I have to thank the Council of the Society for their kindness in appointing a day for the discussion of the question which is the subject of the following paper. The paper has been written at the suggestion of my friends Dr. Clouston and Dr. John Macpherson; but it is right to say, as they have left me a free hand in dealing with the subject, that they are not to be held responsible for the opinions it contains.

“The wicked flea,”—Everybody knows the “wicked flea,” for it is no respecter of persons. It makes its home in the palace of the prince, the hovel of the savage, and the tent of the Arab. The devotions of many a worshipper are destroyed by the Pulex tabernaculi, or church flea, which makes up by its voracity on Sundays for enforced abstinence on other days of the week; and one of the wonders narrated by travellers is that on camping in the desert they have found this wicked little creature waiting for them, ready to bite, although apparently its progenitors from time immemorial could hardly have had an opportunity of gratifying their taste for blood. When in Rome one summer, fleas were abundant in the hotel where I was staying. I used to walk barefooted about my room every morning, and soon a prick on the instep would warn me that a flea was there. I looked down, saw a little black speck, put a wet finger upon it, and after a little rub would transfer it to a basin of water. The sensation of something solid between the finger and thumb and the transference of the black speck from my instep to the water convinced me of the presence of the flea, for I had the threefold evidence (1) of common sensation, (2) of sight, and (3) of muscular sense all combining to prove the actual existence of the flea. At other times during the day I had the evidence of sensation to indicate to me that fleas were again biting, and I felt quite convinced by sensation alone that such was the case, for although I could not corroborate the evidence of sensation either by sight or by muscular sense, yet it was not contradicted by these senses. But sometimes I have felt upon my hand a sensation exactly similar to the bite of a flea, and yet, as the hand has been on my writing-table within full vision, and no object whatever was to be seen on the hand, I have discarded the evidence of sensation in favour of that afforded by sight, and come to the conclusion that no flea either was or had been upon my hand. Had it not been for the sensation of sight, however, and had the hand been hidden from my view, I should have confidently believed that it had been bitten, trusting to the evidence of sensation, which, though unconfirmed by sight or muscular sense, was not contradicted by these senses.

Before giving a description of the particular methods of caring for the insane in use here, to which attention is to be drawn, I consider a statement of the general principles underlying these methods a necessary preliminary, in order to place the reader in touch, if not in sympathy, with my motives, and to enlighten him as to my objects.

A paper upon the subject of “Night Nursing and Supervision in Asylums,” by Dr. Middlemass and the writer, was read at the Annual Meeting of this Association in 1899, in which the practices pursued and the results obtained at the Sunderland Asylum during a period of four years were fully dealt with, and it was advocated—

Dr. Orr has shown you the normal cells of the posterior root ganglia and the changes which they undergo in general paralysis of the insane, and we have thought that it would be of some interest briefly to follow the subject a little further, and to see what is the modem view of the degenerative changes in the cells of the posterior root ganglia and in the nervefibres of the spinal cord in general paralysis and in tabes dorsalis.

The following case shows the necessity for reform in the legal procedure connected with the admission of private patients:—E. E. S—, a lady patient, was admitted on October 26th last, upon the order of a justice of the peace who had not seen her, and upon the medical certificate of her regular medical attendant, and the second certificate of a neighbouring practitioner. Within the statutory period after admission she signed a request to be seen and examined by a judicial authority, under 53 and 54 Vict., cap. 5, sec. 8 (2). On November 2nd I made a return to the Commissioners in Lunacy stating—“She was insane, suffering from melancholia; had a dejected appearance and nervous manner, with delusions of unworthiness; said ‘God would never forgive her her sins’; was agitated, restless, and dissatisfied,” etc. On November 5th she was seen and examined by a local county justice of the peace, who, in the face of these three certificates, and a note in the case book by Dr. Patterson, reported that he did not consider the patient insane. In consequence of this report she was removed by her brother on November 26th, the Commissioners in Lunacy, who apparently, under 53 and 54 Vict., cap. 5. sec. 8 (3), had no option in the matter, having requested him to take this step. I may add we considered her probably suicidal, and when she left I wrote her ordinary medical attendant advising him to watch her, and have her placed under fresh certificates, but she declined to see him again. On the night of December 9th (that is, less than fourteen days after leaving the asylum) E. E. S— committed suicide on the permanent way of the Great Northern Railway in North London. Thus a report by a young and inexperienced justice of the peace outweighs the opinions of two experts, the family medical attendant, who had watched the case for months, and a fourth medical man, who signed the second certificate on admission. Surely this life was sacrificed through a defect in lunacy law!

It is with great diffidence that I venture to address you to-day. I have not made any scientific discovery, and in my own opinion it is great presumption to open a discussion on a subject of which I am merely a student, and on which my studies have not yet enabled me to form definite theories.

