The purpose of this paper is to illustrate and discuss by case-records the affective responses of a number of patients with a schizophrenic reaction type of mental illness. Recently the energies, time and attention of neuropsychiatrists have been focused on the newer methods of treatment of the schizophrenics. As a result of such intensive and extensive study, interest in other problems of schizophrenia has been rekindled. The “shock therapies” have seemed to crystallize certain factors for us. They have tended to bring out into clear relief certain old factors and have produced many new facts so that we have been forced to re-orient ourselves in many diverse ways. Prognosis has been altered, and this fact has led to a minute scrutiny of the patients who have been treated to determine what factors are operating for or against a favourable outcome. One of these is the affective factor. Patients that have retained a good affective response may still be able to combat reality and its ever-present problems of adjustment and re-adjustment. They may recover spontaneously, or they may do so quicker with the help of the “shock therapies.”

In the “Journal” for October, 1881, I recorded a case of feigned insanity in a prisoner who was charged with the crime of murder. The form of mental disorder assumed in that case was acute mania; and the pourtrayment was so good that even the experienced prison officials, who are accustomed with attempts at imposture in all its varieties, were deceived by his histrionic skill. The following case differs in many of its aspects from that one, but it resembles it in respect that the prisoner ultimately confessed his imposition; though, as in the former case, not till after the distinct expression of medical opinion that he was malingering.

Since sulphanilamide has been shown to be of value in the treatment of infections due to a variety of organisms, it was thought that it might be efficacious against bacillary dysentery.

Punishment is the positive infliction of suffering as a righteous result of wrong-doing, and as a deterrent from its repetition. But the wrong-doing of the insane is the result of their malady, which produces it either directly through delusion, or indirectly by perverting their moral sense and relaxing their self-control.

Carriers of the enteric group of organisms are apt to be a source of some administrative difficulty in mental hospitals. The Infectious Diseases Sub-Committee have therefore attempted to estimate the value of cholecystectomy in this condition.

If I may be allowed to speak to you about the importance of functional impediments to the circulation, I would like to do so from the point of view of the anatomist. I shall not speak about the clinical and physiological observations in neuropathology and internal medicine; I want rather to begin with the deductions to which the anatomist is led by his own methods, independent of clinical facts and questions.

The case I am about to describe seems of sufficient importance to bring to your notice, as it presents many points of interest.

Gentlemen,—In the name of the Irish members of our Association, I desire to greet you all with a very cordial welcome on the occasion of this your second visit to our city. Fourteen years have elapsed since you last honoured us with your presence. I hope that a careful comparison of the present state of the institutions here with their condition then will convince you that the spirit of improvement has been among us, and that we have endeavoured in some measure to keep pace with the progress apparent in other districts in this department of the healing art.

