By the courtesy of Sir Patrick Manson, K.C.M.G., I am permitted to show you specimens of (1) the trypanosoma from the human subject, an European, which is the first instance of such a discovery; (2) in monkey got by injecting human trypanosomes, the specimen being one, I believe, of Dr. Castellani's own preparation; and (3) the Tryp. Lewisi from the sewer rat. I make no apology for drawing attention to the possible cause of a disease—sleeping sickness—which is so nearly allied in its clinical symptoms to the condition of katatonia or hebephrenia, two of the varieties of dementia præcox which, in increasing numbers, many of us are called upon to treat. Recently my colleagues and myself have made an unsuccessful attempt at lumbar puncture in order to have examined the cerebro-spinal fluid of a case of katatonia. Let us briefly contrast the trypanosoma with the malaria parasite.

The conditions of life of the whole community in the county of Glamorgan, the staple industry of which is that of coal, in which 17 per cent. of its population are directly employed, are subject to modification through the influence of an arrangement known as the sliding scale, by which the wages of the colliery operatives are determined in accordance with the selling price of that commodity. This scale has undergone several considerable fluctuations in the past twenty-eight years, and these fluctuations have been productive of consequences of no small sociological importance.

Dr. R. S. Stewart's statement, in his paper on “Wages, Lunacy, and Crime,” that he used the term “stress” in the ordinary sense of the term did not escape my attention, and naturally led me to suppose, until I read the subsequent part of his paper, that he meant to use the term in the sense in which it was introduced into psychiatry; and it was his departure from this “ordinary” sense which led me to make my expostulation. I desire to deprecate any notion in the mind of Dr. Stewart, or of anyone else, that I am pursuing this subject from any motive except that of clarifying our terminology from ambiguity and uncertainty. For one of my books I have chosen, as a motto, Huxley's confession: “The whole of my life has been spent in trying to give my proper attention to things, and to be accurate, and I have not succeeded as well as I could wish”; and it is in the continued pursuit of these objects that I venture to resume the subject. No alienist of candid mind will deny that our branch of medical knowledge and art still lags behind other branches; and, while much of this retardation is due to the greater inherent difficulty of the subject, and to other causes, some of it is unquestionably due to looseness of terminology and to that inaccuracy of thought which is indicated by inaccuracy of expression. It is the appreciation of this lack of precision which has prompted me to suggest the abandonment of the terms “mania” and “melancholia,” which no rigour of definition can ever now restrict within useful bounds; and with the same motive I return to the topic of “stress” as a text for the exhortation, not of Dr. Stewart alone, but of all of us, to consider with care what meaning the terms we use will convey to our hearers and readers.

BY the Act 25 and 26 Vict. cap. 54, sect. 16, the General Board of Lunacy, Scotland, may grant authority for the liberation on trial or probation of any lunatic from any asylum for such time and under such regulations as the Board may consider necessary or proper, and by the Act 29 and 30 Vict. cap. 51, sect. 8, every pauper lunatic who is discharged on probation shall remain subject to inspection by the Commissioners during the period of probation, and it shall not be lawful for the parish council to take any such pauper lunatic off the poor roll, or to alter the conditions on which probationary discharge was granted, without the sanction of the Board, during the period of probation.

Considerable attention has recently been directed by several observers to adolescent insanity and dementia præcox, and an increase in the numbers of these varieties, especially of dementia præcox, has been stated to occur, which means an increase in the more hopeless and demented cases. Dr. Wood, for instance, at the Annual Meeting of the Medico-Psychological Association, remarked on the increase in the number of cases of mental breakdown during the age of puberty and adolescence among persons of the upper and middle classes— the ages of which on admission he placed at from eighteen to twenty-eight years—and he suggested as a cause the greater strain of education and the worries of life during the present time. Again, at a meeting of the Section of Psychological Medicine of the British Medical Association, Dr. Robert Jones mentioned an increase of dementia præcox and a general increase of the less curable forms of insanity.

The question of the adoption in Ireland of family care as a method of dealing with mental unsoundness is at once highly academic and highly practical: academic because this mode of treatment has never been hitherto attempted in that country; and practical, because it may be said, with a slight modification of a familiar line, that no nation wants it so much. Perhaps all this is only another way of saying that the question stands exactly in that position in which any earnest and vigorous reformer likes to take a subject up. The crop is ripe, but no sickle has yet swept over the field.

There are probably few conditions which are more difficult to define than hysteria. It is unsatisfactory to make any attempt at generalisation with regard to hysteria, as so many exceptions can be found. It is my opinion that a great many distinct conditions are included under the name hysteria. These conditions are probably as different as epilepsy and migraine. All the various so-called hysterical conditions are closely related to insanity. In many families, whilst one or two of the members are insane, several others are hysterical, and others, again, suffer from allied nervous disorders. I will discuss the varieties of hysteria under the following heads:

The necessity for special care of infants and young children afflicted with defective brain development has been increasingly recognised in recent years, but the modes for providing this care are as yet little developed.

There has lately been added to the resources of the Manchester Royal Lunatic Hospital at Cheadle an additional building, a description of which may be interesting to many connected with asylums and hospitals.

In his paper on “Wages, Lunacy, and Crime in South Wales,” Dr. R. S. Stewart asks how such a state of things as he describes is “to be reconciled with the lately expressed opinion that ‘insanity is, and ever will be, the product of two factors, stress and heredity?”’ These words he puts in quotation marks, but I am unable to trace them to any other source. The doctrine that insanity is a function of two variables, heredity and stress, was first enunciated by me some thirteen years ago, and can scarcely therefore be regarded as a novelty now; but, as it is clear, from Dr. Stewart's question and other remarks that he has a very erroneous notion of the doctrine, and as, moreover, it has been misapprehended and therefore misrepresented by others, perhaps you would allow me space to re-state it; although I think that any one who does me the honour to read it in its original form, as set forth in Sanity and Insanity, would scarcely fall into the errors that I have alluded to.