The results of treatment showed that 112 cases, or 53 per cent. of them, recovered, the women recovering in the largest proportion. In fact, only 31 per cent. of the men got well, while 57 per cent. of the women did so. The numbers who died, on the contrary, were greater proportionately in the men than the women, 4 of the former, or 12 per cent., and 17 of the latter, or 9 per cent., having died up to this time. This would seem to indicate that the disease is rarer, less curable, and more deadly in the male sex than the female; but the numbers are perhaps too few on which to base a correct generalisation.

The patients who recovered had not been so long ill as I had previously imagined. Taking the time they were under treatment in the asylum (the only correct basis I have on which to estimate the duration) 61 of the 122 who recovered, or 55 per cent., were discharged within three months, and 80, or 65 per cent. within six months, and 111, or 91 per cent., within twelve months. There were a few patients who recovered after two years of treatment. The maniacal and the melancholic cases recovered in about equal proportion, but the maniacal in shorter time. The recoveries were much fewer in the women over 50, only 29 per cent. of these getting better. Up to 50 they recovered equally well. At the other ages, from 55 to 60, the cases were the most curable in the men. Only 3 of the 11 over 60 got over their malady.1

SENILE INSANITY.

The psychology of normal old age has yet to be written from the purely physiological and brain point of view. Ports. dramatists, and novelists have had much to say of it from their standpoint. King Lear is beyond a doubt a truthful delineation of senility, partly normal and partly abnormal. By normal

1 These statistics may be profitably compared with those of Dr Merson's admirable paper on this subject, in the West Riding Lunatic Asylum Medical Reports, vol. vi. p. 85.

senility I mean the purely physiological abatement and decay in the mental function running pari passu with the lessening of energy in all the other functions of the organism at the latter end of life. No doubt, in an organism with no special hereditary weaknesses and that had been subjected to no special strains, all the functions except the reproductive should decline gradually and all together, and death would take place, not by disease in any proper sense, but through general physiological extinction. The great function of reproduction stands in a different position from all the other functions of the organism. It arises differently, it ceases differently, and it is more affected by the sex of the individual than any other function. It is, as a matter of fact, not entirely dependent on individual organs. It may exist as a desire and an instinct without testes, or ovaries, or sexual organs. It is really an essential, all-pervading quality of the whole organism, and to some extent of every individual organ, not one of which has entirely lost the primordial fissiparous tendency to multiply. But the physiological period of the climacteric has determined and ended it in its intensity and greatest power, though many of its adjuncts remain; and in the male sex we have to reckon with it and its abnormal transformations to some extent even in the senile period of life.

Physiological senility typically means no reproductive power, greatly lessened affective faculty, diminished power of attention and memory, diminished desire and power to energise mentally and bodily, lowered imagination and enthusiasm, lessened adaptability to change, greater slowness of mental action, slower and less vigorous speech as well as ideation, fewer blood-corpuscles red and white, lessened power of nutrition in all the tissues, a tendency to disease of the arteries, a lessening in bulk of the whole body, but notably of the brain, which alters structurally and chemically in its most essential elements, the cellular action and the nerve currents being slower, and there being more resistance along the conducting fibres.

In the young man there is an organic craving for action, which, not being gratified, there results organic discomfort; in

The senile heredity, therefore, was little more than half t ordinary average heredity.

The form assumed by the different cases is a questi great interest. I confess I was myself astonished at the imevariety of mental symptoms present. Till I had these 203 f analysed, I had not fully realised either the character or u! results of treatment of the disease. Looking first at the sence or absence of mental depression or mental pain, I = that 69 of these cases, or about a third, were depressed, classified by me as labouring under melancholia. To feel pa mental or bodily, the brain needs to be to a certain ext sensitive and active functionally. But the peculiarity of c of the cases of senile insanity was, that the mental depres was merely outward in muscular expression, not being fi any proper subjective sense, and it was certainly not renes bered. It was, in fact, automatic motor misery, and not e scious, sensitive, mental pain. One of the cases lately u my care illustrates this very well :-L. A., æt. 83 at death. E mental power had been failing for three or four years. At i there was failure of memory, irritability, exaggerated opinions. himself, morbid suspicions, sleeplessness, restlessness, and la of self-control. These symptoms gradually got worse, until h memory was quite gone, and he did not know his age, or b wife, or his home. Yet his appetite was good, his health some respects better than it had been before, for a gouty tea ency had disappeared. He looked fresh and well, and le muscular strength in spurts was very great indeed. He had year or so after the beginning of the attack, a sort of her plegic attack, transient and slight; and ever since it began, an going along with it as one of the symptoms of the diseas there was a slight indistinctness of speech, a want of moto activity and perfect coordination in the articulatory muscles, change in the tone of the voice in the direction of feebleness, I difficulty in finding words, a tendency to stop in the middle of sentences, an omission of words, especially nouns-in fact, the typical senile speech, with its mixture of aphasic, amnesic, and

