The manifestation of delusions is so striking a proof of aberration of mind that we seem tempted to inquire if the study of them will in any degree help us to an elucidation of the actual physical change which must either be the cause or, at any rate, the accompaniment of them.

The following case shows the necessity for reform in the legal procedure connected with the admission of private patients:—E. E. S—, a lady patient, was admitted on October 26th last, upon the order of a justice of the peace who had not seen her, and upon the medical certificate of her regular medical attendant, and the second certificate of a neighbouring practitioner. Within the statutory period after admission she signed a request to be seen and examined by a judicial authority, under 53 and 54 Vict., cap. 5, sec. 8 (2). On November 2nd I made a return to the Commissioners in Lunacy stating—“She was insane, suffering from melancholia; had a dejected appearance and nervous manner, with delusions of unworthiness; said ‘God would never forgive her her sins’; was agitated, restless, and dissatisfied,” etc. On November 5th she was seen and examined by a local county justice of the peace, who, in the face of these three certificates, and a note in the case book by Dr. Patterson, reported that he did not consider the patient insane. In consequence of this report she was removed by her brother on November 26th, the Commissioners in Lunacy, who apparently, under 53 and 54 Vict., cap. 5. sec. 8 (3), had no option in the matter, having requested him to take this step. I may add we considered her probably suicidal, and when she left I wrote her ordinary medical attendant advising him to watch her, and have her placed under fresh certificates, but she declined to see him again. On the night of December 9th (that is, less than fourteen days after leaving the asylum) E. E. S— committed suicide on the permanent way of the Great Northern Railway in North London. Thus a report by a young and inexperienced justice of the peace outweighs the opinions of two experts, the family medical attendant, who had watched the case for months, and a fourth medical man, who signed the second certificate on admission. Surely this life was sacrificed through a defect in lunacy law!

In many, the very word “statistics” rouses a feeling of distinct repugnance or distrust. Repugnance, because not a few people dislike this method of expressing information, which indeed is not to be wondered at, bearing in mind that the study of statistics is now a science in itself, and requires considerable training to appreciate. Distrust, because it must be confessed that deplorably misleading statistics have been frequently and unblushingly set forth; this being either the result of ignorance of certain statistical laws and fallacies, or owing to a proneness possessed by some to be carried away by an apparently happy “working hypothesis,” and to then endeavour to make statistics support their theory.

In supplement to my paper on one-sided hallucinations in the Journal of Mental Science for April, 1901, the following case of a similar kind, but presenting special features, is, I think, of sufficient interest to be recorded. The patient is an inmate of the Glasgow Old Men and Women's Home, and is a man of some literary ability, as is shown by his still continuing to contribute articles from time to time to journals published in London. The Home, it need scarcely be said, is for people of sound mind, though many manifest indications of the ordinary mental decay incident to old age. The patient referred to is, however, acute and intelligent, and free from all suspicion of mental weakness or disorder. The account of his experiences, which he submits, may therefore be regarded as very reliable. It seems preferable to give it in his own language, only pruning it a little from unnecessary detail. The form in which it appears is due to his great deafness, on account of which the desired information could only be obtained from him as replies to written questions.

I wish to-day to direct the members' attention to the neuroglia cell and its processes, although time does not permit me to do more than refer in the briefest manner to the present state of knowledge respecting the subtle relationship of the changes of these glia cells to insanity.

Sleep, the state in which man spends a third of his existence, is so intimately related to bodily and especially to mental health, that it must ever be a subject of the greatest interest to alienist physicians. No apology therefore is needed for once again bringing under discussion a subject so familiar.

It is with great diffidence that I venture to address you to-day. I have not made any scientific discovery, and in my own opinion it is great presumption to open a discussion on a subject of which I am merely a student, and on which my studies have not yet enabled me to form definite theories.

T. W—, shorthand writer, admitted January 16th, 1899, suffering from mania.

Case I.—L. M. W—, æt. 37, admitted June, 1901, died eighteen days after admission.

It is a well-known fact that the practice of many physicians and some alienists includes the treatment of persons who have brought themselves to the verge of mental or moral ruin by an indulgence in the use of opium or morphia, the result too commonly of medical advice. This is probably the most common origin of the morphia habit, which was called Morphinomania by Charcot, and Morphinism by Levinstein. Other methods by which the habit becomes established are either through friends or persons in the same house imitating the habit of another, and from curiosity or experiment adopting it and succumbing to its sway. Others have tried it on the recommendation or suggestion of friends, and finding they could not do without it have become victims.

True diabetic insanity is a rarity, and when it occurs does not always take the same form. But it is by no means uncommon to meet with certain lesser mental abnormalities in diabetes which are very constant in character; and what is usually regarded as the typical variety of diabetic insanity is simply an intensification of these abnormalities probably due to inherited or acquired cortical instability. Hence this psychosis derives its interest from the definiteness of its aetiology and the constancy of its symptoms.

