At Page 54 of the First Report of the Commissioners in Lunacy they state that in June, 1846, there were in England and Wales 23,000 persons of unsound mind.

In the article on General Paralysis in the “Nouveau Dictionnaire de Médicine et de Chirurgie Pratiques “(vol. xvi, p. 89., 1878), I thought I had settled the differential diagnosis of this affection when I said:—

“Multiple tumours of the brain, especially those of a syphilitic character, may be accompanied by motor and mental symptoms identical with those of general paralysis. More than once we have observed cases of this kind, and we believe that some do occur in which the differential diagnosis is impossible, except, perhaps, by means of the history. The autopsy alone discloses the error which has existed during the whole duration of the affection.”

In the population of Scotch Asylums, there are so few persons below the age of 10 years that, for practical purposes, it may be correctly said there are none. of the general community, on the other hand, 25·6 per cent. are persons below that age. It is clear, therefore, that the death-rate of the population of asylums cannot properly be compared with the death-rate of the general population. To make such a comparison it is necessary to deal only with the deaths occurring among the 74·4 per cent. of the general community who are above the age of 10 years. When this is done, it appears that the mean annual death-rate for the general population is 1·7 per cent. as compared with 8·3 per cent. for the population of asylums. These figures refer to the whole population of asylums, and to the whole of the general population above the age of 10 years; but in order to show the rates at which persons of different ages die in asylums, and the rates at which persons of corresponding ages die in the general community, the following table has been prepared. It is founded on 3,800 deaths occurring during the seven years, 1870–1876, in the Asylums of Scotland, which had a mean population of 6,421 during those years.

Of all the attributes of man which have been considered sufficiently distinctive to separate him from the lower animals, that of speech has been regarded as of the first importance. It has been looked upon as so essentially dependent upon human intelligence as in itself to constitute a sufficient line of separation between man and all living creatures below him. By none has this position been more strongly upheld than by Max Müller, who maintains that speech is a faculty of man which distinguishes him from all other creatures. This, of course, is true in a general sense; but as every attribute of man is at the present time undergoing a more complete analysis than has ever before been attempted, the dictum may be found not to be so absolutely correct, as at first sight appears; for it may be remembered that the subject of language has hitherto been treated by scholars and men of letters, who have discussed its various forms in relation to a given basis, whereas, at the present time, an endeavour is being made to proceed a step further towards the origin of language by its investigation from a physiological or scientific standpoint. If this be done, and we study the nature of language, as observed in the savage or the infant, we may perhaps discover that it is not altogether so different from what we may call the language of the lower animals. There is so much in man which is common to the creatures below him, that it is impossible to discuss rightly many of his propensities, affections and passions, without considering the form or character which these take in similar organisations. It is not surprising, therefore, that the subject of language should have been made a debating ground for the discussion of the points of difference between man and animals.

The principal arguments that may be brought forward against my proposal are—1st, that it is impracticable and inadvisable, as suggested by Dr. Conolly; and 2nd, that it would entail a considerable increase of expenditure.

Throughout the length and breadth of the kingdom, from the “Dan” of Inverness to the “Beersheba” of Bodmin, if there is one universal wail, and one that is more continuously and persistently than any other given vent to in asylum reports, it is that which refers to the fact that our asylums are becoming, day by day, more and more transformed into receptacles for the care of the insane rather than hospitals for the cure of insanity, and that the more important and paramount object in view is being gradually swallowed up and thwarted under circumstances over which, at present, we seem to have but very insufficient control. Coincidently with this general lament, we find that the separate care and treatment of the chronic and harmless cases in asylums, in some less expensive manner, is urging itself into a prominent position—as a desirable object to be attained for certain economic and other reasons; and it is, to my mind, a matter for some considerable regret that, at the present time, our efforts seem, apparently, to be directed principally, if not entirely, in this channel, to the comparative neglect of the more important and paramount object to which I have referred. That is to say, of the two principal objects at present more particularly engaging our attention, such practical steps as are being taken are rather in the direction of securing a cheaper care of the incurable great majority than towards effecting the cure of the small minority, which I am sanguine enough to believe it is within our power to recall more largely to a state of health, if only more determined and special efforts be made in such a grand and worthy undertaking. Of course institutions for the insane must ever continue to fulfil their desirable function as asylums or safety-houses, and I certainly have no wish to underrate the importance of endeavouring to effect, as far as possible, such economical reforms as may be brought about by the separate and less expensive care and treatment of the chronic and incurable cases of insanity, which are of interest principally (and deservedly so) from a humane point of view; nor do I but consider that the care of the great majority must ever, very largely and very properly, engage attention in Public Asylums; but I do desire, at the present time, to lift up my humble voice in deprecation of the pre-eminence of the practical efforts that are now being made in this direction over those being made to secure a greater rescue of curable cases from life-long insanity, which, after all, should be the object most worthy of the special attention and best energies of the Asylum Physician. Indeed, the separate care of the chronic and incurable majority cannot but hasten the advent of a system, of separate and special treatment of the curable minority, which I am now desirous of advocating.

Mary Ann C., æt. 23; single; was admitted into the West Riding Asylum on the 26th February, 1864. The patient had been previously an inmate of a Workhouse, but had to be removed from thence in consequence of her violent tendencies. It was stated that she was imbecile, and suffered from epileptic fits. No definite history or facts as to parentage and condition at birth were ascertained.

