Dr. Clouston said that when he suggested toxæmia to the secretary as a suitable subject for a discussion at this meeting he had not intended to be the first speaker, because his object was to bring out more fully the views of the younger members who had recently committed themselves so strongly to the toxæmic and bacterial etiology of insanity, and so to get light thrown on some of the difficulties which he and others had felt in applying this theory to many of their cases in practice. It was not that he did not believe in the toxic theory as explaining the onset of many cases, or that he under-rated its importance, but that he could not see how it applied so universally or generally as some of the modern pathological school were now inclined to insist on. He knew that it was difficult for those of the older psychological and clinical school to approach the subject with that full knowledge of recent bacteriological and pathological doctrine which the younger men possessed, or to breathe that all-pervading pathological atmosphere which they seemed to inhale. He desired to conduct this discussion in an absolutely non-controversial and purely scientific spirit. To do so he thought it best to put his facts, objections, and difficulties in a series of propositions which could be answered and explained by the other side. He thought it important to define toxæmia, but should be willing to accept Dr. Ford Robertson's definition of toxines, viz., “Substances which are taken up by the (cortical nerve) cell and then disorder its metabolism.” He took the following extracts from his address at the Cheltenham meeting of the British Association as representing Dr. Ford Robertson's views and the general trend of much investigation and hypothesis on the Continent.

The manifestation of delusions is so striking a proof of aberration of mind that we seem tempted to inquire if the study of them will in any degree help us to an elucidation of the actual physical change which must either be the cause or, at any rate, the accompaniment of them.

Sleep, the state in which man spends a third of his existence, is so intimately related to bodily and especially to mental health, that it must ever be a subject of the greatest interest to alienist physicians. No apology therefore is needed for once again bringing under discussion a subject so familiar.

It is a well-known fact that the practice of many physicians and some alienists includes the treatment of persons who have brought themselves to the verge of mental or moral ruin by an indulgence in the use of opium or morphia, the result too commonly of medical advice. This is probably the most common origin of the morphia habit, which was called Morphinomania by Charcot, and Morphinism by Levinstein. Other methods by which the habit becomes established are either through friends or persons in the same house imitating the habit of another, and from curiosity or experiment adopting it and succumbing to its sway. Others have tried it on the recommendation or suggestion of friends, and finding they could not do without it have become victims.

Do not expect anything new from this paper. Do not imagine that I am going to bring forward any startling theory concerning the origin of delusion, or make any attempt to unravel the mysteries of the cerebral pathology of any one class of delusion.

Derangements of the motor functions of the iris are commonly met with in the insane. They are as common in general paralysis as they are uncommon in all the other forms of insanity together. Their mechanism and import is not well understood, and it is in order to elucidate certain points that I venture to put the following observations before you, and to ask you to comment on them.

Dysentery and diarrhæal affections in English asylums have, for some time past, been attracting considerable attention.

The Commune Hospital was built in 1863 for the reception of poor patients of all classes from the city of Copenhagen. It was therefore necessary to provide a ward for the treatment of the insane. For this special purpose a pavilion was erected simultaneously with the main building, within the grounds of the hospital. It was arranged on the corridor plan, with single rooms only. The pavilion cost between £3000 and £4000. It was forty-two yards long, and had twenty-two single rooms, on two flats, besides a special room in the basement for the reception of patients suffering from delirium tremens. It was by no means intended to provide the city with a regular fully-equipped hospital for the continuous treatment and nursing of the insane. The pavilion was designed to serve as a reception-house, and those patients who did not show signs of improvement within a short time were removed to one of the country asylums. Besides ordinary insane persons, the pavilion was also to receive patients whose condition necessitated isolation, e. g. suicidal cases, epileptics, and severe cases of alcoholic poisoning. Later on, when the physician in charge was appointed Physician of the Court of Justice, all criminals suspected of insanity were sent to the pavilion for observation.