A recent decision of Mr. Justice Coleridge, respecting the invalidity of a medical certificate of insanity, because the name of the street, and the number of the house wherein the examination took place, were not therein stated, has profoundly affected the serenity of the persons most interested in the strict observance of the statutes on lunacy. This decision, the legal correctness of which has not been disputed, invalidates a large number, perhaps the majority, of the documents under which, lunatics placed in confinement since the passing of the late Acts are detained. The case upon which Mr. Justice Coleridge's decision occurred was that of Mr. Greenwood, an aged gentleman of large property resident at Todmorden, He was unmarried but had several natural children, to one of whom, a daughter, he was much attached. It is stated that he had expressed a desire to bequeath some of his property to this daughter; whereupon his brothers caused him to be admitted into a private lunatic ! asylum named the Billingdon Retreat. He was confined in this asylum a day and a night without certificates. The day afterwards he was removed to a public house in a neighbouring town, at which he was seen by two medical men who examined him, and certified to his insanity; but they omitted in their certificates to state the name of the street, and the number of the house in which their examination took place. Through the intervention of personal friends, Mr. Greenwood was brought to London under authority of a writ of habeas corpus granted by Mr. Justice Coleridge. Here he was examined by various medical men expert and non-expert Among the former were Dr. A. Sutherland whose affidavit testified to his insanity, and Dr. Forbes Winslow and Sir Alexander Morrison, whose opnions and affidavits were quite the other way. When the case came on for discussion on Saturday the 10th of February last, Mr. Serjeant Wilkins on behalf of the alleged lunatic raised the question of the validity of the two medical certificates in which, as we have before stated, the name of the street, and the number of the house in which the examination took place, were omitted to be mentioned. Mr. Justice Coleridge reserved his judgment on this point of law, and on the 19th of February be gave his decision that the certificates were invalid in consequence of these omissions, and he ordered Mr. Greenwood to be discharged accordingly. Such is a brief outline of the train of circumstances which has sprung the mine upon the archives of admission papers treasured with such care in asylums and, hospitals for the insane; and copies of which are guarded with jealous solitude in the muniment rooms of Whitehall Place. The Circular of the Commissioners [Feb. 14, 1855] on Lunacy truly states, “This decision, although immediately applicable only to the particular case, has a wider and general bearing, and enunciates the principle upon which the superior Courts of Law will, it is presumed, judge all analogous questions of form.” It enunciates in fact the very simple and reasonable principle, that the validity of documents upon which an Englishman is to be deprived of personal liberty on the ground of insanity, must be in strict and not in loose accordance with the statutary enactments of the legislature. If these enactments have been made too intricate and complicated for use, the difficulty has not arisen with the persons whose I duty it is to interpret them, but with those by whom they were made. It has been stated, that Mr. Justice Coleridge evaded the onerous and disagreeable duty of deciding between conflicting opinions as to the sanity or insanity of Mr. Greenwood, by this decision on the point of law. That be shirked his straight forward duty by taking a side path. But it must be remembered that the point of law was not mooted by the Judge, but by the counsel for the alleged lunatic, and the Judge was compelled to decide upon it one way or another. If the opinion of Mr. Justice Coleridge is unsound in law it can be reversed. If his interpretation of the enactment is correct, but notwithstanding this has a tendency to consequences which will be of serious inconvenience to the public welfare, the only remedy lies in legislative interference and the amendment of the statute.

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

Syphilitic Insanity.—This is the first of the varieties of insanity in Dr. Skae's classification that is due to the action of a poison introduced from without. As might be expected, its symptoms are much more definite than those of the more constitutional and hereditary varieties of mental alienation. Something, too, is known of its pathology, and yet it is only about twenty years since the fact was recognised that the syphilitic poison could produce mental derangement at all. It has been described by English, French, and German authors on insanity and syphilis, but Dr. Wille, the latest German writer on the subject, has given us by far the most complete account of the disease in all its forms so far as it is at present known. An excellent abstract of his paper appeared in the “Journal of Mental Science” for January last, by Dr. Addison.† It is one of the forms of insanity that must be studied in connection with the other syphilitic affections of the nervous system, if we wish to understand it. To describe its symptoms without reference to the syphilitic form of epilepsy, of paralysis, and neuralgia, would be a mistake in every respect. Dr. Reade, of Belfast, and Dr. Todd, of London, were the first in this country to direct special attention to the occurrence of mania as a direct result of syphilis. They both showed that it was one of a train of symptoms that had the specific infection for its starting point; that those symptoms proved clearly that the nervous system, both spinal cord and brain, as well as their membranes, were involved in such cases, and that whatever cured the syphilis cured the neuroses. Dr. Duncan published three very interesting cases of syphilitic insanity in 1863.∗ Dr. Hugh Grainger Stewart published three cases in 1870.† Dr. Wille has collated the symptoms of 77 cases of syphilis, in which there were mental symptoms of one kind or other. Many of Lancereaux's cases, given in his work on syphilis, have mental impairment or disturbance as a part of their history.

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.

The object of the paper is to urge the establishment throughout the country of institutions for the treatment of nervous cases and of early uncertifiable insanity. The fact of certification leads to an erroneous view of insanity, for it does not make a person insane, nor does the absence of it prove sanity. The boundary line of certification is a purely arbitrary one, and, from the nature of the illness and our present ignorance of it, this is bound to be so. Certification does not necessarily mean that at such a moment a person became mentally upset, but rather that at such a time, after observation showing them not to be responsible for their actions, it became advisable, in the interests of themselves or others, to control them, if required, by force.