The cause of the Imbecile has for some time past been a plea which has never failed to elicit the practical sympathy of the public; yet much remains to be done before we have fulfilled our obligation to those who are not lunatics, and are capable, under suitable conditions, of being made self-supporting members of the community. As in this paper I intend to deal chiefly with the future of the improvable imbecile, I think that in the first place the statement that such an individual after training is independently capable of earning his own livelihood is as absurd as it is impossible. I shall presently endeavour to show that without supervision little or nothing can be expected from an imbecile, however highly trained and educated he may be; his whole disposition and temperament away from control completely negatives the supposition, and actual cases have proved that, unless under sympathetic and intelligent guidance, the life of the imbecile as far as usefulness is concerned is not only a blank, but that the individual himself is a burden, and in some instances a nuisance to society and his friends. Secondly, there can be no doubt that much of the careful and patient instruction bestowed upon such cases at the educational establishments is wasted, for the simple reason that at the expiration of their term there many improved imbeciles gravitate to conditions totally unsuitable for them, and under which it is almost impossible to expect that the training which they have received will, so to speak, have a fair chance. On completion of their term of training it may be that in some cases the parents are dead, and there are no relations or guardians to look after them; for a large number there is nothing but the workhouse. Again, their imbecile temperament causes others, perhaps in a moment of pique, to abandon the work which has been obtained for them possibly only by a vast amount of trouble, and they thus become a burden to their relatives. A third section are, away from supervision, incurably vicious, and many in the course of their career become gaol-birds and convicts. The imbecile is one who is totally, or in part, bereft of the faculties necessary to enable him to take a successful part in the battle of life, and I think that it may be safely assumed that, in the whirl of this nineteenth century, with its attributes of high pressure and overcrowding in every direction, the imbecile can of himself secure no place. His appearance, his mental and often physical deficiencies, are all dead against him, and his unstable equilibrium, manifested in uncertainty of temper and morals, renders him in many cases quite unfit to be trusted away from proper care and supervision. In fact, it is unjust and unfair to forget this by exposing these individuals to risks by trusting them too far.

During a period of nearly twenty years' management of a private asylum for middle-class patients, and a like period of consultation practice in our specialty, I have had constantly brought to my notice the difficulty—very often, indeed, the impossibility—of finding proper accommodation for insane patients unable to pay fees of more than fifteen to twenty-five shillings per week, and the difficulty has vastly increased with the increasing numbers of pauper lunatics who now crowd out the already very small number of private patients provided for in county and borough asylums.

The necessity of a cognizance of those Acts of Parliament affecting asylums in their capacity as large employers of labour has become more obvious of late by the operation of an Act which came into force in July last—“The Workmen's Compensation Act”—where, for the first time in British law, a responsibility has been cast upon an employer to pay damages or compensation for personal injuries which are not the result of any negligence or other unlawful act, either of himself or his servants for whose conduct he is legally responsible.

Whilst it is the object of this paper to deal with the subject in the main as limited by the title, it is well that some consideration be given to the general literature bearing upon the relations between diseased conditions of the uterus and appendages and diseased conditions of the mind.

It is now about four years since Drs. Bruce and Macphail first published the results of their treatment of cases of insanity by thyroid, and since then the new drug has been used very extensively in the Royal Edinburgh Asylum. Dr. Bruce has published the results of his further experience there, and though they are not quite so encouraging as those first carried out at Derby they have furnished several remarkable cures, and have shown conclusively that in thyroid we have a decided addition to our means of treatment.

I feel that some apology is due for again opening a subject which seemed to have been disposed of by the report of a special committee of this Association, which sat at the latter part of the year 1894.

I desire to-day to show, to some extent, the difficulties the general practitioner of medicine has to contend with in the treatment of lunacy; difficulties certainly unknown in public asylums, and only partially appreciated in private institutions.

In a reprint from the Neurologisches Centralblatt, No. 21, 1898, Dr. Paul Flechsig gives us some further investigations on the development of the fibres in the human brain. In his examinations he has used forty-eight hemispheres belonging to twenty-eight brains of all periods of early life, from the fótus of seven months to the child of fifteen months. He thus sums up the results to which he has arrived.