374 SCOTLAND.

not as a surgical operator. The bench, however, did not agreewith the rev. gentleman, and fined the defendant E10 andcosts, or six weeks’ imprisonment without hard labour.Newcastle-upon-Tyne, Feb. 6th.

SCOTLAND.(FROM OUR OWN CORRESPONDENT.)

The Morriso Lectures on Insanity.THE first of this series was delivered before the Royal

College of Physicians, Edinburgh, by Dr. John BattyTuke. His intention was to study in these lectures themethods of action of some of the proximate causes of insanity,and the principle of treatment founded on these. He pro-posed to restrict himself mainly to over-exertion of the brainas productive of insanity, and almost exclusively to its actionduring the earliest stages of the condition, when the derangedcerebral apparatus was in a state to react to therapeuticmeasures. He quoted Dr. Creighton’s opening sentences inhis article on "Pathology" in the Encyclopœdia Britannicaas expressing his own views on the relation of theory andknowledge in medicine ; and said that the " unique position ofpathology among the natural sciences was owing to the factthat it was a theory of practice-a body of truth and guess-work existing for the benefit of a working professionwhich is daily brought face to face with emergenciesand is constantly reminded of the need of a reasoned ruleof conduct." For twenty years the lecturer had endeavouredto show the social influences which had induced the publicmind and the profession to regard insanity as a disease of themind. The popular conception of the condition had beenuntil a not very remote period entirely psychological or arude mixture of a pseudo-psychology and a pseudo-pathology.The physician’s conception of the condition had not differedin kind from that of the general public. At the end of the last

century insanity was a symptom of disease, but differed insome mysterious way from all other diseases. The psycho-logical principle found expression in nomenclature, andin the first issue (1871) of the official "Nomenclature ofDiseases," drawn up by a joint committtee appointed bythe Royal College of Physicians of London, all the in-sanities were ranged under six "Disorders of the Intel-lect." Within the last thirty-five years etiology had intheory, if not in practice, been adopted instead of mere

symptomatology as a basis of classification. The etio-logical nomenclatures had served the good purpose of keep-ing before the mind that insanity was merely a symptomof somatic disease ; by deflecting the observer from themisconception involved in the term "mental disease, " andby focussing his attention on the phenomena following onactual or presumed causes, they had directed inquiry as to ’’,consequent alterations in tissue. They had acted as guidesto the higher pathological platform, to the study of thechanges in the organs through which consciousness is mani-fested. There was every probability that we shall have to retainthis system of classification for many years to come, and therewas even a possibility that its terminology may become per-manent, in consequence of a definite pathological meaningbecoming attached to many of the presently recognisedetiological groups. We had not advanced far on thisroad, but there was reason to hope that the study of theinsanities will in future be conducted on the same

scientific principles that governed our views of disease at

large. He had sometimes speculated upon the attitudethe profession would assume if a case of acute maniaor acute melancholia were introduced to it for the first timeand with no previous knowledge of such cases. Imaginetwo cases presenting a congeries of symptoms, the mostprominent in which was a degree of mental alienation.One a man in poor bodily condition, quick and irritable

pulse, temperature above normal, blood poor, bowels costive,oxalates or phosphates in his urine, sleepless, restless, wring-ing his hands and saying his soul was lost; in short, deeplymelancholic. The second a woman with much the same

bodily symptoms, but menstruation arrested, mentallyexalted. Both patients were stated to have suffered fromserious anxieties and sorrows. Under the circumstances,supposed he held that the mind of the college would not turnto the idea contained in the term "mental disease, " but thatfirst impressions would lead to the rough provisional diagnosisof obscure bodily disease, accompanied by unusual forms ofdelirium. It appeared to him extremely likely that the

mental symptoms would not bulk very largely in our eye,that we would commence the study of this new con-

geries of symptoms by careful investigation into the bodilycondition, and that the mental symptoms would be regardedas mere incidents in the case, as we had been in the habit of’regarding delirium of different kinds as a secondary conse.quence of various diseases. After a careful examination of’all the systems we would be forced by a process of exclu..sion to adopt the rough provisional diagnosis of disease ofthe-brain accompanied by mental symptoms-a very differentdiagnosis from that of mental disease. In what part of the.organ would we localise the disease 2 Our teaching would,place it in the frontal and superior convolutions. The only,assignable reason for the existence of bodily and mentalsymptoms from the history was prolonged painful emotion.We would then push our inquiries as to the manner in whichemotion could so act on those gyri as to produce morbidmodifications of the bodily or mental functions. Layingaside this parable, he proceeded to consider facts andtheories bearing on the general proposition that insanity wasthe result of well-defined morbid processes, and that it wasbut one of a group of symptoms in a given case. Morbidsymptoms cannot yet be always referred definitely to actualstructural change, although science was gradually narrowingthe area of ignorance, and year by year diagnosis and treat-ment were based more fully on definite knowledge of normal.and morbid anatomy and the physiology of organs. The

application of this knowledge to the brain had already had;effects in the treatment of many cerebral diseases; buthe asked whether as regarded the insanities theory foundedon this new knowledge had been pushed far enough to.

