In the preceding papers I have endeavoured to review what is at present known of the clinical history of aphasia; having first ventured critically to analyse a certain number of cases recorded by independent observers in various parts of the world, I have then minutely detailed several cases which I have myself had the opportunity of personally watching.

Certainly it would have been more agreeable to those gentler feelings which the occurrence of death rarely fails to produce in men, and more in harmony with that charity which willingly covers over the sins and evil behaviour of an erring creature, once he has paid the last debt of nature, to have made no mention more’ of the convicted murderer, George Victor Townley, but to have allowed him to pass in silence to his suicidal rest. That he whom an audacious intrigue saved from the extreme penalty which the law metes out to the murderer should have become his own executioner, was, perhaps, the last small act of justice which he could do to outraged society; and of him, therefore, it may not untruly be said that nothing in his life became him so well as the leaving of it. But it has been the misfortune of Townley–a misfortune which pursues him even after death–to have been cursed with injudicious friends, and to be the helpless victim of some who, after the manner of parasites, would feed upon his notoriety and make to themselves capital out of his crime. It becomes then a duty not to keep silence under these circumstances, but truthfully to expose the passionate, though unsuccessful, attempt which has been made, by taking advantage of his suicide, and the vulgar prejudice in regard to such act, to set up a sort of justification of that foul disgrace into which, not the medico-psychological speciality only, but the whole medical profession, was mercilessly dragged on the occasion of his trial, and subsequently to it. Furthermore, since Townley's eventful life now constitutes a pathological fact in the annals of great crimes, and since tender feelings of compassion can have no place in pathological investigation of a felon's nature, it is necessary, in the cause of science, however much we may regret the necessity, to present the issue of a case the previous course of which has been recorded and discussed in the numbers of this Journal for January and April, 1864, and more fully in a special pamphlet on ‘Insanity and Crime’ by the Editors. The following is the account of his death and of the inquest upon his body as given in the daily papers:

Shorvon and Sargant (1947) have given a full account of the history and development of the use of ether in relation to excitatory abreaction. They have shown how valuable its use can be to rid patients of emotional tension which has occurred as a result of some particular battle experience, such as being blown up, buried alive, torpedoed, etc. They propound various theories as to the mechanism of excitatory abreaction, and they give a full description of the technique they employed, illustrated by examples from the numerous cases with which they dealt.

Of all the attributes of man which have been considered sufficiently distinctive to separate him from the lower animals, that of speech has been regarded as of the first importance. It has been looked upon as so essentially dependent upon human intelligence as in itself to constitute a sufficient line of separation between man and all living creatures below him. By none has this position been more strongly upheld than by Max Müller, who maintains that speech is a faculty of man which distinguishes him from all other creatures. This, of course, is true in a general sense; but as every attribute of man is at the present time undergoing a more complete analysis than has ever before been attempted, the dictum may be found not to be so absolutely correct, as at first sight appears; for it may be remembered that the subject of language has hitherto been treated by scholars and men of letters, who have discussed its various forms in relation to a given basis, whereas, at the present time, an endeavour is being made to proceed a step further towards the origin of language by its investigation from a physiological or scientific standpoint. If this be done, and we study the nature of language, as observed in the savage or the infant, we may perhaps discover that it is not altogether so different from what we may call the language of the lower animals. There is so much in man which is common to the creatures below him, that it is impossible to discuss rightly many of his propensities, affections and passions, without considering the form or character which these take in similar organisations. It is not surprising, therefore, that the subject of language should have been made a debating ground for the discussion of the points of difference between man and animals.

