In the discussion which followed, Dr. Cahill warmly-supported the suggestion for the separation of the specially mental diseased from the hopelessly insane. He said that it sometimes happened that people of whom there was some hope of recovery became permanently insane on being incarcerated in our asylums. He generally supported the reforms suggested in the paper.

Dr. Fell, in seconding Dr. Collins's motion, said he had listened with the greatest interest to the paper, the writer of which, it was very evident, had been animated by the purest humanity. He had never listened with greater pleasure to a paper, and he thought the Government must give the most careful consideration to the suggestions put forward. He was not against the first examination of suspected lunatics at police stations, but thought "hospital" did not suggest safeguarding and forcible detention.

Dr. Mackie said the subject of lunacy reform should be of still greater interest to the public than it was. In some cases the future of large families depended upon not only the accuracy of the certificates of the consulting doctors, but also upon the treatment in the asylum-The public was greatly indebted to Dr. Collins for his suggestions, and it should insist upon the carrying of them out, especially in regard to separate institutions.

Dr. Symes cordially agreed with the suggestions, but a so agreed with Dr. Fell that the change of term from "asylum" to "hospital" lost strength from a detention point of view. He suggested colonies rather than asylums for epileptics and imbeciles. Sooner or later we would have to take steps to prevent our criminals and lunatics propagating their species. (Here, here.) He suggested an easy method of doing this, and maintained that it was for the safeguarding of the State that it should be done.

Dr. Grace said that 27 years ago he publicly advocated lunacy reform. The people and the Legislature thought there were no other public interests beyond the roads and bridges. He was astonished at the wonderful results obtained by the medical directors of the lunatic institutions—results due to unwearied patience and industry. It seemed hopeless to look for satisfactory results under overcrowding.

Dr. Cleghorn spoke strongly upon the need of classifying the curable and the incurable, and thought the time was opportune for the agitation so ably suggested by Dr. Collins.

Dr. Collins's resolution was carried unanimously.

Dr. Barnett said that Dr. Collins's paper was the most important, from the scientific point of view, that the Congress had yet had before it. In addition to the motion put forward by Dr. Collins, he moved—"That a printed copy of Dr. Collins's paper, with a report of the discussion thereupon, be sent to the Inspector-General of Asylums, with a request that it be brought before the proper authorities." This resolution was carried.

On the motion of Dr. Grace, it was resolved—"That a deputation consisting of the President, the General Secretary (Dr. Campbell), the Parliamentary Secretary, and Drs. Collins (Wellington), Symes (Christchurch), Cleghorn (Blenheim), and Barnett (Dunedin), wait upon the Premier and urge upon the Government the necessity for lunacy reform."

It was decided to meet at 10 o'clock to-morrow morning, when Dr. James will make some observations on public health.

The Congress then adjourned.

Deputation to the Premier.

On the adjournment of the Congress the deputation appointed on the subject of lunacy reform waited upon the Premier, being introduced by the Association's Parliamentary Secretary (Dr. Mason).

Dr. Collins read the Association's resolution, and reviewed the paper read by him upon the points of suggested reform.

Dr. Symes pointed out the extreme importance of the suggested observation ward.

The Premier, in reply, said he was pleased to meet the deputation, and it must be satisfactory to the people; that the Congress had considered the matters brought under his notice. He had been greatly interested in Dr. Fell's paper on cancer, and the increase of the disease was a matter of concern with the Government. Whilst there was nothing to be alarmed at, every precaution was being adopted, and he had no doubt that the steps now being taken with regard to tuberculosis would prove largely helpful. In the matter of overcrowding of the asylums, he was especially glad that such a non-political body as the Medical Congress had brought it before him, especially as it had recently been a subject of an attack upon the Government. Seeing that the Government had spent large sums of money to meet this difficulty, what must have been the state of the institutions before his Government came into power? He must put the collar on the right horse, and tell them plainly that he considered the medical fraternity were largely to blame for putting many people in the asylums who were simply suffering from old age. These old folks should be supported by their relatives, and they had no more right to be in the asylums than he had. People had them put in to avoid keeping them. If a Royal Commission were appointed it would be found that the large increase of inmates in the asylums was due to this cause. Therefore, he was pleased to note the suggestion as to classification. He claimed that his Government had done more for the lunatics of the colony than any other previous Administration. They were now making additions and alterations at Porirua, Nelson, and other places, which must provide ample accommodation. As to hospitals, they had no authority at all over those institutions. What was the good of sending an inspector round to hospitals when he had no authority? the State was giving 24s for every £1 contributed by the public, and there its connection ended. Then-should be a grave responsibility cast upon the medical profession in regard to lunacy certificates. There should be two forms to be filled in—one showing that there was a chance of the subject not being a lunatic, and the other for committal. He quite concurred in the suggestion for an observation ward at the hospitals. If this had been provided years ago there would now be fewer inmates in our institutions. Once people were put in the asylums, who was to get them out? That was where the classification would come in for the future. In regard to lunacy, he ventured the opinion that in this colony we were suffering from what he might call the effects of a vigorous public works policy, and the "breeding-out" suggestion of Dr. Collins would meet this class of heredity. He quite agreed with the deputation as to the separation institutions, but it came to a question of £ s d. Yet money spent in this direction would be money well spent. After a complimentary comparison of the medical profession of this colony with the practitioners of other colonies, the Premier assured the deputation that the Government would give its suggestions careful consideration.

