A little more than a year ago a public meeting was announced as having taken place in this metropolis for the purpose of establishing a “Benevolent Asylum for the Middle Classes.” Though many were without doubt pleased with the project of so useful an undertaking, it appears that the vast majority of the public regarded it with great indifference. For, from time to time, an advertisement in the papers—a doleful and undignified document—has complained of the want of support, begged for further aid, and reminded lately the public that the amount subscribed for the Hartley Colliery Fund over and above what was wanted, would have been more than sufficient to have started the benevolent asylum. The public indifference must be the result of public ignorance; for we well know that when the heart of the country is touched, its sympathy and help are given in a profuse and practical manner. To elicit such aid, however, there must be a reasonable and well understood end in view; and the question is, whether the promoters of this proposed asylum have given a clear idea of what they want, of what they propose to do, and of the way they propose to do it.

Although much of a speculative kind appears to have been written upon the subject of climacteric insanity, more especially as regards the pathology of the disorder, the accumulation of actual facts, bearing upon its genesis, symptomatology, and terminations is comparatively small. Exception must be made for the highly practical paper lately read by Dr. Savage at the Medical Society. A further contribution dealing as far as possible with matters of observation may be serviceable. For the purpose of this paper, in addition to the cases coming under the direct observation of the writers, the records of Bethlem (10 years, 102 cases) and the West Riding Asylum, Wakefield (10 years, 120 cases) have been drawn upon. We are indebted to Dr. Salter, Clinical Assistant, Bethlem Hospital, for much assistance in collecting the cases, and Dr. Percy Smith for permission to use the records of Bethlem.

Several fallacies may occur in the recording of the pressure of the cerebro-spinal fluid. These fallacies may be related to (1) the type of apparatus used, (2) movements of the patient, and (3) reading of the pressure.

I have often stated in conversation that Shakspere, in depicting the agitation into which Othello was thrown by the artifices of Iago, subjected the Moor to an epileptic seizure. Almost without exception, this statement has at first been contradicted; but a perusal and an analysis of Scene 1, Act iv. of the tragedy of “Othello” have, I think, convinced all enquirers that the dramatist's design in the matter was not open to doubt.

The question of how best to secure early treatment for sufferers from mental derangement has long engaged the attention of the medical profession. It will not therefore, we premise, be out of place to scrutinise some of the more recent pronouncements on this subject. and we could not probably find a more appropriate text for discussion in this connection than the little volume on Shell-Shock by Profs. Elliot-Smith and Pear, a second edition of which has lately appeared, the first having been rapidly exhausted. We welcome this fact as showing that more or less general interest in this most vital and important subject is being aroused, and we hope the demand will continue, although, as will be seen, we have perused its contents with somewhat mingled feelings, especially when taken in connection with an address delivered, since the publication of the book, by Prof. Elliot-Smith at the Royal Institution for Public Health.

The present seems to be a favorable moment for directing the attention of the profession to the condition of those insane paupers who are confined in workhouses. A general disposition to criticise the management of these establishments exists in the public mind, and the profession has given unequivocal evidence that it shares in this feeling and is determined to carry out the inquiry thoroughly. If may be safely affirmed that, if this is to be done, there is no part of the subject which demands earlier attention than the condition of those workhouse-inmates who are insane; for the circumstances which call so loudly for reform in the management of “indoor” paupers, especially those who are sick, exist in an extreme degree in the instance of the insane. The upshot of all careful inquiries into these matters, and notably of that inquiry now proceeding in the columns of ‘The Lancet’, is to make prominent the fact that those workhouses which are situated in populous cities are rapidly becoming great hospitals, instead of refuges for tired or lazy vagrants: while, as yet, the guardians who manage them cannot (or will not) understand that this is the case, but persist in treating the inmates as much as possible on the old system, by which the workhouse was a penal residence intended to disgust and repress the applicants for public relief. Under such a régime it has been shown that numbers of acutely sick persons suffer great hardship and have their chances of recovering health and strength materially interfered with; while as for the patients suffering from chronic disease and debility, it can hardly be said that they receive any proper care at all; and it is my purpose in the present paper to show particularly that the insane are the most deeply injured of all classes of indoor paupers by the system usually followed.

Bleuler, in his Text-book of Psychiatry, says that “Reactive mania is unknown.” This statement occurs in the section devoted to the consideration of the reactive states; temporary psychoses, that is to say, where the ætiology is so clear and in such temporal contiguity to the onset of the symptoms that the illness can be definitely laid at the door of some recent alterationin the patient's total life situation.

Before submitting to you my ideas on the much-disputed question of dementia præcox, there are one or two points in the papers of Drs. Jones and Urquhart to which I should wish to draw attention. I will take them in the order in which they occur.