In a short paper like the present I cannot pretend to exhaust the chloral subject, but I hope very definitely to express my opinions, and also to give the grounds on which I have formed them.

The object which I propose to myself in this paper is twofold. The first is to lay before you briefly the general statistical results of five years, in regard to those who have been sent for treatment from the districts of Cheshire, to which the asylum is allotted; and the second is to give the results of some further experience, as bearing on the question of “Local Differences in the Distribution of Insanity,” of which I adduced some illustrations in my Annual Report for 1873, and which were subsequently published in a separate form in the “Journal of Mental Science” for April, 1875.

In following up Dr. Manning's paper in the July number of this journal with these fugitive notes of a series of very pleasant and instructive visits, I would premise that the changes of three years have taken place since it was my fortune to spend a season in Australia—that most hospitable of countries. Victoria has lost Dr. Robertson, and Queensland Dr. Jaap—gaps not readily filled up in a remote and little-known service. Administrative changes in the progressive spirit of the Australian commonwealth have swept away faulty arrangements, but the struggle for improvement remains in able hands and with stout hearts.

The following letter, &c., in reply to recent inquiries, has been received from Dr. Manning, whose admirable “Report on Lunatic Asylums,” undertaken at the request of the New South Wales Government, in 1868, is well known in this country. The information conveyed in the statistics now given cannot fail to be of interest to the readers of this Journal:—

S. B., aged 16 years, was admitted into the Clapton Asylum, May 7th, 1875, with the following history. She was born a healthy girl, having no mental defect. She enjoyed good health up to nine years of age, when she became the subject of chorea, supposed to have been caused by exposure to the sun. She was sent to Margate, in the hope that the change might prove beneficial to her, but the chorea continued. Four years ago, while bathing, epileptic fits came on, and soon afterwards the chorea ceased. Her intellect is said to have become weak after the fits were noticed. She has never since been free from them. She was sent to Caterham and afterwards to Hampstead Asylum, whence she was transferred to Clapton.

This being a paper read for the purpose of eliciting the experience of others, does not purport to be anything more than an account of my experiences of the drug, and my opinions as to its uses.

In the course of my asylum experience, this is the best example of the disease I ever met with, and I am therefore tempted to place it on record.

No part of the treatment of certain conditions of insanity is more important than that which relates to the administration of food when from any cause there is inability to take it, or persistent refusal of it.

John R., admitted into the Melrose Asylum on the 29th May, 1875, æt. 38.

I have been disappointed rather than surprised that no one has given us a full and useful analysis of the Statistics of the Causes of Insanity and of the Occupations of the Patients admitted into Asylums during the year 1876, in the Thirty-First Report of the Commissioners in Lunacy; at present they are a mere rudis indigestaque moles, and I must say that the effort to extract much valuable meaning from them appears to be an arduous one. Thinking that the Tables given in continuation of the same series in the Thirty-Second Report may meet a similar fate of neglect, I somewhat rashly propose to endeavour, if not to extract their full meaning, at least to state what are the facts they most clearly enounce, and, if possible, to suggest a meaning for them. I do this the more readily that they are not an extensive series, and are, therefore, somewhat manageable, and may admit that they have a certain attraction for me, as the most remarkable novelty they demonstrate happens to be a circumstance that on a small scale I have been aware of for some years, and had frequently thought it desirable to have tested on larger numbers, and yet is one to which I do not recollect ever to have seen attention directed. This circumstance is the frequency with which, in comparison with other lunatics, the general paralytic is married.

In enquiries upon the influence of heredity in the causation of insanity we rarely get back beyond the third generation. Few men either know, or care much about their great-grandfathers or great-grandmothers, and fewer are willing to keep in remembrance the existence of an ancestral taint. Nevertheless, in studying these subjects we ought to go back as far as we can, and the few pedigrees which have been traced of the genesis of insanity in families bring out deductions of the highest interest. In studying the fortunes of those ruling houses, whose lives are recorded by history, we occasionally trace the rise and extinction of a family through insanity, or we behold the wane and final extinction of the hereditary disease. There is no deficiency in the materials. Mental disease is very common in royal and noble families, and great disasters to nations have sometimes signalised the madness of their rulers.

In the spring of 1878, while travelling in Spain in company with two friends, I took the opportunity of visiting several asylums. Having entered Spain by the north, I made known my desire to see some Spanish asylums, to an influential citizen of San Sebastian, who gave me to understand that I would find them in much the same condition that English ones were in about 40 or 50 years ago.* He furnished me with letters of introduction to friends in Madrid, through whom I became acquainted with an accomplished and enthusiastic alienist, Dr. J. M. Esquerdo, Lecturer on General Pathology in the General Hospital of Madrid, and director and proprietor of a private asylum in the neighbourhood of that city.

Having met from time to time with cases of brain-fag, and also actual insanity, arising from excessive mental work, I wish to direct attention to-day to this cause of disordered mind, not because it is so wide-spread a cause as many others, but because for this very reason it is in danger of being treated with indifference, whereas at the present moment I regard it as a serious evil, although comparatively restricted in its operation in consequence of the great mass of the people falling under opposite influences; still I fear that it is in schools and colleges as well as in the cottage of the labourer and manufacturer, among students as well as among those who delve and spin, that we must seek for the causes of mental disturbance if we wish to understand them thoroughly.