The present group contains 20 cases of “Dementia following Epilepsy,” of which 12 are of the male and 8 are of the female sex.

The present portion of this paper deals with the subject of progressive and secondary dementia. It includes the consideration of those cases of mental disease which, owing to the existence of certain extra-neuronic encephalic morbid states, do not develop a practically stationary condition of mental enfeeblement consequent on the loss of a proportion of the higher cortical neurones, but undergo a more or less rapidly progressive process of neuronic dissolution, which, if the patient survives to such a stage, finally ends in gross dementia.

I have again ventured to trespass on your time and attention with some remarks on the pathology of epilepsy, partly in order to refer to some criticisms on my views and partly to amend them, because my most recent observations on the coagulation-rate of the blood in this disease seem to indicate that they require some modification.

IN Wright's earliest researches on the opsonic body in human blood serum he used various strains of staphylococci. He found in various forms of staphylococcal invasion, such as acne, furunculosis, and sycosis, that the index of the patient so infected was lower than that of an ordinary healthy individual to the particular organism causing the disease. By his method of inoculation of a vaccine made from the infecting organisms he was able to greatly improve the condition and even cure most intractable cases. Bullock has obtained like results, and cases have been recorded where pneumococcal and other infective diseases have been cured by similar treatment.

“What we gain from speculative philosophy is not so much answers to questions which common sense universally asks, as the knowledge that these questions themselves, since they are based on untrue concepts, must vanish away.”—Paul Möller.

Our distinguished President, Sir William Collins, in his admirable oration delivered to us last year, expressed appreciative sympathy with the main objects of the Asylum Workers' Association. These are, firstly, to raise in the public esteem the calling we have chosen, and secondly, to succour those members of our body who have suffered in the service.

In any province of experience the systematic arrangement of the facts pertaining to it is regarded as one of the most useful instruments in its comprehension and understanding, and for this reason a systematic classification of the various forms of insanity has long been accepted as one of the best signs of psychiatric progress.

The foregoing examples of degenerates, obsessionists, feeble-minded and mentally warped could be multiplied indefinitely. They present minor and less striking phases of the degeneracy and mental disorders met with in asylums, and require, whether at large or in confinement, some part of the care, supervision, and treatment which are accorded to the major degenerates whom it has been found necessary to certify as fitted for detention in asylums. In these institutions may be seen paretic dements, paranoiacs, precocious dements (katatoniacs), maniacs, imbeciles, terminal dements, etc., prone to, and who may have committed, arson; folies circulaires, hysterics, maniacs, moral imbeciles, and imbeciles prone to malicious mischief or criminal prankishness; erotics, senile dements, paretic dements, alcoholics, maniacs, epileptics, and imbeciles prone to indecent propensities, rape, sexual perversion, and the entire gamut of erotic besetments; general paralytics (first stage), imbeciles, kleptomaniacs, climacterics, prone to, and who may have fallen into the hands of the authorities for, theft; homicidal maniacs, epileptics, katatoniacs, paranoiacs, puerperals, alcoholics, and dipsomaniacs who may have committed crimes of blood, cruelty and violence before certification, or who by mere accident may not. These are the many points where criminality and lunacy touch, and it seems at present either a question of the degree of the mental warp or its non-detection which decides whether the asylum or the gaol shall be the destiny of such.

This communication is based on a study of cases in Glasgow's Aged People's Home. The Home is for those in reduced circumstances, but above the pauper grade. It has accommodation for 140 men and 86 women. Reference is made to this point to enable a general inference to be drawn as to the proportion and frequency of cases of the more acute though brief forms of mental disturbance among the old; for with one exception they all occurred within a period of two months since the beginning of the present year. However, looking back over the last twenty years, my impression is that the number of cases here recorded is above the average of our previous experience.

IN all asylums and places where epileptics are taken care of many cases of this condition must occur annually, and the treatment of it must be of grave consideration in the care of these cases. The figures of Dr. Lord show us that in ten years in the Hanwell London County Asylum 26 per cent, of the deaths in epilepsy occurred in the “status,” and these figures are borne out by the returns of the Ewell Colony for Epileptics. Much has been written on the subject, both by British workers and by our Continental confréres, but it is scattered through the literature in isolated monographs, and of late years the interest in the subject seems to have lapsed. The present paper is written with the purpose of inducing someone, more competent than the author, to give us further light on this very interesting condition.