Mr. B—, an accountant æt. 37, was admitted into this hospital on February 6th, 1900, suffering from epileptic mania. That there was insanity or other diseases of the nervous system in his family history was denied, but his brother was said to be very eccentric and to take too much to drink. There was also a suspicion that another brother died of some mental or nervous disease. The patient was married at 21, and his wife had had four children—no miscarriages; the eldest and third are alive and in good health, æt. respectively 16 and 12; the second died at ½ years and the fourth at four months, both in convulsions. He was always excitable and masterful, and latterly had been very quarrelsome; he had always been a sober, steady, hard-working man and a good and kind husband and father. He had built up a good business as an accountant and estate agent. He had had good bodily health generally until five years ago, when he had an ischio-rectal abscess followed by a fistula, which was cured by operation. When he was a boy a brick fell on his head and caused a contused wound, the scar of which is about one and a half inches long on the left side behind, and in which he often had a stabbing pain. He had his first fit when he was 22 years of age, and for some years had them every fourteen to twenty-one days. In a fit he usually turned round and fell down, was unconscious for about an hour, slept about ten minutes, and was then all right. Twelve years ago he was assaulted and knocked down. He was picked up insensible and bleeding from his mouth, nose, and ears; his eyes were “bloodshot” for some time afterwards; he was unconscious for three days, then resumed his business. Since this accident he suffered from very severe headaches, and the fits gradually grew longer in duration and more frequent, until at the time of his admission he had them daily, and sometimes several on one day. Often during the fits latterly he had passed water and occasionally faeces. He had left internal strabismus. There was no syphilis. This was the first attack of mania, and was of a week's duration. For the previous six or eight weeks he had been excited, quarrelsome, and extravagant, but had attended to his business. He had threatened suicide, and to kill his wife. On his admission he was in a state of epileptic mania, talked continuously, complained of everything, said his food was poisoned, accused his wife and daughter of immorality, and was very emotional. He said he had intense pain in his head and was sure there was something seriously wrong with it. The urine contained neither albumen nor sugar. The excitement passed off quickly and he was discharged recovered on the 21st. He had several epileptic attacks during his stay. He was admitted again on January 23rd, 1901, with very similar symptoms. During the time he was at home he had not been able to do much work. When the acute excitement passed off, which it did in a few days, it was found that he had loss of memory and was somewhat demented. In addition to the epileptic attacks, which were very frequent and in which he wetted himself, he had fits which simulated epileptic fits; he fell down carefully and did not wet himself. The delusions persisted, and he was always complaining. In April he said he was going blind, and on examination optic neuritis was discovered. The urine at this time had a specific gravity of 1022, no albumen, no sugar. The optic neuritis rapidly went on to atrophy, and by June he was quite blind. On the evening of July 20th he was heard snoring loudly, and was found unconscious, sitting in his chair. He could not be roused; the temperature was 102°. Next morning he had regained consciousness; the temperature was 102°, the pulse 100, full and bounding, and the skin bathed in perspiration. In the evening he was drowsy but could be roused, answered when spoken to, and put out his tongue when asked to do so. The temperature was 105.8°, the pulse rapid, and the perspiration still very profuse. About six o'clock next morning (July 22nd) he again became comatose, and remained so until he died at 8.15 a.m. A post-mortem examination was made next day by Mr. P. G. Mould. There appeared to be nothing abnormal about the skull, and there was no sign that it had been fractured. The brain weighed 69 ounces, and was sent to the Pathological Laboratory at the Owens College for examination.

This case, which was otherwise an ordinary one of tumour of the frontal lobes, presented as the most marked symptom persistent sleep.

The establishment of a psychiatric clinique in connection with the Edinburgh Royal Infirmary has been strongly recommended to the managers of that institution at a recent meeting of the Edinburgh Medico-Chirurgical Society. The meeting was a very representative one, the discussion being initiated by Sir John Sibbald, and the motion moved by Sir John Batty Tuke.

The contrast in the stated number of private patients in the three kingdoms has long been a striking one, and the causes of the difference are worthy of consideration by all who are interested in the treatment of the insane. Probably the same causes are at work in all parts, and we propose to leave Ireland out of the question and to seek out their true nature by a comparison of England and Scotland

One of the most important and valuable documents that has ever been issued in connection with the institutional treatment of insanity is the Report on the Dieting of Pauper Lunatics in Asylums and Lunatic Wards of Poor-houses in Scotland, by Dr. J. C. Dunlop. It is issued as a supplement to the forty-third Annual Report of the Scottish Commissioners.

“A Flaw in the English Lunacy Law,” to which Dr. Ernest White draws attention(1) is an example of the dangerous power given to the “judicial authority” under the existing Lunacy Act.

Czolgosz, the cacophonously-named murderer of President McKinley, is still the subject of discussion in the United States, the question having been raised whether he was not insane rather than a criminal.

The general index to the first twenty-three volumes of Brain, which has recently reached us, is a valuable addition to our reference shelf. It represents a very large amount of work, which only those who have undertaken similar work can fully appreciate.

Influenza has been more rife than usual this wintry spring, and although fortunately the mortality therefrom has not been very high, its baneful influence has been more widely spread than ever.