In a memoir of Dr. Conolly, of Hanwell, the following passage occurs:—” The tone of the chapel bell coming across the narrow valley of the Brent still reminds me, morning and evening, of the well-remembered and mingled congregation of the afflicted, and who are then assembling, humble yet hopeful, and not forgotten, and not spiritually deserted.” These words of the famous mental physician strike the keynote of the following paper, the purpose of which is to invite attention to some of the advantages of daily morning and evening prayer in chapels of lunatic asylums. Such services “daily throughout the year” are beneficial in various ways. They are helpful to chaplains by their fixedness, involving the exercise of their ministrations daily at regular hours. Any restraint imposed on their movements would be amply compensated by the privileges for their congregations and themselves accruing from continuous worship. The chaplain's presence at morning and evening prayer keeps the congregation and himself in close communication, and many of those who may not themselves attend the daily services are yet aware that the opportunity is within reach. The benefits of such services to many of the patients of an asylum are various. The interval of quietude before the commencement is no doubt felt by many to be restful and soothing. The spirit of a sensitive patient which may previously have been ruffled and discomposed by noise or some irritating occurrence is often calmed and quieted in chapel. The daily morning service is a preparation, as elsewhere, for the day's occupations. To use the expression of a patient unfailing in attendance, evening and morning, the early worship “fortifies for the day.” Another referred to the daily ministrations in chapel as “a great comfort.” A letter from a discharged convalescent contained the remark, “The services at the chapel which I have had the privilege of attending have been to me, as it were, wayside seats, where I have often sat and refreshed myself.” “Dear old chapel,” another remarks, “I have spent many sacred hours there.” Another benefit incident to attendance at daily services is relief to the monotony of the lives of many in asylums, especially of the unoccupied. The walk to and from chapel and its services are a break in the day. This is not a chief advantage; still, it is not valueless. The services for morning and evening prayer appear to be specially well adapted to the circumstances of an asylum congregation. The Prayer Book has a soothing tendency very beneficial to sorrowful and disturbed spirits. Many “weary of earth and laden with their sin” have been relieved by joining in the prayers, by hearing some comfortable words of the Bible, by taking part in some well-known hymn, or by some remark from the pulpit which seemed to apply to their own cases. Again, many patients who neither have a Bible of their own nor ready access to another may yet become profitably acquainted with parts of the Holy Scriptures read at chapel services; and what tender memories, healing in their influence, may be awakened by the words and harmony of some familiar hymn, such as “Rock of Ages”—associated, may be, with earliest recollections. The regular use of daily prayers in chapel may indirectly exercise a wholesome influence on the household at large, and not merely on the accustomed congregation. The very knowledge of the regular hours of prayer may be consolatory to some who perhaps themselves cannot attend. The sound of the bell for chapel service may be a reminder of the duty of worship, and perhaps awaken a desire to go to the house of God. The writer recalls the case of a bedridden patient to whom the sound of the chapel bell was a call to his own devotions. Week-day services may afford an opportunity for the occasional invitation of preachers who might not be conveniently able to come on Sundays. Their presence is valuable, and they supply variety of ministrations, specially desirable for congregations who are necessarily restricted in their movements. Not to patients only, but also to members of the staff—attendants, nurses, etc.—the occasional opportunity of attending week-day services in an asylum chapel may in some cases be beneficial, fortifying and bracing the spirit for the day's work, or refreshing it after the long hours of labour. The merciful invitation,” Come ye yourselves apart and rest awhile,” may be gratefully responded to by resorting, for a brief interval of rest and quietude, to some of the frequent chapel services. These should be short, on weekdays not exceeding, as a rule, 20 or 25 minutes; on occasions when a special sermon is given somewhat longer time must, of course, be allowed. Ordinarily the shortened service indicated in the Prayer Book furnishes an office of suitable brevity. It should be made bright with simple chants and hymns in which the congregation can join, and occasionally a very short devotional reading might be welcomed. Others besides members of the English Church (for in large asylums are various religious denominations) would often be comforted by opportunities for frequent worship, and be led to value the ministrations supplied. For the reasons mentioned, and others besides, week-day services in asylums are very valuable. They should be steadfastly maintained where they already exist, and introduced where they do not. Experto crede.

About the close of 1892 I examined bacteriologically some cases of othæmatoma, with a view of ascertaining if there was any basis for the idea which occurred to me, and which I mooted in an article in the “Journal of Mental Science” for April, 1893, that that condition was the result of bacterial activity. In none of the cases examined was there a history of injury. In the first two (an adult imbecile and a chronic maniac) cover-slip preparations of the extravasated blood—taken with full precautions as regards cleanliness—showed staphylococci, singly, in twos, in fours, and in small groups. In size the cocci resembled closely S. pyogenes aureus or albus. An attempt to cultivate the organism on gelatine and broth failed; unfortunately no agar was at hand. In the light of subsequent experience, I believe that this failure may, with much probability, be attributed to the fact that the amount of material transferred to the culture-tubes was too small. Several drops of the sero-sanguinolent extravasate should be taken for each tube. In the third case (that of a dement) what appeared to be the same organism was found in the cover-slip preparations and grown upon broth and altogether like that of a cultivation of S. pyogenes aureus. In other tubes, however, the growth remained white throughout, so that S. pyogenes albus was present as well.

