In the numbers of the Journal for January and April, 1896, I described the recent action of the Berlin authorities in placing a considerable number of the insane poor under care in private dwellings, which illustrates one of the latest ways in which this mode of providing for the insane has been organised. Having in the year 1895 revisited for the third time the well-known colony of the insane at Gheel, in Belgium, and having once in 1895 and again in 1896 visited the recently established Belgian colony at Lierneux, I now propose to describe the present position of these two colonies, which exemplify the oldest systematised method of providing for the insane in private dwellings.

In the deviations from usual form or type already described—both the new and those adopted from other observers—the material is provided for tests or criteria of various forms of defective or aberrant brain development; and the standard about to be described has its material derived from those sources, and is directly drawn from certain brains.

On looking through some of the numerous observations on the treatment of melancholia by drugs, the most striking point is the diversity of opinion as to their use. This disagreement comes out perhaps most strongly in the case of opium, no doubt because it has been the medicine most widely tried. One leaves the study of the subject with the uncomfortable feeling that the whole drug treatment of melancholia is still quite empirical; for eminent observers press that opium should always be tried in every melancholic, while other no less eminent physicians are equally strong in condemning its use in every case. Our own excuse for adding to the over abundant literature on this subject is that we desire to point out some indication in the use of the two drugs, opium and sulphonal, to which we are convinced that more weight than is generally thought should be given. We have been repeatedly struck by the marvellous effects of opium in some cases of melancholia; and have as often been equally surprised at its utter failure in other cases closely resembling those in which we have been so successful. In hopes of finding some sufficient reason for such apparently contradictory results we have carefully examined the case books of this house for recent years, and have tabulated a sufficient number to warrant, we think, an examination of our conclusions by those who have wider opportunities. To these we have added a few non-asylum cases which we have been able to follow ourselves; which would go towards proving that these two drugs have an action independent of any advantage in any general asylum here. We do not propose to go fully into each case, as this would be unnecessary waste of space, and our remarks can be readily followed by a glance at the tables. No attempt has been made to classify, to arrange, or to select the cases beyond choosing only those in which opium or sulphonal has been given. One selection indeed we could not avoid. The material on which we have had to work being almost exclusively drawn from the upper and middle classes, it was inevitable that our patients should be drawn from the same classes; but this will probably not invalidate our conclusions.

Sulphate of duboisin is a powerful sedative and hypnotic. I have used the drug for some time and administered it both hypodermically and by the mouth, generally in doses varying from grains to , though as much as grains has been given at one time. The hypodermic method is the surer and safer, and is followed by fewer bad effects.

A habit is a voluntary nervous action, which by constant repetition has become automatic. It does not follow that the nervous action has originated in the individual in whom the habit is established. It may have been inherited in its automatic or habitual form.

At these meetings we have an opportunity for resolving doubts by discussion, or it may be of only discovering that in confessing an ignorance which is not singular there is no great sacrifice of self-esteem. I am ready to accept either alternative as the result of our consideration of recoveries from mental disease.

Under the term “Housing the Insane” I wish to bring before you for discussion the various plans that have been adopted of providing for the insane in asylums, colonies, homes, &c., the extent to which they are practicable, the medical supervision they necessitate, together with the size and form of institution which might result from their combination.

The fact that the Medico-Psychological Association has now upon its register upwards of 2,400 nurses, including both sexes, who hold the certificate of the Association “for proficiency in nursing,” renders it unnecessary to offer any apology to this meeting for bringing before it the question of considering the position in which we now stand with regard to our nurses and to the public.