Cases of mental disease which give definite mental symptoms and physical signs of the condition recognised and at present called general paralysis of the insane, and which, moreover give a Wassermann reaction, seem to be invariably due to syphilis, and to contain in many cases spirochætes in the cerebral substance. Out of seven such cases of well-marked general paralysis, which on death were examined for spirochætes by Dr. McIntosh, six cases showed the presence of spirochætes. The seventh case was regarded as doubtful.

For the sake of brevity, I use the term hyoscinism to designate the symptom group which may arise from the administration of scopolamine hydrobromide in repeated doses.

The following short paper is based upon observations made during the examination of the cerebro-spinal fluid from a series of cases of various forms of mental disorder. A good deal of attention has recently been paid to the examination of this fluid in conditions of disease; there have been numerous observers, and several important tests have been devised. In this series of cases a routine examination was followed in every case, which embraced the tests described by Noguchi, and by Ross and Jones, an examination of the cells present, and an estimation of the amount of albumen in the fluid. It is to the last of these methods of examination only that attention is directed in this paper.

Sleep, gentle sleep, Nature's soft nurse, how have I frightened thee That thou no more wilt weigh my eyelids down and steep my senses in forgetfulness?

I feel I should preface my paper on “The Rôle of Hypnotics in Mental Diseases” by the statement that you will merely find in it a collection and corroboration of well-known facts. These facts, however, have been brought together in a form in which I have not been able to find them elsewhere, viz., such as will aid in pointing out the indications for the employment of the different hypnotics, and the types of mental disease in which certain of the drugs appear to be especially useful.

Though the subject of enteric fever would not seem to come within the purview of this Association, yet special features, mental and otherwise, of the outbreak in Omagh Asylum in the end of last year prompted me to put some of the facts before the members of the Irish Division. They will pardon me if they find my remarks rather bald, being mere records of observations, but I hope they will not be altogether uninteresting.

A Full account of the cases on which this paper is founded cannot now be given, as some of them are still under observation; and in others, which have ended fatally, the histological examination of the tissues is not yet complete. We think, however, that sufficient data have been collected to make a preliminary communication desirable. The condition to be considered may be described as “encephalitis,” or “encephale myelitis,” rather from the want of a better term than from any conviction on our part that it is essentially inflammatory in origin.

In their report on this Asylum for 1913, the Lunacy Commissioners state: “Almost 20 per cent. of the patients in each of the Staffordshire asylums are epileptics; this unusually high proportion appears to obtain in each of the Staffordshire asylums, and to be a subject worthy of further inquiry locally.” It is also noteworthy that associated with this high proportion of epileptics is a high tuberculosis death-rate, viz., 25.2 per cent., the average epileptic percentage of the number of patients remaining at the year's end in county and borough asylums in England and Wales being, for 1911, 12.5, while the proportion of tubercular deaths per cent. of deaths from all causes (1902–1911) is 16.6

Lethargic phenomena have often been studied and described in connection with hysteria and hypnotism. It has been pointed out by hypnotists that a state of lethargy occurs at times which takes its own time to disappear. Lethargic states in hysterical persons, whether under the influence of hypnotism or not, are not rare. According to Charcot's classical descriptions the lethargic state can be produced artificially during hypnosis by closing the eyes in the cataleptic phase, but it can likewise be primarily caused by fixation. During the lethargic state consciousness is obscured, sensitivity to pain is diminished, and the tendon reflexes are increased.

Inquiries into the family histories of the pauper insane in large urban districts as a rule result in the acquisition of more disappointment than knowledge.

In the year 1850, Baillarger published an account of a new symptom which he had frequently observed in general paralysis, namely, inequality of the pupils.

F—, single, æt. 61, admitted in December, 1912, and died in April, 1913. History very defective. Mental symptoms had been present for some years. She was very thin and haggard, with marked exophthalmos. The hair was so scanty that she was nearly bald. A fairly large firm and elastic goitre present. One insane ear. Reflexes exaggerated generally, but equal. Muscular system normal. Complete absence of subcutaneous fat. The skin over the front of the abdomen and, to a less extent, that of the rest of the trunk and of the upper parts of all four limbs, was covered with raised, discrete, warty-looking masses. The skin could be picked up from the underlying tissues except in one place on the back of the left thigh, where the skin was atrophied, pigmented, shiny and adherent to the deep tissues, and had been subjected to a good deal of scratching. The skin of the face and hands was quite normal. She was very restless and difficult to examine. She suffered from chronic bronchitis, and had a mild tachycardia as well as a mitral systolic bruit. She suffered from very vivid hallucinations of sight and hearing, and was very excited in consequence at times. She became gradually thinner during her stay here, and passed into a marasmic condition in which she died.

The patient, D. T. M—, male, æt. 51, married, with grown-up, healthy family, was admitted to Montrose Royal Asylum on July 29th, 1913, with history of having threatened violence to himself and to his wife, and of having lost his memory.