Francisque Sarcey says that originality consists, not in thinking new things, but in thinking for yourself things that thousands of generations have thought before you, and that your idea will appear new because you will strongly impress upon it the turn of your mind and tinge it with the colour of your imagination. Something of this kind has occurred in the presentation of dementia præcox. Kraepelin does not even claim the term as his own invention, but refers to it as the original proposal of Pick. We have duly recognised the distinguished position attained by them both, and appreciated Kraepelin's work, especially in investigation and teaching, and his achievements in elucidating morbid mental phenomena. If one is led to differ with him in the light of observations already made in this country and years of personal experience, that difference must be expressed in terms of esteem and respect.

This paper has for its object the placing on record of a considerable number of observations made during the past eighteen months upon the blood of the insane. It was after the perusal of Dr. Lewis Bruce's work upon the clinical aspect of mental diseases that this special subject suggested itself to me as one deserving minute and extended study. Whereas Bruce deals somewhat minutely with the various constituents of theblood, I have confined my observations to the changes that occur in the number and variety of the white blood-cells, and the relationship these alterations have to the acute mental diseases in which they are found. These researches, though still in their infancy, hold out great encouragement to the belief that in such directions we may yet succeed in arriving at a true knowledge of the pathology of mental diseases, and at the same time advance at least one step in what has hitherto baffled all research-the conditions governing the mutual relations of mind and matter.

In the realm of mental disease any finger-post which points a way through the entanglements of ætiology is worthy of consideration. Present-day tendency is to magnify external at the expense of internal causes, a cart-before-the-horse policy which must bring confusion. Comparative lunacy endeavours at least to reverse the position and to start straight by tracing the affinity of form which exists between national brain types and their insane corruptions, or by showing variations in the relative incidence of disease forms and co-ordinating these with dominant social or biological factors.

Having been engaged during the past three years in treating cases of active insanity by rest in bed in the open air, I am able to add my testimony to that of Dr. Easterbrook, as published in the last number of the Journal of Mental Science, as to the value of this method of treatment in suitable cases.

Asylum officials may be roughly divided into three groups. In the first group are included artisans and others who are paid weekly wages, have no emoluments, and live in their own homes away from the asylum, whilst in the second and much larger group are included nurses and attendants (estimated by the Commissioners in Lunacy to number in England and Wales more than ten thousand persons), laundrymaids, housemaids, kitchen-folk and others, who, in addition to their monthly paid wages, usually have the emoluments of board and lodging. In the third group are included chief officers and others who are provided with houses, cottages and apartments on the asylum estate. The weekly paid or artisan class are, as a rule, well paid, contented, and of long service. They do not lead a cloistered life, and it is not with them that this article deals. As to the second group, the public now happily recognises the unselfish labours of the large army of workers in direct attendance upon the insane throughout the country, and it is not necessary to enlarge upon their usefulness to the community. Their hours of duty are very long, their pay is not large, and the restrictions and disadvantages under which they work are very great. Probably all asylums have allowed a certain number of these officials to board and lodge off the premises. Some asylums may be more favourably situated than others, and thus have done more in this direction, but the writer thinks that at all asylums more could and should be done towards de-cloistering the staff. In an asylum constructed to meet the circumstances and placed in suitable surroundings, the sane resident population could be reduced to very moderate proportions. It is urged that when the abnormally long and trying hours of duty are over, as many officials as possible should be altogether freed from institutional restraints. The cost of the erection of asylums would be decidedly lessened if they were built to provide accommodation only for (i) the patients, (2) such members of the staff as must of necessity be boarded and lodged on the premises, and (3) such officials as must have houses provided for them on the estate. Has any asylum authority ever prepared an estimate showing the cost of the erection and upkeep of quarters, and of the provision of necessities and conveniences of every description specially made for members of the staff who do not need, for any particular reason, to be provided with lodgings on the asylum estate?

Narcolepsy is so rare that I deem the following case worthy of record. It is one occurring in a young man suffering from hallucinatory and delusional insanity, who was admitted into the Royal Edinburgh Asylum, in April, 1902, with the following history.

In this paper the writer aims at bringing into prominence some advantages derived from the application of the principles of hospital treatment to the care and management of insane epileptics. Much of the clinico-pathological work recently done on epilepsy tends to support the view that such treatment is correct; and, further, it is now generally accepted that treatment of the so-called “Acute Insanities” (mania, melancholia, etc.) on hospital lines gives the best results.

The great majority of the insane Jews chargeable to the various London unions are cared for in this asylum. Special arrangements are made in order that they may observe the customs and rites which their religion demands of them. A Jewish Rabbi visits them and holds religious services. A Jewish interpretress is on duty daily. There is a Jewish kitchen, where the food is prepared in the manner they are accustomed to. At certain periods of the year they fast as they would do in their own homes.

In the following brief notes nothing is attempted beyond placing on record three undoubted examples of this interesting disease, and thus adding to an ever increasing list of cases.