Two Treatises∗ recently published contain the views of Professor Flechsig, of Leipzig, upon the present state of our knowledge of brain function. The first is in the form of an oration delivered in 1894 in the University Church of Leipzig, of which a new edition appeared last year. The second is a shorter pamphlet, which contains an account of the most recent researches in the structure of the brain. In the oration the notes occupy three times the space of the text; in the other treatise the notes are not so long. In both these notes are important, and form in some passages the most interesting part of the work. He holds that the time has now come when the old introspective psychology must turn for guidance to anatomy and physiology. It is only within the last few years that such claims could be entertained. The localisation of mental operations in the brain was made by Hippocrates from observations of the loss of function caused by diseases or wounds of the head. Polybos, the son-in-law of the great Greek physician, held that the brain was the centre of the nerves and the central organ of the thinking soul; and Erasistratos, of Alexandria, first taught that the superior intelligence of man depended upon the greater size of the human brain, and the more complicated structure of the convolutions. A new era began with the experiments of Fritsch and Hitzig in our own day. Since then experimental physiology and clinical observations, going hand in hand together, have led to the accumulation of a large fund of knowledge about the several functions of the nervous centres. Another path of discovery was opened by Golgi through his new method of differentiating the finer structure of the grey masses of the brain by his silver colourings; and also by Kölliker, who, working with low powers, was able to demonstrate the course of the motor and sensory nerve paths and of the association system in the brain.

Chapter XIII.

Continuing the recapitulation, begun in the last chapter (which dealt thus with the more general morphological states), we next resume in brief the several Chapters, III to VIII, on

The desire of visiting the institutions in Denmark for the education of the defective classes was aroused in me by the praises bestowed upon them by my friend Jakob Soethre and Dr. Frederick Starr.∗ I knew that they were both men well fitted to judge correctly, and not likely to be misled by appearances, which are often deceptive and sometimes are meant to be so. What indeed struck me was the statement that there was no attempt at show in the Danish Asylums. They must, therefore, I thought, depend upon their intrinsic merits. I crossed the North Sea from Hull to Amsterdam in the “Professor Buys,” a route which I can recommend for those who prefer a short sea passage. I travelled through Northern Germany, stopping with some friends at Bremen, where I visited several institutions. In the beginning of July I reached Copenhagen, and soon got into communication with my friend, A. Friis, the Medical Superintendent of the Custodial Asylum for Imbeciles at Ebberödgaard. Besides his eminent qualities as a physician and a man of literary culture, Dr. Friis has the especial merit of speaking English fluently, and, through his kind attentions, I escaped the difficulties and perplexities to which I should have been otherwise exposed.

The refusal of food by an insane patient is a troublesome and frequently a serious matter, partly because, from the absence of symptoms in most cases, it is difficult to arrive at a diagnosis of its cause. In many instances it may reasonably be supposed that subjective feelings of pain or discomfort in the stomach, leading to the refusal of food, arise from organic disease or functional disorder of that organ. That there is a centre in the brain, disorder of which causes a distaste for food, has been suggested, but is scarcely worthy of serious consideration. The cause is more likely to be some local affection, such as malignant disease, gastric ulcer, or simple gastritis, giving rise to pain on the ingestion of food; the refusal of food is then the translation of a protest from a stomach in an unfit state to receive any but the lightest food.

The period chosen is from the introduction of “The Criminal Lunatics Act, 1884,” to the end of the year 1896, and male cases only are considered.

Of 220 cases in which post-mortem examinations were held the following were the conditions as to rigor mortis. It will be seen that in only 11 cases does the condition recorded militate in any way against the statement that “far from commencing in the jaw, then attacking the arms and lastly the legs, and disappearing in the inverse order,” as was at one time taught, and as is stated at the present time in some of our text-books, in whatever order it may commence, it almost invariably disappears first from the jaw, afterwards from the arms and legs; in fact probably in the order of its appearance.