seriously influence treatment, and whether the relations one-to the other of the various organs which composed the sub--stance of the brain had been seriously studied with the viewof considering in what manner and to what extent implica-tions of one or more of them may react on the functionalactivity of the organ. He believed that the practitioner was.not so intimately acquainted with the minute anatomy of aconvolution as he was with the other organs, and that therefore-he was not able to visualise the probable changes which mayoccur in a gyrus during disease. Was a brain convolu-tion often regarded as an apparatus, and was the samekind of conception arrived at in respect of the possibleand probable change which may take place in it as was.arrived at with regard to the other organs ? Believing:that it was not so he proposed to attempt to diagrammatisea convolution. He then proceeded to describe and demon-strate by means of the lantern the structure of a convolution,following the description of Ramon y Cajal, pointing out the-various layers of cells and the processes connected with themas shown by Golgi’s method of preparation and staining. Hethen dwelt upon the true structure of the pia mater, and theimportance and connexions of the lymphatic system in the-brain.

The Edinburgh Long,more Hospital for Incurables.The annual meeting of this institution was held last week.

In the report reference is made to the completion of thenew wing and the reopening of the hospital by the Duke andDuchess of York last October. The hospital now contains90 beds for adults, and when the children’s wards are

completed there will be accommodation for 106 patients;::f:15,000 will be necessary to complete and endow the newbuilding, and of that sum between £10,000 and £11,000have been subscribed. There was an increase in annual sub-scriptions and donations during the past year, but therewas a falling-off in legacies. The total number in the hos-pital at the end of the year was 41 males and 42 females.

Lockmaben and the Board of Supervision.An action has been raised by the Board of Supervision

against the Lochmaben authorities for contempt of court forfailing to carry out the order of the Board to introduce agravitation water-supply to the burgh.The Edinburgh Royal Infirmary and the Royal College of

Surgeons.As has been intimated, some unpleasantness arose re-

garding the management of the Royal Infirmary by the-Royal College of Surgeons returning as managers two of its.Fellows on the acting staff of the infirmary. The College.at the request of the managers, reconsidered the matter, butadhere to their choice of representatives, and deny thatthe managers have any power to interfere with their choiceof representatives. The College further contend that it willbe to the advantage of the infirmary to have members of

375IRELAND.-OBITUARY.

the acting staff on the Board of Management, and point outthat in London and in many of the hospitals in the provincesit is customary to have members of the staff on the manage-ment.

Small-pox in Edinburgh and Leith.Last week seven new cases of small-pox were reported in

Leith and four in Edinburgh.Feb 8th.

______________

"

IRELAND.(FROM OUR OWN CORRESPONDENT.)

Richnaond District Lunatic Asylum.FROM the annual report of Mr. Norman, resident medical

superintendent, it appears that extra accommodation is

required for the insane poor of the city of Dublin, the Rich-mond Asylum having 429 inmates above the allotted number.The Board of Control were in treaty for the purchase of an.estate of about 300 acres, whereon to erect a second asylumfor the district. It has been decided to erect a mortuary,,post-mortem room, and pathological museum, and to build anew laundry, kitchen, and stores. During the past year175 patients died, showing a percentage of mortality of7’6 for males, and 1 5 for females, that for all Ireland being7.6 for males and 9’1 for females. The returns of employment ’,.showed that 68 men worked on the farm, 33 were engaged atvarious trades, 27 men and 25 women worked in the kitchen,85 women were engaged in the laundry, 133 were employedat needlework, and 300 men and 235 women were returned as.attending school.

Insanity in Ireland.Dr. Woods, resident medical superintendent of the Cork

Lunatic Asylum, in replying to a circular from the Lunacy0ffice, Dublin Castle, asking for information as to the allegedincreasing prevalence of insanity in Ireland, states that ifthe number of first admissions be taken as the main test of the

progress of insanity there has been no increase in the countyof Cork during the last ten years. The average number offirst admissions has been 213 ; the number admitted in 1883,the first year of ’the decade, was 211, and the last year 203 ;the readmissions were below the average for the first fouryears and above for the years 1888, 1889 and 1892. There hasrbeen a considerable falling-o.ff in the death-rate, the averagefor the ten years being 9 per cent., being for the first five years11.3 3 per cent. and for the last five 6 ’8 per cent. The informationas to the cause of insanity is very unreliable owing to theimperfect and very inaccurate information supplied on thecommittals. Eighty-three per cent. of the patients arebrought to the asylum by the constabulary, who, as a rule,dmow little about them. Dr. Woods is satisfied that intem-

perance or abuse of alcohol is a far more frequent cause ofinsanity than is assigned, and hereditary disposition is

.always reluctantly acknowledged by the friends and should’hold a much more prominent position as a cause of insanity,than it does in the returns. It is difficult of proof, but hehas long been of opinion that the free discharge of weak-minded but harmless patients and the too early removal ofthose recovering have tended to considerably increase the!number of insane who break down from heredity.

