Mr. President and Gentlemen,—Whilst I feel very much honoured by the presence here to-day of the members of the Medico-Psychological Association of Great Britain and Ireland to listen to a paper from me on the “Cerebrospinal Axis as a Thermal Centre and Water Power,” I am, I confess, not a little anxious respecting the result of my labour. I know I stand before a body of listeners who, from their daily avocation as well as from their accomplished training in mental and physical science, form naturally the most critical audience I could address on the subject to be discussed, and this alone is a cause of grave concern. But there is something more before me. I am about to bring forward an entirely new line of research and observation in so elementary a stage that the simplicity of the thesis itself may, at first sight, seem to imperil its âceptance. I must, therefore, with special emphasis, claim, at the onset, your kindest indulgence.

Dr. Hughlings Jackson remarks that in every case of insanity there are negative lesions of the highest centres, which cause some paralysis, sensory or motor, or both (“Journal Mental Science,” October, 1888). Evidence that this is so has been brought forward by him, principally, however, in relation to the insanity of epilepsy and postepileptic states.

Ten years ago Mr. Jonathan Hutchinson said that the description of a fresh diathesis was almost as easy as the discovery of a new nerve centre or the revelation of a new bacterium. Yet no new diathesis, so far as I know, has since then become generally recognized in our special branch of medicine. To-day the neurotic diathesis stands as god-mother to a large family of diseases, and little has been done to differentiate their ætiology, or to trace their genealogy. On the contrary there seems to be a tendency to exaggerate the importance of environment in the ætiology of many of the diseases of the nervous system, and to ignore the hereditary factor. Especially is this the case with general paralysis. Excepting the writings of a few, a course of reading on the ætiology of general paralysis would incline one to believe that there is no evil under the sun—from syphilis to the cessation of lactation—that may not sufficiently account for the onset of that disease. It seems almost as if the observers had first tried to find an acknowledged raison d'être, and, failing in that, had adduced as “cause” anything in the recent history of the patient at all out of the common, or which had ranked as important in the estimation of his friends.

The population of Norway in 1875 consisted of 891,000 males and 930,000 females. (The details of the last census, 1890, showing a population of two millions, have not yet been published). Of these were insane 2,186 males and 2,382 females, giving a ratio of 23 insane (20·4 males, 25·6 females) to every 10,000 of the population. The total number of admissions into asylums for the year 1889 was 756, a ratio of 4·15 per 10,000. These figures compare favourably with those given in the report of the Commissioners in Lunacy for England for the same year, viz, 29·2 insane (27·2 males, 31·2 females) to every 10,000 population, and a ratio of 5·18 per 10,000 on the admissions. Although Norway is a poor country, such extreme poverty and distress as is found in our large cities does not exist there, and this, probably, accounts for the considerably smaller ratio of insane to population. Of the 756 total admissions 32 per cent, were suffering from melancholia, 27 per cent, from mania, 24 per cent, from dementia, and from general paralysis and epilepsy, equally, 1·9 per cent. The marked preponderance of melancholia over mania is interesting, the opposite conditions obtaining in this country, where mania shows an excess of 24 per cent. The distribution of a small population over a large tract of country, the mountainous character of that country, the monotony of life, the lack of amusement, the phlegmatic character of the race, in contrast to the crowded condition of the people, the high tension of living, and the excitement of city life which prevails in this country probably explain the difference. The small number (1·9 per cent, of the admissions,—being 6·4 per cent, less than in England) of those suffering from general paralysis might be explained in the same manner.

In the remarks which I am about to make I wish it clearly to be understood that, as I personally am not an accounting officer under the Act, I have no personal grievance to ventilate. In this asylum, not only I, but the other officials whose duty it is to make returns of an official nature, have always done so honestly, readily, and fully; and speaking not only for myself, but for others, we have formerly made, and hope in the future to make, all such returns in such a way as to comply with legal requirements, not only in the letter but the spirit of the law. And in such remarks as I make on our audit here, I wish to express myself plainly, but, at the same time, without the slightest suspicion of personal feeling to the auditor, who, I believe, acted conscientiously, and according to what he considered was the meaning of the law on the subject. At the same time, I doubt whether an auditor (in whom no legal or other qualifications are a necessity) is the fittest person to have the decision as to what is legal, expedient, and proper in the expenditure of a large county asylum. At present auditors certainly seem to think that their reading of the Lunacy Act should be accepted, no matter what the opinion of the committee and their legal advisers may be; and by surcharging items, they have it in their power to put committees and officials to such trouble that even if expenditure were proper, right, and in the interests both of the sane and insane inhabitants of asylums, yet one would hesitate about it with the knowledge of the correspondence, trouble, and annoyance which it might entail.

In the preceding part of this paper we considered what may be called the substantive provisions of section 330 of the Lunacy Act, 1890. We now pass on to the adjective part of the section. Suppose that a medical man, against whom an action for damages for the alleged false imprisonment of an alleged lunatic has been raised, is in a position to satisfy the Court or a Judge that “there is no reasonable ground” for imputing to him “want of good faith or reasonable care,” when and how shall he avail himself of his statutory privilege? Upon these important points section 330 displays the vagueness that is almost a characteristic of modern legislation. The only information that it gives us is that an application to stay proceedings may be made “summarily” (a term of which no definition is offered or even suggested) to “the High Court,” and that “the Court or a Judge” may grant or refuse the application “upon such terms as to costs or otherwise” as the said Court or Judge may think fit. Now, in the absence both of any clear light from the section itself and of any authoritative judicial interpretation of it, the maxim Omnis definitio in jure periculosa est applies with peculiar force, and consequently the following observations are offered with some hesitation.

The first fifty cases in which the writer made use of sulphonal have been selected for analysis. The drug has since been freely used by him in many other cases, which are here excluded from consideration; the results in these cases, it may, however, be stated, have been very similar to those afforded by the earlier ones.

R. P., æt. 61; married. Admitted into Wakefield Asylum March, 1885. Formerly labourer in a mill.

It was said that patient had been very intemperate, and that his wife and daughter had contracted venereal disease from him. His mother was stated to have been paralytic for several years before death. This is the only instance of family neurosis.

It is very possible that if medical men were asked to give an account of cases of insanity treated by them in general practice many, especially those who have given attention to the subject, would be able to show some good results. As, however, they do not have the accessories for successful treatment in every case, such as specially-trained nurses, the quietude and repose of asylum life, freedom from the worries of friends and relatives who, from want of judgment and tact, often do much harm, and from whom it is impossible in private life to isolate the patient entirely, physicians in general practice cannot be expected to be able to do so much as those engaged in asylums.

The patient was a well-built man with florid complexion, 70 years of age. He had been in the Crichton Royal Institution for 18 months as a voluntary patient, and was subject to periodic attacks of nervous excitement, during which he was restless, unable to keep still for a moment, had spasmodic movements of the arms and legs, and lost his appetite. When free from excitement he was able to take long walks and never complained of dyspnóa. The action of the heart was usually steady and regular, but towards the end of an attack of excitement it became rapid and feeble. A mitral presystolic murmur had been present for some years. He died suddenly one morning during an attack of excitement. There was a history of gout.

Through the kindness of Dr. Conolly Norman, I am enabled to report the following case of spontaneous cardiac rupture.