In this brief sketch it is my intention to refer to a few of the points which I regard as having an important bearing on the construction of asylums in tropical countries.

In the following paper it is proposed to study the influence which alcoholism exerts upon suicide in this country, so far as that influence can be traced in recent statistics of the movement of these social phenomena. Our discussion will aim more particularly at determining the rôle which alcoholism may have played in the late increase of suicide in England, and at establishing the distinctive characters which constitute the type of alcoholic suicide.

Much attention having recently been given (in the pages of this Journal and elsewhere) to the subject of the systematic training of asylum attendants, it occurred to me last autumn that some advantage might be gained in this direction by the instruction of the staff of this institution in “first aid to the injured,” as prescribed in the scheme of the St. John Ambulance Association. I accordingly announced my willingness to give the necessary course of five lectures and demonstrations, and having obtained the moral and pecuniary support of my Committee, who granted £5 in aid of the project, two classes were speedily formed, the one consisting of 28 men and the other of 39 women (the rules of the Association forbidding mixed classes). The fees were fixed at 2s. for the men and 1s. 6d for the women (including an anatomical diagram), and each pupil was advised also to purchase Shepherd's Manual of “First Aid,” price 1s., and an illustrated triangular bandage, price 6d. The staff of attendants and nurses were so eager to enter the classes that the only difficulty I had was to exclude a sufficient number for the necessary service of the patients on lecture evenings, which were Thursdays, at 8 p.m. Each lecture occupied about an hour, and another half hour or so was subsequently devoted to practical work, in which I had the aid of the assistant medical officer, Dr. Taylor. The subjects embraced in the course included a general outline of the structure and functions of the body, with special reference to the formation of the skeleton, the course of the circulation, and the functions of respiration and the nervous system. The practical instruction was in the application of bandages, chiefly triangular, the various extemporary means of arresting hæmorrhages, and of protecting and securing fractured bones, and what to do in certain emergencies, such as suffocation, drowning, burns, scalds, &c.; also in the removal of the injured on ambulance stretchers and otherwise, and (for women) a cursory account of the principles of nursing. The classes were from time to time questioned on the subjects of the lectures, the matron undertaking the supervision of the practical work of the women. By these various means I think I may say that the pupils were well taught, and at the examination by Surgeon-Major Hutton, one of the Association examiners, out of 15 men and 19 women presenting themselves, 15 men and 18 women passed with credit. The examination was of a fair and specially practical character, the women having, in addition to vivâ-voce questioning, a paper of six questions to answer in writing, and the men being subjected to an extended examination in ambulance drill.

Though many writers have advocated the use of digitalis in various forms of insanity—such as acute, paralytic, or epileptic mania—yet there appears to be great diversity of opinion as to its efficacy, great variety in the methods of administering it, and a wide range in the quantities prescribed. While one has been content to order five to ten minims of the tincture three or four times a day, another has given, in similar cases, single doses of half-an-ounce of the same preparation.

Mrs. X—, a widow, æt. 28, was recently admitted to Graylingwell Hospital as a voluntary patient.

Family history as far as could be made out was negative.

Past history and personality.—She was described as a cheerful, steady girl, who had married at 21, and had unfortunately lost her husband some few months after marriage. More recently she appeared to be somewhat unstable emotionally and, in spite of serious organic disorder, had been energetic and over-active in her pleasures and amusements, and had taken alcohol freely. There was no previous history of “nervous breakdown”, fits or paralysis. Eighteen months ago she had a severe attack of rheumatic fever with endocarditis, and about six weeks before admission had an attack of “influenza”.

