Although much of a speculative kind appears to have been written upon the subject of climacteric insanity, more especially as regards the pathology of the disorder, the accumulation of actual facts, bearing upon its genesis, symptomatology, and terminations is comparatively small. Exception must be made for the highly practical paper lately read by Dr. Savage at the Medical Society. A further contribution dealing as far as possible with matters of observation may be serviceable. For the purpose of this paper, in addition to the cases coming under the direct observation of the writers, the records of Bethlem (10 years, 102 cases) and the West Riding Asylum, Wakefield (10 years, 120 cases) have been drawn upon. We are indebted to Dr. Salter, Clinical Assistant, Bethlem Hospital, for much assistance in collecting the cases, and Dr. Percy Smith for permission to use the records of Bethlem.

The term cerebral pressure requires more exact definition, and ought, I think, to be entirely superseded by a more generic, comprehensive, and intelligible name. It should not be taken in the limited sense of only including fluid pressure, but should be extended so as to embrace a large variety of clinical and pathological conditions.

It will always be a subject of regret that the late Sir Andrew Clark left unfinished an article on “Gouty Melancholia,” which he contributed to the “Journal of Mental Science” (Vol. xxvi., p. 343). In this paper, consisting mainly of an imaginary dialogue between the physician and a medical practitioner who consults him about his patient, he graphically describes the symptoms in reply to the inquiry what Sir Andrew really meant by “gouty.”

The statistics herewith presented as to an item or two of lunacy in Herefordshire have various interesting aspects. Perhaps the one that makes them of most value as elucidating an important side of lunacy statistics generally, and as bearing on the question of an increasing prevalence of lunacy, arises from their being those of the district that possesses the largest percentage of insane persons in England, and probably, therefore, in the world, and from their showing that the persons forming this larger percentage differ in some material respects from the lunacy of the country at large. In other words, the additional persons making the number larger are not more of the same sort, but are of a different class.

The comparative disuse of inquisitions under the new Lunacy Acts is naturally giving rise to much uncertainty and diversity of opinion in medico-legal circles. An attempt to explain the nature and extent of the departure which has been taken under these Statutes may not, therefore, be inopportune. It should be premised that—thanks to the somewhat meagre interest which medico-legal questions excite in Parliament—the pages of Hansard throw little light upon the solution of the difficulty, and the matter is, of course, not one that can readily be made the subject of judicial interpretation.

The “General Report, with Summary Tables and Appendices,” only came into our hands at the close of 1893. In the following very brief résumé of the section devoted to the insane we have omitted the reference to the alleged increase of insanity, as it has already been dealt with at p. 228. Sex, distribution, and age, however, remain.

The patient was admitted into Mavisbank Asylum on the 5th of October, 1891, suffering from monomania of suspicion of probably about a year's duration. He was a well-nourished man, 50 years of age, 66 inches in height, weighing 1601bs.

The Barony parish of Glasgow has a population of about 320,000. The care of the lunatics chargeable to the parish has engaged the attention of the Board ever since its formation in 1845. Various circumstances have contributed to make the experience of the Barony parish, in relation to lunacy, exceptionally valuable. Unlike most of the other parishes in Scotland the Barony Board has always provided asylum accommodation for its lunatics; it has never been dependent upon a District Board of Lunacy for that purpose. Although at one stage of their history pressed to hand over their asylum to the then existing Glasgow District Board of Lunacy, the Barony Board declined to do so, on the ground mainly that, on account of the largeness of the population and the rateable value of the parish, the Parochial Board was better suited to be entrusted with the management of the arrangements for the care and treatment of its pauper lunatics than a District Board of Lunacy, which had a wider area to provide for, and different interests to consult; and further the Barony Board held that the double management involved in having an asylum of their own along with their statutory obligation to provide for the due certification and maintenance of the pauper insane was a distinct advantage to a Parochial Board, inasmuch as it provided the material for a more complete view of the lunacy requirements of the parish, and gave the members of the Board a greater interest in questions connected with the care and treatment of the insane. In the early years of its management the Board provided for its pauper lunatics in asylum wards connected with the poorhouse at Barnhill. That arrangement was never considered satisfactory by the General Board of Lunacy; but the Parochial Board considered the arrangement quite satisfactory, and opposed the views of the Lunacy Commissioners. Ultimately, however, the Lunacy Commissioners got their views accepted by the Parochial Board, and they determined to build a new asylum at Woodilee, Lenzie. Probably the arguments of the Commissioners were less potent than the rapid increase of patients, caused by a great growth in the population of the parish, in bringing about the new departure. With the erection of the new asylum the Barony Board entered upon what may be called a new era in its relation to lunacy administration, for it soon became evident that it was performing the functions both of a Parochial Board and a District Board of Lunacy. That position ultimately received legislative sanction, and so the parish is now a lunacy district, and the Asylum Committee of the Board is practically, though not in name, a District Board of Lunacy.

