In the present section the writer proposes to deal at length with the symptomatology, which is the psychic equivalent of those physical states of the cerebrum which are the necessary precursors of dissolution of the cerebral neurones. There being no suitable word in use for the description of this symptomatology, and it not appearing desirable to coin a new one for the purpose, the term “mental confusion” will be employed to connote, in the broadest sense, the mental symptoms which occur in association with certain pathological states of the cortical neurones which may be followed by the recovery or by a more or less extensive dissolution of these elements.

The clinical study of the physical symptoms of mental diseases has of late years been pushed with energy and originality, not only in this country but also abroad. Advances in the general knowledge of physiological and pathological chemistry and the great doctrine of immunity have had their effect upon the views held regarding mental diseases, and particularly with regard to their causation.

As a preface to the remarks which I propose to submit for your consideration to-day, I wish to recall to your memory the substance of a paper which I had the honour to read before this Association some two years ago(1). In that paper I endeavoured to establish a distinction between two opposed types of drinking, which, having regard to the chief factor in each form, I referred to as convivial drinking and industrial drinking; and I pointed out that these two modes of drinking differed widely in their relations to drunkenness and to chronic alcoholism, convivial excess producing drunkenness but rarely tending to cause chronic intoxication, while industrial drinking, on the other hand, though not an immediate cause of drunkenness, led rapidly and fatally to chronic poisoning. And, as an illustration and proof of the reality of this distinction, I drew your attention to the remarkable differences in regional distribution which are apparent when drunkenness is compared with alcoholic mortality, with attempted suicide, or with the several varieties of crime that are known to be most intimately connected with chronic alcoholism. The accompanying diagram, which I have published elsewhere, will epitomise this statistical evidence. It shows the rate per 100,000 of the population in the agricultural districts, the manufacturing towns, the seaports, and the mining districts of arrests for drunkenness, homicidal crime, and assaults taken together, homicidal crime alone, and attempts to commit suicide calculated on the annual average during the years 1891–1900. The figures below the columns are the comparative mortality figures for a number of the occupational groups which are more or less representative of the industrial conditions in each of the composite areas, viz. for the agricultural districts the agriculturists, for the manufacturing towns the textile and iron workers, for the seaports the dockers, and for the mining districts the coal-miners. The fact which I wish to bring out by means of this table is, of course, that drunkenness and chronic alcoholism are largely independent of one another, and that the more serious evils due to alcohol are connected with the chronic intoxication and not with simple drunkenness. This is most clearly seen in the mining districts, where there is more drunkenness than in any other part of the country, but where, at the same time, there is little chronic alcoholism and, therefore, relatively low rates of alcoholic suicide (as measured by suicidal attempts) and of alcoholic crime. And the explanation which I desire to suggest is, as I have already indicated, that the chronic intoxication is, in the main, a result of industrial drinking and has nothing to do with the convivial excess which produces drunkenness.

While making observations upon the opsonic indices of the insane I noticed that the serum in many of the cases under observation when mixed with the red blood corpuscles of a healthy person agglutinated them.

Among the characteristics which we agree with Kraepelin in regarding as the essential mental features of the personality, varying degrees of capacity for acquiring skill by practice and of liability to fatigue are by far the most important. The effects of practice and fatigue on the course of mental work are such as absolutely to determine the amount that can be done and the mental capacity for work. They differ, however, in their relation to the amount of work done, not only in the antagonistic direction of their effects, but also in other features which clearly show their kinship with the corresponding pheno mena on the physiological side. While the effect of practice hardly ever extends beyond the sphere of the work that has been practised, and acts on other functions, even of a simular nature, only in a limited degree, fatigue has a far more exten sive effect and reduces the general mental capacity for work. There is much in the common experience of daily life which seems to contradict this statement. Thus, change of work seems to have a favourable influence on our working capacity when we are fatigued. This appearance has led even eminent physiologists to assume that fatigue acts within the same narrow limits as practice. Thus, Mosso says, in his book on Fatigue, “Apparently fatigue is localised in a particular region of the brain, for we often see that people who have become incapable of thinking over a certain subject, or considering a particular piece of business, find relief in thinking about some thing else, or free themselves from the sense of dulness in their heads by fixing their attention intently on other and different things-for instance, on a game of chess.” Richter, too, ascribes a restorative effect to change of work in education, and thinks that he has thus discovered why school children do not show more fatigue.

