American Journal of Insanity, April and July, 1895; Alienist and Neurologist, July, 1895; The Journal of Nervous and Mental Disease, June, 1895.

Dr. Clara Barrus writes in the American Journal of Insanity an article on “Gynæcological Disorders and their relation to Insanity.” She tabulates one hundred cases in which examinations were made whether the patient presented symptoms calling for uterine examination or not, and is of opinion that a thorough physical examination is necessary in all female cases, since the manifestations which would lead to examination were only noted in three patients. Very often the pain and discomfort felt by insane patients is misconstrued, and so, while we get no expression of pain itself, we may find the patient suffering from delusions that she is pregnant, that she has been violated during the night, and so on. A synopsis of the table is given, and shows the age of the patient, whether married or not, the presence or absence of menses, lencorrhóa or masturbation, of anomalies and new growths, the condition of the uterus and external genitalia, and the kind of mental disease which is presented. The gynæcologist who learns that it is the exception rather than the rule to find an insane woman with normal pelvic organs must be careful not to assign these abnormal conditions as a cause of insanity, but to keep an open mind, suspending his conclusions until further data can be examined. No doubt the causes of insanity in women are as varied and many of them are identical with the causes of insanity in men, but women have an additional physical and mental strain resulting from the crises which they have to undergo, such as the establishment of puberty, the monthly period, pregnancy, the puerperal state, and the climacteric. None of these by itself is sufficient to produce insanity, and when any of these experiences are said to be the cause of mental disease, we must acknowledge that though these may be the exciting cause, yet the predisposing one is an unstable organisation, causing the patient to be disturbed by occurrences which would only temporarily upset a healthy organism. As regards the table itself, one must guard against the erroneous opinion that the lesions which present themselves are associated more frequently with certain forms of insanity than with others, for although there were thirty-six cases of melancholia and twenty-one of dementia, and only nineteen of mania, ten of paranoia, and twenty-four of miscellaneous mental disorders, we must remember that cases of melancholia and dementia are more tractable and more easily examined, while those of acute mania, paranoia and sexual perversion are examined with difficulty. The author concludes that each case on admission should be examined, and if there is any abnormality present it should be removed if possible; by this means the degree of nerve irritation will be lessened and one of the “stumbling blocks” in the way of the patient's recovery will be removed.

Reference to Flechsig's Bromo-opiate Treatment of Epilepsy was made in the last number of this Journal. Though the results chronicled have so far been few in number, the adoption of this form of treatment in severe or obstinate cases of epilepsy, especially when associated with pronounced mental disturbance, appears worthy of consideration. In the Zeitschrift f. Psychiatrie, Bd. lii., two communications have appeared, each of which gives most favourable results. Linke has administered opium and bromides in succession to seven epileptics, six males and one female, in all of whom marked psychical aberration existed. In rapidly increasing doses he exhibited opium first for six weeks, suddenly changing the medicament to large doses (7·5 grms.) of bromide, which being continued for another period of six weeks was then reduced to a daily dose of 5 grms. This is the method advocated by Flechsig, though other therapeutists have lengthened the periods of administration of each drug. Linke found that during the opium course the epileptic seizures increased greatly in number, and that the body weight in some cases showed a marked diminution. As soon as the bromides were substituted for the opium the fits immediately diminished in frequency, and the body weight in the affected cases increased again. The ultimate result of the treatment was that in one patient the seizures had not recurred from the commencement of the bromide course until the date of his paper; in another, one fit occurred on the third day after beginning the bromides, and then after an interval of freedom for nine weeks two seizures ensued; a third patient had a fit on the first morning of the bromide treatment, after which an interval of sixty-five days without fits elapsed, when the bromide had to be discontinued owing to bromism; five days after its withdrawal the patient had another fit. With reference to the mental condition two patients showed a comparative improvement, they became more cheerful and patient of control; one of these, who had been subject to accessions of intense furor, subsequently remained quite free from them. Two of his seven patients died during treatment, one apparently by reason of deleterious action of opium on an affected cardiac muscle, the other owing to exhaustion due to the epileptic status. In nearly all a moderate degree of constipation was induced when the daily doses of opium reached ·60 grms., easily overcome, however, by simple aperients. When the maximum dose of opium was reached serious symptoms supervened, which rendered careful observation of each case needful. As only two and a half months had elapsed between the commencement of the bromide course and the publication of his paper, Linke discreetly draws attention only to the remarkable effects of this mode of treatment in cases hitherto wholly uninfluenced by therapeutic measures; he certainly makes no claim for the method as a specific curative.

The nineteenth Year-Book (1894) of the New York State Reformatory reflects, even at the first glance, the period of trouble from which the Reformatory has only lately emerged. It is a very plain and unpretentious document, without even a single illustration. Although the charges which have been brought against the Superintendent, Mr. Brockway, do not affect the special characteristics of the institution, i.e., the indeterminate sentence and the system of physical and psychic treatment now familiar to readers of this Journal, they tended to throw discredit upon the Reformatory, and moreover random and ignorant statements of the case appeared from time to time in England, even in influential medical journals. As the matter has cow been fully investigated and finally settled, it may be worth while briefly to set forth the results.

The Annual Meeting was held in the Rooms of the Association, 11, Chandos Street, London, W., on Thursday and Friday, July 23rd and 24th.