It was first demonstrated on a large scale, by what was observed in the “Insane Colony” at Gheel, in Belgium, which, some fifty years ago, began to attract the attention of those engaged in lunacy administration, that a large number of the insane may be suitably provided for in private dwellings. It is now more or less widely recognized that in many cases they can be provided for in this way better than in asylums; and as regards the insane poor that they can often be thus provided for in a way not only conducive to their own welfare, but also at less cost to the public. This fact has received its most complete and systematic recognition in the lunacy administration of Scotland. Practical effect has been given to this recognition in various ways both on the continent of Europe and in America. One of the most recent and important steps in this direction has been taken by the authorities of the great city of Berlin, and it is proposed to give an account of what has been done by the Berlin authorities in the following paper.

The following analyses were undertaken with the idea that the results obtained from them might throw some light on the cause of the seizures or fits that generally occur in the later stages of general paralysis.

The degenerative changes in the tissues of lunatics are more or less well known, at any rate the grosser or naked-eye lesions that are to be expected, but even amongst these there are some points that, I venture to think, may receive further attention. Of histological changes we can say more positively that much light may yet be thrown on their nature. As to their cause—the cause of the degeneration of nerve cells, for instance—we are lamentably ignorant.

One of the best and latest descriptions of the functions of the thyroid gland is that by Victor Horsley.∗ This paper furnishes an account of recent work on the subject, and so fully details the results arrived at by other workers that I use it as my chief reference throughout this paper.

Perhaps one of the most difficult investigations possible is the study of the mental characteristics of savage and semi-savage races, and, before formulating any theories regarding their psychic history, it is necessary that a careful study should be made of their mode of life, their normal mental state, and such folk lore as is accessible to us.

II. Criminal lunatics.—A brief note as to this class of patients will be of interest. Professor Meyer has very decided opinions as to their care and treatment. He fears that the practical outcome of advanced theories would be to change asylums into prisons—a change that would by no means possess the charm of novelty. According to some authorities the term “criminal lunatic” should be limited to such persons as were criminal before they became insane; others would include all insane persons who have committed an offence against the penal laws; some have even stretched the phrase to include all those whose mental condition would lead one to expect impulsive misdeeds, moral insanity, etc. The Academy of Medicine of Belgium gave an authoritative opinion on this subject in 1889. In answer to the inquiries of the Minister of Justice regarding criminal lunatics and criminal asylums, they resolved that these classes should be regarded as criminal, and should be relegated to a special institution— 1. Any insane person who has committed a criminal act. 2. Any criminal who has become insane after sentence. 3. Any insane person confined in an asylum who has committed or attempted a criminal act. In the special asylum, accommodation would be provided for all those insane persons presenting on examination homicidal irresistible and violent impulses, or similar evil habits.