The organization of the study of psychiatry and neurology at the Universities in Holland has been very difficult. Schreuder van der Kolk, the well-known reformer of psychiatry in my country, was Professor of Physiology at the University of Utrecht. The fruit of his work was the asylum of Meerenberg, exemplary at that time, very useful still, but he did not organize medical education in psychiatry. He died in 1862. It was not until 1871 that our “Society of Psychiatry” was constituted. The many petitions originating from this society brought about the first possibility of psychiatrical teaching by our “law on higher education,” of 1877. The director of the asylum in Utrecht, Dr. Van der Lith, got the title of a university professor. His lectures were not obligatory, and he retired in 1878. In Amsterdam an energetic young doctor, Arie de Jong, taught psychiatry from 1878 to 1881. When he retired psychiatrical teaching was no longer given in Holland. Organization of this branch of medical education had never existed. Examination in it did not exist. Asylum doctors were mostly recruited from military medical men, returned from our colonies, who desired to add the small pay of the asylum to their pension.

Within the last two or three years a considerable amount of work has been done in this country in the treatment of general paralysis by malarial inoculation. While it is yet too soon to form a final opinion on the results of the experiment, the present seems to be an opportune moment for reviewing what has been done, and for reaching at least some tentative conclusions. In this connection it is important to remember that the method is not altogether new, as it has been in use on the continent for the last seven years with but short interludes.

In adult intelligence testing the Wechsler-Bellevue Intelligence Test is increasingly used and is gradually taking the place of the Terman-Merrill. Not only is its verbal part better adapted to adult life, but it has the added advantage of being at once a verbal and a performance test. A comparison of a subject's achievements in the two parts of the test often shows where his strength and weakness lie, and so sometimes affords a clue to difficulties which he may experience in his work or otherwise without being aware of their cause.

I trust to be excused if in these days of pathological and anatomical research, I ask you to examine with me to-night a group of symptoms. I need hardly say that the study of symptoms must ever be of importance in the treatment of disease, and especially of that disease with which we are all concerned, and although to the general medical public the subject of hallucinations of hearing may have no special interest, yet the members of this association know that they characterize a very peculiar and well-defined class of patients, and that, common as they are, their nature and pathology are uncertain and mysterious. I have, therefore, chosen them, as the subject of a paper, chiefly for the purpose of promoting discussion concerning them, and eliciting the opinions of those here present.

Dr. Prentice said that syphilis, in its incidence, diagnosis and treatment, presented, in mental hospital practice, problems which differed from those met with in dealing with the disease in general practice and in V.D. clinics. In the former its incidence was higher than in the general population, and that was largely because many of those whose nervous system had become affected by the later stages of the infection ultimately developed a psychosis. Drugs which were efficacious in somatic syphilis showed but little therapeutic effect in the treatment of the nervous system when affected by syphilis. There was a wide variation in the syphilis occurrence-rate among new admissions to mental hospitals, namely, from 5% to 31%; there was no doubt that incidence varied in different parts of the country; for instance, at Whittingham Mental Hospital, Lancashire, the male admissions in one year showed 21–9% with syphilis, and females 8–9%. At Narborough in the past two years—using the same methods of diagnosis—the positive males were only 7–7%, the females 4–6%. It was difficult to estimate reliably what proportion of the general population suffer from syphilis, but comparison of the figures of the Royal Commission on Venereal Diseases with those given by numerous workers in mental hospitals—excluding cases of general paresis and meningo-vascular syphilis—showed that the part played by syphilis in the ætiology of ordinary mental diseases must be a very small one. Bearing in mind the body-mind relationship, any toxic or infective process which could be a factor in the ætiology of mental illness should be dealt with. Even if the disease were predominantly psychogenic, all possible physiogenic factors should be eliminated or dealt with.

The puncture of the cisterna magna was proposed and carried out in 1919 by Wegeforth, Ayer and Essick, who performed a series of experiments on animals before applying the method to man.

IN February, 1914, there came before the French Senate a project for the revision of the law of 1838 regarding the insane. The law of 1838 states that “each department is to have a public establishment designed specially to admit and care for the insane.” This article was rewritten in the new project as follows. “Persons suffering from mental affections which compromise public order or who are dangerous to themselves or others are to be cared for and detained in special establishments when they cannot be provided for at their own homes.”