Melancholia is by far the commonest form of mental disorder that can be regarded as a true insanity, and from its general manageability is very often treated at home. A knowledge of it is therefore useful to the practising physician. There is another reason which increases the importance of this knowledge. Melancholia is always dangerous owing to the possibility of the patient taking his own life, and the presence of a tendency or desire to commit suicide is not sufficiently recognised by the members of the medical profession. It exists at one stage or another during the course of practically every case.

The case which forms the subject of this paper presents no rare or unusual features, being of quite an ordinary type such as one may meet with every day. Its relative freedom from complexity is the feature which makes it especially suitable for analysis. The delusional formation was strictly localised and showed no tendency to spread into other fields, and but for the one morbid theme the patient could be regarded as normal. It is from the less complex forms of mental disturbance that one may hope to obtain the most insight into the development of abnormal mental processes, and it is for this reason that the case which I am about to bring to your notice has been chosen for consideration.

The study of history, too often confined to the acquisition of bare records of facts and the mere recapitulation of actions, has more and more tended to widen its scope and to include in its purview the analysis of motives as an integral factor. It is true that the bald statement of events has an interest, and for some an overwhelming interest, whereto they confine themselves either by reason of intellectual inertia, or because compelled to restrict their wandering thoughts by reason of the powerful voice of authority; for others more intellectually alive or not subject to the same restrictions the conclusions do not suffice—the why and the wherefore must, if possible, be deduced. The keenly deductive type has been admirably delineated by Conan Doyle, and “Sherlock Holmes” may well stand as an example of those minds which urge their possessors inevitably to progress, so far as is humanly possible, to the unravelling of ultimate causes.

In complying with the Honorary Secretary's request to read a short paper on some clinical or pathological cases, it occurred to me that it might be of some interest to the members to review a few instances of sudden death, or rather sudden and unexpected death, where the cause was unsuspected; in life, and in some instances left in doubt after post-mortem examination.

My excuse for reading to you a paper on asylum dysentery must be that, as the Commissioners in Lunacy state, “there is still a singular difficulty in affording a reasonable explanation of the exceptional prevalence of dysentery in asylums.”

With the exception of cretinism, mongolism and amaurotic idiocy, and juvenile general paralysis, it may be said that the only classification of congenital mental deficiency is one based on the degree of mental defect.

A case of puerperal insanity, although distressing in its symptoms, is always welcomed by the asylum physician, for the reason that he knows in all probability the patient will make a good recovery.