The following case illustrates the influence of heredity on the protracted types of insanity originating from or excited by self-abuse.

The development of psychiatry in England in the eighteenth century is particularly interesting because it shows the growth of public concern for the insane which led to the establishment of Public Subscription Hospitals and, later, the County Asylums. The general history of the period has been covered in works by Kathleen Jones, Denis Leigh, and Hunter and Macalpine, and books have also been devoted to the history of individual hospitals founded during those years, such as Bethel Hospital, Norwich (1725), St. Luke's Hospital, London (1751), the Manchester Lunatic Hospital (1766), and the Retreat, York (1792). For affluent patients there were, of course, a number of private madhouses, later officially ‘Licensed Houses', scattered about the country; in 1880 there were 40 of these outside the metropolitan area, and in London and Middlesex 14 are recorded in 1807 and 20 in 1815. The Private Madhouse Act (1774) provided for the provincial houses to be inspected by the local justices. In practice this Act was not very effective (11).

Gheel is a well-worn theme on which it is hard to say anything that is very fresh. But circumstances of various kinds have of late contributed to renew general interest in this ancient settlement. The condition of lunacy affairs in our own country is somewhat fluid just now, and the insertion of any foreign object may help to bring about solidification. Finally, I had occasion to revisit Gheel during the past summer. On the whole, when I was asked for a paper for to-day it seemed not unsuitable that I should fall back upon this time-honoured topic.