I often hear it said that pathological anatomy has proved a failure in the attempt to solve the problems of insanity.

“He, verily, did not hit the target of truth who took for his missile the phrase, the Desire for Existence; not the Desire for Existence— such is my teaching—no, the Wish for Power!”

It is quite likely with regard to the title of this paper that critics may say—

“Why cannot the writer say clearly what she is going to talk about? The words ‘early nervous and mental,’ cover so enormous an area,” or again “Why in any case should we of the Medico-Psychological Association be troubled with the word ‘nervous’ ; surely that pertains exclusively to the Neurological Society? Why should nerves—inferior spinal things—be mentioned in the august presence of those con cerned with the brain?” and yet there is no nerve of interest in the healthy human being which is not interdependent upon, or in close association with a brain. It is inconceivable that any nerve should suffer and leave the brain unaffected, if not from impressions sent up and down, then from absence of impres sions, and it is upon this vital essential oneness of the whole nervous system that I wish to lay stress to-day.

In striking contrast to the elucidation of the cause and progress of various diseases by modern methods of examination, the phenomena of epilepsy, although long and widely studied, remain, to a very large extent, obscure. In recent years, however, some definite although dissociated facts have become known, and abiding views formed, from therapeutic and pathological data, and, within the last few years, from the investigation of the heredity of those afflicted. Although these facts may be comparatively few in number, it is surprising that no attempt is made even in the most recent text-book, to correlate such facts as are known and accepted, and to formulate a comprehensive theory which could be tested by experiment and further and independent observation.

As the cases which come under notice in the present paper are of a somewhat miscellaneous character, and as, moreover, no one of them could, by the widest interpretation of the term, be described as insane, one feels a certain hesitancy in contributing them to a journal avowedly devoted to psychiatry. Though varying in type, they have this in common, however— that there was in every case an underlying or concomitant mental factor which afforded a clue to the case, and the most reliable indication for the line of treatment to be adopted. Briefly they belong to the category of the psychoneuroses, and in the main were treated on psychotherapeutic lines. No uniform method was adopted, waking suggestion, persuasion, hypnosis, or the induction of a hypnoid state being utilised, separately or in combination, according to the exigencies of the particular case. Where necessary, it was supplemented by medicinal and general hygienic measures, but except in one case there was no attempt at psycho-analysis in the accepted sense. In most of the cases an attempt was made to induce hypnosis, but in Cases 3 and 6 it was only possible to attain what is called by American writers the hypnoidal or sub-waking state. In this state, according to Sidis (1), “Emotional excitement subsides, voluntary activity is changed to passivity, and suggestions meet with little resistance. The sub-waking state is above all a rest state, a state of physical and mental relaxation.” The utmost that was obtainable in these cases was a condition of passivity, and of cessation from voluntary activity, in which there was increased susceptibility to suggestion, and which lacked many of the characteristic phenomena of true hypnosis. Whether this is merely a mild degree of hypnosis, or a condition sui generis, as Sidis contends, is not practically important, though in favour of the latter view it is to be noted that it is difficult to pass from it into true hypnosis even after many sittings. Nor is there the tendency to attain deeper stages of “sleep,” which characterises the genuine hypnotic state. Apart from the increased suggestibility, the mere state of quiescence and tranquillity (which can be maintained for an indefinite period) affords a valuable means of nerve recuperation where psychomotor unrest and anxiety are prominent symptoms. Thus it is particularly useful in typical neurasthenia, mild degrees of melancholia, and conditions in which the nervous energy is depleted, and where physiological rest is the primary requisite.

Sleep, gentle sleep, Nature's soft nurse, how have I frightened thee That thou no more wilt weigh my eyelids down and steep my senses in forgetfulness?

I feel I should preface my paper on “The Rôle of Hypnotics in Mental Diseases” by the statement that you will merely find in it a collection and corroboration of well-known facts. These facts, however, have been brought together in a form in which I have not been able to find them elsewhere, viz., such as will aid in pointing out the indications for the employment of the different hypnotics, and the types of mental disease in which certain of the drugs appear to be especially useful.

In their report on this Asylum for 1913, the Lunacy Commissioners state: “Almost 20 per cent. of the patients in each of the Staffordshire asylums are epileptics; this unusually high proportion appears to obtain in each of the Staffordshire asylums, and to be a subject worthy of further inquiry locally.” It is also noteworthy that associated with this high proportion of epileptics is a high tuberculosis death-rate, viz., 25.2 per cent., the average epileptic percentage of the number of patients remaining at the year's end in county and borough asylums in England and Wales being, for 1911, 12.5, while the proportion of tubercular deaths per cent. of deaths from all causes (1902–1911) is 16.6

Inquiries into the family histories of the pauper insane in large urban districts as a rule result in the acquisition of more disappointment than knowledge.

F—, single, æt. 61, admitted in December, 1912, and died in April, 1913. History very defective. Mental symptoms had been present for some years. She was very thin and haggard, with marked exophthalmos. The hair was so scanty that she was nearly bald. A fairly large firm and elastic goitre present. One insane ear. Reflexes exaggerated generally, but equal. Muscular system normal. Complete absence of subcutaneous fat. The skin over the front of the abdomen and, to a less extent, that of the rest of the trunk and of the upper parts of all four limbs, was covered with raised, discrete, warty-looking masses. The skin could be picked up from the underlying tissues except in one place on the back of the left thigh, where the skin was atrophied, pigmented, shiny and adherent to the deep tissues, and had been subjected to a good deal of scratching. The skin of the face and hands was quite normal. She was very restless and difficult to examine. She suffered from chronic bronchitis, and had a mild tachycardia as well as a mitral systolic bruit. She suffered from very vivid hallucinations of sight and hearing, and was very excited in consequence at times. She became gradually thinner during her stay here, and passed into a marasmic condition in which she died.

The patient, D. T. M—, male, æt. 51, married, with grown-up, healthy family, was admitted to Montrose Royal Asylum on July 29th, 1913, with history of having threatened violence to himself and to his wife, and of having lost his memory.

On April 16th–18th, 1913, the Johns Hopkins Hospital, Baltimore, Maryland, opened the Henry Phipps Psychiatric Clinic. No event in the history of American psychiatry more justly deserved celebration, and none ever received more dignified and fitting observation. Scholars of world renown gathered from widely-separated parts to participate in the launching of the new enterprise. Practically the entire fifth number of vol. lxix of the American Journal of Insanity is devoted to the publication of the addresses delivered at the opening exercises, and every reader of the Journal of Mental Science would do well to review this remarkable collection of memoirs. There will be found a more complete and more authoritative résumé and retrospect of psychiatric progress than could possibly be conveyed in one or all of the annual letters of your correspondent.

The activity of Italian alienists during the year 1913 has not been very extensive in range, but it is nevertheless considerable, especially in view of the complexity of the subjects which have been selected, and of the antecedent fitness which the different authors showed they possessed for their thorough treatment.