Gentlemen,—I am not going to weary you with a catalogue—it would be a long one—of the distinguished sons that Dumfriesshire and Galloway have sent forth; I ask you to bear with me for a little while I appeal for your generous admiration of the most illustrious of all of them —I mean Thomas Carlyle. and such an appeal is not unnecessary, for this illustrious man—glorified by genius— has more than any great man of modern times been subjected since his death to detraction and disparagement. Late in securing the recognition of his claims as a writer, for it was not until he was in his forty-second year that the British public really took note of him, he rose rapidly thereafter in fame and popularity, and after his rectorial address in this University, in 1866, was the object of enthusiastic national regard. He died in universal honour, the ablest and highest of his literary contemporaries vying with each other in sounding his praises, extolling his heroic and unsullied life, and describing him as sovereign by divine right amongst the British men of letters of his generation. But a change speedily came over the spirit of the scene. Carlyle had not been a week in his grave when the Reminiscences, edited by Froude, appeared; these were followed within a year by the Letters and Reminiscences of Jane Welch Carlyle; and after these came rapidly The Early Life and The Life in London, for which also Froude was responsible. “It was these nine volumes,” says Masson, “that did all the mischief.” Full, at least as regards the earlier volumes, of slovenly press errors, and obviously very hurriedly prepared, they depicted Carlyle in his darkest and gloomiest moods, almost ignoring the bright and genial side of his nature, and gave prominence not merely to the biting judgments he had passed on public men, but also to his pungent comments on private individuals then still living. Froude was Carlyle's most intimate friend in his hitter days; he was his chosen literary executor; he was his faithful disciple in doctrine; he has, with lofty eloquence, described his extraordinary personality and gifts, and put on record his conviction that, with all his faults of manner and temper, he was the greatest and best man he had ever known. and yet, for all that, it has been his part to open the flood-gates of adverse criticism, and to supply all the quacks, and idiots, and sects, and coteries whom Carlyle had scourged, in his day, with nasty missiles with which to pelt his memory. Even Froude's warmest defenders are constrained to admit that he showed defective reticence and bad taste, and every impartial reader of the Reminiscences must, I think, perceive that in his vivid sympathy with that brilliant woman, Mrs. Carlyle, Froude has many times been betrayed into references to her husband that are unjust and almost vindictive. When Carlyle was working at the French Revolution “his nervous system,” says Mr. Froude, “was aflame. At such times,” these are Mr. Froude's words, “he could think of nothing but the matter which he had in hand, and a sick wife was a bad companion for him. She escaped to Scotland to her mother.” The plain inference from this is that Mrs. Carlyle, when an invalid, was driven away from home by Carlyle's neglect and irritability. The fact is, that it was solely the state of her own health that sent her to the north, and that she had no peace or comfort till she got home again. She writes, on returning on this occasion: “The feeling of calm and safety and liberty which came over me on re-entering my own house was really the most blessed I had felt for a great while.” Does this sound like coming back to a self-absorbed bear of a husband? “The house in Cheyne Row,” says Mr. Froude, “requiring paint and other readjustments, Carlyle had gone to Wales, leaving his wife to endure the confusion and superintend the workmen alone with her maid.” Thus Froude insinuates that Carlyle selfishly went off to enjoy himself, leaving his wife to drudgery and discomfort. But the facts are that Mrs. Carlyle was a house-proud woman, and took delight in her domestic lustrations, and that while Carlyle was in Wales at this time, on one of those excursions which were essential to the maintenance of his health and of his bread-winning labours, Mrs. Carlyle went off on a holiday on her own account to the Isle of Wight, from which she was very glad to return to her dismantled home. I could quote a dozen paragraphs like these in which Froude seems to seek, by innuendo or elision, to convey the impression that Carlyle was systematically hard and heartless in his relations with his wife, whereas the truth is that, with failings of temper and thoughtlessness—from which few are exempted—he was a tender and affectionate spouse.

A man, aged 50, was admitted on 4th October and died 15th October, 1897. The medical certificate stated that he was suffering from delirium tremens.

The subject of these notes was a gentleman who was admitted under the care of Dr. Deas, at Wonford House, in June, 1895, and remained there until his death in July, 1896.

