Here we shall consider the effect of shame; then try to discover why we feel it at certain times, and whether it can be represented as the development of any other emotion.

At a time when there is a gradual but certain change spreading through our methods of treatment of the insane, and chemical compounds are being replaced by other methods, it may appear unneccessary to record results obtained by the use of drugs. But this short paper is intended only to give my experience as to the effect that nucleinate of soda has upon the progress of acute mental disorders.

The South Yorkshire Asylum, Wadsley, near Sheffield, was offered to the War Office by the West Riding Asylums Board under the scheme prepared by the Board of Control.

The first thing I wish to call to your attention is the distinction between the foot-pound and the cubic foot. The footpound is used to measure work, and when work is stored it is called energy. The cubic foot is used to measure material substances, or the space in which bodies are contained. What I have to say relates to things measured by the footpound or corresponding unit, and not to things measured by the cubic foot.

The accompanying photograph illustrates an attitude when sitting frequently adopted by many cases of dementia praecox. The point to which special attention is directed is the position of the arms and hands. The arms are held close to the trunk, with, as a rule, the elbow-joint in a condition of stiff extension and the hands in pronation, and resting on the lower part of the thighs, or even on the knees. When the photograph was taken there was no special posing for the purpose of this note, the subjects merely being told to sit down. In the wards I have seen these particular patients as well as others maintain this position for hours at a time. They sit, as a rule, rigidly upright, for example, in the case of the man shown, whose head is erect with the eyes staring forwards. In other cases the body and head may be bent slightly forwards. Most frequently the feet and knees are found to be close together, but, as in the case of the woman on the extreme right, the legs may be kept apart.

The subject of this paper is the criteria of an accused person's fitness to plead to an indictment charging him with some criminal offence. It is a consideration of the questions which are involved in the special verdict of “insane on arraignment.” We shall see, however, that in this connection the word “insane” is used in an extended sense.

[We have received the following Address from Dr. Brush, who, knowing that we have had some difficulty in obtaining sufficient material for the Journal since the war began, kindly offered it for publication in our pages, while it will appear simultaneously in the July issue of the American Journal of Insanity, of which Dr. Brush is the Managing Editor. He is also the President of the American Medico-Psychological Association for the current year, and his views will no doubt be full of interest for his colleagues in the specialty on this side of the Atlantic.—Editor. Journal of Mental Science.]

On first coming to the Federated Malay States I was led to believe that general paralysis of the insane was unknown. Seeing that syphilis is very common, it seemed strange that general paralysis of the insane should not occur. Very shortly, however, after the Central Asylum was opened I noticed some cases which were extremely like general paralysis of the insane. These I watched and studied very carefully, and in a short time became convinced of the existence of the disease. I have mentioned the presence of general paralysis of the insane in each of my annual reports, but think it is now time to go further, and demonstrate, as far as reports of actual cases can, the existence of general paralysis. Probably the best way to give proof of its existence is to quote three cases which can hardly be mistaken for anything else.

The question of the adaptability or suitability of the method of female nursing of male patients in asylums, which is the all but universal practice in general hospitals, if not exactly what might be termed a “burning” question, has been forced into unexpected prominence during the present crisis of affairs. The military and naval requirements of a great country fighting not merely for a great ideal, but for, if perhaps the less noble, certainly the more urgent and so to say personal object of maintaining its own existence, necessitated the raising—and at very short notice—of our two great services to their maximum strength, and, therefore, a demand on the male population of the British Empire of such magnitude as has never been experienced before. This demand has, as we know, been promptly and liberally responded to, and by no class of men perhaps more readily than those serving on an asylum staff, over 3,000 of whom, as shown in the Journal of October last, have joined the colours. Such a drain on the at no time very ample nursing resources of these institutions could not fail to cause very serious inconvenience. The shortage occasioned had in some way or other to be compensated for, if even to only a limited extent. In some cases men of mature age have been employed to replace those who have left, but these are probably not procurable in any great numbers owing to the demand for middle-aged men for munitions and other work connected with the war, and also for doing the enormous amount of business—trade, agriculture, etc.—which must be carried on throughout the country generally. Consequently, resort to the employment of women as substitutes for male nurses has had in many instances to be adopted.

So little has been written in this country on Pseudologia Phantastica, or Pathological Lying, that Dr. George Robertson, Physician Superintendent of the Royal Asylum, Edinburgh, has urged me to report the following case of this disorder associated with hysteria and a certain degree of moral defect.

As this is a fairly rare condition, the following case is considered worth publishing:

R. P—, æt. 39, married, a private in the R.F.A., was admitted to the Isle of Wight County Asylum on January 2nd, 1915, from a Red Cross Hospital in a condition of status epilepticus. The history obtained from his wife was interesting. He joined the Army when about 18, and spent six years in India. He took part in the South African War for fifteen months. He returned to England in 1903, married, and had several healthy children, and had lived at Dorchester for the last ten years. At the outbreak of war he was called up on the Reserve, and sent to France with the B.E.F., and was in the battle of the Aisne. Early in October he developed “epilepsy,” and was invalided to England. He had always been strong and healthy till then, and never had a fit previously. Under treatment he improved, and was on sick furlough, when in November he had a severe epileptic attack, and was readmitted to a military hospital. He then became sullen, drowsy, and irritable, with occasional slight fits till December 20th, when he had three severe attacks, but came round from them, and was able to write a clear letter to his wife on December 26th. On January 1st, 1915, he started having severe fits, and these continued up to his admission twenty-four hours later.

Among the many duties of life which have had to be thrown overboard in consequence of war strain is that of recording and tabulating facts connected with asylum experiences. It certainly would be undesirable that a process, which at the best of times is but a burden to many, should be continued when the asylum, more than any other class of institution, is heavily stressed by an increase in function accompanied by a notable decrease in the means of performing function. Nevertheless it cannot be denied that a breach in a long continued series of medical observations is in itself somewhat of a misfortune.