Case IV.—History of Syphilis: namely, venereal sore; sore throat; and subsequent general “rheumatic” pain. Later on, melancholia and suicidal propensity. Severe and prolonged cranial, and mainly nocturnal pain, with local tenderness, relieved by specific treatment. Hepatic disease; incipient pulmonary phthisis. Recovery.

While on a trip through Holland in the year 1877, I visited the well-known School for Idiots at the Hague, and, thinking that my observations might perhaps prove interesting to others as well as myself, I have put together the following notes:—

I.—Notes of a Case of Paralysis of the Insane discharged from the Yarmouth Naval Asylum, in which amendment commenced during an attack of Erysipelas of the face.

The “After-Care,” that is, of poor and friendless female convalescents on leaving asylums for the insane. That out of about 59,000 pauper patients estimated to be inmates of lunatic asylums and other institutions,* there should be many, both male and female, who, on attaining convalescence, require further assistance to enable them to resume life's duties, with fair prospect of success, would reasonably be expected.

Principles of Construction, etc.—I think I am justified by modern Scotch and English experience, as well as by my own, in laying down the following principles for the construction of an asylum for the insane, accommodating two hundred patients, and suitable for every class of the population, which, I understand, is an essential element in the solution of this problem in America.

In the report of the International Congress of Mental Medicine, which appeared in this Journal in October, 1878, I referred briefly to the discussion which took place upon the provision made, or proposed to be made, in France for criminal lunatics and lunatic criminals. I was not, however, able to give at that time the conclusions arrived at in the debate, nor did space allow of my giving an account of the Quarter at Gaillon for insane convicts. I am now able to supply both omissions, and believe that the information conveyed as to what is being done across the Channel will be of interest to those in Great Britain and Ireland who are concerned directly or indirectly with the important subject of criminal lunacy.

It has been pointed out that, however potent Islam has proved in the history of civilisation, progress within its narrow boundaries is unknown—its development is at once full-blown. And especially is this true with regard to the treatment of its lunatics; for whatever credit may be due to the pioneers of Mohammedanism in originating the idea of the separation of the insane from the sane, it is sadly marred by the fact that in thus caring for the welfare of the community at large they have quite overlooked that of the luckless minority.

In this short paper I have no idea of adding one to the already too numerous class-names of insanity, but I am anxious that asylum physicians should have their attention called to a clinical type of disease which may exhibit mental symptoms, and may thus add to the small store of useful knowledge of the subject.

In one visit to an asylum, during which all conversation has to be carried on through the medium of a dragoman, it is not easy, however intelligent he may be, to gain all the facts which one desires bearing on the many questions which arise in reference to the insane in a land placed under such different conditions from our own, as is Egypt. Hence no further excuse is needed for the insufficiency of my observations on the Cairo Asylum, which I visited on Dec. 11, 1878.

One of the most interesting discoveries of recent times in the department of Neuropathology is indisputably Metalloscopy, of which, as is known, Burq† is the real founder. But Burq did not possess the needful scientific authority, and immediately on its first timid appearance, in 1851, Metalloscopy was banished to the region of the impossible and of fancy by scepticism on à priori grounds, and, hardly born, disappeared into complete oblivion after a very ephemeral existence. And thus it remained, till at length, two years ago, Charcot, the great French neuropathologist, resumed Burq's researches, and not only confirmed them, but gave them an important extension. The twice-repeated reports† to a commission appointed by the Société de Biologie, as well as the numerous publications of Charcot, Vigouroux, and Landolt on this topic, are already become the common property of the medical public.

It will be impossible for me to discuss this evening the different theories that have been brought forward to account for the production of aphasia (including under this term all forms of affections of speech), and I limit myself therefore to a few remarks upon one of them.

This case which is an interesting contribution to the study of the psycho-motor centres is an example of an old encapsuled nodule in the left hemisphere, resulting from a lesion in childhood, which destroyed the superior parietal convolution, and produced atrophy of the superior portion of the postcentral and para-central convolutions. The right leg was paralysed, but regained its function to a certain extent, while the right arm became completely useless. The paralysed extremities atrophied. There was atrophy of the right lateral and of the left anterior columns of the spinal cord. Descending degeneration of the pyramidal tracts.

The subjoined cases are of most interest from the duration of the symptoms which were finally recovered from.

It is astonishing how a medical case, simple in its character, obvious in its nature, and of which the diagnosis does not present serious difficulty to a mental physician, may become lost in a fog, and obscured by a number of irrelevant questions, when it comes into a Court of Law. Conflicting interests, the contention of lawyers, the technicalities which bar the admission of this or that particular fact in evidence, which is important in a scientific investigation—in which truth alone is the object of the inquirer—the mass of details which are crowded into the case, the probable ignorance and obtuseness of some of those who have to form a judgment; the necessarily imperfect medical knowledge of counsel, and also of the Judge himself; the prejudice of the public in regard to asylums for the insane—all these circumstances combine to prevent a dispassionate and scientific inquiry into a case of alleged lunacy. Under such circumstances, the wonder perhaps is not that juries often blunder on questions of lunacy, but that they manage, as often as they do, to blunder on the right side. So has it been in the action of Nowell v. Williams—in which the plaintiff sought to recover damages for false imprisonment on the ground that he had been confined in Northumberland House, he being at the time sane. He was in medical practice in Cornwall Road, London. He passed the College of Surgeons and the Hall in 1860–61, and became L.R.C.P. (Edin.) in 1865. His age is 43.