Syphilitic Insanity.—This is the first of the varieties of insanity in Dr. Skae's classification that is due to the action of a poison introduced from without. As might be expected, its symptoms are much more definite than those of the more constitutional and hereditary varieties of mental alienation. Something, too, is known of its pathology, and yet it is only about twenty years since the fact was recognised that the syphilitic poison could produce mental derangement at all. It has been described by English, French, and German authors on insanity and syphilis, but Dr. Wille, the latest German writer on the subject, has given us by far the most complete account of the disease in all its forms so far as it is at present known. An excellent abstract of his paper appeared in the “Journal of Mental Science” for January last, by Dr. Addison.† It is one of the forms of insanity that must be studied in connection with the other syphilitic affections of the nervous system, if we wish to understand it. To describe its symptoms without reference to the syphilitic form of epilepsy, of paralysis, and neuralgia, would be a mistake in every respect. Dr. Reade, of Belfast, and Dr. Todd, of London, were the first in this country to direct special attention to the occurrence of mania as a direct result of syphilis. They both showed that it was one of a train of symptoms that had the specific infection for its starting point; that those symptoms proved clearly that the nervous system, both spinal cord and brain, as well as their membranes, were involved in such cases, and that whatever cured the syphilis cured the neuroses. Dr. Duncan published three very interesting cases of syphilitic insanity in 1863.∗ Dr. Hugh Grainger Stewart published three cases in 1870.† Dr. Wille has collated the symptoms of 77 cases of syphilis, in which there were mental symptoms of one kind or other. Many of Lancereaux's cases, given in his work on syphilis, have mental impairment or disturbance as a part of their history.

We have seen that Simple mental weakness, the first form of weakmindedness, is neither more nor less than a want of mind, in some degree. In it the higher emotions are blunt, perception is dull, and all the processes are backward or sluggish.

The following rough notes are compiled chiefly from the reports of the various Mission Hospitals established throughout China, and the Health Returns of the Treaty Ports, published under the auspices of the Chinese Customs' Service. It is a very wide question, and our materials are scanty.

The treatment of the insane in families, and the system pursued at Gheel, are generally regarded as identical. The experiment which has been going on for centuries in the little Belgian town appears to satisfy all the requirements of a crucial experiment; and it is supposed that it furnishes in its results a demonstration of the worth or worthlessness of the family system of treatment. Friends and foes have long been accustomed to investigate the matter at Gheel, and to found their respective verdicts on the system which they may have observed there.

That the amount and types of insanity vary in different countries, and even in different portions of the same country, has long been a recognised fact; but my object in this short paper is, by means of an illustration drawn from one district, to show within what narrow limits, as regards locality, great differences may be observed in the distribution of insanity.

In the introductory remarks contained in the previous portion of this essay, I said that, as far as possible, I would refrain from referring to the condition of the nervous centres as seen after death, except to explain the nature of certain phenomena seen in these diseases during life. Having arrived at the second portion of my subject, I shall draw attention to the condition of the brain and spinal cord where death has been the result of an epileptic fit, or while the patient has been in what is now so well understood as the Status Epilepticus.

In the American “Journal of Insanity” for Jan., 1875, there is an article by Dr. Ray on a contested will—the Duncan Will Case—in which he discharges, as he says, “the ungracious task of exposing some features of a trial little calculated to shed much lustre on the medical jurisprudence of his country.” Had he said that it was not calculated to shed any lustre, but well fitted to cast some ignominy, upon the medical jurisprudence of his country, it would have been hard to dispute the statement. There was nothing in the will itself, nothing on the face of it, which yielded the least indication of insanity; not one of the persons who were in frequent and close intercourse with the deceased for nine months before his death, most of whom were persons of education and of good social position, had the least suspicion that he was not in his right mind; and those who were about him when he made his will, and up to the time of his death, agreed that he was not in any degree unduly influenced in the disposal of his property, and that he understood perfectly what he was doing. In fact, the main provisions of his will, which was made eleven days before his death, were in accordance with the scheme of distribution of his property which he had adopted in two previous wills made by him. If ever, then, a will appeared to be a rational act rationally done, this was one.

The Irish Blue-book for 1873—the twenty-third Report of the Inspectors and Commissioners of Control of Irish Asylums for the Insane—fonns the first of what bids fair to be a much improved series of these interesting annual records. The improvement consists in the more systematic arrangement of the information regarding each of the twenty-two district Asylums, as well as the Central Asylum for Criminal Lunatics at Dundrum near Dublin. The history and present condition of each of the twenty-three public institutions is given, with commendable fulness, and we have no doubt that future reports—when the Inspectors get accustomed to the new style—will contain information as compelete as could be wished for.

This great subject is treated by Dr. “Vedie by giving very shortly:—

1. 1.— A resumé of those psychological facts which bear most upon the subject.

2. 2.— An examination of physiological phenomena connected with the former. Then shall become evident the laws which govern all psychological and physiological phenomena.

3. 3.— The application of these laws to pathology and therapeutics; or, what is equivalent, an examination of the pathological and therapeutical phenomena produced by mental causes. The question of miracles naturally falls to be discussed in connection with this part of the subject.

4. 4.— The reasons why some educated people and even physicians err in their views concerning miracles, and misunderstand the natural laws which regulate these phenomena.

The Archivio for 1873 and 1874 contains fewer original papers than usual, though some of them are of particular interest and importance. Professor Verga continues his very detailed and careful account of General Paralysis, from which I can only find space to extract the following points. He remarks that inequality of the pupils is not peculiar to that disease, but occurs in all other varieties of insanity connected with organic affection of the brain. Some stress is laid upon the occasional loss of power over other involuntary muscles, of the bladder and intestine, causing ischuria and constipation, which are often relieved by the use of strychnia. It is singular to observe that some paralytics in Italian Asylums cease to open their mouths freely when they speak, as is the custom of their countrymen; but “speak between their teeth, like the English.” In other cases, Dr. Verga has noticed that these patients always shout, as if they were speaking to deaf persons, either from not being able to regulate, or from not observing the loudness of their voice. He has also observed that, in the early stage of the disease there is occasionally genital excitement with persistent priapism. He sums up all the causes of general paralysis under the head of abuse of the moral and intellectual powers, or of the cerebral functions.