Dr. Cleghorn, as an old immigration officer, bore out Mr. Seddon's statement with regard to some classes of people who came to the colony during the "vigorous public works policy," some of whom were by no means desirable.

Dr. Mason thanked the Premier for his readiness to meet them and his courteous and satisfactory reply, and the deputation then withdrew.

Evening Post Typ.

care and treatment hut you are not certain and you refuse to sign you do an injustice to the patient and to the community generally; if he is not a (it and proper person to be taken charge of and detained under care and treatment, and you sign his committal, you do an injustice to the patient, and you may have the worry and annoyance of having to defend your action in a Court of Law. The very fact of your being called upon to examine this class of patient means that they are suffering from some functional or organic disease of the brain or are supposed to be so suffering, and you ought to be allowed to suggest that the patient be sent to the special ward of a general Hospital for care and treatment until such time that they are cured of their disease, or until it is there ascertained that their disease is so far advanced that they should be committed to the Special Hospital for Mental Diseases. By this I mean that there should be some intermediate place, and I can only suggest the ordinary Hospital, where such cases would be under proper medical treatment and observation.

Can we recommend to the public or to the Government any means by which overcrowding in our special Hospitals can be prevented.

I have already touched upon the necessity of having an intermediate establishment for doubtful cases. I will cite one example of a case which appears to me to show the necessity for such a place.

A young woman was certified as insane and sent to an Asylum. The medical superintendent had her placed in a separate house, where she was carefully nursed and treated. In three or four weeks she recovered sufficiently to know where she was. She was told that she had been very ill, and that she was sent to the Asylum for treatment and change of air. In a short while she was able to leave the Asylum cured. Had she not been isolated, but treated in the Asylum itself with the other patients about her, in all probability her convalescence would have been delayed; possibly the effect of contact with incurable cases would have so affected her that she might have suffered a relapse and eventually increased the number of incurables. Instead of being cured in six or eight weeks she might have been a drag on the colonies' resources for 10, 15, 20, or even 30 years.

Before suggesting any other methods by which the congestion of our Asylums can be relieved, I would ask you to allow me to read from Dr. MacGregor's able report some of the chief causes of insanity in the Colony:— page 8

1.	Out of a total number of 466 cases admitted during the year 1896, in 125 the cause is stated as unknown. I think we may reasonably infer that if the true cause in those cases marked as unknown could be traced, we should find that in a large proportion of them there was some hereditary taint.
2.	The most frequent cause in the cases where the cause can be traced comes under the clause Congenital and Hereditary. Out of the 466 cases, 51 are attributed to this cause.
3.	Next to hereditary taint comes drink, which claims 47 out of the total of 466.
4.	Then in order of their frequency comes religion, 28.
5.	Evil habits, 25.
6.	Senile decay, 19.
7.	Worry, 19.
8.	Epilipsy, 14.
9.	Child-bearing, 11.
10.	Injuries to head, 9.
11.	Financial anxiety, 6.

There are many other causes given each of which claims a small proportion of the 466 cases. However, those given above are the chief causes.

Hereditary and drink stand out as being the most frequent causes of insanity.

