Gall-stones are stated to be most common in females of advanced years by all writers on the subject, but is the frequency of their occurrence in such cases fully recognized? There is a further question, one which more immediately affects the medical officers at asylums, and which it is possible to have answered. Do gall-stones occur more commonly in the insane than in others, and is it possible for insanity to have any influence on the formation of biliary concretions?

I feel that an apology is due from me for the introduction of this paper, which is really unworthy of the name, and only purports to be a collection of rough notes put together at the times and in the places mentioned. As such I venture to offer them to you.

In the preceding part of this paper we considered what may be called the substantive provisions of section 330 of the Lunacy Act, 1890. We now pass on to the adjective part of the section. Suppose that a medical man, against whom an action for damages for the alleged false imprisonment of an alleged lunatic has been raised, is in a position to satisfy the Court or a Judge that “there is no reasonable ground” for imputing to him “want of good faith or reasonable care,” when and how shall he avail himself of his statutory privilege? Upon these important points section 330 displays the vagueness that is almost a characteristic of modern legislation. The only information that it gives us is that an application to stay proceedings may be made “summarily” (a term of which no definition is offered or even suggested) to “the High Court,” and that “the Court or a Judge” may grant or refuse the application “upon such terms as to costs or otherwise” as the said Court or Judge may think fit. Now, in the absence both of any clear light from the section itself and of any authoritative judicial interpretation of it, the maxim Omnis definitio in jure periculosa est applies with peculiar force, and consequently the following observations are offered with some hesitation.

The following facts appear noteworthy as bearing upon the morbid condition going by the names “hæmatoma of the dura mater” and “pachymeningitis hæmorrhagica interna.” In the course of recent experiments I have had occasion to incise the dura mater of (anæsthetized) rabbits and apply Sp. Vin. Gallic. or diluted cantharidin to the cerebral cortex through the aperture so made. On killing one of the animals after the lapse of 48 hours and opening the skull almost the whole of the right hemisphere (that operated upon) was seen to be covered with dark-red clot. This term is justified by the appearance of the exudate, whatever its origin may have been. On incising and reflecting the dura mater it was found that the clot lined the inner surface of that membrane, and had no connection with the subjacent structures. The vessels of the dura were unduly prominent and numerous, but there was no swelling of the membrane, and, apart from the clot, its inner surface was free from exudate. The clot was raised without difficulty, and washed gently in water; the colouring matter came gradually out, and left a delicate, greyish-pink, translucent, continuous pseudo-membrane of sufficient consistence to permit of manipulation. This was divided into two portions, which were stained with hæmatoxylin and safranin respectively. Microscopically the pseudo-membrane was found to consist of red and white corpuscles (the former in considerable majority), a meshwork of fibres (fibrin, apparently), and an amorphous substance, uniformly stained.

Eighteen years have passed since Kahlbaum published his memoir upon this subject, yet it may be said that the claims of katatonia to be regarded as a distinct disorder are still unsettled. This prolonged period has not, however, been marked by phases of belief, such as are often exhibited subsequent to the publication of accounts of new disorders, or follow proposals to rename and reclassify disorders already known; at first enthusiastically believed in and subscribed to, these fall, at a later stage, upon evil days of neglect, and even oblivion. But with katatonia it has been otherwise. At no time does there appear to have been any widespread enthusiasm in alienist circles about this affection; at most it seems to have appealed to individuals, who have expressed merely isolated views, the statement of which has led to nothing more than limited controversy. Probably it may be said with justice that katatonia, for the majority of medical men in asylums in this country (at any rate), was but a name up to quite recent times; having a doubtful significance for some, for many quite without meaning. Granting that this remark is true, the truth brings with it no surprise, for the disorder referred to meets with scant notice in English text-books. This may be said without casting any reflection upon these works, which, of course, are not bound to treat of disorders not universally recognized.

The first fifty cases in which the writer made use of sulphonal have been selected for analysis. The drug has since been freely used by him in many other cases, which are here excluded from consideration; the results in these cases, it may, however, be stated, have been very similar to those afforded by the earlier ones.

R. P., æt. 61; married. Admitted into Wakefield Asylum March, 1885. Formerly labourer in a mill.

It was said that patient had been very intemperate, and that his wife and daughter had contracted venereal disease from him. His mother was stated to have been paralytic for several years before death. This is the only instance of family neurosis.

It is very possible that if medical men were asked to give an account of cases of insanity treated by them in general practice many, especially those who have given attention to the subject, would be able to show some good results. As, however, they do not have the accessories for successful treatment in every case, such as specially-trained nurses, the quietude and repose of asylum life, freedom from the worries of friends and relatives who, from want of judgment and tact, often do much harm, and from whom it is impossible in private life to isolate the patient entirely, physicians in general practice cannot be expected to be able to do so much as those engaged in asylums.

The patient was a well-built man with florid complexion, 70 years of age. He had been in the Crichton Royal Institution for 18 months as a voluntary patient, and was subject to periodic attacks of nervous excitement, during which he was restless, unable to keep still for a moment, had spasmodic movements of the arms and legs, and lost his appetite. When free from excitement he was able to take long walks and never complained of dyspnóa. The action of the heart was usually steady and regular, but towards the end of an attack of excitement it became rapid and feeble. A mitral presystolic murmur had been present for some years. He died suddenly one morning during an attack of excitement. There was a history of gout.