In the numbers of the Journal for January and April, 1896, I described the recent action of the Berlin authorities in placing a considerable number of the insane poor under care in private dwellings, which illustrates one of the latest ways in which this mode of providing for the insane has been organised. Having in the year 1895 revisited for the third time the well-known colony of the insane at Gheel, in Belgium, and having once in 1895 and again in 1896 visited the recently established Belgian colony at Lierneux, I now propose to describe the present position of these two colonies, which exemplify the oldest systematised method of providing for the insane in private dwellings.

There is convenience in dealing with the anterior and posterior central, or middle, or transverse, gyres (ascending frontal and parietal), in companionship with the central fissure, and without prejudice to this fissure as a boundary line between frontal and parietal lobes; although one might say much for a distinct “central” or, better, transverse lobe; of which the Insula may be taken as an annex.

Chapter V.

Temporal Lobe.

This chapter concerns the temporal, and the next the parietal, lobe; but it is desirable to preface the main subjects of these two chapters by some remarks on a large area partly pertaining to both the lobes mentioned, and partly to the occipital.

Music, as a term, suffers much from diffusiveness. When we reflect that, in one sense or another, it denominates anything between the idle notes of the plough boy and the finished performance of an opera singer, between the productions of a Jew's harp and of a cathedral organ, between the playing of two or three foreign tramps and of a Philharmonic Orchestra; when we reflect that man's attitude to music is at one time active and at another passive, and when we also reflect that the acceptance of sound as music by man is largely dependent on his individual views and tastes, we must see how impossible it is to invent a definition of music that will serve as a universal standard, to which we can refer psychological observations without lengthy qualifications and limitations. I put forward this self-evident proposition in order to show how easily we may fall into error in particular considerations, if the term is used generally and without specialisation.

In the deviations from usual form or type already described—both the new and those adopted from other observers—the material is provided for tests or criteria of various forms of defective or aberrant brain development; and the standard about to be described has its material derived from those sources, and is directly drawn from certain brains.

The only papers dealing with latah, with which I am acquainted, are a brochure by Mr. H. O. O'Brien, of the Straits Settlements Civil Service, published some years ago in the Asiatic Journal, and a short notice by Dr. A. M. Browne, of Sydney, published in the Provincial Medical Journal, 1887; though the Miryachit of the Siberians and Lapps, the jumping disease of America, and the Bah-tschi of the Siamese, diseases allied to, if not identical with, that which forms the subject of this essay, have been all fully described. Quite recently, and since I had begun to put these notes together, Dr. Van Brero has written a paper on the subject; and Mr. F. A. Swettenham, the British Resident of Perak, has published a book called “Malay Sketches” in which there is a chapter on latah, dwelling principally on the humorous side of the question as it appears to bystanders. Mr. Swettenham likens latah to cases of hypnotism shown him in one of the Paris hospitals.

I have much pleasure in acceding to the request of the editors of this Journal to give my personal experience of “suggestion” (with or without hypnosis) as a therapeutic agent.

On looking through some of the numerous observations on the treatment of melancholia by drugs, the most striking point is the diversity of opinion as to their use. This disagreement comes out perhaps most strongly in the case of opium, no doubt because it has been the medicine most widely tried. One leaves the study of the subject with the uncomfortable feeling that the whole drug treatment of melancholia is still quite empirical; for eminent observers press that opium should always be tried in every melancholic, while other no less eminent physicians are equally strong in condemning its use in every case. Our own excuse for adding to the over abundant literature on this subject is that we desire to point out some indication in the use of the two drugs, opium and sulphonal, to which we are convinced that more weight than is generally thought should be given. We have been repeatedly struck by the marvellous effects of opium in some cases of melancholia; and have as often been equally surprised at its utter failure in other cases closely resembling those in which we have been so successful. In hopes of finding some sufficient reason for such apparently contradictory results we have carefully examined the case books of this house for recent years, and have tabulated a sufficient number to warrant, we think, an examination of our conclusions by those who have wider opportunities. To these we have added a few non-asylum cases which we have been able to follow ourselves; which would go towards proving that these two drugs have an action independent of any advantage in any general asylum here. We do not propose to go fully into each case, as this would be unnecessary waste of space, and our remarks can be readily followed by a glance at the tables. No attempt has been made to classify, to arrange, or to select the cases beyond choosing only those in which opium or sulphonal has been given. One selection indeed we could not avoid. The material on which we have had to work being almost exclusively drawn from the upper and middle classes, it was inevitable that our patients should be drawn from the same classes; but this will probably not invalidate our conclusions.

