We are all of us familiar with the expression “to run amuck,” but perhaps comparatively few of us are familiar with the significance of the term in the Eastern Archipelago. Amuck, or, as it is properly spelt Amok, is a Malay word, and means a furious assault, its derivatives, Mengamok and Pengamok respectively, meaning to commit a furious assault and the person who runs Amok.

Last year I paid a visit to the different schools of hypnotism in France, and I saw hypnotism used as a therapeutic agent in the wards of Professor Bernheim of Nancy, of Dr. Luys at the Charité in Paris, and of Dr. Auguste Voisin at the Salpêtrière. I became convinced of the reality of the phenomena, and of its great value as a therapeutic agent in certain cases, and therefore since my return I have made such use of it as time and opportunity permitted among the female pauper patients at Morningside Asylum. I here give an account of some of the cases I hypnotized and of the various reasons, both therapeutic and otherwise, for which I made use of this agent, and I shall conclude with a brief summary of its uses. I exclude from here, however, all examples of its use for physical ailments.

The discussion which I have been invited to open is on a subject which is new to all of us, and which may, therefore, simply on this account, claim a share of our attention. Indeed, on searching the works of Clouston, Blandford, Savage, and others, as well as the extensive periodical literature which is at our disposal in the “Journal of Mental Science,” the “West Riding Asylum Reports,” and similar publications in France and Germany, the subject of mental affections occurring subsequently to influenza has hardly been mentioned with a single word previous to the epidemics of that distemper which we have recently passed through. Nor is there anything to be found on this subject in the numerous books and papers descriptive of influenza which have appeared before 1890. All that has been written on mental disorders in connection with influenza previous to that date refers to the febrile or initial delirium which may occur at any time during the progress of the feverish attack, and may, indeed, precede all other symptoms, setting in sometimes before there is any rise of temperature. This initial delirium has been described as long ago as 1510 by Sauvages, and later on by Huxham, Ash, Haygarth, Gray, Smyth, Rush; more recently by Lombard, Bonnet, and Pétrequin, and during the last epidemics by Ewald,1 Joffroy,2 Gwynne,3 Creagh,4 Nicholson,5 Van Deventer,6 Mairet,7 and others. In the German Collective Investigation Report, edited by Leyden and Guttmann,8 no less than 276 such cases have been collated. It is, however, not this initial delirium which we have met here to consider to-day, but those better defined psychoses which are prone to occur after the feverish attack is over, during, or some time subsequently to convalescence.

The following notes on expression are supplementary to a paper on the same subject published in this Journal twelve months ago.

I think it is a general rule in all well-organized prisons, that, periodically, the staff holds meetings to take decisions upon the measures to be taken concerning the prisoners whose conduct is not, or has not been, following the regulation of the house.

Little has been written, and comparatively little is known with precision, concerning the insane of Greece—whether we speak of the little kingdom alone, with its present population of nearly 2,500,000, or of the Greeks in general, who live in Macedonia, in Asia Minor, in Egypt, or elsewhere outside of the present limits of Greece. This whole community, diverse in origin and residence, but united by a common language and a common religion, considers itself as one, and sends to the two asylums in Greece—the old Phrenokomeion of Corfu (founded in 1838), and the comparatively new Dromokäiteion in Athens—insane persons from all the countries in which Greeks reside. Thus, during the year 1892 the Athenian Asylum (which takes its special name from a Greek family named Dromokäites, whose wealth has endowed it) received 70 admissions; and of these 13, or nearly one-fifth, came from places outside of Greece. A smaller proportion among the 175 (more or less) who now reside in the Corfu Asylum are from outside of Greece, and it is probable that this proportion is constantly diminishing there. But Athens, from its central position, its rank as a capital, and the affection with which most Greeks regard it, is likely to draw to itself more and more the persons attacked with insanity outside of Greece. This fact will increase a little the visible insanity of the kingdom; but so many are the causes tending to conceal the extent of this malady there that the circumstance of these outside accessions need hardly be taken into account. There is no census of the Greek insane, even professing to be exact, and I have been forced to rely, in my tours and inquiry during two visits to Greece (in 1890 and 1893), on the estimates of careful persons and my own observation.

