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This great subject is treated by Dr. “Vedie by giving very shortly:—1.—A resumé of those psychological facts which bear most upon the subject.2.—An examination of physiological phenomena connected with the former. Then shall become evident the laws which govern all psychological and physiological phenomena.3.—The application of these laws to pathology and therapeutics; or, what is equivalent, an examination of the pathological and therapeutical phenomena produced by mental causes. The question of miracles naturally falls to be discussed in connection with this part of the subject.4.—The reasons why some educated people and even physicians err in their views concerning miracles, and misunderstand the natural laws which regulate these phenomena.

In 1893 one of us published an account of an unusual condition of the scalp. He believed that the abnormality had not previously been described. In this opinion, however, he was mistaken, for as far back as 1884 Poggi had recorded a case. Since attention was first directed to the matter a few writers, English and foreign, have published cases and ventured on various but conflicting opinions in explanation of the facts observed. The last known contributor is Dr. Eugenio Bravetta, who communicated a paper to the Medico-Chirurgical Society of Pavia in 1910. It contains an account of three typical examples, and is useful in giving a list of published cases with their authors; but it is specially valuable because it epitomises the views of the various writers. As this communication of Dr. Bravetta is in Italian, a language not read by the majority of us, we venture to give, by way of introduction, a free translation and abstract.

On Trephining in Epilepsy due to Injury of the Skull. By Dr. M. G. Echeverria.

Men and women hold to and have faith in certain opinions as the result of long thinking around and along certain lines. Our social and political tendencies are the outcome of an analysis more or less critical, and believed by the individual to be impartial. A scattered phrase or an apparently insignificant incident may attract attention, and be the beginning of a prolonged mental conflict which is finally determined by a definite line of thought. It does not follow that the reasoning is always logical, or the argument conclusive to people of other opinions, but nevertheless a conclusion is arrived at, and it is final.

The urine of the insane has been hitherto comparatively seldom the subject of minute examination, because, independent of the numerous opposing difficulties, no special importance was attached to it. And yet, more exact observations of the quantity of urine secreted by this class of patients should claim our interest on several grounds. This subject, moreover, cannot be ignored if we desire to penetrate the darkness which surrounds, especially in the insane, the complicated processes of chemical change; for it is in them that such peculiar and obscure phenomena of vital chemistry and nutrition occur. We see how other internal maladies, injuries, and wounds, without any treatment, are cured surprisingly quickly; how the insane, independent of the amount of food consumed, often undergo in a very short time, an astonishing increase or decrease of weight, and endure total abstinence from food incomparably longer than other individuals. Cases in point are recorded, which almost exceed belief. Thus, Wigand (Ueber Wahnsinn. Kempten, 1839), relates the detailed history of a lunatic who ate nothing for 62 days, and died in the hospital at Kempten, on the 63rd of starvation. In Henke's Medical Jurisprudence there is a similar case, where death occurred on the 64th day under violent convulsions.

With the ever-increasing number of processes proved to be due to the action of micro-organisms, bacterial and protozoal, it is natural that a similar line of research should be suggested in the study of the psychoses. It has long been realised that the classification and differentiation of the various conditions by mental signs alone is confusing and unscientific. Gradually more importance has come to be placed on general clinical observations as indicating broadly the primary disturbances in the economy of the body, secondary consideration being given to mental symptoms as showing the change effected in the individual nervous system by the general disturbance.

American Journal of Insanity, Vol. xxviii., January to April, 1872.

At a time when there is a gradual but certain change spreading through our methods of treatment of the insane, and chemical compounds are being replaced by other methods, it may appear unneccessary to record results obtained by the use of drugs. But this short paper is intended only to give my experience as to the effect that nucleinate of soda has upon the progress of acute mental disorders.

In the present retrospect we shall attempt to give, as briefly as possible, what is more interesting or important in the numbers of the “Annales Médico-Psychologiques” from September, 1871, to July, 1872, both inclusive.

When this case first appeared in the Court of Session, Edinburgh, in March last, it excited much attention among the general public, and it formed a frequent subject of discussion among members of the medical and legal professions. The progress of the suit was watched with much interest; the evidence led was carefully weighed; the opinions of the medical experts were freely criticised; the charge of the judge gave the utmost satisfaction to some, while the verdict of the jury equally delighted those who held a contrary opinion. The case presents many points of interest for those engaged in the study and treatment of mental diseases, but any remarks to be made on the points which demand special notice will be given after an abstract of the evidence has been presented to the reader. It may be remarked that the evidence was very voluminous, and that while every effort has been made to make the present abstract as short as possible, care has been taken to avoid obscurity, and no really important piece of evidence has been omitted for the sake of brevity. It must also be added that this account of the case has been made up from the reports of the proceedings which appeared in the “Scotsman.”

