At Page 54 of the First Report of the Commissioners in Lunacy they state that in June, 1846, there were in England and Wales 23,000 persons of unsound mind.

Throughout the length and breadth of the kingdom, from the “Dan” of Inverness to the “Beersheba” of Bodmin, if there is one universal wail, and one that is more continuously and persistently than any other given vent to in asylum reports, it is that which refers to the fact that our asylums are becoming, day by day, more and more transformed into receptacles for the care of the insane rather than hospitals for the cure of insanity, and that the more important and paramount object in view is being gradually swallowed up and thwarted under circumstances over which, at present, we seem to have but very insufficient control. Coincidently with this general lament, we find that the separate care and treatment of the chronic and harmless cases in asylums, in some less expensive manner, is urging itself into a prominent position—as a desirable object to be attained for certain economic and other reasons; and it is, to my mind, a matter for some considerable regret that, at the present time, our efforts seem, apparently, to be directed principally, if not entirely, in this channel, to the comparative neglect of the more important and paramount object to which I have referred. That is to say, of the two principal objects at present more particularly engaging our attention, such practical steps as are being taken are rather in the direction of securing a cheaper care of the incurable great majority than towards effecting the cure of the small minority, which I am sanguine enough to believe it is within our power to recall more largely to a state of health, if only more determined and special efforts be made in such a grand and worthy undertaking. Of course institutions for the insane must ever continue to fulfil their desirable function as asylums or safety-houses, and I certainly have no wish to underrate the importance of endeavouring to effect, as far as possible, such economical reforms as may be brought about by the separate and less expensive care and treatment of the chronic and incurable cases of insanity, which are of interest principally (and deservedly so) from a humane point of view; nor do I but consider that the care of the great majority must ever, very largely and very properly, engage attention in Public Asylums; but I do desire, at the present time, to lift up my humble voice in deprecation of the pre-eminence of the practical efforts that are now being made in this direction over those being made to secure a greater rescue of curable cases from life-long insanity, which, after all, should be the object most worthy of the special attention and best energies of the Asylum Physician. Indeed, the separate care of the chronic and incurable majority cannot but hasten the advent of a system, of separate and special treatment of the curable minority, which I am now desirous of advocating.

S. B., aged 16 years, was admitted into the Clapton Asylum, May 7th, 1875, with the following history. She was born a healthy girl, having no mental defect. She enjoyed good health up to nine years of age, when she became the subject of chorea, supposed to have been caused by exposure to the sun. She was sent to Margate, in the hope that the change might prove beneficial to her, but the chorea continued. Four years ago, while bathing, epileptic fits came on, and soon afterwards the chorea ceased. Her intellect is said to have become weak after the fits were noticed. She has never since been free from them. She was sent to Caterham and afterwards to Hampstead Asylum, whence she was transferred to Clapton.

John R., admitted into the Melrose Asylum on the 29th May, 1875, æt. 38.

In the spring of 1878, while travelling in Spain in company with two friends, I took the opportunity of visiting several asylums. Having entered Spain by the north, I made known my desire to see some Spanish asylums, to an influential citizen of San Sebastian, who gave me to understand that I would find them in much the same condition that English ones were in about 40 or 50 years ago.* He furnished me with letters of introduction to friends in Madrid, through whom I became acquainted with an accomplished and enthusiastic alienist, Dr. J. M. Esquerdo, Lecturer on General Pathology in the General Hospital of Madrid, and director and proprietor of a private asylum in the neighbourhood of that city.

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.

On Trephining in Epilepsy due to Injury of the Skull. By Dr. M. G. Echeverria.