The object of this communication is to draw from the members of the Association the modern treatment of fractures as adopted in institutions for the insane. It is obvious that the various plans, as practised in hospitals, must be considerably modified in asylums. For instance, to strap and bandage a case of fractured ribs, secundum artem, taxes any medical officer, unless the patient is quietly disposed and clean in his habits. However, with skill and a fairly docile patient, there should be little difficulty in the management of ordinary fractures of the bones below the elbows and the knees. From time to time one reads of cases of fractures of the ribs occurring in asylums, remarkable autopsies being recorded. It is difficult sometimes to give a correct history of their causation, and, in consequence, much opprobrium has been unjustly cast on asylum officials. It is believed by not a few that there is a peculiar affection of the ribs in the insane causing them to fracture readily. It is said, too, that it is common in general paralysis. Dr. Christian has stated in the Journal of Mental Science, January, 1886, that he is decidedly opposed to the idea that general paralytics are more liable to fracture of the bones. He gives 250 cases, and says, “I can assure you, gentlemen, I have not come across a single case of fracture among them.” But no figures of the kind can be relied upon unless verified by post-mortem examination. It is not uncommon to find in the mortuaries of ordinary hospitals and asylums, and in the dissecting-room, specimens of fractured ribs, the causation of which is unaccounted for. With our present pathological knowledge of the osseous system we must withhold our verdict.

The portrait of the late Sir John Bucknill, which forms the frontispiece of the present number, will forcibly recall to a large proportion of the members of this Association the personality of one who for many years held so prominent a place in their ranks.

The London Asylums Report of this year gives evidence that the Pathological Laboratory established at Claybury has borne good fruit, and gives promise of an even larger yield in the future.

The conjoint Laboratory of the Scottish Asylums is now open and fully equipped for work. Already the pathologist, Dr. Ford Robertson, has made reports upon cases of special interest submitted to him for expert opinion, and on the 11th November the Scottish Division held their Autumn Meeting in the large room of the laboratory. Much care and thought have been bestowed upon the arrangements and fittings, with a view to thoroughly practical work, and all the necessary apparatus for histological research has been procured. The Scottish Division is to be congratulated upon having secured central and convenient premises in immediate contact with the Laboratory of the Royal College of Physicians at 12, Brisco Place, Edinburgh. This is beneficial to the College as well as to the asylums, since the close association of workers in science is both stimulating and helpful.

The absence of a law of settlement in Ireland is beginning to be acutely felt in connection with the chargeability of lunatics. The insane who are sent to public asylums in Ireland are not paupers in the same sense as in England, for they do not necessarily come first within the purview of the Poor Law. A considerable number of broken-down people of Irish birth, however, who become insane in England and Scotland are deported by the Poor Law Authorities in the latter countries to Ireland, and are then transferred to District Asylums.

The sudden collapse of the Lunacy Bill last year brought to a standstill the work of the conjoint Committee of the British Medical Association and our own on this subject.

This Committee, it is to be hoped, will still continue its labours, and be prepared, before the next Session of Parliament, with a workable adaptation to the English law of the Scottish clause dealing with the same stage of mental disease.

The last Report of the General Board of Lunacy for Scotland contains a most important and urgent appeal for legislative measures in relief of the poorer classes of the insane in Scotland. It is a closely reasoned declaration of the opinion of the Commissioners in view of the fact that the Royal Asylums are no longer adequate to meet the requirements of those who are but little removed from the “pauper” class. This has been apparent for some time, and the conviction, which has grown in strength, has found utterance in the suggestion now made, viz., that the powers conferred upon the County Lunacy Authorities of England should be extended to the District Lunacy Boards of Scotland. The existence of tracts of country where no provision has been made for those in narrow circumstances, the want of sufficient accommodation in existing institutions, the unfortunate results of the present condition of affairs have weighed with the Commissioners in urging that a measure of relief should be granted by Parliament.

Those of our members who listened to Dr. Ellis' interesting paper on Latah will be interested to read his report on the lunatic asylum over which he presides.