Feb. 6th. ______________

Obituary.T. CRANSTOUN CHARLES, M.D., M.R.C.P. LOND.

IT was with regret that we announced in the last issue of’THE LANCET the unexpected death of Dr. T. Cranstoun’Charles. Dr. Charles was born at Cookstown, countyTyrone, and received his early education in the Cooks-town Academy. He afterwards proceeded to Belfast,where at the Queen’s College he highly distinguished’himself and graduated in 1869, obtaining first-class honours- and the gold medal. He subsequently became assistantlecturer in chemistry and chemical physics at that college.He was for some time resident physician to the BelfastInfirmary and Hospital for Contagious Diseases and laterincreased his medical knowledge by visits to the chief,hospitals in this country and to those of Paris and Vienna.dn 1875 he became connected with St. Thomas’s Hospital

as demonstrator of physiology and afterwards held varioussimilar appointments in connexion with the teaching staffuntil’ his death. He was medical registrar from 1876 to1879 and wrote the medical reports for those years, conjointlecturer on general anatomy and physiology from 1884 to1886, and lecturer on practical physiology from 1879 to1893. Dr. Charles was a volunteer ambulance surgeonand did good work during the Turco-Servian war of 1876.Although at the time of his death he was physician tothe Westminster Training College, the greater part of hislife was spent in scientific research, the nature of whichis indicated by the titles of some of his better knowncontributions to the literature of the day. To the Philo-

sophical Magazine he contributed papers on the Analysis ofCoals and Lignites and Methods of Organic Analysis, andhe wrote articles on Specific and Latent Heats, Heat ofCombination, Thermodynamics, Ozone, &c. for "Mackenzie’sDictionary of Chemistry." He also wrote on WorkingSchemata of the Circulation of the Blood and Lymph inthe Journal of Anatomy and Physiology; on Ichthyol : a Con-tribution to its Therapeutics, and on Pulmonary Phthisis: itsPathology and Curability in Early Stages, in the columns ofTHE LANCET ; and on Intermittent Albuminuria in the St.Thomas’s Hospital Reports, &c. A more important contribu-tion to chemistry was a book of 600 pages on Physiologicaland Pathological Chemistry produced in 1885, a second editionof which was published in America two years later. Dr.Charles was a very hard worker and was formerly known tomore than one of the editors of our daily papers as acontributor of most acceptable articles on subjects of

general interest, evincing much power of research, origi-nality and literary attainments. As a teacher he was appre-ciated for his earnestness, industry and good-nature, thoughan occasional rapidity of utterance sometimes militatedagainst that clearness of expression which is so importantin one engaged in teaching. Warm-hearted and impulsive,he was liked by all, and his tall, stalwart form will long bemissed. Dr. Charles was in his forty-fifth year.

ARTHUR STEDMAN, M.R.C.S., L.S.A.ON Jan. 28th last this well-known and esteemed practitioner

in the county of Surrey passed to his rest at the age of sixtyyears. He was educated at Tunbridge Wells GrammarSchool, and after an apprenticeship to Mr. Miles of Gillinghamhe entered the medical school of University College, London,where he obtained several class distinctions and acquiredthe life-long friendship of many of his fellow students. Hethen went as assistant to Dr. Carter of Pewsey, Wilts, andafterwards practised for a short time at Cookham, Berks,and Cullompton, Devon, respectively, finally succeeding tohis father’s practice at Great Bookham, where he re-

mained until his death. He was medical officer and

public vaccinator to the boards of guardians of Epsomand Dorking, and held various dispensary appointments.He was also for the last twelve years medical officer ofSt. John’s College, Leatherhead. This last was his favouritework and one in which he took the deepest interest, allowingno pain or suffaring to interfere with his duties there. Hiszealous and kindly supervision endeared him to all connectedwith the school, which owes much to him. He also tookthe greatest interest in local affairs and actively and success-fully promoted many social undertakings, to the greatadvantage of the neighbourhood, especially of the poorerinhabitants, by whom he was regarded with the warmestesteem as one of their best and truest friends. He was agreat lover of flowers and garden pursuits and was most pro-ficient in botany, which was his favourite study. In thecourse of his life he acquired a splendid herbarium, whichhe bequeathed to Lord Ashcombe. He was an excellent

type of country practitioner-calm and resourceful in an

emergency, untiring in his devotion to his professionalwork, jealous to a degree of professional honour and integrityand ever ready with advice and help to all who were introuble or difficulty. The patience and fortitude with whichhe bore the painful disease which ultimately proved fatalwere noble in the extreme, and a worthy termination of a lifedevoted unselfishly to the interests of others.

ROBERT HAGYARD, M.R.C.S., L.S.A.THE circumstances connected with the death of this gentle-

man, which took place on the 2nd inst., were of a peculiarlydistressing character. About two years ago Mr. Hagyard