The interest of this case is enhanced by the fact that minute clinical descriptions of this particular form of insanity are few in number.

The author records two cases in support of his view that the syndrome of acute delirious mania is frequently an effect of renal disease, is, in fact, a hyperacute uræmic insanity.

The record of American psychiatry for the past year is not an eventful one so far as matters of interest to trans-Atlantic readers are concerned. At the beginning of the year the subject of interest was the New York Pathological Institute and the difficulties that involved its management. For a number of months it has been in a state of suspended activity—not dead but sleeping—and now appears to be about to start again on a fresh career of usefulness. A new organisation has been planned, an advisory board appointed, consisting of recognised authorities in their departments, and including representatives of the related specialties of psychology and general biology, as well as those of pathology, neurology, and psychiatry. The gentlemen who have accepted positions on the board are well known, and their interest in the Institute and its aims undoubted. Their names will carry weight; Professor McKeen Cattell holds the chair of psychology in Columbia University, Professors Ewing and Herter represent the two great medical schools of Bellevue and Cornell, Dr. H. A. Hern, of Albany, a well-known neurologist, Dr. Bumpus, of the American Museum of Natural History, Drs. Pilgrim and Macdonald, representing the State Hospitals, and Dr. Frederick Peterson, ex officio, as commissioner of lunacy, complete the board. These gentlemen will exercise a general oversight over the work, and when a new working staff has been appointed, we may look for good work, carried on under more favourable conditions than was formerly the case. It is the intention in their reorganisation not only to carry on original research as in the past, but to utilize the Institute for special instruction of the members of the different asylum staffs in psychiatry and special research work. It will be located in one of the departments of the Manhattan Hospital until such time as a special reception hospital for the insane can be provided.

Dr. Crothers puts forward the thesis that in a certain number of cases the development of psychoses and of organic diseases of the nervous system is due to a single profound intoxication by alcohol. In some instances the symptoms of the nervous affection follow immediately on the intoxication; in others a considerable latent period intervenes. Puberty and late middle life are pointed out as times when intoxication is peculiarly liable to be followed by these paralcoholic disorders. The author believes that morbid inebriety appearing late in life has often this origin.

M. Lentz has dealt with the statistical and clinical study of criminal lunatics, a subject hitherto entirely untouched in Belgium. He shows that no serious attention has been paid to these criminal lunatics or insane criminals, who may be classed as insane, abnormal, and vicious. If the limits of these different classes are hard to define, criminological science must nevertheless distinguish them, even artificially. Seeking a criterion to characterise criminal lunatics, properly so called, M. Lentz finds it in their pathogeny, manifest in the two elements cause and effect. But amongst these lunatics occur pretty often offenders who only become insane in the course of their detention. They generally pass unnoticed, and go from the prison to the asylum.

Reference to this subject has been made on more than one occasion in the pages of this Journal, but the matter is of sufficient importance to call for further notice. Dr. Laufer considers as proved that hypochlorisation, i. e. the reduction of the chlorides in the dietary, enhances the efficacy of the bromides in the treatment of epilepsy. This method of treatment we owe to Drs. Ch. Richet and Toulouse. The object of the present paper is to explain the modus operandi. It is pointed out in the first place that, without the addition of an atom of salt, the dietary, provided that it is a physiological one, contains a sufficiency of NaCl, that the customary use of salt as a condiment and as a culinary addition furnishes a luxus supply, and that the withdrawal of this luxus, without producing any harmful effect, makes itself felt as a slight reduction in the NaCl exchange of the tissues. Next reference is made to the tendency of bromides to accumulate in the tissues generally, and in particular in those of the liver and brain, observers differing as to the greater relative affinity of these two organs for the bromide. We are then asked if it would be surprising that in the presence of a deficiency of chlorides such kindred salts as the bromides should fix themselves in the tissues in greater quantity after the manner of a substitution. That such substitution does in fact obtain has been proved by various observers by the demonstration, e.g., that hydriodic and hydrobromic acids appear in the stomach, and to some extent replace hydrochloric acid when animals are given iodides and bromides in appreciable quantities; and yet more directly it has been shown that the administration of bromides during hypochlorisation may raise the bromide contents of the tissues above that of the chlorides even (Nencki and Schumow Simanowski).

This paper describes a case of inveterate epilepsy, in which periods of mental calm along with convulsive seizures alternated with periods of delirious excitement without convulsions. The effect on this case of the above-mentioned treatment was to suppress wholly the delirious periods, whilst at the same time the spasmodic attacks were greatly diminished.

During the past year there has been a change in the directorship at three of the State Asylums. Dr. Helweg at Oringe died, and Dr. Pontoppidan at Aarhus was appointed to the University of Copen hagen as Professor of Medical Jurisprudence and Hygiene. At Aarhus, Dr. Pontoppidan was succeeded by Dr. Hallager, Director of the Viborg Asylum; and Dr. Helweg by Dr. Willerup, his former medical assistant.