I desire to-day to show, to some extent, the difficulties the general practitioner of medicine has to contend with in the treatment of lunacy; difficulties certainly unknown in public asylums, and only partially appreciated in private institutions.

The liberty of the subject, so dear to all Englishmen, is under certain conditions placed by the law of the land at the discretion of any two qualified medical men. That the confidence thus reposed in the members of our profession has not been abused is proved by the evidence of an unimpeachable witness, namely, that of the Earl of Shaftesbury, who, as Chairman of the Commissioners in Lunacy, asserted before the special Parliamentary Committee, that in his experience of nearly thirty years “there has not been more than one or two cases in which any person has been shut up (that is, in a lunatic asylum) without some plausible ground for his or her temporary confinement; but in every instance, with these exceptions, there have been certain plausible grounds in fact or in logic, sufficient to justify the temporary confinement of the persons, and their being submitted to medical treatment.” It is highly creditable to our profession, that a man of Lord Shaftesbury's position and experience should be able to give this strong and definite testimony, to the manner in which the statutory powers of medical men in giving certificates of insanity have been exercised; but at the present time it is not my desire to dwell upon the sound judgment and honest intention with which this great social responsibility has been discharged, but to direct the attention of the meeting to the abundant and constantly recurring errors of form, which are committed in filling up medical certificates, in the hope of affording such few hints as my experience may suggest, by which they may be avoided. So abundant are these errors, that I hear medical gentlemen connected with private Lunatic Asylums assert that it is the exception, and not the rule, to receive with a patient, admission-papers which require no amendment. Indeed, a physician in charge of a first rate private asylum assures me, that he has never yet received admission-papers which did not need amendment. This is a matter of great importance, for (to say nothing of the delay and expense incurred in procuring these amendments, which are so great that the proprietor of a large private asylum assures me, that he invariably prefers the expense of procuring altogether new certificates) any errors or omissions, not discovered and rectified, would leave the proprietor of an asylum liable to heavy damages, under an action for false imprisonment. The courts of law very properly require that these medical documents, under which men are deprived of their liberty, shall be drawn up in exact accordance with the provisions of the statute. An early illustration of this principle was afforded by the decision of Mr. Justice Coleridge, in the case of Mr. Greenwood, in which he declared that the medical certificates were invalid, and that the patient had been improperly confined, because the name of the street, and the number of the house, in which the medical examination had taken place, were not stated upon the certificate. The formal part of the certificate is indeed a very simple one, and contains no one thing which might be omitted.

During the year from May, 1898, to May, 1899, 26 male and 28 female patients in the Derby County Asylum were attacked with the disease variously known as dysentery, dysenteric diarrhoea, or colitis, and characterised clinically by bloody stools and rise of temperature, and in advanced cases showing in post-mortem examination extensive thickening and ulceration of the lower end of the large intestine, with numerous microscopic hæmorrhages into the submucous layer. Of the 54 attacked, 23 died, in 13 the colitis being apparently the direct cause of death, in 10 a contributory cause. Some brief notes of our attempt to ascertain the cause of the outbreak may be of interest, though the results obtained were mostly negative or inconclusive.

The deeply interesting and instructive Museum of Criminal Anthropology, founded by Lacassagne in the noble university on the banks of the Rhone, is well known to all medical visitors to Lyons. It is now proposed by the Faculty of Medicine at Turin to establish a museum somewhat similar in character, though of wider scope, at the university with which Lombroso has so long been connected. All the material, so far as it can be collected, for the study of the causes, symptoms, and therapeutics of insanity and criminality will here be brought together. The medical man, the lawyer, and the philosopher will be able to examine the “palimpsests” of the asylum and the prison, the data concerning the ætiology of crime and mental perturbations, the geography of crime, etc., and the skeletons and brains of the insane and criminal will demonstrate the close connection between mental aberrations and corporal abnormalities. Such a museum must form a most valuable source of instruction in psychiatry, and it is to be hoped that the initiative of France and Italy may before long be followed in England. I may add that a Museum of Psychology—not of morbid psychology especially—was founded a few years since at Florence by Professor Mantegazza.

In the introductory remarks contained in the previous portion of this essay, I said that, as far as possible, I would refrain from referring to the condition of the nervous centres as seen after death, except to explain the nature of certain phenomena seen in these diseases during life. Having arrived at the second portion of my subject, I shall draw attention to the condition of the brain and spinal cord where death has been the result of an epileptic fit, or while the patient has been in what is now so well understood as the Status Epilepticus.

In succeeding, as President of the Medico-Psychological Association, the distinguished professor whose term of office now expires, I beg to return you my best thanks for the honour you have conferred upon me. I must at the same time express my regret that I was unable to attend the last annual meeting of the Association, when I might, as on previous occasions, have pleaded my total unfitness for the office, and have again obtained your assent to the selection of one more suited for that honourable distinction. Having, however, been placed in what I consider a false position, I have now only to trust to your kind forbearance and beg your support in the fulfilment of the duties.

C. M., admitted January 17th, 1870, æt. 24. Married; wife of sailor; can read and write; Church of England; from Whitehaven.

This Committee was constituted in July, 1922, by the Lord Chancellor, The Earl of Birkenhead, “to consider and report upon what changes, if any, are desirable in the existing law, practice and procedure relating to criminal trials in which the plea of insanity as a defence is raised, and whether any and, if so, what changes should be made in the existing law and practice in respect of cases falling within the provisions of Section 2, sub-section (4) of the Criminal Lunatics Act, 1884.”