Let it be clearly understood that I would not in any way interfere with the liberty of the individual, nor would I ask page 9 that the furnishing of the certificates be made compulsory. The object to be gained by asking these questions would be to direct the attention of the public to the fact that there are certain diseases which are hereditary, and that it is not advisable for families who have the same hereditary taint to intermarry. Not only does the happiness and health of the individuals depend on healthy marriages, but there is the duty that the individuals owe to their children, who, though yet unborn, have a right to demand that they shall not be loaded by a possibly avoidable hereditary taint. I will quote three cases which may be of interest:—

1.	Dr. O'Hara, at the Intercolonial Congress held in Dunedin two years ago, mentioned the case of a squatter who married his delicate daughter to a phthisical man, and who in the same year gave large sums of money for some rams by which he hoped to improve the breed and constitution of his sheep.
2.	Some years ago a man suffering from tuberculosis consulted me as to whether he should marry. He told me that the woman he wished to marry was delicate and was said to be in an early stage of consumption. I strongly advised him not to marry. He followed my advice. The woman died about eighten months ago. The man died some nine months ago. Had they married and had children, those children would have been left with an unenviable legacy.
3.	A man consulted me as to whether he should marry. Some twelve months previously he had contracted syphilis. He was not cured. I urged him not to marry for at least another twelve or eighteen months, and to continue treatment for that time. When he left me I was fully convinced that he would put off his marriage. Five or six days later I saw the announcement of his marriage in the marriage list in the newspapers. Had he told me that he would disregard my advice I should have been powerless to prevent him committing such a crime. The inviolability of professional confidence would have closed my mouth Such a man dared not have produced a medical certificate of health.

It is not an unusual thing for a man when he marries to insure his life. Every man ought to do it. When he insures he has to produce two or three reports from friends as to his page 10 health and habits. He has moreover to pass a careful medical examination, and if he is found to be a good healthy life he is accepted as a first-class life for the sum for which he desires to insure.

Is it too much to ask that when men and women marry they should produce certificates of health? Health and happiness not only for themselves but for their children depend upon their healthy marriage.

The next most potent cause of insanity is drink. Alcholism is known to be hereditary, therefore obedience to the law of heredity in this case would be beneficial. Education also is a powerful factor in reducing the tendency to drink. If it could be established in the minds of the public that it was a disgrace to indulge too freely in alcoholic liquors; if it could be recognised that it was, to use a school-boy's term, "bad form" to get intoxicated or to abuse the use of alcohol, it might lessen the evils of drink. However, it may be ignorance on my part, but I am happy in the belief that New Zealand is one of the most temperate countries on the face of the earth. Whatever may be his faults the young New Zealander is not addicted to intemperate habits as far as my observation goes. This may be due to the system of free education.

Is it right that inebriates, epileptics, and morphio-maniacs should be committed to the same establishments as the melancholic, the demented and the general paralytic? I think not. A separate establishment for this class of cases would be a great boon. Such an establishment would materially lessen the congestion of our Asylums, or, as I would rather call them, our Special Hospitals. A Special Hospital for such diseases could, I should think, be made self-supporting or almost so. At Seacliff, where the Government has 700 acres of land, there is ample space for such an establishment.

Lastly, I come to the question of classification. Referring again to Dr. MacGregor's report, in 1896 there were 466 cases admitted into our Asylums, of these 154 were discharged recovered, and 41 discharged relieved, making a percentage of recoveries on admissions of 39.82. Surely a very large percentage when you consider that these have recovered, although they have had to associate with the large number of hopelessly incurable cases, and it suggests that some method of separating the possible curable from the hopelessly incurable might tend to improve the percentage of recoveries, or, at least, to diminish the number of relapses. However, this question of classification is entirely one for experts.

In conclusion, I may state that the number of persons confined in our Asylums on 31st December, 1896, was 2,315. Probably, as the Asylums are still overcrowded, there are at the present time the same number resident therein. Those 2,315 of our fellow creatures who, from the very nature of the disease with which they are afflicted, require plenty of space for sleeping accommodation, ventilation, &c., are, according to Dr. MacGregor's report, confined in establishments which are overcrowded. They are absolutely helpless, and it is their very helplessness which appeals to us for our sympathy and help.

I beg to move, Gentlemen, "That the Government be urged by this association to relieve as soon as possible the congested condition of our Asylums."