At the Second Quarterly Meeting of the Medico-Psychological Association (January 28th, 1869), I read a paper on The Alleged Increase of Lunacy. I there observed that the alleged increase of lunacy is a frequent theme of discussion in the public press, as also a subject of anxious enquiry in society, and that there is hardly a Board-room of any county asylum in which the question is not raised with the practical intent of determining the amount of provision to be made for the care and treatment of the insane poor, and I added that, in order to satisfy such enquiries on the part of the Visitors of the Hayward's Heath Asylum, I had recently endeavoured to see if our existing statistical records afford any means of solving this pressing question, Is lunacy on the increase in our generation? Moreover, considering the opportunity of the second quarterly meeting of the Medico-Psychological Association, for scientific discussion, might fitly be used for the farther sifting of this important State question, I then submitted to its critical examination the figures and results with which my enquiry into the alleged increase of lunacy had furnished me. These results, which were worked out in a series of carefully compiled tables, I may thus briefly sum up:—1.—Total Numbers of the Insane.

Many years ago—between 1854, when I was appointed to the medical charge of the Murray Royal Institution, and 1859, when the first Report of the new Lunacy Board for Scotland was issued—I took much interest in the subject of provision on the large scale for the chronic insane; advocating strongly for the harmless, incurable, industrious classes thereof, some modification of what is now variously known as the “Gheel system,” “Boarding-out system,” or “Family system,” of treatment. I was then of opinion that, hesides utilising or applying this system on the small scale in connexion with existing or prospective public hospitals for the insane—it was not only desirable, but feasible, to construct de novo one or more National Colonies on the Gheel plan—adopting of course only those features in the original Gheel that were worthy of imitation, or that it might be found practicable to imitate, in this country—and omitting or modifying those that appeared objectionable. I had no doubt as to the practicability of the scheme; though I was quite alive to the objections that would be offered—the difficulties that would attend its inauguration. Most unfortunately, as it seems to me, such a plan did not at that time, in any form, find favour with the authorities charged with the control of the state arrangements for the treatment of the insane poor in Scotland, and a golden opportunity was thus lost of establishing on Scottish soil an improved Gheel free ab initio from the defects of its grand prototype.

At the meeting of members of the Medico-Psychological Association which took place last November, in Edinburgh, a resolution was passed expressing “a strong opinion as to the necessity of making clinical teaching in insanity imperative in every medical curriculum.” It was agreed that it would not be wise on our part, as an association, to specify the details of those measures, which we hoped the various medical schools might feel disposed to take in furtherance of this object. But it is evidently the special duty of members of this association to consider the subject carefully in every detail, and to be prepared to give a mature opinion upon it.

Under the present section it remains to consider the influence of the emotions in inducing hydrophobia, tetanus, and catalepsy.

The minute pathological anatomy of the brain being at present but little advanced, the following contribution is offered towards its elucidation in mental disease.

During the past year (1870), twenty deaths have occurred in the Carmarthen Asylum; and the following notes have been made regarding the state of the ribs and sternum in each case.

The frequent occurrence of fracture of the ribs in the inmates of Lunatic Asylums has recently attracted much attention. And the more attention has been called to it, the more frequent does the occurrence seem to have become. This fact alone would make one suspect that the injury was not due to improper violence on the part of the attendants. Without, however, entering into this question, I propose here merely to record the results of my examination of the bones of two patients who lately died in the Sussex County Lunatic Asylum with fractured ribs. Whether or not further observation may justify a wider extension of the conclusion that the bones break so readily because they are diseased, at least I cannot hesitate to adopt it in the present instance.