This is the third paper by this author on the same subject. In this case the types of alteration of the nerve-cells were two:—First, the disintegration of the chromatic substance which, reduced to fine granules, was scattered uniformly through the cell, rendering it homogeneous; the nucleus central and unaltered. This is the usual type following toxines. Second, the type with central chromatolysis and deformity, and displacement of the nucleus. This is the type following the cutting of the axis-cylinder process. In this case, this was associated with degeneration of the fibres of various parts of the motor tracts, and was probably an example of the secondary degeneration of the nerve-cell from “reaction at a distance.” The lesion in the pyramidal tracts of the cord stands in relation to the symptoms presented by the patient, e. g. hypertonus, exaggeration of the tendon reflexes, paresis of the upper limbs. The curability of such cases is not in contradiction with the anatomical facts, as the alteration in the nerve-cell is reparable. The primary degeneration of the fibres is probably due to the same toxine as had produced the nerve-cell change.

This paper gives a very elaborate analysis of 742 cases of alcoholism (males) admitted to the Lichtenberg Asylum during the six years 1893–99. The cases are classified according to the number of previous admissions, mode of admission (from police, from hospitals, and voluntarily), length of interval in relapsing cases, duration of treatment, nature of symptoms, predisposition (heredity, trauma, epilepsy, etc.), external influences (occupation, home conditions, etc.), nature of offence in criminal cases. Further cross classifications show the relations of these different orders of fact to one another.

Dr. Paris confirms by his testimony the value of rest in bed in the treatment of the insane. He also points out that it does not really raise the expense of maintenance appreciably, for if, on the one hand, it necessitates an increase in the staff of attendants, it obviates the cost of the destructiveness of the maniacal patient, and the greater and more prolonged consumption of sedative medicines, etc. Another aspect of this question is the lessened call for surgical treatment which rest in bed brings with it; thus the metrorrhagias, wounds, and fractures are much less in evidence, and one accident in particular is of much less frequent occurrence, viz. hernia.

In this paper, the authors point out the frequency with which gynæcological troubles are found associated with mental perversions, and they insist upon the dependence in many cases of the latter upon the pelvic mischief. According to the traditions of asylum practice in France a pelvic examination is only performed after the consent of the relations has been obtained. At the asylum of Ville-Evrard, with 400 to 450 beds, this consent was obtained in sixty-six cases only. Excluding, for reasons, five of these cases, there were found gynæcological troubles in fifty-nine out of the remaining sixty-one cases. With this enormous proportion in view, and the frequent ætiological relationship between this form of disease and mental aberration, the refusal of the relations to allow the necessary examination of patients who are themselves not able to act on their own behalf becomes a very serious matter, and the authors ask whether society, which takes upon itself to commit a patient to an asylum and by law to administer and protect the property of the individual, cannot take better care of that other form of property—health. True, in cases where symptoms are urgent we may take it upon our own consciences and act then and there as we deem best for the patient, but, as MM. Picqué and Febvré insist, where does urgency begin in matters medical and surgical?

Dr. Channing pleads with much force for the wider establishment of out-patient departments for the treatment of mental affections in connection with hospitals and dispensaries. Such departments, besides giving treatment and instruction (a very important part of their work), would serve as a “repository for the troublesome, a clearing house for doubtful cases, and a bureau of information in regard to the necessary machinery to be made use of in committing or otherwise disposing of patients.” Those who have had charge of our overcrowded out-patient rooms will appreciate to the full the need which Dr. Channing points out, for it is absolutely impossible under present conditions to give the mental cases which now and again present themselves as out-patients the attention they require. As it is these sufferers have to content themselves with a dose of mistura alba or calomel, or perhaps a dose of bromide and some hasty words of reassurance, and then the “next patient.” Perhaps the greatest service which these mental departments promise is in connection with defective children, some of whom “furnish a portion of the dullards in the schools, who are such an injury to the advance of the average pupils. Others become tramps or criminals. The girls often become the mothers of illegitimate children, and so spread the circle of degeneration and defect wider and wider.” Dr. Channing accentuates the importance of the last-mentioned work, and in order to utilise more effectually the proposed department he systematises in tabular form the investigation of the defective child.

The advances referred to are, first, the erection of detached hospitals at asylums and the allocation of cases on admission to the various parts of the asylum where they can be best dealt with. Not least among the advantages of this system is the result that the less interesting cases “are not lost sight of, as they are apt to be in a block full of recent admissions.”