The following cases of gross cerebral lesion occurred in epileptic idiots:

CASE 1.—S. J— was admitted to Leavesden Asylum in December, 1897, ret. 17. He was then noted to be a confirmed epileptic idiot. He died in March, 1904, of ulcerative colitis. During his residence there he had frequent severe fits.

The new Lord Chancellor does not seem to be able to increase the Lunacy Commission, although apparently the need for an increase in its strength is becoming daily more apparent, and is acknowledged on all sides.

The disability of Medico-Psychologists connected with private asylums, from being appointed as Lunacy Commis sioners within a year of such connection, is in a fair way to be abolished. This is due to the initiative of Dr. Mercier, resulting in a deputation to the Lord Chancellor, consisting of Dr. Mercier and other members of this Association, whose repre sentations were very favourably received.

This new addition to the periodical literature on abnormal psychology, made its first appearance on April ist last, and is to be published bi-monthly. The Editor-in-Chief is Dr. Morton Prince, Professor of Nervous Diseases, assisted by Dr. Hugo Münsterberg, of Harvard, Dr. C. L. Dana, of Cornell, Dr. I. I. Putnam, of Boston, and Dr. Adolf Meyer.

Some time ago an occurrence in regard to the manner of dealing with an attendant charged with breach of discipline in this asylum was commented on unfavourably in this journal. It is with pleasure, therefore, that we note in the Connaught Champion of March 17th the report of a case in which the committee of this asylum exercised their disciplinary powers in the most exemplary and satisfactory manner, showing at the same time the keenest desire, not only to protect the patients, but to support the medical superintendent and officers in the maintenance of the discipline that is so necessary to the successful treatment of the insane. The comments of the Connaught Champion, in a special article on the case, are also extremely satisfactory, as indicating that there is a healthy local public feeling determined to support its official repre sentatives in insuring that kindly and sympathetic treatment of the sick and suffering which is so eminent a characteristic of our Irish brethren.

The Asylum Workers' Association, which has now entered on its second decade, held its annual meeting on June ist, at ii, Chandos Street. Sir J. Crichton-Browne took the chair in the unavoidable absence of the President, Sir J. Batty Tuke, who was unanimously re-elected for the coming year.

An important deputation, organised by the Central Hospital Council for London, was received by Lord Crewe, the Lord President of the Council, on June I4th. The deputation in cluded Sir Frederick Trêves, Sir Thomas Barlow, Dr. J. Kingston Fowler, Dr. W. H. Allchin, and several matrons of London and provincial hospitals.

The Educational Committee is not resting on its oars after the successful recognition which has been obtained of the eligibility of asylum nurses for registration, but is actively engage in still further improving the training and elevating the examination standard.

In this paper, Dr. Anton principally treats of the vicarious action between the cerebrum and the cerebellum. His observations support the experiments of Luciani, who found that after extirpation of the cere bellum, the compensation came from the sensory-motor spheres of the cerebrum. Dr. Anton observes from the experiments of Goltz up to the present day there has been evidence collected to show that after the extirpation of the hemispheres the basal ganglia can take up the lost functions in a surprising measure. This especially holds good with animals of a lower order; Goltz's celebrated dog lived eighteen months after the removal of the cerebrum. Even in man there is a vicarious renewal of function. From the classical experiments of Gudden and from numerous pathological observations, it has been proved that if symmetrical portions of the brain are destroyed there is often increased growth in the opposite hemisphere. Gudden found that by permanently closing up one nostril in a dog, there resulted an increase of the olfactory lobe of the other side. This compensatory power is stronger in the young. Dr. Anton studied the case of a child who could at least stand, and walk with help. The cerebellum had almost disappeared, the cerebrum seemed unimpaired, though it weighed no more than that of a child of three and a half years. There was hypertrophy of the strands of the fillet and of the pyramids in connection with the sensory-motor zone of the hemispheres. These tracts were as large as in a grown man, a proof of the vicarious activity of the motor apparatus of the cerebrum.

Brodmann exhibited to the Psychiatric Society of Berlin two monkeys from whose brains he had removed the anterior and posterior central gyri. They had hemianopsia and loss of motor power in the hand. As the result of his experiments, he found that little impairment of function followed small excisions of the posterior central convolution, whereas a similar removal from the anterior central at once caused helplessness in the use of the hands (meaning, we suppose, the upper limbs), especially in the smaller joints. This powerlessness lasted for eight or ten days. In dogs, there is the same restitution of function, even after excision of both median gyri. Brodmann notes that after excision of the anterior central gyri there is much degeneration of the anterior tract, but comparatively little after a more extensive removal of the posterior central convolution.