Examples of true hysteria are relatively rare in asylum populations, and in the present series of cases there are but six instances amongst the 728 patients, and all these are of the female sex. The writer has, however, during his asylum experience, seen more than one case of genuine hysteria in the male sex.

Last summer, in the course of a tour in the United States and Canada, I visited a number of Asylums for the Insane, jotting down my observations and impressions at the earliest opportunity after leaving the respective establishments. They are now submitted in a condensed form in these notes; and I trust that they may convey to the readers somewhat of the interest experienced by myself during my visits. It is almost superfluous to say that the physician-superintendents received me most courteously, and their kind attention will ever be suggestive of pleasant recollections in connection with my trans-Atlantic trip. Without further preface, I shall proceed first to give a short account of the Michigan Asylum,* visited 13th June, 1868.

Relapsing fever as a curative agent in paresis has been tried as far back as 1921, when several continental observers favourably commented on it. The close similarity between the two diseases in their causal agents and blood-serum reactions strongly commends the theory that the induction of a spirochótal fever in general paralysis might lead to the production of immune and anti-bodies in sufficient amount as to effect an amelioration in the symptoms, if not a complete arrest in the progress of this deadly malady.

The present portion of this paper deals with the subject of progressive and secondary dementia. It includes the consideration of those cases of mental disease which, owing to the existence of certain extra-neuronic encephalic morbid states, do not develop a practically stationary condition of mental enfeeblement consequent on the loss of a proportion of the higher cortical neurones, but undergo a more or less rapidly progressive process of neuronic dissolution, which, if the patient survives to such a stage, finally ends in gross dementia.

The particulars of the new Acts relative to the care and treatment of lunatics will probably be before the public at the time of the appearance of this number of the Journal. The proposed Act affecting Chancery lunatics has already appeared, and requires no particular comment. It is to be hoped, however, that the enormous expense attendant on opposed commissions may be diminished. The absurd reference of one of the most delicate and difficult of metaphysical questions to a jury will still, no doubt, prevail.

The cases dealt with in the present paper came under review during the course of my duties as Medical Officer to the Leeds Committee under the Mental Deficiency Act. They comprise examples of the four varieties of mental defectives defined by that Act, viz., idiots, imbeciles, feeble-minded, and moral imbeciles, and include most of the clinical types described by writers on the subject. The commonly accepted division into primary and secondary groups has been adopted; a third group, containing cases which appear to combine the characteristics of both types, and a fourth group containing “doubtful” cases, in which the data are insufficient to allocate them definitely, being also added. It has seemed useful, too, to give columns showing the number of cases corresponding to the accepted clinical types, those complicated by epilepsy, those exhibiting pronounced stigmata of degeneration, as well as those showing a definite family history of neuropathic affections, tubercle, or alcohol respectively. It is obvious that many of these cases will figure under the several heads. The following analysis then shows the proportion of cases under each of these heads of the total number of cases examined, viz., 200:

More than two years have elapsed since the Szondi test material became available on the home market, but it seems that the widespread use of the test has been considerably delayed by the lack of a translation of Dr. Szondi's books (1, 2). Susan Deri's Introduction to the Szondi Test (3), which appeared last year, may, however, have enabled some who felt attracted by the test to acquaint themselves with it. The purpose of Deri's book is to give some guidance for the clinical handling of the test and for its interpretation. For the rationale she refers to Szondi's own books.

Anyone who has attempted to work up statistical facts from a Pathological Record must have felt how much time and trouble were wasted in wading through case after case which had no connection whatever with the subject in hand.

The system of exchange with other journals has enabled us to increase the number of periodicals from which we may cull matter for these excerpta, and may hope to maintain and to increase their interest and usefulness among our readers. Moreover, we shall not restrict our choice of extracts to the contents of foreign journals only, but extend it also to essays, brief memoirs, and to the summaries of the contents of works of more considerable magnitude which come before us, with the intention of more fully representing the state of opinion and practice prevailing on the Continent and in America, with regard to whatever concerns the pathology and treatment of insanity and the management of asylums. And it is another portion of our design, when detailing the opinions and labours of our fellow-workers in psychiatry in other countries, as far as practicable, to form an estimate of them by the light of, and in comparison with, those of our own countrymen; in other words, to attempt a critical examination of their value and importance.

Experiments with animals have shown that electrostimulation of brain tissue is followed by a number of biochemical changes in the brain. The information obtainable is limited since there are only comparitively few reports about investigations in this field (4).

In a disease with so widespread a seat as general paresis, in which the cerebral syphilitic changes are local manifestations of a generalized infection, it is only reasonable that an attempt should be made to correlate the cerebral changes with those found in other organs in the same body.

The injudicious defence of two lady thieves on the plea that they were subject to that form of mental unsoundness to which Mathey and Marc have given the sounding title of kleptomania, has attracted public attention to this form of mental disease, and has given rise to a considerable amount of written and spoken nonsense upon the subject. Even “our facetious contemporary” has had his jests and his caricatures thereupon, and in the slang of the day a burglar has become a kleptomaniac, and a prison a kleptomaniac hospital. Alienist physicians have of course received their full share of sarcastic remarks, as theorisers not over-wise nor over-useful to society, who would willingly provide for every crime a decent veil, by referring it to some strange form of mental disease. Now there is such a tiling as theft which is the result of mental disease; and also, let us boldly avow our conviction, though we write within the precincts of a madhouse, that there is such a thing as theft which is simply a crime, an attack made by the selfishness of one individual upon the rights of another. Let us even take the broader ground, and avow our profound conviction that insanity and crime are distinct and separate entities, wide as the poles asunder in all instances where their distinctive characters are well marked; although undoubtedly there are instances which are divided by partitions as thin as those which Dryden places between wit and madness, or rather instances in which the qualities of crime and insanity are so intimately combined that the task of analysing the nature of the act becomes no easy one either to jurist or physician.

Medical science on the experimental side has been productive of no more interesting or fruitful results than those which have appeared in connection with the study of hæmolysis. The groundwork of this subject was laid by Bordet (1) in 1900 by the discovery of the fact that an immune serum contains a thermostable substance (immune body), which, in the presence of the original immunising agent (blood-corpuscles or bacteria), is capable of absorbing complement; that is to say, a hæmolytic or bacteriolytic serum heated to 57° C. for an hour will lose its power of lysing the homologous blood or organisms, but it will retain thermostable substances whose activity can be restored by the addition of fresh non-immune serum.

When we find, as recorded in the book of Samuel, that the great Psalmist resorted to imposture and “feigned himself mad and scrabbled on the doors of the gate, and let his spittle fall down upon his beard;” we cannot be surprised if minds less gifted should, for whatever purpose, assume the character of a madman. The beautiful conceptions of Shakespeare unfold to us in its highest fulness the rôle to be sustained by the player who is “but mad in craft.” We are told how Hamlet:—

Repulsed,
Fell into a sadness; then into a fast;
Thence to a watch; thence into a weakness;
Thence to a lightness, and by this declension,
Into the madness wherein now he raves,
And all we mourn for,

and how Edgar, amid all his witless jabbering, himself exclaims aside :—