Mr. B—, an accountant æt. 37, was admitted into this hospital on February 6th, 1900, suffering from epileptic mania. That there was insanity or other diseases of the nervous system in his family history was denied, but his brother was said to be very eccentric and to take too much to drink. There was also a suspicion that another brother died of some mental or nervous disease. The patient was married at 21, and his wife had had four children—no miscarriages; the eldest and third are alive and in good health, æt. respectively 16 and 12; the second died at ½ years and the fourth at four months, both in convulsions. He was always excitable and masterful, and latterly had been very quarrelsome; he had always been a sober, steady, hard-working man and a good and kind husband and father. He had built up a good business as an accountant and estate agent. He had had good bodily health generally until five years ago, when he had an ischio-rectal abscess followed by a fistula, which was cured by operation. When he was a boy a brick fell on his head and caused a contused wound, the scar of which is about one and a half inches long on the left side behind, and in which he often had a stabbing pain. He had his first fit when he was 22 years of age, and for some years had them every fourteen to twenty-one days. In a fit he usually turned round and fell down, was unconscious for about an hour, slept about ten minutes, and was then all right. Twelve years ago he was assaulted and knocked down. He was picked up insensible and bleeding from his mouth, nose, and ears; his eyes were “bloodshot” for some time afterwards; he was unconscious for three days, then resumed his business. Since this accident he suffered from very severe headaches, and the fits gradually grew longer in duration and more frequent, until at the time of his admission he had them daily, and sometimes several on one day. Often during the fits latterly he had passed water and occasionally faeces. He had left internal strabismus. There was no syphilis. This was the first attack of mania, and was of a week's duration. For the previous six or eight weeks he had been excited, quarrelsome, and extravagant, but had attended to his business. He had threatened suicide, and to kill his wife. On his admission he was in a state of epileptic mania, talked continuously, complained of everything, said his food was poisoned, accused his wife and daughter of immorality, and was very emotional. He said he had intense pain in his head and was sure there was something seriously wrong with it. The urine contained neither albumen nor sugar. The excitement passed off quickly and he was discharged recovered on the 21st. He had several epileptic attacks during his stay. He was admitted again on January 23rd, 1901, with very similar symptoms. During the time he was at home he had not been able to do much work. When the acute excitement passed off, which it did in a few days, it was found that he had loss of memory and was somewhat demented. In addition to the epileptic attacks, which were very frequent and in which he wetted himself, he had fits which simulated epileptic fits; he fell down carefully and did not wet himself. The delusions persisted, and he was always complaining. In April he said he was going blind, and on examination optic neuritis was discovered. The urine at this time had a specific gravity of 1022, no albumen, no sugar. The optic neuritis rapidly went on to atrophy, and by June he was quite blind. On the evening of July 20th he was heard snoring loudly, and was found unconscious, sitting in his chair. He could not be roused; the temperature was 102°. Next morning he had regained consciousness; the temperature was 102°, the pulse 100, full and bounding, and the skin bathed in perspiration. In the evening he was drowsy but could be roused, answered when spoken to, and put out his tongue when asked to do so. The temperature was 105.8°, the pulse rapid, and the perspiration still very profuse. About six o'clock next morning (July 22nd) he again became comatose, and remained so until he died at 8.15 a.m. A post-mortem examination was made next day by Mr. P. G. Mould. There appeared to be nothing abnormal about the skull, and there was no sign that it had been fractured. The brain weighed 69 ounces, and was sent to the Pathological Laboratory at the Owens College for examination.

No. 2345, æt 27, transferred from Saughton Hall to Murray's Asylum, Perth, on June 4th, 1897. An unmarried male.

Do not expect anything new from this paper. Do not imagine that I am going to bring forward any startling theory concerning the origin of delusion, or make any attempt to unravel the mysteries of the cerebral pathology of any one class of delusion.

This case, which was otherwise an ordinary one of tumour of the frontal lobes, presented as the most marked symptom persistent sleep.

The question of better provision for the care of idiots and imbeciles has of late been one of some prominence in the more thinly populated counties, and in several of these the county authorities are being urged to act in the matter. In large centres of population, where the number of the congenitally deficient is sufficiently great, and is under a single authority responsible for their care, it is more economical to provide for this class in separate institutions; but where you have, say in a county, a number of authorities, each responsible for the maintenance of only a few cases, it is on the face of it an expensive business for each of them to provide special and separate accommodation; still, it is highly desirable that some steps should be taken to put this class of case under more favourable conditions than at present.

During the last few years great importance has been attached to the consideration of the treatment of those patients who, though not permanently insane, presented mental symptoms requiring immediate and active treatment. Physicians who are brought into contact with large numbers of cases of bodily disease are generally agreed that many of them exhibit mental symptoms concurrently with their bodily illness which are entirely due to the disease itself, such as the initial delirium of pneumonia or the profound depression of influenza.

Derangements of the motor functions of the iris are commonly met with in the insane. They are as common in general paralysis as they are uncommon in all the other forms of insanity together. Their mechanism and import is not well understood, and it is in order to elucidate certain points that I venture to put the following observations before you, and to ask you to comment on them.

The establishment of a psychiatric clinique in connection with the Edinburgh Royal Infirmary has been strongly recommended to the managers of that institution at a recent meeting of the Edinburgh Medico-Chirurgical Society. The meeting was a very representative one, the discussion being initiated by Sir John Sibbald, and the motion moved by Sir John Batty Tuke.