In the article on General Paralysis in the “Nouveau Dictionnaire de Médicine et de Chirurgie Pratiques “(vol. xvi, p. 89., 1878), I thought I had settled the differential diagnosis of this affection when I said:—

“Multiple tumours of the brain, especially those of a syphilitic character, may be accompanied by motor and mental symptoms identical with those of general paralysis. More than once we have observed cases of this kind, and we believe that some do occur in which the differential diagnosis is impossible, except, perhaps, by means of the history. The autopsy alone discloses the error which has existed during the whole duration of the affection.”

The principal arguments that may be brought forward against my proposal are—1st, that it is impracticable and inadvisable, as suggested by Dr. Conolly; and 2nd, that it would entail a considerable increase of expenditure.

In following up Dr. Manning's paper in the July number of this journal with these fugitive notes of a series of very pleasant and instructive visits, I would premise that the changes of three years have taken place since it was my fortune to spend a season in Australia—that most hospitable of countries. Victoria has lost Dr. Robertson, and Queensland Dr. Jaap—gaps not readily filled up in a remote and little-known service. Administrative changes in the progressive spirit of the Australian commonwealth have swept away faulty arrangements, but the struggle for improvement remains in able hands and with stout hearts.

In the course of my asylum experience, this is the best example of the disease I ever met with, and I am therefore tempted to place it on record.

Having met from time to time with cases of brain-fag, and also actual insanity, arising from excessive mental work, I wish to direct attention to-day to this cause of disordered mind, not because it is so wide-spread a cause as many others, but because for this very reason it is in danger of being treated with indifference, whereas at the present moment I regard it as a serious evil, although comparatively restricted in its operation in consequence of the great mass of the people falling under opposite influences; still I fear that it is in schools and colleges as well as in the cottage of the labourer and manufacturer, among students as well as among those who delve and spin, that we must seek for the causes of mental disturbance if we wish to understand them thoroughly.

Case IV.—History of Syphilis: namely, venereal sore; sore throat; and subsequent general “rheumatic” pain. Later on, melancholia and suicidal propensity. Severe and prolonged cranial, and mainly nocturnal pain, with local tenderness, relieved by specific treatment. Hepatic disease; incipient pulmonary phthisis. Recovery.

In this short paper I have no idea of adding one to the already too numerous class-names of insanity, but I am anxious that asylum physicians should have their attention called to a clinical type of disease which may exhibit mental symptoms, and may thus add to the small store of useful knowledge of the subject.

One of the most interesting discoveries of recent times in the department of Neuropathology is indisputably Metalloscopy, of which, as is known, Burq† is the real founder. But Burq did not possess the needful scientific authority, and immediately on its first timid appearance, in 1851, Metalloscopy was banished to the region of the impossible and of fancy by scepticism on à priori grounds, and, hardly born, disappeared into complete oblivion after a very ephemeral existence. And thus it remained, till at length, two years ago, Charcot, the great French neuropathologist, resumed Burq's researches, and not only confirmed them, but gave them an important extension. The twice-repeated reports† to a commission appointed by the Société de Biologie, as well as the numerous publications of Charcot, Vigouroux, and Landolt on this topic, are already become the common property of the medical public.

This case which is an interesting contribution to the study of the psycho-motor centres is an example of an old encapsuled nodule in the left hemisphere, resulting from a lesion in childhood, which destroyed the superior parietal convolution, and produced atrophy of the superior portion of the postcentral and para-central convolutions. The right leg was paralysed, but regained its function to a certain extent, while the right arm became completely useless. The paralysed extremities atrophied. There was atrophy of the right lateral and of the left anterior columns of the spinal cord. Descending degeneration of the pyramidal tracts.

It is astonishing how a medical case, simple in its character, obvious in its nature, and of which the diagnosis does not present serious difficulty to a mental physician, may become lost in a fog, and obscured by a number of irrelevant questions, when it comes into a Court of Law. Conflicting interests, the contention of lawyers, the technicalities which bar the admission of this or that particular fact in evidence, which is important in a scientific investigation—in which truth alone is the object of the inquirer—the mass of details which are crowded into the case, the probable ignorance and obtuseness of some of those who have to form a judgment; the necessarily imperfect medical knowledge of counsel, and also of the Judge himself; the prejudice of the public in regard to asylums for the insane—all these circumstances combine to prevent a dispassionate and scientific inquiry into a case of alleged lunacy. Under such circumstances, the wonder perhaps is not that juries often blunder on questions of lunacy, but that they manage, as often as they do, to blunder on the right side. So has it been in the action of Nowell v. Williams—in which the plaintiff sought to recover damages for false imprisonment on the ground that he had been confined in Northumberland House, he being at the time sane. He was in medical practice in Cornwall Road, London. He passed the College of Surgeons and the Hall in 1860–61, and became L.R.C.P. (Edin.) in 1865. His age is 43.

In the April number we criticised the psychological side of Dr. Maudsley's work in this volume from the point of view of a merely idealist, or, as he would call it, “metaphysical” theory of knowledge.

The last class includes the so-called “general paralysis without mental symptoms.”

The Annual Reports of the Commissioners in Lunacy possess a special interest to those who are engaged in the care and treatment of the insane, taking, as they do, a comprehensive survey of facts which can ordinarily be viewed only from a limited standpoint; and they have a general interest for the public, because these facts bear a distinct and an intimate relation to questions which materially affect the wellbeing and progress of society. At no period has this been more the case than at the close of a year, which has been marked by a concentration of public attention upon the seclusion and treatment of insane persons such as has not occurred since the passing of the Lunacy Acts towards the middle of the century. Moreover, the burden of insanity has been yearly increasing, and its fiscal relationships have assumed an importance which the diminished prosperity of the country has brought into more than ordinary prominence.

The Retrospect has been done from the following periodicals and papers; but is not yet finished in the following pages:—

In the Archivio Dr. Porporati communicates two papers on insanity in women connected with the physiological changes of the sexual organs. The most novel part of these are his observations on insanity beginning during pregnancy. In most of his cases this was characterised by hatred of the husband, against whom groundless accusations of cruelty were made. The patient sometimes recovered after delivery, but this was more frequently followed by no benefit.