As long ago as 1901 my attention was called to the therapeutic value of electricity administered through the medium of warm water in a bath by my friend Dr. Lewis Jones, Physician in Charge of the Electrical Department, St. Bartholomew's Hospital, London. He considers this is the best means of employing electricity for general therapeutic purposes, describing it in his work on medical electricity as a method of great value whenever general stimulating and tonic effects are required. In this work will also be found reference to the treatment, some years since, of eighteen males and five females at Claybury Asylum by Dr. Robert Jones, with results which he considered satisfactory. In these induction coil currents were used in the bath. The method appeared to me likely to prove much more convenient and practical than the usual methods of faradism and galvanism, which do not lend themselves to the purposes of general as apart from special and local application. Largely, I think, for the lack of a convenient method of general application, electrical treatment has been almost discarded, at any rate in this country, in mental diseases. I hope in this communication to show that this therapeutic means is one which should not be neglected.

The following observations are founded upon the records of 301 autopsies performed by myself at Rainhill Asylum. They are concerned principally with certain abnormal and morbid manifestations which occur within the crania of the insane. Of these the chief are, on the one hand, indications of subevolution, as shown by macroscopic structural defects of the cerebral hemispheres, such as deficiency of weight or of convolutional complexity, and on the other, evidence of dissolution as exhibited by wasting of the cerebral hemispheres. The relationship existing between these abnormal and morbid manifestations and certain other intracranial appearances is also discussed. No attempt, however, has been made—for reasons which will afterwards be given—at any close correlation between these abnormal and morbid manifestations and the mental states recorded during life. The observations, therefore, are of a pathological rather than a clinical nature.

From the earliest ages in the history of man, we find evidences of the existence of beings stunted in body and defective in mind, whose relations with their fellows varied through the centuries. At one epoch they were exalted almost to the level of a deity, and their symptoms were interpreted as manifestations of Divine will. At another they were looked upon with loathing and disgust, not unmingled with fear. Still later, they were either the playthings of kings or the victims of cruel jibe and blow, and their existence at the present day, and the associated conditions of insanity, crime and intemperance, constitute one of the most serious, if not the most serious problem which a civilised community is called upon to solve.

The subject of lunacy administration in our Colonies, and in other countries, is one not so well known as it should be to those of us who are specially interested in these matters in this country, and I was pleased to see recently articles in our Journal by Drs. Eric Sinclair and Beattie Smith treating of this subject as found in Australia. If our Editors published a series of articles referring to lunacy administration, as met with in our Colonies and foreign countries, these might prove useful when our own Lunacy Act undergoes amendment.

From the earliest times in the history of medicine probably no subject has been more thought about, no subject more frequently attacked, than that of heredity, and it is therefore not without a certain amount of hesitation that that all-important subject is brought into consideration in such an article as this.

Until the specific causes of the various types of colitis are ascertained dysentery may be regarded as a group of symptoms which are presumably the result of microbic action, although it does not follow that the organisms which have been isolated from the intestines are invariably the specific cause of the symptoms, or that their presence will necessarily produce the symptoms; even the Shiga (or Flexner) bacillus, which is looked upon by many as the origin of non-amoebic tropical dysentery, has been found in the fæces of healthy persons (v. Allchin). It is probable that the specific organisms are some of the various bacilli and micrococci which are commonly to be found in the intestines, and which are normally benign in character, but through certain influences within and around the subject, become pathogenic.

The presence of delusions, whether arising primarily or following other mental states, is significant of a faulty cerebral action, yet the co-existence of normal ideas suggests that the morbid process is limited to certain groups of nerve-cells. It is thus reasonable to suppose that many of the nerve-cells associated with ideation are in such cases working normally. There would appear to be “wrong thought centres” or “wrong series of associations” giving rise to delusions.

The Lunacy Commission, it is rumoured, is to be increased to the extent of an additional medical and an additional legal member, but the amalgamation of the Medical Chancery visitors with the Commission is not yet carried out, even if seriously contemplated.

Between the class of patients who can pay one pound a week and those who only pay the ordinary rate of maintenance in county and borough asylums is a large class of patients who could pay something less than the cost of the private annex and something more than the pauper rate of maintenance.

A contemporary medical paper states that the committee of management of the above-mentioned asylum has decided that in future no post-mortem examinations shall be made on the bodies of unclaimed persons, except in cases of suicide, accidental or doubtful death.

It has not always been an easy task—this preparation of the American section of the epitome on psychiatric work. Year after year the writer has paused before that word “Progress'’ with a big “P,” obsessed by the limitations which it places on the subject-matter, perplexed at his inability to sift the wheat from the chaff, and to delineate clearly in all the activity called psychiatric only those features which surely made for progress.

The asylums for the insane, since their transformation, have become veritable hospitals; and the medical work, especially as regards the curable and improvable cases, approaches that of the ordinary hospital. The result is that the insane in all modern asylums are cared for and observed day and night, as in a hospital, and assiduous nursing is given alike to the excited, agitated, degraded, paralytic, turbulent, destructive, suicidal, etc.

During the year 1909 the scientific output has been highly satisfactory. Its peaceful termination was in marked contrast to the discomforts we have already experienced during the present year owing to the floods in Paris. The members of the Société Medico-Psychologique were not able to meet in January, and the Maison de Santé d'Ivry, founded by Esquirol, was suddenly inundated, an event which entailed the hurried removal of the patients to another establishment.

At the annual meeting of the German Association for Psychiatry, held on March 23rd and 24th, at Cologne and Bonn, the principal subject for discussion was the question of the connection between syphilis and general paralysis. The speakers were Plaut (Munich) and Fischer (Prague). Dr. Plaut came to the following conclusions: (1) Without syphilis no paralysis. (2) It is not improbable that during paralysis active virus still exists in the body, and spirochætæ are present. (3) There are not sufficient reasons for presuming there is a syphilis à virus nerveux. (4) The fact that, in those who afterwards became paralytics, the early symptoms of syphilis were singularly mild, suggests an abnormal predisposition. (5) The attempts to establish a connection between heredity, degeneration and temperament, or constitution and general paralysis, have had no definite results, and it would appear doubtful if there are sufficient grounds for accepting a peculiar predisposition of brain. (6) The exogenous influences (alcoholism, trauma, cerebral fatigue) have probably no essential effect, but act only as associated factors, diminishing the somatic and psychic resistance. (7) The variability of the syphilitic changes in the different stages of the disease does not appear to be caused by differences in the character of the spirochæte, but by a gradual change in the way the patient reacts, because this change of reaction leads to tertiary manifestations in only a small percentage of syphilitics, and a further change may lead to paralysis; it is not astonishing that only a small number of syphilitics become paralytics. (8) A number of considerations makes it probable that paralysis is preceded by preparatory syphilitic processes of a chronic kind; it is impossible to say if these are localised in the central nervous system or in any other part. The elapse of a long period of time between syphilitic infection and the onset of paralysis is perhaps explained by this circumstance. (9) The uselessness of mercury in paralysis does not disprove a connection between syphilis and paralysis, because of our ignorance of the pharmacology of mercury. (10) The decision whether the histological changes in paralysis are of a syphilitic character must be, and is, left to the anatomist. (11) The result of serum diagnosis points to a very close connection between syphilis and paralysis. Regarding this we have no clear idea as to the biological position of the reacting substances at present, but some day a definite answer will be forthcoming.