:—“The Annali di Freniatria,” of Turin; “Il Manicomio,” of Nocera Inferiore; “Il Pisani,” of Palermo; and “L'Anomalo,” a “Gazzettino,” published at Naples. On the other hand, I regret to say that no copies have been sent since 1888 of Lombroso's always interesting, if sometimes paradoxical, “Archivio di Psichiatria ed Antropologia Criminale.”To some extent these periodicals may be considered as equivalent to our Asylum Reports; and they doubtless show the great activity and zeal with which our specialty is studied in Italy. But from another point of view they seem to me no unmixed advantage. Each periodical is starved by the scattering of so much ability, which was formerly concentrated in fewer journals; and the space left vacant has been, to a great extent; occupied by matters of local, temporary, or secondary interest. When allowance is made for this, Italian psychological literature will be found quite equal to the high level it has attained in former years.

The asylums of the State are divided into the public, the quasi-public, and the private. Exclusive of idiots and feeble-minded women, the number of insane under custody on the 1st of October, 1889, was 15,507. The Commission consists of three members, a physician, a barrister, and “a citizen of reputable character.” The medical and legal commissioners are required to make 132 visits each year; the medical commissioner is expected to make 22; and the whole Commission, or a majority thereof, have to make 106, being a total of 260 visits to the various State institutions during the year. Literal compliance with the requirements of the Act of 1889 is physically impossible, and the Commissioners detail certain arrangements which will facilitate the performance of their duties. The systems of accounts and statistics in vogue at the several State asylums show a lack of uniformity, and the Commission believes that these systems can be unified; to this end they have suggested a conference of asylum managers and superintendents with itself. The first effort towards intervention by the State in the case of the insane was made by Governor Throop, in January, 1830, but it was not until January 16th, 1843, that the New York State Lunatic Asylum was opened. In the course of a few years the asylum was filled, and it became necessary to send back to the poorhouses those patients who had received what was supposed to be the limit of beneficial treatment. Their treatment in these poorhouses was so bad that the Legislature passed what is known as the “Willard Asylum Act,” which provided for a State Asylum for the chronic insane. The Willard. Asylum was opened on October 13th, 1869, but soon became overcrowded. At this time the debt incurred by the State in aiding the prosecution of the civil war was most grievously felt, and in 1871 the Legislature passed an Act, by which counties might, upon showing that they had made proper provisions, care for their chronic patients. On October 1st, 1889, there were 5,371 patients in the county poorhouses and State asylums for the chronic insane. The Commission inquired into the two systems of care and treatment—the one conducted by the States and the other by the counties—and found that the latter did not provide the facilities which one would expect to find in every well-managed custodial institution or in any ordinary hospital. Some illustrations of evils inherent in the system of county care of insane patients in county alms-houses arc related, and the Commission concludes that the system “in practical operation has been found to have failed and fallen short of the hope entertained for it when the Act of 1871, sanctioning its trial, was passed.” The Commission makes many recommendations, of which the most important are: (1) that all of the insane in the county poorhouses in all the counties of the State, except New York and Kings, be transferred at the earliest possible date to State asylums; (2) that all laws having for their object the division of the insane into the so-called classes “acute” and “chronic” be repealed, and that all the insane be treated solely with reference to their curability; and (3) that an asylum be provided for the helpless and unteachable idiots.