A seven weeks' visit to seven principal universities in the eastern States of America is a sorry qualification for talking to you upon this subject. Nor, indeed, is it easy during the brief time at my disposal to give you a satisfactory account of the impressions which I formed during my visit. I can only hope that the shortcomings and inaccuracies of this paper do not exceed what may be called their normal number under such circumstances, and that you may be induced some day to repeat for yourselves experiences which I have been the first to enjoy with such pleasure, interest, and profit. Nowhere will your colleagues extend a warmer welcome to you, nowhere will they take greater trouble in displaying and explaining to you their institutions.

The theories by which it has been endeavoured to explain the existence of hallucinations are manifold. In this field, as in so many others where we watch the play of mental phenomena, our point of view varies from time to time, so that the explanations which were once deemed more or less satisfactory become unmeaning when the problem to be solved has itself shifted ground.

From time to time one meets with the opinion, or with expressions and general phrases indicating the unavowed opinion, that “idiopathic” epilepsy results from a toxæmic state,—that is to say, that epilepsy the disease is caused by poisons circulating in the blood; or less positively that epilepsy the paroxysm is determined, the attack precipitated, by the transient presence in the blood of such poisons; and in both cases the unexpressed idea seems to be that these poisons get there, in the manner of other auto-intoxicants, by reason of the inefficient performance of the digestive function in some respect.

Dr. Carlyle Johnstone, introducing the discussion, said: It is several years since any active steps have been taken by the Scottish Division, or by the Association itself, to obtain retiring allowances for the officers and servants of Scottish district and parochial asylums. Nothing has been done in the interval by the State or the local authorities to satisfy our reasonable claims or to remove the special injustice under which Scotland suffers. A memorial on this subject was presented to the Lord Advocate by the Scottish Division in 1877, and a similar memorial was presented to the Secretary for Scotland, Lord Lothian, in 1887. The representations of the Division were politely received, but no practical results have followed. It may be considered that it would be futile to send in a third petition; but the present Secretary for Scotland has never been approached by our body, and he may fairly consider that if we do not ask for pensions we do not want them. There is reason to believe that at any moment a Bill for the amendment of the Scottish Lunacy Acts may be introduced into the House of Commons. We should leave no stone unturned in order to secure that in this Bill provision shall be made for the granting of superannuation allowances in all Scottish public asylums. I have brought this question before the Asylum Workers' Association and the Parliamentary Committee of the Medico-Psychological Association, and both of these bodies have now memorialised Lord Balfour on behalf of the Scottish asylum workers. In my opinion our Scottish Division should do the same. The conditions of service in Scotland are so anomalous, so grossly unfair as compared with those in England and Ireland, that, if only we keep on protesting and agitating the matter, we may reasonably expect by our continual importunity to obtain justice sooner or later. At each General Election we ought to approach every candidate for Parliamentary honours, lay our case before them, and obtain from them individually, if possible, an expression of their sympathy with our claim and a promise to vote for a Bill which shall satisfy this claim. This is what we ought to have done at the last General Election. I hope that this meeting will resolve that this shall be done at the next one. It does not appear to me to be opportune to approach Members of Parliament at this moment. In a decaying House, with a dwindling majority on the side of the Government and many Members proposing to go into retirement at the dissolution, we can scarcely expect Members to pledge themselves to vote for what cannot be regarded as a “popular” or “economical” measure. But we ought, I think, to get into touch with Lord Balfour at once, and make plans for bringing pressure to bear on all Scottish candidates at the General Election, which may possibly occur at an early date.

A granular condition of the ventricular ependyma has long been recognised as a pathological condition in various cases of insanity, and is so common in cases of general paralysis that we are surprised when it is not present. It is, however, by no means confined to that specific class of case, but exists in others, and, although not so frequent, is sufficiently common to make one inquire into its cause and as to its bearing, if any, on insanity.

Fifteen years ago the late Professor Korsakow described an assemblage of symptoms met with most frequently amongst chronic alcoholics. He claimed that they represented a distinct disease, which he termed polyneuritic psychosis, and later cerebropathia psychica toxæmica. The cardinal features of this affection, according to him, were, besides the polyneuritis, amnesia and pseudo-reminiscence. We in England, perhaps wisely, are slow to accept new diseases; but as now a large amount of literature has accumulated around “Korsakow's disease” from physicians in all parts of Europe, it may be of interest to give an account of twelve cases among women which I have met with presenting the symptoms of this affection.

Before describing this disease as it occurs in Egypt at the present day, let me give a few historical notes of the use of Cannabis Indica, of which hasheesh is the local preparation. For this, and much other information contained in this paper, I am indebted to the report of the Indian Hemp Drugs Commission of 1893. This valuable report was drawn up by a committee appointed by the Government of India, and in its pages a very full account of the use of hemp drugs in India is to be found. Unfortunately it appears that no lunacy expert sat on the Commission, and in my opinion its findings as to the relations between hemp drugs and insanity are not conclusive.

Tænia solium is common enough in this country in man, but its cystic stage is, I think, met with very infrequently; that is the reason I bring this short paper before the meeting in order to elucidate whether cases of the following kind are met with in any frequency in South Africa.

One of the most interesting points connected with the concept katatonia is its relation to the morbid phenomena included under the older term melancholia attonita. Many modern exponents of the former, especially in Germany, would deny the existence of stuporose melancholia altogether. Yet it seems to me that cases occur conforming to the descriptions of the latter which cannot be included in the category of katatonia without the merest straining of terms. In this connection I think the following two cases are instructive:

D. R—, æt. 27, butler, of Italian nationality, resident in England for past eight months, married, two children, the younger aged six weeks; in prison for petty larceny.

If we trouble ourselves to look back and study the treatment of insane persons in olden times, we cannot but be struck by the fact that our forefathers regarded insanity as a disease which needed active treatment, and it generally received such at their hands; and that, however much the weird and sudden outbursts of religious frenzies, sudden seizures, and mad impulses were regarded as evidences of demoniacal possession, or God-inspired action, the patients so affected, and rendered conspicuous by their conduct, received at the hands of their fellow-creatures treatment which, however curative in intention, must have tended rather to elimination than recovery, and in this respect differed little from that meted out to the physical illnesses, wounds, and accidents of the patients of bygone times.