Dr. Bevan Lewis ascribes to the Deiters cells of the brain a phagocyte function; as the scavengers of the brain they absorb and remove effete material, and also according to his view attach themselves to degenerated nerve-cells, whereby these structures are gradually through their agency absorbed and removed.

In venturing to read before you a paper on “Tuberculosis in the Insane; its Prophylaxis,” I am deeply conscious of the responsibility of my position. The very mention of tuberculosis seems to reopen long vistas of investigation and research, which stretch far away into the distance of the earliest medical times. Since the days of Galen and Mangetus the learned in medical science have with unwearying persistence investigated and studied the pathology and treatment of this disease. To the work of these I fear I have little to add, but I submit that neither the presentment of old truths in a new light, nor the adaptation of past experiences to present needs, is without its value. It is from this point of view, then, that I have ventured to approach so vast a subject.

It is more than half a year since I gave notice that I should draw the attention of this Association to the question of Medical Secrecy, and invite the Association to give an expression of opinion upon it. On the first occasion the subject was postponed at the request of the President, and on the second, at the Annual Meeting, I was unfortunately prevented by urgent business from being present.

My paper to-day—entitled the Relation of Diabetes to Insanity—is practically a continuation of one which I had the privilege of reading before the Annual Meeting of the British Medical Association last year, and which subsequently appeared in the Journal of Mental Science last January.

It has long been recognised that the neuroglia presents difficulties of a very special kind in the way of its histological study. These difficulties are due mainly to the remarkable lack of affinity shown by its extra-nuclear part for the usual staining reagents. No histological method that has yet been described serves in a satisfactory manner for the complete investigation of this tissue in its normal and pathological states. The most generally serviceable at present in use is, I think, beyond all question the fresh method of Bevan Lewis. It at least furnishes us with a reliable test for the presence or absence of hypertrophy and sclerosis; but it does not give a complete or clear view of the normal tissue, the fibres remaining for the most part invisible (except in tissues from some of the lower animals), and the nuclear structure being quite obscured. Golgi's method gives us only a silhouette of a small proportion of the neuroglia-cells and fibres. It does not aid us in the solution of questions regarding nuclear and protoplasmic structure. Weigert's new method gives us a very clear view of the fibres and nuclei, but it leaves the protoplasm invisible in the normal state. Its chief deficiency, however, consists in the fact that its use is restricted to the fresh human brain. It is of little value for ordinary postmortem-room tissues, or for those of the lower animals. Other methods that might be mentioned are likewise imperfect in their results, or extremely limited in their utility. In these circumstances it is scarcely surprising that there is still the widest difference of opinion among the recognised authorities regarding the normal structure of the neuroglia. Yet until this question is carried beyond the stage of controversy it is obvious that all our views of the pathological changes occurring in the supporting tissue of the central nervous system must remain vague and unscientific.

This is the first asylum of the London County Council and the fifth for London, and it stands on a hill 230 feet above ordnance datum in a freehold estate of 269 acres, one-and-a-half miles from Woodford Station, on the Great Eastern Railway. It is about nine miles from the Royal Exchange. The ground was bought by the Middlesex Justices for £39,415. They first visited the spot on 27th February, 1886, almost seven years before patients were received. About 70 acres of the ground is woodland, and the soil is clay with beds of gravel interspersed. The Justices proceeded to fence in the estate, build two lodges, lay down a granite tramway from these to the building site, and level the top of the hill, a plateau of about a dozen acres in extent, for all the central and some of the outside blocks, and also to complete the foundations, when the Local Government Act of 1888 transferred the care of lunatics and the management of County Asylums to the County Councils.

Sulphate of duboisin is a powerful sedative and hypnotic. I have used the drug for some time and administered it both hypodermically and by the mouth, generally in doses varying from grains to , though as much as grains has been given at one time. The hypodermic method is the surer and safer, and is followed by fewer bad effects.

Early this year I contemplated publishing a short account of the electric lighting of Claybury Asylum, the first large County Asylum to be so lighted throughout; but at the request of one of the editors of the Journal I consented to enlarge the scope of my paper so far as to include a review of the progress of electric lighting in asylums generally.

A habit is a voluntary nervous action, which by constant repetition has become automatic. It does not follow that the nervous action has originated in the individual in whom the habit is established. It may have been inherited in its automatic or habitual form.

It is frequently levied as a reproach to prison surgeons that they fail to realise how slender and impalpable is the border-line between crime and insanity, and that the proper inmates of an asylum are too frequently treated with the penal discipline of a prison.