When I was invited, during my last summer holiday, to read a paper on this subject, I agreed with a light heart; but on more mature reflection the glow of satisfaction at being so honoured has paled before the spectre of responsibility in addressing a body of experts on a subject peculiarly their own and remote from the paths of my usual work. I can only ask your indulgence, and—negative though most of the conclusions are—hope that they may suggest certain points in the treatment, and especially in the pathology of these conditions.

Few authorities on mental disease are agreed as to the part played by syphilis in causing mental deficiency. Similarly, the cause of epilepsy, although it is one of the oldest known diseases, has remained undetermined by the methods of investigation hitherto employed.

The association of general paralysis with syphilis has probably been discussed with more frequency during the past two decades than any other subject relating to insanity, and probably the large majority of alienists now consider syphilis a sine quâ non in its causation.

Forty years ago at Hampstead Asylum under the Metropolitan Asylums Board, an attempt was made to give the patients under sixteen some instruction in music and singing and also in simple work in school—an idea borrowed from Earlswood Asylum. This was apparently so successful that the Board suggested the building of a schoolroom and shoemaker's and tailor's shops.

Some forty years ago, Dr. Bruce Thomson, the first resident surgeon to this prison, contributed to the medical journals a series of observations upon over 5,000 prisoners. He dealt chiefly with the more obvious physical defects which, to his thinking, supported the theory of the existence of the instinctive criminal, and though his observations were somewhat generalised, he was rightly regarded as a pioneer in the science of criminal anthropology. He also drew attention to the prevalence of weak-mindedness among juvenile prisoners, and stated that as much as 12 per cent. of all prisoners required special observation soon after admission because of mental defect. There is little doubt that in his time the old method that consigned all forms of disordered conduct to prison still persisted, and many changes have since taken place that would tend to diminish his percentage. Prison discipline is still, in spite of its mildness, largely credited with bringing into prominence many symptoms that are put down to mental defect. It would be reasonable to look for a considerable reduction in the numbers of weak-minded persons in prisons during a period when prison administration can conscientiously take to its credit the fruits of a progressive spirit that is not, however, readily granted to it by many whose reforming enthusiasm takes no thought of the spade-work that has preceded their own awakening. The psychological point of view is prominent in the most recent methods of dealing with the criminal. Preventive detention for the habitual, probation for the first offender, Borstal training for the juvenile delinquent, etc., all recognise the mental aspect of the offender as fully as any system that can be evolved by the mental pathologist. That the mental abnormality of the habitual major offender is a more complex affair in its origin and treatment than is insanity will, I am sure, be amply verified by the future experience of the preventive detention institutions, where grave disorder can only result if the treatment views too much in this light of irresponsibility the vicious tendencies of the inmates. From whatever point of view we look upon the habitual and professional criminal, it is certain that many of this type may be safely left to the law which is rightly concerned with the protection of the public, and continually progresses in an endeavour to fit the punishment to the individual.

On the evening of May 28th last, whilst making the visit for my colleague at the time of the evening meal, I had my attention drawn to a patient's urine by the deputy charge nurse of the male infirmary. He said it was very high coloured. I looked at the urine, and instead of finding, as I expected, a concentrated urine loaded with urates, I had presented for my inspection a urine of a distinctly reddish-brown colour, very suggestive of the presence of some blood derivative.

In the July number of the journal Drs. Dods Brown and Ross give an account of the various methods which have been used to produce an increase in the number of leucocytes in the blood. These methods are numerous and varied, but they do not include one which was discovered accidentally in the treatment of the case about to be described, nor have I been able to find any reference to a similar case in the literature. Various drugs such as nucleic acid, ceredin and argentum colloidale have proved efficacious, and Dr. Lewis Bruce has stimulated the leucocytes by the injection of such an irritant as turpentine. In the present case, however, the simple intra-venous injection of normal saline solution, containing no drug whatever, was found to produce a marked leucocytosis, which in one instance reached the high figure of 28,000. For permission to publish the notes of this case I am much indebted to the kindness of Dr. T. C. Mackenzie.

If, in this the ninth annual letter of your correspondent to the Journal, he should leave out the usual introductory plaint as to the impossibility of crowding the important psychiatric news of the year, even in shortest form, into the allotted space, the patient reader—if there be such—might welcome the change of style. Some vindication, however, is due the writer if he seems to supply a parcel of fragments rather than a true epitome.

The 100 cases were reported from Stafford Prison between the dates September 26th, 1911, and August 20th, 1912, i.e., a period of about eleven months. During this same period, there were received into Stafford prison 2807 males and 611 females (excluding debtors, and penal servitude prisoners who were sent to Stafford from other prisons). Some allowance would have to be made in these figures for the same individual having been received more than once during the period under review.

P. G—, æt. 40, admitted January 9th, 1912, on a charge of assault; had been a sailor for many years, during which period he contracted the morphia habit. Since 1884 he had been taking the drug, gradually arriving at the stage previous to admission, when he was taking 15 gr. a day. The largest dose he ever took was 15 gr., followed in an hour by 10 gr.

Two Bills presented to the Chambre des Députés, recognising insanity as a ground for divorce, have not yet been debated. According to the motion of M. Maurice Violette, detention in an asylum during three consecutive years is necessary, and the applicant must submit, with an interval of one year, three requests for the nomination of two physicians for the purpose of examining the patient and attesting incurability. The writ has to quote the three reports, and divorce cannot be granted unless the signers unanimously certify that such insane person no longer presents any prospect of recovery. The Bill of M. Maurice Colin requires also as an indispensable condition a detention of three consecutive years in an asylum and a certificate of incurability; but even subsequently to the divorce, the successful applicant remains responsible for the maintenance of the lunatic. M. Maurice Colin gives as a characteristic mark of incurable insanity the disappearance, without any possible return, of intellectual and moral personality. But he repels the plea for divorce when this condition is a consequence of senility.

The question of suicide is one that has exercised the minds of most persons at one time or another, as cases are of such common occurrence, and present such a variety of features, that anyone interested in present-day social conditions cannot fail to give the matter some amount of consideration.

The prime importance of classification of patients in asylums with a view to securing the best results of treatment cannot be denied. By classification is meant, not a rigid division of patients strictly according to their form of mental disorder, but rather a selective grouping of patients in wards and villas, where the amount of supervision, the nature of treatment, the extent of freedom and the general environment is best calculated to promote recovery, to discourage mental excitement, and to secure contentment and the highest possible standard of conduct in each case.

F. Siemens (Lauenburg in Pomerania), at the annual meeting of the German Society for Psychiatry at Kiel, in May, 1912, made the proposition, which received unanimous support, that the Empire might be called on to establish a biological institution for the investigation of the physical basis of mental diseases. He said that the building of expensive establishments and the discovery of new methods of accommodation cannot in the long run satisfy either physician or people. Neither was it of any value to continue the diligent grouping of mental symptoms into types according to the fancy of the alienist. There were only two kinds of symptoms in mental disease: (a) The elementary, caused by physical disease such as anxiety, hallucinations, emotionalism, stupor, catatonia, and delirium; (b) symptoms of a purely mental kind, arising out of the misinterpretation of those elementary derangements by the psyche. The study of the action of the internal secretion of glands encouraged the hope that in the investigation of mental diseases much also will be gained by this means. The individual provincial asylums were not in a position to accomplish the task of so comprehensive an inquiry, nor were the individual clinics at the universities, but the Empire must establish an institution on a large scale for this purpose.