It is only within the last two or three years that alienists have learnt to recognize the importance of the existence in cases of progressive paralysis of the insane of certain extremely interesting neuro-muscular anatomical alterations. Too long was the teaching of Lockhart Clarke,1 Tigges,2 Westphal,3 Magnan,4 Voisin,5 Mendel,6 etc., that the cerebrospinal changes represented the sole anatomical substratum of the clinical features in this disease, regarded as infallible, and it is pleasing to think that our erroneous conceptions have been removed by the energetic researches and discoveries of another generation, including among their number Déjerine,7 Lubimoff,8 Mierzejewski,9 Bianchi,10 Fürst-

I. Admissions.—The following table shows in decennial periods the numbers admitted at different ages, and the percentage proportion of admissions in each age-period:—

It was my fortune to spend a week at Göttingen in the month of May of this year, and the following notes of conversations and extracts from the published writings of Professor Meyer† may be taken as representing the opinion of the best German school of psychiatry at the present time. Professor Meyer's career has been long and distinguished. Educated at Berlin, imbued with an enthusiasm that impelled him to teaching there as early as 1858, he was in due course appointed to the Hamburg Asylum, whence he was transferred to Göttingen more than a quarter of a century ago. His name is familiar as an authority on mental diseases, and his present position is indicated by his having been selected to report upon “Psychiatry,” in the volume descriptive of the German Universities prepared for the Chicago Exhibition.

I read, at the time of its publication in 1886, and again in 1890, after a visit to Dr. Tuke in London, his first paper on the “Alleged increase of insanity,” and I await with much expectation the full text of his recent paper on the same topic. The conclusion that I draw from the statistics there presented (in 1886) is not exactly the same that my friend Dr. Tuke draws. I distrust very much the records of first attacks; so far as my observation goes—extended now over a period of 30 years, and many thousand cases of insanity whose certificates I have separately examined—there is nothing in the proverbially doubtful statistics of the insane more dubious than those affecting to give the date of a “first attack.” Even for purposes of comparison, year by year, they have scarcely more value than a mixture of pounds sterling, years of our Lord, bushels of wheat, and a few other numbers jumbled together in an account, so totally varying are the judgments and the exactness of the certifiers who set down the alleged “first attack.” Until these variances can in some way be reduced by the better observation of the asylum physician, I, for one, am inclined to leave the tabulation of “first attacks” where good sense has long left the asylum tables of “causes of insanity.” One may possibly be as good as the other, but neither can throw any clear light on the real facts of insanity.

I propose in the following article to state succinctly, and I trust fairly, the arguments and facts on the affirmative and negative sides of this question, confining myself to England and Wales, and endeavouring to determine on which side the greater weight of evidence lies.

Although much of a speculative kind appears to have been written upon the subject of climacteric insanity, more especially as regards the pathology of the disorder, the accumulation of actual facts, bearing upon its genesis, symptomatology, and terminations is comparatively small. Exception must be made for the highly practical paper lately read by Dr. Savage at the Medical Society. A further contribution dealing as far as possible with matters of observation may be serviceable. For the purpose of this paper, in addition to the cases coming under the direct observation of the writers, the records of Bethlem (10 years, 102 cases) and the West Riding Asylum, Wakefield (10 years, 120 cases) have been drawn upon. We are indebted to Dr. Salter, Clinical Assistant, Bethlem Hospital, for much assistance in collecting the cases, and Dr. Percy Smith for permission to use the records of Bethlem.

The “General Report, with Summary Tables and Appendices,” only came into our hands at the close of 1893. In the following very brief résumé of the section devoted to the insane we have omitted the reference to the alleged increase of insanity, as it has already been dealt with at p. 228. Sex, distribution, and age, however, remain.

It seems as if the troubles produced by certifying were taking a new line, and parish officers, who hitherto have not been troubled much in exercising their medical discretion as to persons of unsound mind, are going to have their turn of worry. The medical officers of workhouses have no interest in signing certificates for the removal of the insane to asylums, and their masters, the Guardians, can hardly be looked upon as interested either, but this notwithstanding, the parish of Lewisham will have cause to remember the danger of sending persons supposed to be of unsound mind to the County Asylum.

There is, and has been for some time, an indignant revolt on the part of the Superintendents of Asylums in the State of York and the State Commission in Lunacy. In England the almost unanimous feeling among mental specialists favours the existence of a Lunacy Board. With some exceptions the action of the Board in London has been fairly judicious. The late Lord Shaftesbury held the opinion strongly that very considerable freedom of action must be left to medical superintendents, even on points on which the Commissioners, individually or collectively, might entertain opposite views. In some instances in which this course has not been pursued by the Board, the result of the collision has been unfavourable to the authority of the Commissioners.

