The present group contains 20 cases of “Dementia following Epilepsy,” of which 12 are of the male and 8 are of the female sex.

“What we gain from speculative philosophy is not so much answers to questions which common sense universally asks, as the knowledge that these questions themselves, since they are based on untrue concepts, must vanish away.”—Paul Möller.

Our distinguished President, Sir William Collins, in his admirable oration delivered to us last year, expressed appreciative sympathy with the main objects of the Asylum Workers' Association. These are, firstly, to raise in the public esteem the calling we have chosen, and secondly, to succour those members of our body who have suffered in the service.

This communication is based on a study of cases in Glasgow's Aged People's Home. The Home is for those in reduced circumstances, but above the pauper grade. It has accommodation for 140 men and 86 women. Reference is made to this point to enable a general inference to be drawn as to the proportion and frequency of cases of the more acute though brief forms of mental disturbance among the old; for with one exception they all occurred within a period of two months since the beginning of the present year. However, looking back over the last twenty years, my impression is that the number of cases here recorded is above the average of our previous experience.

In the realm of mental disease any finger-post which points a way through the entanglements of ætiology is worthy of consideration. Present-day tendency is to magnify external at the expense of internal causes, a cart-before-the-horse policy which must bring confusion. Comparative lunacy endeavours at least to reverse the position and to start straight by tracing the affinity of form which exists between national brain types and their insane corruptions, or by showing variations in the relative incidence of disease forms and co-ordinating these with dominant social or biological factors.

In this paper the writer aims at bringing into prominence some advantages derived from the application of the principles of hospital treatment to the care and management of insane epileptics. Much of the clinico-pathological work recently done on epilepsy tends to support the view that such treatment is correct; and, further, it is now generally accepted that treatment of the so-called “Acute Insanities” (mania, melancholia, etc.) on hospital lines gives the best results.

The great majority of the insane Jews chargeable to the various London unions are cared for in this asylum. Special arrangements are made in order that they may observe the customs and rites which their religion demands of them. A Jewish Rabbi visits them and holds religious services. A Jewish interpretress is on duty daily. There is a Jewish kitchen, where the food is prepared in the manner they are accustomed to. At certain periods of the year they fast as they would do in their own homes.

Writing in the Nineteenth Century of 1889, in an article entitled, “Lunatics as Patients, not Prisoners,” Sir John Batty Tuke drew attention to the steadily increasing incubus of pauper lunacy, and raised the whole question of lunacy administration in England and Wales. In this paper he asked whether, commensurately with the increasing expenditure on the care and treatment of lunatics, even at that time enormous, there had been achieved an understanding of the hidden processes which underlie the insanities, and some means of arresting their occurrence, such as the ratepaying citizen might reasonably expect in return for the vast sums expended. These questions Sir John Tuke answered by a decided negative, and he adduced as his main reasons for this unsatisfactory state of affairs that, in the first place, asylums were merely asylums in the classic sense of the term, places of refuge, “model lodging-houses for the insane,” not great hospitals for the cure of disease; and, in the second place, that the medical men who had the direction of these establishments were occupied with administrative and economic duties to the practical exclusion of scientific investigation and their proper function of healers of the sick. He even staged that it was quite an open question whether, in a certain number of cases, asylum treatment did not tend to aggravate the disease and render it chronic. That a certain number recovered in consequence of it, that a certain number recovered in spite of it, and that a certain number became demented because of it, were, he believed, each and all equally true statements. “A man merged in a crowd of irresponsible beings, all under the influence of a common discipline, and under the control of common keepers, must lose his individuality, and cannot possibly receive that anxious care and attention at the hands of one physician which is necessary from the nature of the case. What every case of insanity demands as the primary condition for recovery is, separate and individual treatment and consideration.”

I Wish that the advocacy of what I believe will be one of the most important developments in the history of our specialty had devolved on someone occupying a higher position in our branch of medicine, someone whose opinions and views would carry more weight and influence than mine can aspire to; at the same time thirty years' experience as a medical officer in London and provincial asylums, public and private, perhaps entitles me to open a discussion on a subject on which I have spent some thought, and I am proud of the privilege of doing so before this Association to-day.

At a quarterly meeting of this Association held last year at Nottingham, we showed the results of our experiments with toxins upon the spinal cord and brain of rabbits. Our main conclusion was, that the central nervous system could be infected by toxins passing up along the lymph channels of the perineural sheath. The method we employed in our experiments consisted in placing a celloidin capsule filled with a broth culture of an organism under the sciatic nerve or under the skin of the cheek; and we invariably found a resulting degeneration in the spinal cord or brain, according to the situation of the capsule. These lesions we found to be identical in morphological type and anatomical distribution with those found in the cord of early tabes dorsalis and in the brain and cord of general paralysis of the insane. The conclusion suggested by our work was that these two diseases, if toxic, were most probably infections of lymphogenous origin.