The object of the paper to be now read is to evoke discussion on certain questions connected with the above scheme. Inasmuch as the system has received but a limited trial in this country, but few facts concerning its actual working are to be expected as yet. It is, however, deserving of consideration in this its embryonic period. An out-patient clinique was started at the Wakefield Asylum in January, 1890, and also adopted at the other West Riding Asylums. I can only speak of the results in the first-named institution.

July 15th.—The following differences between James and Odo were noted in the first few months of the latter's existence:—James's eyes from the first were noticeably wide open, and seemed to look. They seemed much larger than Odo's. Now they are soft and languid. James was somewhat delicate during infancy, but grew out of it; stomach easily deranged. Softness of eyes in some measure due to very long lashes; but I find comparative brightness or languor of eyes a sure guide to his state of health. Odo's eyes have steadily grown in apparent size, because (the converse from James) the older he has grown the wider he has opened them. They are now wide, round, and bright (blue). James has very large pupils; Odo not. Odo apparently healthy, can partially raise himself up; has cut thirteenth tooth; has a placid temperament; does not cry much, i.e., will lie awake for long periods, which James never would do; sleeps all night for most part, which James seldom did. In short, thus early the one shows an excitable, the other a placid temper. Odo objects to being taken by a stranger, although he very soon gets over his misgivings. At this age James showed no distrust of strangers. Odo has a distinct manner to the three persons he knows best—nurse, mother, and father. He coos and smiles to mother when she comes to take him. He only smiles to father. Smiles more but talks less than James did at same age. By talking I mean saying “coo,” “ug-gug, and the expression called “crowing” Cries at once on being scolded. James did not understand a scold at same age. Odo always tries to seize father's moustache when taken by him. In the case of women it is the hair he goes for in preference to anything. Odo makes use of smiles at five months old, and used them unconsciously at four months, which James (see notes on him) did not do till his seventh month. On the other hand, Odo uses his hands only to grasp things, or at most to put them to his mouth. At the same age James always put them to his mouth and could play with them, that is, pull them about.

While working purely on the lines of physical science it will be admitted that all observations recorded should be described in terms connoting physical phenomena, so given as to be capable of repetition, and, if possible, of measurement. No forces and no causes can be admitted as potent except those known to physiology and other branches of physical investigation. It follows that in dealing with the mental functions of the brain—here termed psychosis—we have nothing to do with “mind as an abstract entity” or with processes of feeling and consciousness, and must confine our attention to neural acts without either admitting or denying the existence of other potencies with which, while working on the lines of physical science, we are not concerned.

Under this heading I propose to make a few inquiries relative to the principal forms under which this disease shows itself, and more especially into the likelihood that it is undergoing some modifications under various influences. This latter possibility has impressed me for some time, and, on addressing several specialists on the subject, I find that no few share the same opinion. So far as the question of modified type is concerned, the difficulty which presents itself at the outset is that it is uncertain whether the older writers recognized general paralysis under the Protean aspects now known to us—supposing them to have existed—and it may be an error to assume that its now varied forms are extensions of, or deviations from, a more concise and specialized group of symptoms. If, on the other hand, we can rely upon the observations of those who have spent a considerable number of years in lunacy practice, and can at the same time by statistics indicate that noteworthy differences are becoming apparent between recent and former cases of general paralysis, some basis for belief in a variation of type may be assumed.

I propose in the following paper to review briefly the treatment that has recently been made use of in myxœdema, and compare the several ways in which it has been carried out, after a few preliminary remarks on the pre-thyroid methods.

