dementia is still incipient or has only made a little progress that any difficulty can arise, just as it is only in the least-marked degrees of imbecility, and in the partial forms of mania that there can be any necessity for so minute an examination. In all cases it is well to ascertain the state of the patient's general health, and to note whether the complexion is pale or florid, dusky or bronzed. The skin ought to be examined, and the temperature carefully taken, and the condition of the pupil and retina ascertained. Inquiries ought to be made into the state of the digestion, as to the appetite and bowels, and, if the patient is a female, as to the state of the menstrual functions. The tongue, of course, ought to be examined and the patient's sensitiveness of skin, and sensibility to heat and cold tested. Enquiries ought also to be made with reference to the patient's sleep, as to whether it is sound and tranquil, or light and broken.

In many cases it will be expedient to examine the letters and other writings of the patient. Many men "write themselves down" asses. They are off their guard when they are writing to some friend, and they are not under the restraint of a personal presence, or tempted to the dogmatic reticence by the questions that are put. Timid people will be bold in a letter, and insane persons will often betray their delusions in ink. A comparison between letters of a supposed lunatic during the time of the alleged insanity, and before its inception, will often prove useful.

Something must be said concerning the slovenly way in which certificates are filled in. It is a somewhat curious fact that a training which ought to make men accurate-such as a systematic study of medicine-should have the directly opposite effect. Perhaps it is, as Bacon says, writing that makes an accurate man, but one thing can be said with confidence, and that is, that medical men are most inaccurate. We were once present in a class of Medical Psychology and Mental Disease while its pupils, who were young men who had just taken their degrees, were being exercised in the filling up of certificates. The certificates when filled up were submitted to us, and we regret to say that, out of the eighteen or twenty which were submitted to us, not one was correct. They had, it appeared to us, in every case, neglected to read the rubric directions, as to how it was to be filled up, with anything like rational care. The following statements which we have procured from an asylum case-book, and which were in the certificates given under the head of "facts indi

cating insanity observed by myself," will farther illustrate, and will go far to prove, this assertion.

One medical man gives as a fact indicating insanity observed by himself" She seems to be a person of very deficient intellect, and lives alone with an old woman who is intensely deaf;" another, "laughs in an incoherent manner;" another, "answers to any questions that may be put to her, and desires to be on the open sea;" another; "that her lips are in motion as though in mental conversation;" another, "commenced laughing for a considerable time;" and still another put "an excitable aspect and oblivious manner." All these indicate a considerable amount of incoherence at least in the medical man, and the absurd solecisms and bad grammar are too obvious to require mention. We will quote one other example that has been supplied us. "She is," says the medical man, speaking of the patient, "at this moment exclaiming vehemently about death, and the skies, and all sorts of incoherent subjects; that she is violent and intractable. I have a medical certificate before me of the patient's insanity: it appears to be distinctly puerperal mania."

From this we gather that, in the opinion of this medical man, "death and the skies" are "incoherent subjects." What is meant by "incoherent subjects" we do not profess to understand, any more than we know what a "mental conversation" or an "incoherent laugh" is. But we learn more, that a "medical certificate" may be distinctly puerperal mania" that all these things are facts, that they indicate insanity, and that they have been observed by this highly intelligent medical practitioner.

If medical men would read the marginal notes which are appended to the printed form which they are required to fill in, and if they would pay some attention to what they read, these stupid mistakes could not arise: It is best to form every statement of fact into a sentence, and to be careful that, when speaking of what you have yourself observed, you do not introduce matter which has been communicated by others. Vague terms are to be carefully avoided; and opinions are never to be stated as facts. The necessity of the statement of such rules is shown by the above instances of blunders.

One word may be added with regard to the appearance of a medical man as a witness in court. It need scarcely be pointed out in this place that all definitions of insanity are to be avoided. Many things

cannot be defined, but may be described. The diagnosis of a disease does not lie in the recognition of one symptom, but in the recognition of a large number of symptoms in a certain combination. Yet upon these very points counsel will attempt to shake the evidence of medical witnesses. Some medical gentlemen have been so foolish as to attempt definitions of insanity in the witness box. And the result might have been anticipated; they failed in the attempt; they were laughed at for their trouble, and the evidence they gave upon other points lost the weight which ought to have been attached to it. It is well never to attach too great importance to one symptom. It is much safer to refuse to regard any circumstance as in itself a satisfactory diagnostic symptom. In that case the medical witness is in the stronghold of opinion. Opinion is impregnable. Scientific facts, when stated with the inferences drawn from them, are food for forensic powder, Refuse to acknowledge the efficacy of special tests, They are much prized by lawyers, as they impress a jury, but it is beneath the dignity of the profession to stoop to what is only a kind of scientific claptrap. It is well not to form an opinion without having had sufficient opportunities of judging, and in all cases more than one visit ought to be paid to an examinee, and sometimes it would be well that the patient should be under the care of the medical man, who would speak with accuracy as to his sanity or insanity, for a considerable time.