paretic symptoms. The senile speech I look on as just as characteristic as the aphasic, the general paralytic, or the hemiplegic speech, and just as illustrative of brain function. He had all the signs of advanced atheroma of his vessels.

About the middle period of his disease, his memory was quite gone for recent things, and you could scarcely engage his attention for more than a few seconds on any one subject. At times, in fact mostly, he showed a kind of happy negative contentment. If you could get the thread of his old life, he would tell old stories, make speeches, and look as wise as possible; but all this time he did not know who you were, or where he was, or the day of the week, or the month, or the year, or what he had for dinner. Then suddenly, without any outward cause, a change would come over him. He would look most miserable, would moan, and groan, and weep (tearlessly), wring his hands, uttering disjointed exclamations of sorrow; but he could not tell you what grieved him, and in a minute or two he might be quite cheerful, and he remembered nothing about it, denying that he was at all dull or ever had been so. Or he would at times suddenly, causelessly, become intensely suicidal, trying to strangle himself, running his head against the wall, or clutching his throat with his hands. In that condition you could not rouse his attention. He was, in fact, practically unconscious, and when controlled or prevented carrying out his suicidal attempts, he would struggle and resist desperately and unreasoningly. At other times he would have sudden homicidal attacks. But in half an hour after all this he would be calm, chatty, and utterly oblivious of everything that had occurred. The whole thing in fact, the pain, the suicidal and the homicidal impulses, were so many automatic acts unaccompanied by motive, reason, or remembrance, and were the mere motor signs of some organic discomfort. All his worst symptoms used to come on at night, when he would become noisy, restless, shouting, resisting, and quite unmanageable, alarming the household and neighbourhood. The continuance of those symptoms wore out everyone con

nected with him. Of all forms of insanity, the senile is apt to become most aggravated at night. It might be supposed that there could scarcely be any conceivable circumstances under which a man of that age, with means enough to procure proper attendance, would have to be sent from his own home. Yet those circumstances occurred. Home treatment was a failure, and could not be any longer persisted in. Certainly he did better in a villa of the asylum, with plenty of fresh air and regulated exercise "little and often," regularity of life, lots of milk and eggs, and digestible, plain food, and good skilled attendance; getting fat and sleeping far better. But of course he slowly got more enfeebled in mind; his suicida impulses became less intense, his noise at night less, and his resistiveness more controllable, but his motor restlessness remained. All his symptoms were irregularly periodic and remissional. For months he would be quiet, and then would have a few weeks of motor excitement, and night noise, and impulsiveness. What is the cause of these aggravations in senile cases, and they are very common, almost universal! I really do not know. I presume one must look on them as being partly mere action and reaction, activity and exhaustion simply. In such a case we can have no reproductive perioli city to deal with. He died of simple senile exhaustion, but with resistance to feeding, restlessness, and noise to some extent, up till three days of his death.

It is very difficult to know how to classify such a case symptomatologically. There was undoubted dementia, and there was maniacal excitement. There were all the outward signs of suicidal melancholia, and the symptoms of true impulsive insanity. I adopt the rule, that wherever there is marked mental pain, or the outward signs of it, the case is put down as melancholia in our books. L. A.'s case is a typical example of pure senile insanity of the melancholic type. But many of the cases of senile insanity classified symptomatologi cally as melancholia were entirely different from this case Several of them were cases of simple melancholia that proved