The present portion of this paper deals with the subject of progressive and secondary dementia. It includes the consideration of those cases of mental disease which, owing to the existence of certain extra-neuronic encephalic morbid states, do not develop a practically stationary condition of mental enfeeblement consequent on the loss of a proportion of the higher cortical neurones, but undergo a more or less rapidly progressive process of neuronic dissolution, which, if the patient survives to such a stage, finally ends in gross dementia.

IN Wright's earliest researches on the opsonic body in human blood serum he used various strains of staphylococci. He found in various forms of staphylococcal invasion, such as acne, furunculosis, and sycosis, that the index of the patient so infected was lower than that of an ordinary healthy individual to the particular organism causing the disease. By his method of inoculation of a vaccine made from the infecting organisms he was able to greatly improve the condition and even cure most intractable cases. Bullock has obtained like results, and cases have been recorded where pneumococcal and other infective diseases have been cured by similar treatment.

The foregoing examples of degenerates, obsessionists, feeble-minded and mentally warped could be multiplied indefinitely. They present minor and less striking phases of the degeneracy and mental disorders met with in asylums, and require, whether at large or in confinement, some part of the care, supervision, and treatment which are accorded to the major degenerates whom it has been found necessary to certify as fitted for detention in asylums. In these institutions may be seen paretic dements, paranoiacs, precocious dements (katatoniacs), maniacs, imbeciles, terminal dements, etc., prone to, and who may have committed, arson; folies circulaires, hysterics, maniacs, moral imbeciles, and imbeciles prone to malicious mischief or criminal prankishness; erotics, senile dements, paretic dements, alcoholics, maniacs, epileptics, and imbeciles prone to indecent propensities, rape, sexual perversion, and the entire gamut of erotic besetments; general paralytics (first stage), imbeciles, kleptomaniacs, climacterics, prone to, and who may have fallen into the hands of the authorities for, theft; homicidal maniacs, epileptics, katatoniacs, paranoiacs, puerperals, alcoholics, and dipsomaniacs who may have committed crimes of blood, cruelty and violence before certification, or who by mere accident may not. These are the many points where criminality and lunacy touch, and it seems at present either a question of the degree of the mental warp or its non-detection which decides whether the asylum or the gaol shall be the destiny of such.

IN all asylums and places where epileptics are taken care of many cases of this condition must occur annually, and the treatment of it must be of grave consideration in the care of these cases. The figures of Dr. Lord show us that in ten years in the Hanwell London County Asylum 26 per cent, of the deaths in epilepsy occurred in the “status,” and these figures are borne out by the returns of the Ewell Colony for Epileptics. Much has been written on the subject, both by British workers and by our Continental confréres, but it is scattered through the literature in isolated monographs, and of late years the interest in the subject seems to have lapsed. The present paper is written with the purpose of inducing someone, more competent than the author, to give us further light on this very interesting condition.

Having been engaged during the past three years in treating cases of active insanity by rest in bed in the open air, I am able to add my testimony to that of Dr. Easterbrook, as published in the last number of the Journal of Mental Science, as to the value of this method of treatment in suitable cases.

Narcolepsy is so rare that I deem the following case worthy of record. It is one occurring in a young man suffering from hallucinatory and delusional insanity, who was admitted into the Royal Edinburgh Asylum, in April, 1902, with the following history.

In the following brief notes nothing is attempted beyond placing on record three undoubted examples of this interesting disease, and thus adding to an ever increasing list of cases.

The following notes are the outcome of observations made during a recent period of six months upon ninety-two patients in the Royal Aberdeen Asylum.

Dr. Clouston is indefatigable. He once more appeals to the charitable public in the columns of the Scotsman, for the establishment of wards in the Edinburgh Royal Infirmary for the treatment of incipient insanity. The editor of the Scotsman lends his powerful aid to the proposal, and various letters have followed on this inception. Six years ago the scheme was carefully considered and definite proposals were made, but financial difficulties compelled postponement. The unanimity of the medical profession and the apparent assent of the philanthropic public augured favourably for success; and it is hoped that the public interest is again awakened by the representations which have been made more recently. It would appear that the success of the special department of the Albany Hospital in the State of New York and the special wards established in Glasgow has been undoubted. The former is in contact with a general hospital and has all the advantages of such a connection, but the latter is specialised and separated from the general hospitals of the west. A suggestion has been made that Saughton Hall might be used for the purpose indicated, but we would strongly deprecate any arrangement of that kind. The whole intention is to avoid segregation and the very appearance of an asylum, to bring the early treatment of mental disorders into living contact with the medical work of a great hospital. It is not proposed to create an asylum within the Edinburgh Royal Infirmary, but to provide open wards for the early treatment of the insane, under the care of a skilled physician who will enjoy the active co-operation of the medical and surgical staff as may be found necessary in the circumstances of each particular case.

Health is the most important asset of a nation or an individual, without which all other possessions are comparatively valueless, and it is astonishing that this fundamental truism has not been recognised by a people priding itself on its common sense and practicality.

The desirability of increasing the output of clinical work in British asylums has been frequently dwelt on in the pages of this Journal, but no apology is needed for again recurring to the subject, since there still remains very considerable need of further progress in this direction