The patient, æt. 34, a lawyer by profession, married, with neuropathic heredity, and having himself presented all his life symptoms of the degenerate temperament—obsessions, labile emotional tone, tremors, etc.,—was accused of immoral acts with boys under his care. It was proved that for many years he had shown a morbid passion for flogging boys about the age of puberty on the bare nates, frequently offering them bribes to get their consent to the operation. He also stroked and pinched the buttocks, but did not at any time touch the genitals, nor did he himself on these occasions show any signs of sexual excitement.

In an address to the Gynæcological Society of Naples, the author, who is apparently a thorough-going optimist, urges the desirability of accelerating human progress to perfection by a system of artificial selection involving the sterilisation of the degenerate. He thinks it preferable that women should be the victims of this system, and he exhorts his gynæcological hearers to devise new and safer operations to this end.

The author considers that the present time is favourable for bringing the provisions of the criminal and civil law into better accord with modern views of insanity. He touches on most of the aspects of lunacy legislation, and suggests various reforms in principle and procedure. He particularly emphasises the need of fuller recognition by the law of the pathological element in the criminal nature; the practical corollary of this admission should be the establishment of asylums for criminal lunatics, and of other special institutions intermediate between the prison and the asylum for degenerates and weak-minded criminals.

Dr. Benedikt has been moved to wrath by the recent progress of the theory, especially current in the experimental school of psychologists, that even small doses of alcohol act injuriously on mental function. Anticipating that this heresy would be supported by the Vienna Anti-alcoholist Congress, he has accordingly confided to the columns of the Wiener medizinische Presse, with a perhaps excessive candour, his opinion of the doctrine and its advocates. The latter are, in the professor's view, for the most part a lot of “young-lady-like idealists,” “altruistic hypochrondriacs,” “sophists,” and so on. Dr. Benedikt confines himself to the use of these energetic epithets and to the rhetorical invocation of universal practice in regard of alcohol; he does not meet the theory which he denounces by criticism either of the experiments on which it is based or of the interpretation which has been placed upon these experiments.

This is a medico-legal report on the condition of a lady arrested for repeated acts of fraud and theft. Her history is of interest. During the past twenty years she has been under treatment in Camberwell and Banstead Asylums in this country, in three asylums in America, and in many on the Continent. She was of good family (with a marked predisposition to phthisis and nervous disease) and highly educated. She was the authoress of two novels of the decadent type, which caused some talk when they were published in 1892. The chief difficulty in deciding the question of her responsibility arose from the largely negative results of her examination. The reports sent from the different institutions were vague and unsatisfactory, and no definite diagnosis had evidently been possible. Morphinism, hallucinations of hearing, and tendency to suicide were facts, however, stated in different reports. From the history and the great variety of the symptoms of her different illnesses, Professor Bianchi came to the conclusion that her condition had an hysterical basis, and that she was not responsible. This finding was accepted by the Tribunal. Subsequent symptoms also confirmed this diagnosis.

This is an extract from a communication made at the Congress of Psychiatry, 1900, in collaboration with Dr. Toulouse. It is important, in the first place, that candidates for the post of attendants in asylums should be carefully selected before being engaged, and attendants properly treated (isolated, etc.) when suffering from phthisis. Disinfection of infected rooms, and avoidance of overwork among them should be attended to. A special asylum sanatorium for tubercular patients should be erected. At Villejuif this is already realised. Attention is called to the mortality statistics of the asylum in the department of the Seine. Out of a total of 1017 deaths there were 170 from pulmonary affections (including forty-five cases of phthisis, eleven of hæmoptysis, and thirty-three of chronic bronchitis). Some reference is made to information obtained from Great Britain, Italy, and Germany on this question of tuberculosis in the insane.

Devon.—The Committee report four times in each year to the County Council, which we believe to be an uncommon practice. Yet in addition to this they desire to be brought into still closer relation to the parent body.

Glasgow, Gartloch.—This report is the last which Dr. Oswald will issue. His translation to Gartnavel, on which we congratulate him, will be dealt with in another part of the Journal. Though it is only the fourth report of the asylum, it tells of a proposed increase of 240 beds in the shape of separate villa pavilions for chronic cases. Dr. Oswald has carried out the training of attendants to the full, and has added practical and theoretical instruction in sick cookery and massage by competent teachers from Glasgow. We notice, with regret, that several important tables of statistics are omitted. Those dealing with past history (Nos. 2, 3, and 4) do not appear. The admissions were more than 50 per cent. of the average residence.