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 book may be said to clear away the cloud of obscurity which has for well-nigh four centuries hung over the history of Juana, the Queen of Castile. The kingdoms of Castile and Aragon were politically united by the marriage of Ferdinand and Isabella. They had five children, Isabella, Juan, Juana, Maria, and Catalina.

Of recent years a considerable amount of study has been devoted to the nerve changes which are to be found in sane patients dying during the senile epoch, but comparatively little has been written concerning the alterations which occur in the nervous system of aged insane individuals. The object of this communication is to attempt from the pathologist's standpoint to elucidate some of these characteristic senile phenomena. I propose to briefly describe the morbid changes, both macroscopical and microscopical, which in my experience occur in aged insane persons, and to conclude by offering some remarks on the pathology of certain of these phenomena which I have particularly investigated. Before proceeding further, I would mention that the entire material for my observations has been afforded by the Lancashire County Asylum, Rainhill, and to Dr. Wiglesworth, the Medical Superintendent of that institution, I am indebted for permission to make use of that material and the asylum records in the compilation of this paper. My investigations have extended over a period of 18 months, and comprise the partial examination of the nervous system of all patients over 60 years of age who have died since my appointment as pathologist to the asylum. Of such cases θere have been 22 males and females their average age bone a matter of difficulty. In cases where no adhesion exists and the calvarium is readily removed, a slackness and dimpling of the dura mater—particularly of the frontal area—is generally seen, and proclaims an atrophy of the enclosed parts. The subdural hæmatoma or so-called pachymeningitis interna hæmorrhagica, so frequently met with in general paralysis of the insane, is not uncommon in senile insanity. Of 54 cases of that affection observed by Dr. Wiglesworth1 in this asylum, 12 occurred in patients over 60 years of age, while in a series of subdural hæmatomata collected by Sir J. Crichton-Browne and Dr. Bevan Lewis2 at the Wakefield Asylum, nine per cent, occurred in cases of “pure senile atrophy” of the brain, and 26·5 per cent. in cases of “chronic disorganization of the brain” (which, I take it, includes many senile cases); and, lastly, of the 50 cases of senility which I have examined, four presented this condition. The subdural fluid is invariably increased in quantity. The arachnoid membrane, particularly that covering the sulci and meningeal veins, is generally opaque, and the pacchionian bodies hypertrophied. A subarachnoid hæmorrhage I have only seen in one case, viz., in a demented female, æt. 78, who a few days before death suddenly became partially paralyzed in the extremities of the right side. At the autopsy an extremely wasted brain with a great excess of cerebro-spinal fluid was found, and lying in a hugely dilated subarachnoid space, situated at the point of junction of the horizontal limb of the intra-parietal sulcus with the post-central sulcus on the surface of the left hemisphere, was about 1½ ounces of dark, clotted blood and sanious serum. This was obviously pressing upon subjacent parts of the ascending parietal, superior parietal, and supramarginal convolutions—hence the paresis. The source of the hæmorrhage was not discovered, but that it issued from a ruptured, small pial vessel was doubtless. Further, that the hæmorrhage had actually occurred into the subarachnoid space was undeniable, as the stretched arachnoid membrane was clearly distinguishable confining it, and on the surface of the underlying cortex, which, by the way, was not lacerated, the delicate pia mater could be plainly traced. in fact, can often be detached in one sheet, but it does happen in some cases, especially if the brain be somewhat decomposed, that its removal is accompanied by a decortication exactly similar to that which is described as characteristic of general paralysis. In all the senile brains which I have examined there has been more or less atrophy and decrease in weight, and in some cases it has reached an extreme degree, leaving thin convolutions, and wide, shallow, gaping sulci. The frontal segment invariably suffers most, and the cerebellum and the mesencephalon participate in the wasting. The following table shows the average weight of the various parts of the brain in the cases I have examined:—

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.

A. Clinical, by Dr. Conolly Norman.

N. P. was admitted to the Dublin District Asylum in February, 1886. Nothing was known of his antecedents, nor was there any history whatever save that he had been guilty of an unnatural offence, had been committed to prison, and had been found to be insane. He would or could give no information about himself.

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.”