In 1954 Shaw et al. described the action of Megimide (bemegride) in shortening sleep and restoring consciousness in laboratory animals under the influence of barbiturates. Subsequently, in 1955 Shulman et al. reported the results of the use of this drug in the treatment of barbiturate overdosage in man. Since then Megimide has been widely accepted as a valuable antidote in barbiturate poisoning, but there has been much discussion on whether it is a specific antagonist to barbiturates or a non-specific central analeptic.

Although we have, for some time past, begun to emancipate ourselves from the idea that insanity is a disease of the mind, and admit, in theory at least, that it is strictly a disease of the body, as much so as typhus, or any other disease involving perturbed mental phenomena, yet we have scarcely hitherto begun to investigate the pathology of insanity from this point of view. Even yet we classify the forms of the disease by the mental manifestations it presents, and speak of mania, melancholia, dementia, &c., when our aim ought to be to differentiate the physical or chemico-vital somatic conditions; we describe the insanity of fear, of pride, of exaltation, &c., much as if we should classify ulcers as those of the hand, the arm, the leg, and the trunk, instead of attending to the more important characters of ulcers in general with their true specific differences. For, I venture to think, that Professor Ferrier's researches point strongly to the view that the differences in direction, so to speak, taken by the mental phenomena depend to a great extent upon the differences in the portion of brain-tissue principally affected. The investigation of the physical causation and conditions of insanity will doubtless be laborious and tedious work, but there can be no doubt that the results to be obtained will more than repay the labour which must be expended in the investigation.

“The wicked flea,”—Everybody knows the “wicked flea,” for it is no respecter of persons. It makes its home in the palace of the prince, the hovel of the savage, and the tent of the Arab. The devotions of many a worshipper are destroyed by the Pulex tabernaculi, or church flea, which makes up by its voracity on Sundays for enforced abstinence on other days of the week; and one of the wonders narrated by travellers is that on camping in the desert they have found this wicked little creature waiting for them, ready to bite, although apparently its progenitors from time immemorial could hardly have had an opportunity of gratifying their taste for blood. When in Rome one summer, fleas were abundant in the hotel where I was staying. I used to walk barefooted about my room every morning, and soon a prick on the instep would warn me that a flea was there. I looked down, saw a little black speck, put a wet finger upon it, and after a little rub would transfer it to a basin of water. The sensation of something solid between the finger and thumb and the transference of the black speck from my instep to the water convinced me of the presence of the flea, for I had the threefold evidence (1) of common sensation, (2) of sight, and (3) of muscular sense all combining to prove the actual existence of the flea. At other times during the day I had the evidence of sensation to indicate to me that fleas were again biting, and I felt quite convinced by sensation alone that such was the case, for although I could not corroborate the evidence of sensation either by sight or by muscular sense, yet it was not contradicted by these senses. But sometimes I have felt upon my hand a sensation exactly similar to the bite of a flea, and yet, as the hand has been on my writing-table within full vision, and no object whatever was to be seen on the hand, I have discarded the evidence of sensation in favour of that afforded by sight, and come to the conclusion that no flea either was or had been upon my hand. Had it not been for the sensation of sight, however, and had the hand been hidden from my view, I should have confidently believed that it had been bitten, trusting to the evidence of sensation, which, though unconfirmed by sight or muscular sense, was not contradicted by these senses.

Tridione (Abbott) is 3.5.5-Trimethyloxazolidine-2, 4-dione, and has been demonstrated clinically to have an inhibitory effect on petit mal, myoclonic and psychomotor seizures in epilepsy. Gibbs, Gibbs and Lennox first demonstrated a similarity between the cortical dysrhythmias in certain cases of schizophrenia and those of psychomotor epilepsy, whilst Kalinowsky and Putnam, as a result of these findings, gave the anti-convulsant dilantin as a successful sedative to 60 cases showing mental symptoms. Since tridione has a specific action against psychic equivalents in epilepsy, it was thought that its administration to patients showing chronic mental disturbances might result in at least a similar improvement.

The case of W. C., a boarded-out lunatic, who recently made a murderous attack upon the wife and child of his guardian, has brought under public notice and discussion several matters connected with lunacy administration in Scotland. It would, obviously, be improper to discuss questions here which are still under the responsible consideration of the General Board of Lunacy. Therefore I do not intend to refer to such questions, and may venture to express the hope that the subsequent discussion will be confined to the one point raised, viz., the mode of procedure adopted by the criminal authorities.

Through the kindness of Dr. Conolly Norman, I am enabled to report the following case of spontaneous cardiac rupture.