With the publication in the “Pall Mall Magazine” of the first of Lord Wolseley's articles on “The Decline and Fall of Napoleon,” the inveterate controversy as to the position of the “Corsican Parvenu” in the military and general history of the world assumes a new aspect, the development of which, as psychologists, we shall watch with much interest. There have already been three great epochs in this protracted conflict of opinion. To his contemporaries and rivals of the type of Dumouriez, Bonaparte was a magnificent charlatan of mediocre ability, fit only to serve as a divisional commander under men of light and leading like themselves. The school of thought, however, which saw no genius in the famous march from Boulogne to Ulm and Austerlitz necessarily wielded an ephemeral influence, and was quickly superseded by the reactionary school, of whose views Thiers was at once the founder and the ablest exponent. Over the veteran author of “The Consulate and the Empire” the spirit of Napoleon exercised a fascination of which the records of hero-worship furnish few analogies. Then came the school of Lanfrey, Taine, and Seeley. The method which these great writers sought to pursue in investigating the life and character of Bonaparte was excellent. They set before themselves as the object to be attained a cold, critical survey, detached alike from the rancour of Dumouriez and the adulation of Thiers. But they failed, and failed badly. In spite of all their critical acumen—and perhaps because of it—the Napoleonic idea eluded their grasp. They were no better fitted for their task than Bunyan would have been for that of writing an impartial biography of Charles the Second, and the writer who will raise a real living Napoleon from the 32 volumes of “Correspondance” in which his life and thoughts are entombed has still to appear above the literary horizon. Lord Wolseley makes no attempt to fill this vacant rôle. Indeed, we doubt whether it could be adequately filled by one who believes Napoleon to have been “the greatest of all the great men” that ever lived. But he makes a contribution of much interest and value to a question that has been occasionally mooted of late years, viz., What was the mysterious malady from which the French Emperor suffered at the close of his public life in Europe? Perhaps we ought to suspend a definite answer to this question till we see what else Lord Wolseley has to say on the subject in his remaining articles. But in the meantime a rapid summary of the evidence on the point available to any student of modern French literature may not be inopportune. Of course, the matter to be considered is whether there was, in fact, at the end of Napoleon's military career a failing in his powers. Our ancestors would, no doubt, have deemed it unpatriotic to question that the “Boney” whom Wellington beat at Waterloo not only knew his best and did it, but was as competent a general as the hero of Arcola and Rivoli. But this comforting position is no longer tenable. Lord Wolseley points to the fatal delay of Napoleon at Wilna in the Russian campaign of 1812, and his equally fatal omission to support Ney at the crisis of the battle of Borodino; and, if we mistake not, the campaigns of Leipsic and Waterloo yield evidences still more cogent that the very faculty of commandership repeatedly deserted Bonaparte at the time when its presence was essential to his fortunes. The direct testimony of his contemporaries to the same fact is not wanting. Marshal Augereau (as we learn from Macdonald's memoirs) noticed it, although his coarsely-grained and jealous mind saw in it only a proof of the incompetence which he preferred to consider as a characteristic of his master, and the officers who received the fugitive Corsican on his return from Elba were astounded at his alternate fits of garrulity and silence, tremendous energy and hopeless lassitude. If, then, the fact of Napoleon's mental and physical decline is established, what was the cause? Lord Wolseley goes no further at present than “mental and moral prostration,” and there is certainly nothing extraordinary in the theory that the prodigious and continuous strain to which the mighty intellect of the great captain had for years been subjected was at last destroying its machinery. But there is also positive evidence, we think, that Napoleon had become the victim of epilepsy, and without dwelling on the subject further just now, till Lord Wolseley's series has been completed, we may point out that the theory here suggested derives some corroboration from the circumstance on which his lordship's first article offers abundant proof, that while Napoleon's power of executing his plans was impaired, the splendour of his military imagination survived, and even increased in apparent brilliancy at the last.

