Examples of true hysteria are relatively rare in asylum populations, and in the present series of cases there are but six instances amongst the 728 patients, and all these are of the female sex. The writer has, however, during his asylum experience, seen more than one case of genuine hysteria in the male sex.

The hope that a study of aphasia might show a way to a better understanding of the nature of insanity is not new. Even at a time when far less was known about aphasia than is known to-day such a hope was not without easily conceivable grounds. It will now hardly be maintained that the perverted speech of a lunatic is always to be regarded as a just presentation of perverted thought. Not only is the thought disordered, but often also the speech itself. The symptom of perseveration, for instance, does not always represent morbid prevalence of an idea; it may express a disorder which lies rather within the sphere of speech. This is well illustrated in a case of eclamptic insanity reported by Heilbronner. Of pictures representing birds of various kinds, the patient designated many in succession as “swan,” even when identification was correct; she called a stork a swan, and at the same time alluded to the stork fable. In this instance it is not the idea that clings, but the word, as in the recurring utterances of an aphasic. In many forms of mental disease we meet with symptoms of amnesic aphasia, loss of nouns, inability to name objects seen. In certain forms of incoherence we can recognise an element of paraphasia. Thus we can often obtain a clearer conception of the speech disorder of a lunatic by regarding it from the aphasic standpoint.

“The evidence … so strong that the relations of mind and nervous structure are such that the cessation of the one accompanies dissolution of the other, while … with death there lapses both the consciousness of existence and the consciousness of having existed.”

The following case presents certain points of interest. The extreme prominence of pain crises in the beginning is unusual. Suicidal tendencies in general paralysis are sufficiently uncommon to be noteworthy, though they are by no means as uncommon as is generally supposed. The same may be said of delusions of conjugal infidelity. Finally, multiple lipomata occurring in this disease have not, as far as I am aware, attracted the notice of any English author.

This fragmentary paper is to suggest rather than to inform. It is a bedside analysis of the urine in 969 female patients consecutively admitted into Claybury Asylum, and the notes cover a period of several years. Although the facts are many, the deductions are few, and although possibly nothing new is related, yet these notes involve an extensive collection of common details, and there has been some labour undertaken to present them. The summary may, I venture to hope, serve as an incentive to others to contribute more detailed statistics upon an aspect of mental diseases which is at present much talked of and much written about, viz., the relation of insanity to auto-intoxication and its dependence upon changed metabolism, particularly in an alteration through this changed metabolism of the normal functions of the kidneys, and I propose to run somewhat rapidly through the following headings. And first as to—

In any department of knowledge worthy of the name of science I think it will be admitted that one of the most important elements is terminology. The accurate (and adequate) expression of facts by appropriate words is a prime essential in the advancement of knowledge; the absence or imperfection of such is one of the greatest hindrances to progress. And perhaps no more forcible example of this can be adduced than the case of psychiatry, that sphere of knowledge in which all who are members of this Association are supposed to be more or less expert students. I doubt if any branch of science has suffered more than our own from the disability of an imperfect terminology, a point which it is hardly necessary to argue. I may, however, by way of illustration remind you of the numerous schemes of classification of insanity which have from time to time appeared, a matter with respect to which every writer on the subject seems to have done that which was right in his own eyes. But what would be thought of any science—say botany, chemistry, or zoology—if a new system of classification, and even new terms for genera and species, were to be brought out with the same frequency, or anything like the same frequency, as in the case of insanity? Can anything be more bewildering to anyone commencing the study of insanity than to take up book after book and find each writer adopting a different classification, and grouping cases under one heading or category which the next authority he takes up places under another and quite different one? Surely there ought to be, in the first place, agreement amongst authorities as to the meanings of terms, and in the next place at least some permanent basis of classification which all can accept, capable, no doubt, of expansion and modification with the advance of knowledge, but not liable to continual changes, not to say upheavals, in its fundamental structure.

The David Lewis Colony is one of the latest results of the sympathy for the epileptic spread, if not originated, by Pastor von Bodelschwingh, of Bielefeld.

It is the prevalent opinion that phthisis is the scourge of our English lunatic asylums, and that these institutions are, literally speaking, hotbeds for the growth and distribution of the tubercle bacillus. In the Irish asylums, where the death-rate from phthisis alone amounts to nearly 30 per cent. of all causes of death, there seems to be just grounds for this belief. In the English asylums, however, the mortality is much lower, and is but little, if any, greater than that amongst the general population. This can be verified by examination of the Registrar-General's Report, from which it appears that phthisis accounts approximately for one in twelve of all deaths. These figures probably represent less than the true proportion of deaths from phthisis, since post-mortem examinations in the majority of cases are not made, and thus, doubtless, many cases of pulmonary tuberculosis are overlooked.

The few remarks which I have to make in dealing with the subject of this paper are only fragmentary, and are intended merely to direct your attention to the subject, and to elicit a resolution embodying your views which can be sent on to the authorities responsible for the government of Ireland.

This system of care rests on the solid foundation of a principle of human nature—the mothering instinct in women. This is not restricted in its operation to a woman's own offspring, but extends in a certain degree to all children as well, and often manifests itself in the most striking manner in those women who have no children of their own. Nor is it reserved for the helplessness of childhood alone, but it includes within the scope of its action the weakness of the sick person and the infirmity of the aged. As a consequence of this, a liking exists on the part of most women for sick-nursing, which in some amounts to an instinctive craving which must be gratified, and almost all for the same reason possess a natural aptitude in picking up the practical details of nursing and care which amounts in not a few to a species of genius. If we exclude the care of insane men from our view, it can be said that wherever we have weakness and suffering and the need of personal care, there women find an opportunity for the exercise of what is a natural vocation, there we find them acting as “ministering angels.”