The daily Press, or at least a certain section of it, oscillates between two extremes in its views of the treatment of lunatics.

Perusing certain remarks made recently by a Mr. Berdoe in a lay paper, anent a therapeutic enquiry by Dr. Berkley at the City Asylum, Baltimore, and weighing these after a consideration of criticisms to be found in the British Medical Journal of September 18th and September 25th last, the thoughtful ratepayer—especially of the Metropolis, where Mr. Berdoe's superfluous energies find a vent—may well pray to be saved from his friends. Everywhere, and especially, probably, in the Metropolis, any painstaking investigation having for its object the determination of means whereby mental disorders may be arrested before they pass into the interminable night of chronic dementia, would be cordially approved of by those who contribute to the maintenance of county asylums, which look to become vast hostelries for the incurable in mind. Dr. Berkley records in the Bulletin of the Johns Hopkins Hospital for July, 1897, the results of the administration of thyroid extract in cases that “had either passed, or were about to pass, the limit of time in which recovery could be confidently expected.” We need not here describe Dr. Berkley's work, of which our readers can judge in the original. We content ourselves with the observation that it is the record of the trial of a medicinal agent, carried out scientifically, and for the benefit of the patient. To Mr. Berdoe, however, it appears that Dr. Berkley's work was “a study of poisoning, as a poison might be tested on an animal.” Viewing the matter in this lurid light, Mr. Berdoe felt forcibly that the interests of the public were in jeopardy, and, thus agitated in mind, was constrained to seek out a sympathetic confidant, whom he found in the Daily Chronicle. The “up-to-date” and democratic organ upon which Mr. Berdoe's choice fell was far too astute to miss the opportunity of heading a letter “Experiments on Lunatics;” and consequently we find his feelings concentrated under that harrowing title in an issue of the above newspaper. Those members of the profession who may have seen his letter, though it may be denied them to gauge the intensity of Mr. Berdoe's feelings, will not fail correctly to estimate his action in this matter. They cannot but regret that he should have condescended, not merely to have addressed his strictures upon a medical colleague to a lay organ, but further—to quote from our medical contemporary above-mentioned—to have made statements which “are not accurate,” and to have given “a very unfair version of the facts.”

But, while we condemn libel on a professional brother, while we protest, alike in the interests of humanity and of our profession, against any stupid effort to excite prejudice against the proper use of new methods, we would denounce any real “experiment” upon lunatics unhesitatingly. It is not too much to say that such a procedure would be cowardly, immoral and infamous. On similar grounds we are inclined to condemn the practice of pressing into the service of science criminals under sentence of death. This has, however, been occasionally carried out. Thus Küchenmeister gave twenty cysticerci cellulosó, on two occasions, to a criminal; and it is recorded that “afterwards” nineteen tapeworms were found in his intestines; and thus the converse of feeding pigs with the proglottides of the tænia was experimentally manifest. It appears to have been reserved for a Viennese specialist to make what is probably the first experiment upon an insane person, and we record the fact with regret and reprobation. Those members of the Association who attended the Moscow Congress, and who heard the discourse of Krafft-Ebing on general paralysis, may be already aware of the circumstances; for we gather from an account of the proceedings of the Congress (as they related to Psychiatry) which appears in our French contemporary, Annales Médico-Psychologiques (Nov.-Dec., 1897), that this address made mention of the experiment alluded to. The announcement, it is stated, caused considerable surprise and emotion, as we can readily believe. It would appear that a certain specialist in Vienna, whose name is not disclosed, being desirous of throwing light upon the question of the relationship between syphilis and general paralysis, conceived the idea of inoculating with the former disease nine general paralytics taken at random from his clinique. Of these six remained free from syphilis, but three contracted it, the conclusion being that syphilis was not the cause of the general paralysis in these latter cases. The moral laxity which permitted this shameful indulgence of scientific curiosity was justly censured by the public Press. The Deutsches Volksblatt of August last has an article upon the subject entitled “Human beings in place of rabbits for experimental purposes.” The enemy have indeed had occasion to blaspheme.