Nothing would now be gained by an elaborate account of the Zierenberg case, or a justification of the verdict at which the jury arrived. Although it is probable that the plaintiffs suffered from the interposition of the Long Vacation between their case and that of the defendant, for the jury would naturally remember most vividly what they heard last, and although the terms of the libel in Truth were, perhaps, at some points stronger than the evidence warranted, it is impossible to doubt that the verdict was a right one. It is clear (1) that the plaintiffs were coarse, ignorant, and interested people, utterly unfit to have the care of inebriates, and (2) that the régime of the St. James's Home reproduced many of the worst abuses of the old asylum system which Lord Shaftesbury, who, by a strange irony of fortune, was once its President, did so much to destroy—the want of scientific or even rational classification, and the ancient, weary round of seclusion, harsh words, and blows. The reflections which the case suggests are not unimportant. It is obvious that voluntary “retreats” of this description ought to be made subject to Government inspection. It is out of the question to suppose that men of affairs like Lord Shaftesbury, Lord Aberdeen, and Mr. Samuel Morley can exercise any effective supervision over institutions of this character, or that their names are sufficient hostages to the public for their proper administration. Again, one cannot fail to observe that the disclosures in the Zierenberg case amply warrant Mr. Asquith's recent remarks to the deputation which pressed upon him the need for an amendment to the Inebriates' Acts, as to the caution with which the principle of compulsory sequestration has to be adopted and applied. It was stated in evidence that one patient at least was brought to the Zierenberg Home by a chimney sweep. It may be (Mr. Labouchere himself was, we believe, the author of the suggestion) that a contingent drawn from this humble, though deserving, section of the industrial community might profitably be added to the ranks of our “hereditary legislators.” But we have no desire to see its members, or, indeed, the members of any other class, without the special qualifications of knowledge and responsibility, left free to act as the arbiters of the liberty of habitual drunkards.

The first and altogether indispensable qualification for the work of the minister of Religion is, and must ever be, that his heart and soul are absorbed in his work. All the learning of the schools would be of no avail, and yet all possible knowledge of both men and things could find ample scope in that interesting and all-embracing field of service, the very “labour of love!” But if the heart-service of any religious minister of the Gospel is so all-important a requisite for the due performance of the daily duties of the ordinary parish priest, yet more is it so in the case of him whose daily duty, nay, whose great privilege it is to “minister to the mind diseased,” and unless the heart be really and truly in his work he can be of little, if any, good service to the mentally afflicted. Such a sad condition would prove a most prolific source of unhappiness and unprofitableness all round. “Can the blind lead the blind?” It is an old-established truth that no two persons are totally and unmistakably alike! Even so is it a moral fact that no two characters agree in every particular; and yet more, this thought brings me to the most interesting consideration of the whole matter, viz., the psychical condition of the insane, which is as varied as the physical and moral states of ordinary mortals. Quot homines tot sententió. The asylum chaplain, whose heart and soul are really and truly in the work, will make it his daily study to fathom the psychical conditions of his afflicted flock, so as to find ways and means and opportunities for the soothing balm of comfort and consolation! Very deep and sincere has been the gratitude of many a poor man or woman thus lovingly dealt with, and great the chaplain's encouragement and reward! Nisi dominus frustra.

With the increasing publication of monographs on various branches of medicine, the compilation of a treatise on nervous and mental diseases, or on any other class of diseases, must become more and more tedious and difficult, readers becoming more and more critical. But, without being too exacting, one may still be disappointed with Dr. Carter Gray's work, and after careful perusal we can but award it lukewarm praise. As we shall have occasion to show, it is of decidedly unequal merit—some of the chapters, with the author, we take it, at his best, leave nothing to be desired; but in others we find but scant descriptions, and there are important omissions—omissions which we cannot (after reading the author's preface) qualify as non-essential.

This is a novel written “for a purpose,” the purpose being the exposition of heredity. We are suspicious of such productions for the reason that it is impossible to blend dry scientific facts with the ordinary attributes of popular reading in such a way as to prevent imagination overcoming accuracy. This work, though interesting in many ways, cannot be said to successfully dress science in a popular garb, while it contains many elements of danger to ordinary novelreaders. As to technique, we need hardly say that word structure and word painting are masterly. The plot may be described as a weaving of horrors, psychological, moral, and physical, into a tale of rural and domestic life, the latter being just of that easy and natural character which does so much to promote, whether for good or evil, the intaking of the more active incidents.

Any contribution to medical psychology from M. Féré is likely to be of value, and this little book on the family treatment of the insane forms no exception. He belongs to the school which would treat the insane in the country with the advantage of being well occupied in farm labour or other ways. It is stated that the Conseil Général de la Seine has decided to place out in this way 400 inoffensive senile dements. With regard to this it is rather difficult to understand how this class of patients are suitable for this location, however desirable it may be to eliminate them from an ordinary asylum. Many references are made to England and Scotland by M. Féré. At present the family treatment of the insane may take the form of a colony annexed to an asylum; a free colony; or thirdly, as single patients. Of the first, Altscherbitz, near Leipsic, is a well-known example. Claremont (Oise), while carried on by the private enterprise of the brothers Labitte, has presented a successful instance of economy. The author especially mentions under this head the colony of Ilten, near Hanover, founded by Dr. Whrendorff.” The system of Ilten consists essentially in the extension of the surveillance of the establishment, to which the patients may be returned at the shortest notice, the doctor having his eye always upon them. They may besides receive there special care and treatment. This mode of treatment costs little, the maintenance of each patient amounting to 337.50 francs annually, without any building” (p. 19).

