Gentlemen,—In taking the chair of this Association allow me to offer to the members, whether present or absent, my sincere thanks for the honour they have done me in electing me their President. I frankly confess that I was not at all prepared for this honour, nor do I see quite clearly even now how it came about that a body of men devoted, both by personal tastes and by official position, to the cultivation of one particular branch of the great medical art and science, should have thought fit to honour with their confidence one whose relations with that special work are only those of the profession at large. At all events, it may justly be said that in having thus acted, you have most emphatically pronounced for the doctrine that the profession of medicine, and the healing art on which it rests, are one, and not manifold; and that as among the different churches, and even sects, we may hope to find a common Christianity, so among all the distracting specialisms of our own profession, we may reasonably hope to find one faith, one object, one discipline of the mind, and, to a great extent, one great science, both of mind and of bodily function, underlying all the diversities of our various careers as physician, surgeon, gynæcologist, oculist, aurist, alienist, &c.

If I fix a square peg into an oblong hole, the fact that they do not fit is instantly perceptible; but it is manifest that the. several percepts of the peg and of the hole must precede the perception of the relation of non-adjustment subsisting between them. Furthermore, if I want to determine how much the peg lacks in size, I must measure separately both the peg and the hole before I can calculate the amount of the hiatus between them. What is true of this simple case of adjustment is true of the complex case of the adjustment of the organism to its environment. However rapid and apparently immediate may be the cognition that a patient is insane—is unadjusted to his environment—yet that cognition must be preceded by a previous knowledge both of the organism itself and of the environment with which his adjustment has failed. The truth of this statement, which is involved in the definition of Insanity, may not be at once apparent, but a little consideration will render it clear. It is manifest that before pronouncing a man insane, we must first know something about him, but that we must also take into account his environment is, perhaps, not so self-evident.

A study of the so-called reflexes, both superficial and deep, is of considerable interest in general paralysis of the insane. Of these the knee-phenomenon, knee-jerk (Gowers), or patellar tendon-reflex, is one so easily examined, so well known, and of such valuable import, that what follows will mainly be devoted to the consideration of this physiological phenomenon.

Only since advancing science has demonstrated the true connection between mind and body, and dispelled the illusory fancies of metaphysicians, has a rational philosophy sprang up regarding the nature of mental processes. The study ot psychology having at length been placed on a proper basis and freed from the spiritualistic haze with which it has so long been shrouded, there is now great reason to hope that much may be accomplished in elucidating the various phenomena of mental disease. No study of insanity that is not founded on a physical basis can be of any real value in throwing light on the many phases of mental disorder, or in assisting to a knowledge of the proper method of treatment and management of the insane.

The conditions established to regulate the admission of patients into lunatic asylums have given rise, in every country, to a great deal of discussion. On the one hand, many unacquainted with medicine are inclined to dread the abuse of the power to confine individuals not really insane under the pretext of insanity, and with more or less criminal intent; therefore these persons contend that admissions to asylums should be preceded by intricate formalities and repeated inquiries, with the interference of some public authority, such as a commission of either judicial or administrative officers. On the other hand, physicians advocate the necessity of prompt recourse to an asylum, not only for the patient's own benefit, but for his family's welfare; they demonstrate that a man labouring under acute insanity cannot be left to himself during the time required to set in motion the working of such complicated machinery as that proposed to be brought into action prior to his admission into a hospital; they further reject all interference of the public authorities to this end, as hurtful to private family feeling and the maintenance of professional secrecy, demanding, likewise, the greatest facilities for easy admission, guaranteed, nevertheless, by any number of subsequent examinations, or other means of inquiry into the case; and, finally, they hold that such supposed illegal confinements do not exist, since it has not been proved that any one really of sound mind has ever been shut up in any asylum, and that, therefore, the liberty of the subject is in no danger whatever. So in this respect we may rest confident, seeing that the past gives us full assurance for the future. Such is, upon the whole, the main point of dispute in every discussion on the subject, which happens to spring up again and again in different countries.

“Tödtung des Dienstherrn im Zustand Krankhafter Bewusstlosigkeit (Friedreich's Blatt für Gerichtliche Medicin,” 4 Heft, 1881).