F. M., a domestic servant, aged 20 years, was received into the Inverness Asylum on 13th June, 1894, suffering from acute mania of about a fortnight's duration. There was no assigned cause for the attack, nor was a hereditary tendency to mental or nervous disease admitted.

Since the discovery that Bacillus coli vaccine (1) or albumose (2) were as effective as typhoid vaccine (3) in the treatment of typhoid fever, the use of non-specific protein therapy has been popular for almost any disease for which there is no other satisfactory form of treatment. T.A.B. vaccine, a mixture of typhoid and paratyphoid A and B organisms, has been found more regular and reliable in its results than typhoid vaccine (4); but milk, antitoxic sera, peptone and a variety of other substances have been used, and even malaria is considered a form of this treatment, segmentation of the parasites producing the foreign protein (5). It has been observed that Gram-negative organisms, such as the gonococcus and typhoid bacillus, produce more marked reactions when given intravenously than the Gram-positive organisms, such as staphylococci, streptococci and pneumococci (5).

Generalized xanthoma is a cholesterol disturbance of the cells, coincident with a normal lipoid content of the blood serum.

The case described involves the skull, dura mater, brain, pleura and gallbladder.

By the death of Dr. Henry Rayner our Association has lost one of its oldest and most esteemed members, who had done great service to it and to the cause of the insane.

The subject to which I invite your attention is not of a scientific nature, but it is, I venture to submit, of considerable importance to the gentlemen directly interested, to specialists in mental science, and to the public in general.

The system of exchange with other journals has enabled us to increase the number of periodicals from which we may cull matter for these excerpta, and may hope to maintain and to increase their interest and usefulness among our readers. Moreover, we shall not restrict our choice of extracts to the contents of foreign journals only, but extend it also to essays, brief memoirs, and to the summaries of the contents of works of more considerable magnitude which come before us, with the intention of more fully representing the state of opinion and practice prevailing on the Continent and in America, with regard to whatever concerns the pathology and treatment of insanity and the management of asylums. And it is another portion of our design, when detailing the opinions and labours of our fellow-workers in psychiatry in other countries, as far as practicable, to form an estimate of them by the light of, and in comparison with, those of our own countrymen; in other words, to attempt a critical examination of their value and importance.

The great progress which medicine in general has made during recent years, must in considerable part be ascribed to the anatomical direction it has assumed. The study of pathological anatomy has entirely changed the character of medical science, which, instead of a chaotic medly of unfounded theories and ingenious hypotheses, the fruits of speculation, is now a philosophic system resting on a firm foundation of facts with mutual and definite relations. To such an extent has the pathological investigation of disease been carried, that, in the ordinary maladies which attack the body, the instances are now exceptional where we cannot demonstrate certain gross, palpable changes of structure having an invariable causal connection with functional disturbance. By bringing diagnostics to our aid, we can also in many cases predict with confidence and precision the nature and extent of the lesion which will be found after death. But the triumph does not cease here. In conjunction with chemistry and the microscope, pathological anatomy has passed from the gross alterations of organs, and succeeded in elucidating the processes and changes which take place in their ultimate elements; and Virchow, bringing to the subject all the zeal and instinct of genius, has given us an insight into the arcana of cell-life, and laid down the comprehensive generalisation as the basis of a new pathology, that the cell is the ultimate agent by which, both in health and disease, structural and functional alterations are effected. All the practical departments of the healing art have participated more or less in this progress. Medicine proper, or that branch which restricts itself to the study of internal diseases, has separated itself more and more from dynamics, and found a natural explanation of its symptomatology in anterior changes of structure; while surgery and mid-wifery, with their outbranching specialities, are daily becoming more anatomical in character.

It has been suggested to me by a professional friend, in whose judgment I place much confidence, that I shall aid in demonstrating the value of night nursing in the moral treatment of the insane, and perhaps remove prejudices which yet exist against its use, by laying before the members of this Association a record of my experience of the system at the Sussex Asylum during the first half of this year.

In my first lecture on the nomenclature of varieties of insanity I dwelt upon those phraseologies which have already been in use. The first of these was the old well known classification, which was grounded on the physical temperament, and conduct of the patient; and which confined itself very much to the question, whether he was violent, low spirited, or silly. Mania, melancholia, and dementia, being applied to these states; monomania and moral insanity, arising in after years as auxiliary to these terms, and being a refinement on the idiosyncracies of various cases. The second phraseology was one which Dr. Noble has developed, if not originated; it dwelt upon the metaphysical position of diseased mind, discarding the consideration of conduct and temperament. It tells us which part or faculty of the mind is diseased; it contains, in short, a geographical sketch of the mind and its diseases, and gives us some ideas of the exact position of each case in the history of diseased mind. Emotional, notional, and intelligential insanity are the chief terms of this vocabulary. I stated my belief that a consideration of both of these histories, the physical and the metaphysical, the state of the conduct and temperament, as well as a history of the part of the mind diseased, were necessary, for a terminology which should represent a fair history of the varieties of diseased mind; and I proposed to compile a nomenclature of the varieties of the disease, constructed from the conjoint consideration of these two histories.

In their report on this Asylum for 1913, the Lunacy Commissioners state: “Almost 20 per cent. of the patients in each of the Staffordshire asylums are epileptics; this unusually high proportion appears to obtain in each of the Staffordshire asylums, and to be a subject worthy of further inquiry locally.” It is also noteworthy that associated with this high proportion of epileptics is a high tuberculosis death-rate, viz., 25.2 per cent., the average epileptic percentage of the number of patients remaining at the year's end in county and borough asylums in England and Wales being, for 1911, 12.5, while the proportion of tubercular deaths per cent. of deaths from all causes (1902–1911) is 16.6

In every civilised community, however imperfectly the wish may be fulfilled, the desire is to do equal justice to all; to up hold the law as a terror to evil-doers, and the protector of the innocent.