This part maintains the excellence of the preceding parts of this important work. It deals with exophthalmic goitre, acromegaly, general exfoliative epidemic dermatitis, and unilateral hypertrophy of the face, and thus pipes some of the lesser tunes in the grand orchestral performance of Disease. Exophthalmic goitre is carefully considered and admirably illustrated. Under the ætiology reference is made to Gautier's classification of cases into primary and secondary, or into idiopathic and symptomatic, the latter being held to result from some obvious peripheral lesion, and upon this division Bramwell comments as to the impossibility of drawing sharply such a line; he thinks, however, that a practical therapeutic value may attach to the classification. This is no doubt a just view, for the idiopathic diseases, so-called, are everywhere suffering encroachment, proximate causes revealing themselves to the careful inquirer.

It is rarely that we have read a more detestable book than the one under review. As its title indicates, it is a description of a lunatic, but from the beginning to the end it revolts one. To begin with, the unfortunate man, named Labat, has an insane mother, whose mother also was insane. He was wealthy and of good family, and is thus able to marry a beautiful but poor girl, who has two children, both of whom die in convulsions. A most truthful but horrible description of a fit is given, exact in all its fearful details. The mother determines to have no more children by her husband, and as the latter insists upon conjugal rights, she goes to the doctor, who is readily seduced by her, and a liaison is started, which results in the birth of a fine healthy son, who bears strong indications of his paternity. The putative father is jealous, and though he takes no open steps, he evinces his disgust, and the doctor, to save himself, calls in a medical friend, who is persuaded that the accusations against his medical ally are untrue, and who treats them as delusions, and on an urgency order consigns M. Labat to a “Maison de Sauté,” kept by an ex-marine medical officer, whose treatment is of the most downright and brutal kind; he has a belief in subduing disease by means of douches and strict discipline, the patient passes through a period of distress, and very nearly loses his reason, and the details of the life in the asylum are revolting and disgusting in the extreme. He determines to suppress his real feelings and to acquiesce in the doctor's ideas, and as a result he is discharged cured. He rejoins his wife, who, receiving him coldly, causes further trouble, which ends in the murder of the child, and the flight of M. Labat. He is taken to another asylum, which is a private adventure asylum, where more brutality is exercised, and the patients are treated more as slaves than as sufferers from disease. Thence M. Labat, who has now become really insane, is taken as an insane criminal to Bicêtre, only to be tested and tortured with electricity. He once more is sent to the original “Maison de Santé,” where in the end he is boiled to death in a hot bath by accident. Madame Labat has also become permanently insane, and so the story ends. Such a book is not only unhealthy, but it is mischievous in the last degree; it represents, as if occurring at the present day, a state of mismanagement in asylums which has disappeared for many years. It causes prejudice, not only against the medical profession as a whole, but more particularly against the special branch which we cultivate. It is an untruthful libel. The medical discussions on the symptoms of mental disorder are very exact, pointing to the handiwork of one who has had medical training. “It is a filthy bird that fouls its own nest.”

This valuable work consists of 24 chapters, each of which is written by one well acquainted with the subject. Two of them are written by the learned editor. Dealing with the diseases of warm climates, many of the maladies described are unfamiliar to practitioners in Britain, and none of them have special interest to the readers of this Journal save the chapter on goitre by Francis N. Macnamara, M.D. This paper gives a connected account of the prevalence and character of this affection in India, and the conditions under which it occurs. Goitre is principally met with in Northern India at the foot of the Himalayas, in the Delta of the Ganges, in the mud flats of Assam, and in the district of Multan. Dr. Macnamara tells us of places in which the endemic cause of goitre is so intense that a short residence often causes it to appear amongst the troops. Two stations are mentioned in Upper Assam where a three months' residence insures a well-marked goitre.

The biography of Robt. Boyle, which this number contains, will be read with much interest, and is written in Sir Benjamin Richardson's usual felicitous style. The portrait which accompanies it adds another to the admirable gallery of portraits which alone would make the “Asclepiad” of permanent value. The first article in this number of the “Asclepiad” will be read with interest—“The moment for blood letting”—seeing that Sir Benjamin Richardson can speak from experience of “the old and new practice.” The conclusion arrived at is that vevesection is useful now as formerly under the following conditions:—