There is a very general impression among members of the medical profession abroad that it is only by the free use of stupifying drugs that British alienists are able to dispense with the use of mechanical appliances in the management of the insane. It cannot be gainsaid that, by the use of toxic remedies, noisy and violent patients may be as effectually controlled for the time being as by any species of mechanical appliance; nor can it be denied that in many of our asylums narcotics and sedatives are employed in such doses, so continuously, arid for such purposes as to justify the appellation of “chemical restraint.” But there are no facts to bear out the assumption that it is by excessive drugging we are enabled to avoid the use of restraining apparatus in our asylums. On the contrary, there is incontrovertible evidence to show that in foreign asylums where mechanical restraint is extensively practised, chemical restraint is likewise employed to an extent not thought of in this country. Dr. Wilbur∗ has been at pains to collect statistics for purposes of comparing the relative extent to which mechanical and chemical restraint is carried in British and American asylums. The result of his investigation clearly shows that in British asylums and in the few American asylums conducted on non-restraint principles, chemical restraint is not the substitute or alternative for mechanical restraint, but that, on the contrary, the general rule seems to be: the more mechanical restraint, the more chemical restraint.

When I accepted the great honour of giving the Maudsley Lecture this year, I was instructed that my subject should be one of popular interest. The theme of “Education in Medicine” was chosen with some trepidation, not so much on account of any lack it might have of intrinsic interest, but because its elaboration might lead me to express views not entirely in harmony with popular opinion. “Education in medicine” rather than “medical education”, because I had it in mind to discuss the kind of instruction which, if within his reach, would enable the layman to recognize and appreciate some of the principles on which the practice of medicine is based and pursued. And my choice was determined by the conviction, which must be generally shared, that the practice of medicine is much handicapped by a want of understanding, and therefore of sympathy and co-operation, on the part of the public—a want of understanding, the causes of which might be explored with advantage to both parties concerned in it.

By the death of Dr. Henry Rayner our Association has lost one of its oldest and most esteemed members, who had done great service to it and to the cause of the insane.

Cholesterol metabolism in epilepsy has been investigated by a number of observers during recent years, but the results have been contradictory and confusing, as the following summary shows: 1920, De Crinis (1): Cholesterol increased before seizures. 1923, Pezzali (2): Cholesterol decreased before seizures; low average levels in epileptics. 1927, Robinson, Brain and Kay (3): Cholesterol decreased before seizures. 1927, Osnato and Killian (4): Results negative. 1929, Goodall (5): Results negative. 1929, Fox Gosden and Brain (6): Cholesterol decreased before seizures; general low values in epileptics and increased variability in individual patients. 1930, Duncan (7): That there is no definite evidence to show that the occurrence of an epileptic fit is associated with a fall in the level of cholesterol in the blood.

Five cases of fatal lead poisoning occurred between 1884-6 among the employés of a certain white lead factory in the East of London. The cases presented the following common characters. They were all adult women, aged from 18 to 33. They had all worked at the factory for short periods from three to twelve months. They all exhibited mild symptoms of plumbism, such as a blue line round the gums and more or less ill-defined indisposition; paralyses were absent. They were all in their usual state of health within a few days or hours preceding death. Death was unexpected—mostly sudden. In four cases it was preceded by epileptic fits and coma, but in the fifth case no convulsions were noted, although they may have occurred during the night.

That there is a history of hereditary defect attached to the great majority of cases of dementia præcox.

The occurrence of micro-organisms in the urine is well known to be associated with a variety of pathological conditions, among which mental diseases have been included. A definite connection between urinary bacteria and insanity, however, does not seem to have been made out, the subject being even more obscure than the relation of the intestinal flora to mental disease, which has been much more frequently investigated.

The valuable report on the history and condition of the McLean Asylum for the Insane for the year 1858, derives a peculiar importance from the few pages which the Superintendent devotes to the causes of insanity, so far as they were developed and affected by the peculiar circumstances of the year, and were connected with the recent financial crisis and the religious excitements of that period. Dr. Tyler discourses wisely upon these matters, and gives admonitions which, were they heeded, would save many from mental disturbance and more from mental death.

The development of megaloblastic anaemia as a complication of anticonvulsant therapy is now well recognized, and a total of thirty cases has been recorded.

Badenoch (1) reported the first detailed studies of megaloblastic anaemia developing in epileptic patients treated with phenobarbitone and epanutin, whilst Fuld and Moorhouse (6) reported the association with primidone (Mysoline) alone. In all the cases reported, the anaemia responded to folic acid therapy, whilst anticonvulsant drugs were continued.