Mr. Whiteway's paper on this subject in the last number but one of the Journal is very interesting to medical men as an indication of the view taken by an enlightened legal mind, and it is especially interesting to us as proving that all legal minds are not so steeped in mediæval notions of responsibility as some medical men are apt to suppose. It contains, however, statements that must not be allowed to go unchallenged, and it pushes the doctrine of irresponsibility further than I, for one, should be prepared to follow.

The slides were taken from sections of the cortex of several cases of juvenile general paralysis, mostly stained by Nissl's method or one of its modifications. The work was done at the London County Asylums Laboratory at Claybury.

The object of this paper is to briefly consider the various forms of insanity which are complicated by epilepsy, and for convenience we shall discuss them as they occur during infancy, puberty, adolescence, the climacteric, and the senile periods.

It is obvious that it would be quite impossible within the short limit of time at our disposal to enter into a full and complete account of all the data collected with reference to these admissions, which commenced on January 1st, 1892, and terminated on December 31st, 1899; I will therefore confine my remarks to the more important features presented by them.

The modern conception of asylums as hospitals for the treatment of those diseases whose salient phenomena are mental, and the fact that insane patients are peculiarly liable to be attacked by ordinary physical diseases, for which they must be treated in asylums, render it essential that these institutions should in their organisation and equipment be approximated to general hospitals as closely as their peculiar circumstances allow. In general hospitals nowadays the pathological department takes a position the importance of which is increasing every year, owing to the extraordinary progress in all branches of pathological science, and it is just as important that this department should be efficiently worked in asylums. Its functions may be said to be twofold, clinical and what we may roughly call anatomical.

The observations upon which this essay is written have been made in the Coppice Hospital, and refer to cases admitted between 1st August, 1859, and 1st August, 1893, and still surviving at the latter date, and to cases thereafter admitted consecutively, all of which have come under the writer's care, being 175 in all.

During the sixteen years I have been at York 206 cases of acute mania have been admitted, inclusive of 29 relapsed cases occurring in sixteen individuals. Of these 206 cases, 171 have recovered, 8 have died during the attack and because of the mania, and 3 have died during the attack from intercurrent bodily diseases, 12 have been discharged relieved to the care of friends, 7 were transferred to other asylums, and 5 remain under care.

The pictures I am going to show are taken from photomicrographs of the giant pyramidal nerve-cells of the upper part of the ascending frontal convolution, and the neighbouring paracentral, and my remarks refer entirely to this variety of cell. They have been studied in sections, stained after modifications of Nissl's method, and in film preparations in which the entire cell is seen.

The term hysteria among the ancient Greeks had reference to a disease primarily due to some abnormal state of the female generative organs. Even yet we assign a foremost place to the sexual elements in hysteria, but more as a symptom than as a cause of the disease. We find that the greater the number of cases we investigate the more we shall be impressed by the fact that a marked element of sexual perversion generally exists, at times so dominating the reasoning powers of the patient that he becomes firmly convinced that unless his sexual desire is indulged the community will suffer in some inexplicable manner. In a recent case I found this symptom strongly marked in connection with the habit of masturbation. As a rule the “delusional errors” of these patients are vague. They generally can be brought to admit that their ideas are erroneous; and their ability or otherwise to do this should, I think, bear much weight with regard to prognosis.

This subject is of such magnitude and it presents so many aspects that it would not be possible to develop it at all satisfactorily within reasonable limits, if one were to attempt to deal with it comprehensively. I shall therefore be excused if I pass very cursorily over certain systems of treatment which do not, and dwell more upon certain others which do fall within my competence. The selection will by no means represent the order of importance.

Dr. Clouston in the unavoidable absence of Dr. Ford Robertson made the following remarks:—The first fact that I have to direct the attention of the meeting to is that Dr. Ford Robertson has devised a new method of examining nerve-tissues by depositing platinum in them. By the use of this platinum method he has demonstrated, amongst other things, that what is called the neuroglia is composed of two sets of elements instead of one, as is generally considered. The neuroglia, as exhibited by this and other methods, is attached to the arteries, to the fibres, and to the brain-cells, forming a generally supporting medium. Dr. Robertson has discovered that in addition to this there is another set of cells, which he has called the mesoglia cells, consisting in a typical form of a cell-body, a nucleus and a number of processes. These processes are in no way connected either with the vascular substance or with the nerve-cells or the nerve-fibres. The mesoglia cells are entirely different from neuroglia cells in appearance, and are found in both the white and grey matter, and in such abundance that Dr. Robertson thinks that there are as many mesoglia cells as there are neuroglia cells existing all through the brain. Sometimes they have no processes, sometimes two processes, but the illustrations show a typical mesoglia cell from the dog and from man. The exact function of these mesoglia cells we certainly do not know, but they certainly do not act in any way as a support to the general brain structure. The mesoglia cells seem to have a phagocyte action in certain pathological conditions. They supply, if not all, at least the greater part of the amyloid bodies which are found in some of the chronic brain degenerations. I think you will agree that it is very important that Dr. Ford Robertson should have discovered a new element in the brain, the particular use of which will doubtless be demonstrated by some of the large number of enthusiastic workers on this subject.

“The recovery of the curable, the improvement of the incurable, the comfort and happiness of all the patients, should steadily be kept in view by the architect from the moment in which he commences his plan.”—Conolly, Construction and Government of Lunatic Asylums, p. 1.

IN the present day the great increase in the number of certified lunatics has raised the question of asylum architecture to one of primary importance. New asylums are being built and planned in all parts of the country, and the managing authorities are keen to provide the best possible accommodation for the suffering ones under their care.

Very perplexing to the student of insanity is the question as to how states of exaltation or depression arise. On the physical side to what changes in the nervous system do they correspond? And are these changes localised in different parts of the nervous system in mania and in melancholia; and, if so, what is the site whose disarrangement issues in exaltation or depression?

During the course of a series of investigations upon the arterial pressures in recently admitted cases of insanity, we were struck by the fact that the arterial pressures in cases of acute melancholia of recent onset followed a more or less definite course.

A complete analysis of the mentally-afflicted Jew is far too vast a subject to bring before this meeting, and any attempt to give you the entire result of my investigation into the subject would occupy far too much of your time.