It seems as if the troubles produced by certifying were taking a new line, and parish officers, who hitherto have not been troubled much in exercising their medical discretion as to persons of unsound mind, are going to have their turn of worry. The medical officers of workhouses have no interest in signing certificates for the removal of the insane to asylums, and their masters, the Guardians, can hardly be looked upon as interested either, but this notwithstanding, the parish of Lewisham will have cause to remember the danger of sending persons supposed to be of unsound mind to the County Asylum.

The following case is of interest on account of the successful localization of a cerebral disease, as well as from the fact that this is the first recorded case, so far as I am aware, where, in a South African Asylum, the aid of surgery has been invoked to alleviate a cerebral disease giving rise to mental aberration.

If the Dutch judicial authorities ever seriously proposed to hypnotize De Jong, in order to extract from him a clue, which they believed him to be able to give, as to the whereabouts of his alleged victims, the proposal was very promptly extinguished by public and professional criticism both in Holland and in this country. Even the inquisitorial jurisprudence of the continent surely cannot sanction so flagrant an injustice as to convert a prisoner into his own accuser and judge by the aid of hypnotic suggestion. For this and none other would be the result of the hypnotization of persons accused of crime. We are not unmindful of the subtle distinction which the Dutch law is said to draw between the use of statements made by hypnotized subjects as a medium for further inquiry and the acceptance of such statements as legal proofs; the former, we are told by some authorities (although their opinion is disputed), the law of Holland permits, the latter it prohibits. In point of fact, however, this distinction is worthless. Once let an acute juge d'instruction compel a prisoner to supply him with “clues,” and he will soon both turn them into legal evidence (how far such evidence is reliable we shall consider immediately), and let the jury understand that the case for the prosecution is corroborated by the testimony of the prisoner himself. If the hypnotization of prisoners should ever again become a practical question on the continent, we trust that the fact to which we have here called attention will be kept in view, and that a form of inquisition, which is morally as unjustifiable as the rack, will not be introduced under the cover of a distinction without a difference. The case against the hypnotization of prisoners becomes all the stronger when we consider how unreliable the testimony of hypnotic subjects has been proved to be. It is unnecessary to sum up the evidence on this point in any detail. Every student of hypnotic science is familiar with the story of how Lombroso endeavoured to obtain from a criminal, convicted on the clearest evidence, a confession of his guilt, only to find that the convict repeated the same tissue of falsehoods which he had told at his trial; and this case is corroborated by the incident recorded by Moll, of a subject who resisted suggestions to confess the commission of some crime so strenuously as to induce a violent attack of tetanus. It is true that, on the other side, we have the instance of the hypnotists who were obliged to waken a patient lest he should make them the repositories of inconvenient secrets; but there is apparently nothing to show that these incipient confessions were true, and in any event an isolated case of this kind cannot out-weigh the evidence in support of the contrary conclusion. It is not only because of its repulsiveness and probable uselessness that we rejoice that the proposal to hypnotize Do Jong was abandoned. There can be no doubt that if such an experiment had been tried it would have repelled both the public and the medical and legal professions from giving to the phenomena of hypnotism that respectful consideration to which they are justly entitled. How injuriously the prospects of hypnotic science in this country were affected by what transpired at the Eyraud and Gompard trial, no intelligent observer of contemporary medico-legal history needs to be told. We should have regarded a second contretemps of the same kind with deep regret. In a variety of forms the problem of hypnotism will soon be upon us. We may close our eyes to its approach. Pur si muove. How shall we determine the civil capacity and the criminal responsibility of hypnotized subjects? When is hypnotic influence “undue?” How shall we best protect the patient from the hypnotist, and the hypnotist from possible false charges on the part of the patient? With these and other questions of the same description we shall have ere long to deal. We earnestly hope that no untoward incidents in the meantime will deter the educated public from studying hypnotic phenomena in a spirit of calm and dispassionate inquiry. It would, indeed, be a misfortune if, when the problem of hypnotism comes up for solution, its intrinsic difficulties should be intensified by our want of familiarity with its terms.