Dr. Baer is the chief medical officer at Plötzensee, a prison which represents the criminal world of Berlin, and from which (as Dr. Baer himself tells us) the prisoner usually emerges to become a confirmed recidivist. There should be much to say about such a criminal world as this, both in anthropological and in many other respects, and the book, therefore, arouses high expectations.

Dr. Clouston explained that he was the spokesman of Drs. Middlemass and Robertson, who had made almost all the sections and had supervised the micro-photography. He explained that as yet micro-photography had many disadvantages owing to the very delicate structure of the brain and the high powers that had to be used, as well as the difficulty in photographing many of the aniline stains. In the case of some of the sections more than six slides had been made before a satisfactory photograph was got.

Dr. Strahan's prominent motive in writing this study of suicide is to emphasize the importance of heredity in its causation, in the hope that something may be done to diminish it in the future.

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.

Mr. Ellis is to be congratulated on the difficult task which he has successfully accomplished in this book, of collecting the enormous material scattered in books and periodicals concerning the differential characteristics of man and woman, sifting it, and presenting it to his readers in an agreeable and methodical manner. He steers remarkably clear of the marked bias which has vitiated in the past the conclusions of various writers on this fascinating subject, and a great feature of the work is, therefore, the calm judicial way in which evidence is presented and the scientific spirit which pervades it.

It is not suggested that the specimens to be shown on the screen afford anything like an exhaustive demonstration of the constituents of a convolution. They are mainly intended to show the extreme value of Golgi's method for elucidating the important anatomical connections between cell and cell, and between area with area. Dr. Clouston must be congratulated on being able to submit such an admirable series of slides illustrative of the microscopic morbid anatomy of the brain. One experiences a feeling of envy of the rising generation at being able to start so far along the road. When I some thirty years ago began such investigations I could not make a section—only two men in Great Britain knew how to do so. I had to commence at zero; and I shall never forget the feeling of satisfaction when for the first time I was able to demonstrate a nerve-cell by my own unaided efforts. But methods of imbedding, cutting, and staining were soon discovered, and those of us who were working at the subject were, within a few years, able to demonstrate, describe, and figure a large proportion of the morbid changes which have been so brilliantly exhibited to-day. With such a demonstration the first volume of the pathological anatomy of the insane brain may be considered to be closed; it may have to be re-opened from time to time for marginal notes, but for all practical purposes of the post-mortem theatre we know roughly the general characters of the changes in the membranes, vessels, cells, and glia, so far as they can be made out by the Bevan Lewis and other methods. The second volume must deal with interruption of connections due to changes in the cells. This will be a long and difficult task; but if, as we have seen to-day, so much has been overcome within the last thirty years, we may fairly anticipate that the next generation of workers will accomplish very much more. The great value of Golgi's method and its modifications is that the various processes of the cells can be traced for long distances, and the characters of their insulating material can be demonstrated. When I place before you the best demonstration of a nerve-cell that can be obtained by aniline staining and another prepared by Golgi's process, you will at once see the immense advance that has been made. In this section of a great pyramid the character of the axis cylinder process at the base is seen to differ from the “splendid tufts” (as Ramon y Cajal calls them) in which the apical protoplasmic process ends; the basal axis cylinder is shown to bifurcate and to throw off numerous collaterals; and the lateral protoplasmic processes can be traced for long distances. The apical processes and the “splendid tufts” present a mossy appearance, differing in this respect from the apical poles of cells of other zones, and from the basal axis cylinder process of the pyramids. It can be determined that these processes are never anatomically connected; therefore, that the impulses they convey must be transmitted by contact only. When discussing lately with Prof. Cuningham the probable function of this mossiness I suggested it must be for the purpose of presenting a more extensive area of contact, and this view is supported by the interesting statement made by Dr. Andriezen that he has found in chronic dements that the mossiness has been lost or much diminished. Ramon y Cajal has, by his modification of Golgi's process, demonstrated the important fact that the poles of the external or molecular layer, of the pyramidal zone, and of the internal or polymorphous layer differ in their distribution, those of the outer zone being directed horizontally, and for the most part antero-posteriorly, and never descending; that the axis-cylinder process of the pyramid is in direct communication with the projection fibre, and probably with the commissural fibre; that its apical process runs up to the surface of the brain; and that the poles of the great cells of the polymorphous layer never extend beyond the pyramidal zone. This, along with the demonstration of the large cells (Cajalsche Zellen) of the molecular layer strongly suggest that each zone exercises special functions. It is impossible on the present occasion to go into further particulars. I must apologise for the roughness of the demonstration. I thought it might interest some members to be able to see what important results may be looked for from the use of Golgi's and Ramon y Cajal's methods. If we hold that mental action is a function of connection it is of extreme value to have at our command a method of investigation by which may be shown that the cell-processes suffer a Wallerian degeneration as a consequence of the implication of cell integrity.

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:—