The past year has not been notable for any special events in American psychiatry, though the usual amount of activity has existed. There has been no retrogression, and signs of a better future ahead as regards political control of charitable institutions have appeared in quarters where they are most welcome. In Illinois, for example, where for ten years past politicians have controlled the institutions, recent events have made reform in this regard a political issue, and both parties are, so to speak, tumbling over each other in their zeal to utilise it to their own advantage. The scandal that excited this was not abuse of patients or bad financial management, for neither of these has been proven, but the assessment of employés for political purposes, which has at last aroused the public conscience. The outcome can hardly fail to be good, and we may hope at least for a better state of affairs than existed even before the politicians took control. It is a slow work educating the public as to the political neutrality of hospitals for the insane, but it is being done, and the prospect is that they will before very long be as free from the abuses of partisan politics in Illinois as in any of the older states of the Union. I have spoken of this matter in previous letters, but it is right that I mention it again, for it is the chief fault of our public institutions, and the one that is more than everything else responsible for their failings.

At the “Congrès des Médecins Aliénistes et Neurologistes” Dr. Ernest Dupré, of Paris, gave a lecture on the self-accusing insane, studied from a medico-legal point of view. He made first an ætiological and clinical study of the idea of self-accusation; and second, a medico-legal study of the conditions created by these patients, and the duties of magistrates and of the physicians commissioned to report upon their mental condition.

At the annual meeting of the Association of German Alienists (held at Munich on April 14th and 15th, 1902), one of the first items of business was the appointment, at the instance of Professor Hoche, of Friburg, in Baden, of a statistical committee to collect information on all occurrences regarding the insane, especially suicides and crimes committed by insane persons, judicial condemnations of the insane and the weak-minded, the admission of sane persons to asylums; in short, all the incidents which go to show the defects of the lunacy law and the need for its reform. In this way it is hoped that they will be in a position to give material help to the State in the framing of new lunacy legislation.

The Italian scientific production in the domain of psychiatry has been, in 1902, rich, important, and varied; and although our young alienists spread themselves over the whole field, yet they neglect somewhat the practical side—the application of the theoretical views and conclusions to great questions, such as the hospital treatment of the insane, the overcrowding of the asylums, family care, etc. These have not yet been settled, but the younger section of alienists will finally, by their enthusiasm, find a solution.

The following is a brief notice of the Russian Literature of Nervous and Mental Diseases:

The State Secretary for the Department of Instruction has to some extent been an agent in the progress of mental science by rendering compulsory for students of forensic medicine a course of lunacy in an asylum extending over two months. By an unfortunate imitation of the Italian system, which in a single chain unites subjects of so diverse a character as toxicology, legal medicine, and mental diseases, the best method of freniatric teaching is not obtained. In Spain, a physician at the end of his career knows nothing at all of mental infirmities and affections. The action of the State Secretary is the more surprising when one remembers his order founding and establishing separate and compulsory chairs, both clinical and theoretical, of dermatology, otology, and ophthalmology. Alienists in Spain are disappointed, and regret that so incomplete a step should have been taken in so important a matter, for physicians at present look either dumb or foolish at court when cases of criminal responsibility, civil incapacity, etc., are being tried.

In this paper the author discusses at some length the nature and relationships of the various reflexes which have been described in the foot. There are at present very marked differences of opinion among the various authorities as to the value and pathological significance of these reflexes.

The author describes a case and the pathological appearances found after death, and bases upon it some considerations regarding cerebral tumours. The patient for years had suffered from a monoplegia affecting the one arm, and was also subject to attacks of epilepsy. There was no headache, no vomiting, no disturbance of vision, and no weakening of the intellect. Twenty-five years after the beginning of these symptoms dementia supervened. At the autopsy, a tumour about the size of a small hen's egg was found in the middle of the right Rolandic region in correspondence with the posterior third of the frontal lobe. The tumour was an endothelioma, rich in cells probably of a sarcomatous nature, and without any nervous elements. The author points out the complete absence for twenty-five years of any mental symptoms is in complete accord with the theory of Bianchi, the unilateral nature of the lesion and the extraordinary slowness of its development giving time for compensation. An examination of the contents of the softening showed that the vessels remained normal; the nerve-fibres were very markedly altered, and the nerve-cells were reduced in number. The permanence of any cortical nerve elements was due to the slowly progressive interruption from the gradual compression and to the absence of any inflammatory process. The softening that surrounds tumours has been attributed by some to the compression of the small vessels, or to a superadded obliterative arteritis caused by syphilis or tubercle, the degeneration of the nervous elements following this. The author regards the extension of the softening to have been caused, not by the pressure of the tumour itself, but rather by pressure of fluid surrounding it. This produces in some cases an increase of tension, to which the white matter cannot offer sufficient resistive power, and hence the degeneration.

In the discussion of obsession the point at issue has been especially the relative importance of the intellectual and the emotional element. Recent experiments apparently establish that organic modifications (muscular or vaso-motor) are anterior to the affective state, and therefore to the idea, and not consecutive.

The object of this paper is to show the important part played by introspection in the mechanism of certain delusions, and especially in the genesis of psycho-motor hallucinations. The complete notes of a case carefully observed in this connection are given—that of a woman aged forty-three years. Tormented by the thought of wrong-doing, by ideas of doubt and fear, the patient was especially anxious to analyse and explain her mental condition. She at first is satisfied that her ideas take birth within her mind, then believes that she is selfhypnotised; a stage further she suspects the domination of some indefinite power which directs her thoughts, experiments upon her, hypnotises her, and speaks within her. If she thinks evil of certain persons she hears them “inside “herself replying, insulting her. At times she moves her lips when speaking her own ideas, and is conscious of a conversation, an asking and a replying, going on in her head. Ideas of guilt are generally associated with these phenomena, and she asks forgiveness for these ideas, which spring up without the intervention of her will. The explanation which satisfies her best is that she is hypnotised and made to think, and the measure of her guilt is the consent which she gives to certain of these ideas—this consent being withheld in the case of others. The thesis which the authors endeavour to prove is that the interior language is the principal source of a considerable number, if not of most, psycho-motor hallucinations. They urge the importance of a careful study of the mental life of patients, and the fallacy of restricting observations to somatic examination alone.

These five cases are interesting on account of the important question of the aetiology of general paralysis.

Dr. Stradonitz, in a long paper, recommends historical research in connection with hereditary disease, and prescribes some methods of inquiry which are sufficiently obvious. Every one has two parents and four grandparents, and in this ratio his ancestors might go on doubling at each generation, till three hundred years back the ascendant roll might have 1024 persons. Actually this never takes place through the marriage of cousins in the first, second, and farther degrees.

This is the report of a case of homicidal obsession developing as a result of nervous exhaustion in an individual of the so-called criminal type.

In this paper, the author reports two personal observations which presented a combination of mental disturbance with symptoms of peripheral paralysis, and in connection therewith enters at some length into a critical examination of Korsakow's disease.