Among the many abnormal cephalic sensations the following constitute an important group:—

I thought it might prove of some interest to demonstrate at the psychological section the instrument I have hitherto used at the West Riding Asylum for the purpose of registering the reaction time to a sight and sound signal. The instrument in its original form, as made by the Cambridge Scientific Instrument Company, may be familiar to you, but lately I have so far modified it and extended its utility that I think it will be well to indicate the changes introduced in detail. The original, with minor alterations, has been described so fully in Dr. Hack Tuke's new “Dictionary of Psychological Medicine” that I shall only briefly refer here to the general scheme of its construction, referring those who seek more minute particulars to this article.

We are in the habit of regarding general paralysis as in the main a disease of the prime of life—of a time when the fresh vigour of youth has subsided, but before the first touch of decay has laid its hand upon the organism; when the mental faculties are strained to the utmost in the pursuit of wealth or pleasure, or social distinction, or in the keen struggle for existence entailed upon so many of our race. We are not indeed unaccustomed to meet with cases of this disease occurring both before and after this epoch of life, but the association of general paralysis with the period of childhood and puberty has hitherto been a very unfamiliar idea. Nevertheless, scattered cases have from time to time been published which tend to show that the period of life which appears to offer most exemption from all the ordinary causes of the disease may still claim its victims, and that at, or about, the period of puberty cases may occur which, both clinically and pathologically, appear incapable of separation from the ordinary forms of the disease with which we are so familiar.

Is the beneficial effect often produced in a case of recent and acute insanity by local inflammation (cellulitis) mainly due to the local disturbance or to a general, systemic disturbance? This question appears to me to have more than a mere theoretical interest, for the following reason:—If the effect noted be due mainly to the local inflammation we may go on applying blisters and equivalent chemical irritants on a sufficiently large scale to the skins of patients; but if the result is to be ascribed solely or largely to the accompanying general disturbance, it will be advisable to consider whether such cannot be evoked with greater certainty and thoroughness than is possible with the means now employed. I much doubt whether local inflammation, the result of chemical irritation, can be compared, from the point of view of influence upon existing mental disorder, with cellulitis∗ of unknown origin, such as occurs in the insane. Upon this point it would be instructive to hear the opinions of experienced observers. No one probably will deny that a more profound general disturbance is associated with idiopathic cellulitis than with inflammation due to chemical irritation. If, then, cellulitis is capable of producing the more striking mental alteration, it seems legitimate to ascribe this to the more profound systemic disturbance referred to. The qualitative difference in the nature of the irritants in the two cases possibly entails some difference in the modes of local reaction; even if this be so one would still, I think, be justified in adhering to the conclusion reached, i.e., that the greater mental effect produced by cellulitis is due to the greater systemic disturbance.

The class of cases described under the term Paranoia have long been recognized in England, though, perhaps, they have not been studied to such an extent as on the Continent, and have, no doubt, been looked at from a different point of view. The word in Greek literally means “madness;” we find it employed by authors synonymously with the terms Wahnsinn and Verrücktheit, and on account of the confusion existing between these, Mendel, in 1881, and Werner, in 1889, proposed to substitute “paranoia” for them. In this sense it may be taken to mean “systematized insanity,” a definition which covers all classes of paranoia.

At the commencement of our description of subdural membrane formation, we deferred consideration of the sudden lessening of intracranial pressure, which we regard as the most important cause of its production. This is a point we shall take up now, along with some other general questions connected with subdural membrane formation.

The amount of land originally belonging to the Omagh Asylum amounted to fifty-two acres. This land surrounds the asylum, and is bounded partly by a wall and partly by a river.

For the benefit of those who have not followed the recent discussions I have compiled tables of the cases of myxœdema treated by thyroid injection and feeding that have thus far been published in this country. These, I trust, will be found useful and easy of reference. The main points of each case are arranged under a few convenient headings, viz., the sex and age of the patient, the duration of the disease, the length of time the treatment had been carried out at the time of reporting, the dosage and method of administration employed, the results obtained, and, where such existed, any ill effects that were seen to follow or occur during the course of the treatment. In all there are details of 100 cases shown. A glance at this summary will bring out certain points of interest and importance.