Every physician in charge of a hospital for the insane should do all in his power to aid in the advance of mental physiology, mental pathology, and physiological psychology, not only for his own immediate benefit as a study; but with the intent of reaching a better knowledge of the mental processes, and elucidating, as far as possible, the recondite problems of mind. These require careful and exact study, but that study will give power to the individual, while it will enable him more definitely to trace the intricate connection of cause and effect in the cases which call for his examination. It is certain that the more thoroughly these processes are studied the better will be the effect of treatment, and the more satisfactory will be the result to the patient and to the physician. He will learn more fully that while medical study than it has yet received; and by the knowledge thus obtained a way will be found for the more scientific application of medical, moral, and hygienic measures than they have heretofore received.

It is an undoubted fact that the diagnostic terms moral insanity and obsessions have been the cause of serious misconceptions in science and in criminal practice; and, further, that such misconceptions may paralyze justice and menace the moral standard and even the safety of society. It nevertheless marks a great advance in the progress of psychology to have recognized that many criminal and vicious acts result from congenital defects. These defects are sometimes accompanied by atypical anatomical forms of the body, and especially of the skull; but the value of these abnormalities is relative, not absolute.

There is, and has been for some time, an indignant revolt on the part of the Superintendents of Asylums in the State of York and the State Commission in Lunacy. In England the almost unanimous feeling among mental specialists favours the existence of a Lunacy Board. With some exceptions the action of the Board in London has been fairly judicious. The late Lord Shaftesbury held the opinion strongly that very considerable freedom of action must be left to medical superintendents, even on points on which the Commissioners, individually or collectively, might entertain opposite views. In some instances in which this course has not been pursued by the Board, the result of the collision has been unfavourable to the authority of the Commissioners.

E. D., aged 31, a short, stout, dark-featured woman, attended at the out-patient department of the Grosvenor Hospital on February 22nd, 1892. She gave the following history:—Healthy girlhood. Menstruation appeared at the age of 11. The periods were regular, but she had much pain during the flow, which usually lasted for four days, and never was excessive. Married at 27. No family. Two years ago she had an attack of “inflammation in the belly,” and was admitted into a London General Hospital. When there she was told she had a tumour, but nothing further being done she left that institution and went home. Had been in good health and quite regular up to Christmas, 1891, at which date her last period occurred. Soon afterwards she began to feel ill, and had attacks of sickness throughout the month of January. On the evening of February 10th she was suddenly seized with acute pain in the abdomen, and had attacks of sickness and faintness during the night. Turpentine stupes were applied, and gave some relief, and the pain passed off towards morning. Her doctor was then sent for, and he attended for three days, during which time she was kept in bed. At the patient's request, however, he discontinued his visits, but two days later, in consequence of a second attack of a similar nature, he was again called in, and remained in attendance for four days, the patient being kept in bed and under the influence of morphia. At the end of that time she got up, and not being satisfied about her condition she came to the Grosvenor Hospital, where she was seen by my colleague, Dr. Gibbons, who strongly advised her to come into the Hospital. Two days later she was admitted under his care.