The urine of the insane has been hitherto comparatively seldom the subject of minute examination, because, independent of the numerous opposing difficulties, no special importance was attached to it. And yet, more exact observations of the quantity of urine secreted by this class of patients should claim our interest on several grounds. This subject, moreover, cannot be ignored if we desire to penetrate the darkness which surrounds, especially in the insane, the complicated processes of chemical change; for it is in them that such peculiar and obscure phenomena of vital chemistry and nutrition occur. We see how other internal maladies, injuries, and wounds, without any treatment, are cured surprisingly quickly; how the insane, independent of the amount of food consumed, often undergo in a very short time, an astonishing increase or decrease of weight, and endure total abstinence from food incomparably longer than other individuals. Cases in point are recorded, which almost exceed belief. Thus, Wigand (Ueber Wahnsinn. Kempten, 1839), relates the detailed history of a lunatic who ate nothing for 62 days, and died in the hospital at Kempten, on the 63rd of starvation. In Henke's Medical Jurisprudence there is a similar case, where death occurred on the 64th day under violent convulsions.

This paper contains not only an account of some of the Dutch asylums, but a short résumé of the system of management and inspection. Their condition and arrangements appear to be good, and are very favourably spoken of by Dr. Billod. None of his remarks, however, call for special notice here, except one, which is an amusing commentary on the opinions of those who see in Gheel and similar colonies the perfection of asylum treatment. When at the Utrecht Asylum he saw two private patients who had escaped from Gheel in order to return to Utrecht, where they had formerly been under treatment.

I have read with much interest Prof. Cleland's article “On the Seat of Consciousness.” I agree with many of the author's opinions, especially with those contained in the critical or negative part of his work; but it appears to me that the positive portion, notably the extension of consciousness to the peripheral terminations of the nerves, is scarcely in agreement with the facts supplied by clinical observation and physiological experiment.

This paper has for its object the placing on record of a considerable number of observations made during the past eighteen months upon the blood of the insane. It was after the perusal of Dr. Lewis Bruce's work upon the clinical aspect of mental diseases that this special subject suggested itself to me as one deserving minute and extended study. Whereas Bruce deals somewhat minutely with the various constituents of theblood, I have confined my observations to the changes that occur in the number and variety of the white blood-cells, and the relationship these alterations have to the acute mental diseases in which they are found. These researches, though still in their infancy, hold out great encouragement to the belief that in such directions we may yet succeed in arriving at a true knowledge of the pathology of mental diseases, and at the same time advance at least one step in what has hitherto baffled all research-the conditions governing the mutual relations of mind and matter.

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Annates Médico – Psychologiques. November, 1877—September, 1878.

This paper goes over the same topics that are quite familiar to those at all acquainted with the interminable discussions connected with the nomenclature and classification of mental disease. There are brief notes of some fresh cases. The concluding paragraphs are as follows

In his clinical lectures Mr. Syme used to observe that cases may be interesting and important either because they are examples of diseases frequently met with, or because they are instances of maladies of unusual occurrence; the common cases deserve study and attention simply because they are common, whilst the rare cases call for special investigation because we may thereby discover facts which may explain phenomena in cases of every-day experience. The two cases which I am about to describe are examples of a rare combination of nervous diseases; but any remarks on this and other points must be deferred until the cases themselves have been described.

Nocturnal Epilepsy.—By Dr. Echeverria.—A paper, in English, on the same subject appeared in this Journal, vol. xxiv.

In the following brief notes nothing is attempted beyond placing on record three undoubted examples of this interesting disease, and thus adding to an ever increasing list of cases.

I. American Journal of Insanity, Vol. xxvii., July, 1870, to April, 1871.

It is indeed a true saying that to be successful in the treatment of disease clinical observation must be accompanied by biological and bio-chemical research. Yet the practice of medicine in times not so very remote was chiefly based on careful observation and common sense. In by far the majority of diseases the ætiology was not understood, and this was strikingly true of the acute forms of mental derangement. Still, devoted workers and searchers after truth continued their investigations on the dead and their experiments on the living. Gradually appliances were improved and new methods pursued, and with such brilliant results that at last the true cause of infective disease was discovered. One by one bacteria were isolated and studied, and thus a great world of medical research was opened out and results obtained which have already wrought untold blessings to humanity.

Functional disturbances of the digestive system are common accompaniments of neurasthenia. I shall avoid all attempt to classify them, and confine myself to describing certain cases in some detail with a view to bringing out the points of practical importance in causation and therapy.

Kate H., aged 42, married, the mother of one child, a barmaid in her younger days, was admitted into the Northumberland County Asylum on October 10th, 1889, suffering from delusions, loss of memory, and paralysis of the upper and lower limbs.

Some time ago I employed my leisure in hunting up all facts which might throw some light on the condition of lunatics in Great Britain in former times. In my then position it was extremely difficult to obtain access to the class of books most likely to yield me the information desired, but from such as did fall in my way all matter of the least value for my purpose was excised. The labour connected with this pursuit was much greater than most might be inclined to credit, and some men of a utilitarian frame of mind may be inclined to believe that labour on such a subject was wasted, and might have been much more profitably expended on other branches of research.

Many varieties of functional disturbance are found in men enlisted for the present war, and not the least interesting is mutism. In a hospital set apart for the treatment of nervous disorders many cases of complete loss of speech are met with, and these may be divided conveniently into three main categories as follows: Mutism arising in the field, in hospital, and previous to participation in active service.

