I must confess that I approach the consideration of the relationship between general paralysis of the insane and syphilis with a certain degree of diffidence, seeing that here we have to deal with a question which is constantly being made the subject matter of discussion by modern alienists, and which in itself presents points of surpassing interest.

In the study of genius and insanity we shall endeavour to follow the empirical rather than the polemical method. This will require the statement of many facts, gathered from different sources, but principally from the instructive works, “L'Homme de Génie,” by Cesare Lombroso, and “Psychologie Morbide,” by Moreau (de Tours).

The dangers to be apprehended from the abuse of cocain are probably hardly yet quite realized, at least in this country. A great deal of harm has undoubtedly been done of recent years by the use of cocain as a help to break off the morphia habit. An exaggerated estimate of the assistance to be obtained from the former drug has been formed by such writers as Freund, and although Lewin and Erlenmeyer have warned us not to fly from Scylla to Charybdis, still it is to be feared that the notion lingers that cocain may be used advantageously and safely for this purpose. Nothing can be more mistaken. Cocain is more seductive than morphia; it fastens upon its victim more rapidly, and its hold is at least as tight. Cocain solutions are probably somewhat too freely prescribed in cases of disease of the nose and naso pharynx. Patients who use the drug in this way become very soon acquainted with its agreeable effects. Several cases have been recorded by American authors of cocain habit arising thus. That cocain has not been even more extensively misused is probably due to its being still a comparatively new drug, and also in part to its costliness. Up to the present time the largest number of its victims appear, unfortunately, to have been medical men.

In the case of Ellen D., a female general paralytic in an advanced stage of the disease, whenever she was spoken to her features would be distorted by an exaggerated grin; the eyes nearly closed by the action of the lower part of the orbicularis palpebrarum, mouth opened and its angles retracted, the upper lip excessively elevated showing the gum, the tongue lolled out between the teeth always on the left side, and enormously deep naso-labial folds produced, curving round the angles of the mouth and blending with each other on the end of the chin.

For some time past a considerable amount of attention has been directed, not only on the Continent, but also in the United States, to the provision for epileptics in separate cottages on the same estate, and this article has been written in the hope that it may lead to the early establishment of an “epileptic colony,” which shall be a home for the homeless, an industrial institution for those to whom ordinary avenues of trade are shut, a hospital where cure or some alleviation shall be possible, and an educational centre for the training of the young, thus creating a prosperous, industrious, and thriving community to serve as a model for many other such yet to be founded in this country. The word “home,” or “colony,” is suggested as being free from the repulsiveness which might attach to the name “asylum,” which would be somewhat of a misnomer.

I feel that an apology is due from me for the introduction of this paper, which is really unworthy of the name, and only purports to be a collection of rough notes put together at the times and in the places mentioned. As such I venture to offer them to you.

Eighteen years have passed since Kahlbaum published his memoir upon this subject, yet it may be said that the claims of katatonia to be regarded as a distinct disorder are still unsettled. This prolonged period has not, however, been marked by phases of belief, such as are often exhibited subsequent to the publication of accounts of new disorders, or follow proposals to rename and reclassify disorders already known; at first enthusiastically believed in and subscribed to, these fall, at a later stage, upon evil days of neglect, and even oblivion. But with katatonia it has been otherwise. At no time does there appear to have been any widespread enthusiasm in alienist circles about this affection; at most it seems to have appealed to individuals, who have expressed merely isolated views, the statement of which has led to nothing more than limited controversy. Probably it may be said with justice that katatonia, for the majority of medical men in asylums in this country (at any rate), was but a name up to quite recent times; having a doubtful significance for some, for many quite without meaning. Granting that this remark is true, the truth brings with it no surprise, for the disorder referred to meets with scant notice in English text-books. This may be said without casting any reflection upon these works, which, of course, are not bound to treat of disorders not universally recognized.