The Report for 1892 of the Commissioner of the Metropolitan Police throws a somewhat startling light on the present position of the controversy as to the relative juridical value of long and short sentences respectively in the case of offences against property, such as burglary and housebreaking, which constitute, as Sir Edward Bradford truly observes, the peculiar work of the habitual professional criminal. Now the statistics for 1892 point to the fact that in so far as crimes of this description are concerned the short sentence theory has already triumphed over its rival. The convictions upon indictment in 1892 for offences under the class in which burglary and housebreaking are included numbered 409. A considerable proportion of these convictions were of habitual criminals, and yet ten years' penal servitude was the maximum sentence recorded, and this sentence was imposed in three cases only. In one case the sentence was eight years, in six cases it was seven years, in two cases six years, in twenty-nine cases it was five years, in two cases four years, and in thirty cases three years. In the 409 cases, therefore, there were 73 sentences of penal servitude, and 61 of these were for terms of five years or under. When we examine the matter more closely the defeat of the long sentence theory appears still more remarkable. Though there were 143 convictions for burglary, only 19 sentences of penal servitude were passed, the maximum being seven years, and this term was imposed in only two cases. The convictions for breaking into dwelling-houses, shops, etc., numbered 179, and in respect of these only 32 penal servitude sentences were recorded. One of these was for eight years, one for seven years, two for six years, and the rest for terms of five years and under. Sir Edward Bradford has no doubt that the policy of judicial leniency which has thus, to all appearances, set in will increase the national roll of habitual crime—(1) because short sentences do not deter confirmed criminals, and (2) because the obvious practical result of the short sentence theory is to raise permanently the proportion of such criminals who are “at large” at any particular time. It does seem undesirable that the legal principles which have hitherto obtained in regard to the punishment of professional criminals should be abandoned before we have at least had an inquiry by a competent tribunal into their working, and also into the probable effects of the system which it is proposed to substitute for them.