In the “Journal of Mental Science” for April, 1863, there appeared a paper by Dr. W. Carmichael McIntosh, entitled “Asylum Notes on Typhoid Fever.” In his introductory remarks, Dr. McIntosh notices the increased interest attached to the occurrence of physical diseases as observed in the insane, and the value of observations thereon, when the sane and insane suffer from the same disease and are under observation at the same time. There is then an opportunity of noticing the influence of such blood poisons as the scarlatinal and typhoid, as affecting two classes of the community; and as the patients are under medical observation from the very commencement of the illness, peculiar advantages are offered for a close investigation of all symptoms, mental and physical, from their first appearance. Dr. McIntosh further observes, “additional light might be thrown upon mental pathology and treatment, if such observations, sufficiently extensive, were correctly made and recorded. Alienists have long noted the influence of physical diseases in the course of an attack of insanity; and recently cases from foreign journals have been given by Dr. Arlidge, where recovery has followed wounds causing profuse suppuration in melancholia and general paralysis; scarlatina in suicidal melancholia; dysentery and acute rheumatism in monomania; dysentery and a compound fracture of the elbow in religious monomania; lastly, profuse intestinal hæmorrhage is mentioned by M. Baillarger, as ushering in recovery in a case of “painful hallucination of vision consequent upon injury from a railway accident.” It is with the view of adding a few cases to those which have already appeared in the various journals that the following examples of insanity, with intercurrent scarlatina, are published; so that when a sufficient number have been recorded they may be collected for comparison and further examination, and it may be that some useful and interesting results may be obtained. For as we are in the habit of watching the effects of drugs introduced by ourselves in cases of insanity, in the hope that ultimately we may arrive at a scientific method for such medicinal treatment, there appears no reason why we should neglect, but rather the reverse, the observation of cases in which, through contagion, a specific blood poison has been introduced into the system, and which produces characteristic and obvious symptoms. In the present state of matters one would scarcely feel inclined or be justified to run the risk of exposing an insane patient to the poison of typhus or measles for the chance benefit which might result to the mental state; but it is not unreasonable to think that some day we shall be able to modify the course of many diseases, perhaps mental among the others, as we now do in the case of small-pox through vaccination.

There are questions upon which the sagacity and ingenuity of observers have been vainly exercised since the beginning of time. They remain for examination, waiting a definite solution, which may never be discovered. Such is the question of the nature of epilepsy.

The illustrations which accompany this short paper are interesting examples of a sexual deformity very seldom met with in young women. I have not thought it necessary to collect the literature bearing on this subject, and I do not know of any special papers on it. In various works, however, it is referred to in a stereotyped fashion. The general opinion seems to be that it is almost exclusively among women who have passed the period of sexual vigour that beards are found; that such women are of a masculine disposition of body and mind; that the characteristics of their sex are usually imperfectly developed; and that they are, as a rule, barren. Whether such opinions are correct or not I cannot say, but they do not apply to the cases about to be described. Both these women appear to be perfectly developed in their sexual characteristics; one, indeed, now a widow, is the mother of three children. In both cases the hair began to grow on the face shortly after the patients arrived at the age of puberty. The deformity caused them great annoyance, so much so that one of them appears to have been teased into an attack of mania by her neighbours. In her case a hereditary tendency to insanity existed, and one of her sisters is now insane. By cutting, or shaving, they attempted to diminish the disfigurement, but, of course, with only temporary benefit. There can be no doubt that some irregular action of the nervous system is the cause of the growth of the hair in these cases; and it would be an interesting investigation, had we the materials, to discover if bearded women were more subject to nervous diseases than their more favoured sisters.

The accompanying illustration represents what is believed to be a hitherto undescribed abnormality of the scalp. The condition was discovered accidentally. I observed an attendant cutting a lad's hair, and remarked that he was not doing it very well, as there appeared to be numerous scissor-marks. It was explained that the marks were due to the arrangement of the hair. This led to careful examination of the whole scalp. Its condition is very well represented in the illustration. On each side there are five deep furrows, passing from behind forwards. Those nearest the middle line are straight; the others slightly curved, and they are the more curved the further they are removed from the middle line, and at the same time they diminish in length. When the hair is of ordinary length the condition of the scalp would not be suspected; it is only when the hair is very short that the furrows become evident. For the purpose of preparing the accompanying illustration the hair was cut as short as possible, but the hair growing in the furrows was necessarily left somewhat longer than elsewhere, with the result of indicating with great clearness the course and arrangement of the depressions. The furrowing of the forehead is not abnormal, but is produced by the patient whenever he is annoyed, as he was when the photograph was taken.

As an appendix to Dr. Macleod's paper, I may give the following facts relating to a woman at present under my care at Morpeth:—She was admitted in May of last year. The medical certificate stated that she had an imbecile look; that she could not talk rationally; that her memory had failed; that she was extremely dirty in her habits; that before she was taken ill her disposition and conduct was quite different; that she was liable to outbreaks of temper and excitement.