Using successive analyses of hospitalized mentally handicapped people from a geographically defined Welsh catchment area, this article attempts to evaluate changes in cohorts of such patients. It suggests the likelihood that the level of hospital accommodation predicted in the White Paper ‘Better Services for the Mentally Handicapped’ will be sufficient.

Five cases of fatal lead poisoning occurred between 1884-6 among the employés of a certain white lead factory in the East of London. The cases presented the following common characters. They were all adult women, aged from 18 to 33. They had all worked at the factory for short periods from three to twelve months. They all exhibited mild symptoms of plumbism, such as a blue line round the gums and more or less ill-defined indisposition; paralyses were absent. They were all in their usual state of health within a few days or hours preceding death. Death was unexpected—mostly sudden. In four cases it was preceded by epileptic fits and coma, but in the fifth case no convulsions were noted, although they may have occurred during the night.

I have been frequently obliged to give expression to my views on asylums and their future organisation. These views are expressed in official documents and private letters, which have never been published. A few observations which I made cursorily at the Naturforscher-Versammlung, in Hanover (“Zeitschr. f. Psychiatrie, “XXII., p. 390), as an indication of my point of view, were much too briefly and aphoristically given not to be subject to misconception. I therefore propose to devote the following pages to a connected, though necessarily brief, explanation of what I believe to be necessary or advantageous in the immediate future arrangement of lunacy matters in Germany, and to indicate towards which side I lean in the undoubted crisis which the question of the public provision for the insane has now reached. I apprehend neither detriment nor danger in this crisis, which is merely the progress towards more complete organisation. To wish to ignore it would not improve the matter. The predetermined conclusion to see the only good and right possible in things as they now exist is a far greater hindrance to the discovery of truth. If science can present new points of view, if urgent wants are brought to light, which cannot be satisfied by the present means of publicly providing for the insane, the requirements must not, in such circumstances, be ignored or denied, but the means must be made to suit the necessities. It was in this way that things were treated when the present asylums were founded; and is it possible that at the present time no further advance can be made ? It is, however, to be remarked, as was said a few years ago by Damerow, who was for the most part an authority with the opponents of reform (“Zeit-schr. f. Psychiatrie, “XIX., 1862, p. 187), “There is nothing further to be obtained in the future with the present public institutions for the cure and care of the insane.”

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.

We have seen that Simple mental weakness, the first form of weakmindedness, is neither more nor less than a want of mind, in some degree. In it the higher emotions are blunt, perception is dull, and all the processes are backward or sluggish.

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.