With the publication in the “Pall Mall Magazine” of the first of Lord Wolseley's articles on “The Decline and Fall of Napoleon,” the inveterate controversy as to the position of the “Corsican Parvenu” in the military and general history of the world assumes a new aspect, the development of which, as psychologists, we shall watch with much interest. There have already been three great epochs in this protracted conflict of opinion. To his contemporaries and rivals of the type of Dumouriez, Bonaparte was a magnificent charlatan of mediocre ability, fit only to serve as a divisional commander under men of light and leading like themselves. The school of thought, however, which saw no genius in the famous march from Boulogne to Ulm and Austerlitz necessarily wielded an ephemeral influence, and was quickly superseded by the reactionary school, of whose views Thiers was at once the founder and the ablest exponent. Over the veteran author of “The Consulate and the Empire” the spirit of Napoleon exercised a fascination of which the records of hero-worship furnish few analogies. Then came the school of Lanfrey, Taine, and Seeley. The method which these great writers sought to pursue in investigating the life and character of Bonaparte was excellent. They set before themselves as the object to be attained a cold, critical survey, detached alike from the rancour of Dumouriez and the adulation of Thiers. But they failed, and failed badly. In spite of all their critical acumen—and perhaps because of it—the Napoleonic idea eluded their grasp. They were no better fitted for their task than Bunyan would have been for that of writing an impartial biography of Charles the Second, and the writer who will raise a real living Napoleon from the 32 volumes of “Correspondance” in which his life and thoughts are entombed has still to appear above the literary horizon. Lord Wolseley makes no attempt to fill this vacant rôle. Indeed, we doubt whether it could be adequately filled by one who believes Napoleon to have been “the greatest of all the great men” that ever lived. But he makes a contribution of much interest and value to a question that has been occasionally mooted of late years, viz., What was the mysterious malady from which the French Emperor suffered at the close of his public life in Europe? Perhaps we ought to suspend a definite answer to this question till we see what else Lord Wolseley has to say on the subject in his remaining articles. But in the meantime a rapid summary of the evidence on the point available to any student of modern French literature may not be inopportune. Of course, the matter to be considered is whether there was, in fact, at the end of Napoleon's military career a failing in his powers. Our ancestors would, no doubt, have deemed it unpatriotic to question that the “Boney” whom Wellington beat at Waterloo not only knew his best and did it, but was as competent a general as the hero of Arcola and Rivoli. But this comforting position is no longer tenable. Lord Wolseley points to the fatal delay of Napoleon at Wilna in the Russian campaign of 1812, and his equally fatal omission to support Ney at the crisis of the battle of Borodino; and, if we mistake not, the campaigns of Leipsic and Waterloo yield evidences still more cogent that the very faculty of commandership repeatedly deserted Bonaparte at the time when its presence was essential to his fortunes. The direct testimony of his contemporaries to the same fact is not wanting. Marshal Augereau (as we learn from Macdonald's memoirs) noticed it, although his coarsely-grained and jealous mind saw in it only a proof of the incompetence which he preferred to consider as a characteristic of his master, and the officers who received the fugitive Corsican on his return from Elba were astounded at his alternate fits of garrulity and silence, tremendous energy and hopeless lassitude. If, then, the fact of Napoleon's mental and physical decline is established, what was the cause? Lord Wolseley goes no further at present than “mental and moral prostration,” and there is certainly nothing extraordinary in the theory that the prodigious and continuous strain to which the mighty intellect of the great captain had for years been subjected was at last destroying its machinery. But there is also positive evidence, we think, that Napoleon had become the victim of epilepsy, and without dwelling on the subject further just now, till Lord Wolseley's series has been completed, we may point out that the theory here suggested derives some corroboration from the circumstance on which his lordship's first article offers abundant proof, that while Napoleon's power of executing his plans was impaired, the splendour of his military imagination survived, and even increased in apparent brilliancy at the last.

After much discussion, and having passed through the searching ordeal of a Select Committee, the new Rules of the Association have been agreed to, and now await the passing of the minutes at the annual meeting to be formally adopted.

The increasing prevalence of suicide in this country is a phenomenon of grave social importance. Many of its causes, doubtless, lie beyond the range of either legislative or administrative remedies. We cannot avert the influence of commercial depression or religious excitement or alter the thousand and one climatic, telluric, and social conditions which lead men to take away their own lives. Nor can we return to the drastic policy of earlier days, when the suicide was buried at midnight in the king's highway with a stake through his body, and without the rites of Christian sepulture. But two deterrents might be tried. In the first place, instead of treating attempted felo de se as attempted murder, it might, in accordance with Sir James Stephen's suggestion, be regarded only as a secondary offence, punishable by secondary punishment. Again—and the prospect held out by the Death Certification Committee's report, of fresh legislation in our “crowner's quest law,” gives to this point an immediate interest—coroners' juries ought not to be permitted to return, nor should coroners be allowed to receive verdicts of “temporary insanity” in cases where not a vestige of evidence of mental disease in the legal sense of the term was adduced. The amiable humanity which inspires such verdicts is worthy of some respect, but its consequences are bad, and further manifestations of this weak disregard of duty ought to be prohibited by law. It may well enough be that the average felo de se is not able fully to appreciate either “The Suicide's Argument” or “Nature's Answer” to it, at the time when he lays violent hands on himself. But this is not what the law means, or ought to mean, by insanity; and we see no reason whatever why the mental state of suicides should not be determined by the criteria which govern the question of criminal responsibility in other cases. We deplore this weak sentimentality.

The subject which I have the honour to bring before this learned Association concerns persons whose mental condition is unsatisfactory, either by arrest of brain development before birth or in early childhood, or as a result of altered intelligence following injury or acute disease in infancy, in adolescence, or even in adult life.