General paralysis is common in our large cities, and assumes so many disguises that it is necessary to be ever on the alert for it. About a third of the male admissions to asylums between the ages of thirty-five and fifty suffer from it, and the possibility of its presence should always be remembered in the case of a man of this age presenting mental symptoms. Such men are usually the heads of families, and occupy positions of responsibility, for as a rule those who suffer from general paralysis are no weaklings. The social troubles and inconvenience produced by the occurrence of adolescent or senile insanity, bad as they may seem, are therefore trivial compared with those produced by a disease such as this, which attacks the bread-winner of a family and the head of a business in the prime of his life.

The title of this brief paper will be familiar to many of you as the heading to letters which have recently appeared in several successive numbers of the British Medical Journal. Some of the letters have been signed with the full name of the writers, others with a pen name. They have all been characterised by moderation of language in the presentation of the case in which the writers and many others are deeply interested. For some time past I have felt strongly that something should be done to improve the position of assistant medical officers of asylums, and am in full accord with the work of the Committee of this Association, who have recently furnished an interim report upon this subject. A further report will doubtless soon be forthcoming upon the financial and social position of assistant medical officers, and it is this view of the case which I desire to place very briefly before you this afternoon.

At the request of the Council, and with your permission, I propose to lay before you this afternoon the following points for your consideration: firstly, the importance of organised after-care in cases discharged recovered or relieved from mental disorder; secondly, the lamentably small proportion of these discharged cases which are brought under the notice of those engaged in after-care; thirdly, the limitations imposed by the constitution of this Association in its practice of after-care; and lastly, certain suggestions—partly the outcome of conversations with your Secretary, Mr. Thornhill Roxby—with a view to increasing the scope of the Association's work.

“Let us examine,” says Swift, in his “Digression concerning Madness” in a Tale of a Tub, “the great introducers of new schemes in philosophy, and search till we can find from what faculty of the soul the disposition arises in mortal man of taking it into his head to advance new systems, with such an eager zeal, in things agreed on all hands impossible to be known; from what seeds this disposition springs, and to what quality of human nature these grand innovators have been indebted for their number of disciples; because it is plain that several of the chief among them, both antient and modern, were usually mistaken by their adversaries, and indeed by all except their own followers, to have been persons crazed or out of their wits; having generally proceeded in the common course of their words and actions by a method very different from the vulgar dictates of unrefined reason; agreeing, for the most part, in their several models, with their present undoubted successors in the Academy of modern Bedlam … Of this kind were Epicurus, Diogenes, Apollonius, Lucretius, Paracelsus, Des Cartes, and others; who, if they were now in the world, tied fast, and separate from their followers, would, in this undistinguishing age, incur manifest danger of phlebotomy, and whips, and chains, and dark chambers, and straw.” So wrote the greatest satirist in his pungent and acrid way; and there can be little doubt but that, had he lived to become acquainted with some of Swedenborg's later writings, he would have classified him among that miscellaneous group of “others.” It may seem to some a work of supererogation once more to state the facts which lead to this conclusion; but it is hoped that they will realise that in this recapitulation the object is not to asperse the reputation of a great man, but, by setting forth the story of his life, to show why it was that so great a change was wrought in him, and why he turned from the scientific pursuits of his earlier years to the visionary speculations of his later days. By undertaking such a work a writer is certain to incur the odium of those who rigidly maintain their unshaken belief in the sanity of their prophet; that is regrettable, but regrets will not alter facts.

Forty years ago at Hampstead Asylum under the Metropolitan Asylums Board, an attempt was made to give the patients under sixteen some instruction in music and singing and also in simple work in school—an idea borrowed from Earlswood Asylum. This was apparently so successful that the Board suggested the building of a schoolroom and shoemaker's and tailor's shops.

Some forty years ago, Dr. Bruce Thomson, the first resident surgeon to this prison, contributed to the medical journals a series of observations upon over 5,000 prisoners. He dealt chiefly with the more obvious physical defects which, to his thinking, supported the theory of the existence of the instinctive criminal, and though his observations were somewhat generalised, he was rightly regarded as a pioneer in the science of criminal anthropology. He also drew attention to the prevalence of weak-mindedness among juvenile prisoners, and stated that as much as 12 per cent. of all prisoners required special observation soon after admission because of mental defect. There is little doubt that in his time the old method that consigned all forms of disordered conduct to prison still persisted, and many changes have since taken place that would tend to diminish his percentage. Prison discipline is still, in spite of its mildness, largely credited with bringing into prominence many symptoms that are put down to mental defect. It would be reasonable to look for a considerable reduction in the numbers of weak-minded persons in prisons during a period when prison administration can conscientiously take to its credit the fruits of a progressive spirit that is not, however, readily granted to it by many whose reforming enthusiasm takes no thought of the spade-work that has preceded their own awakening. The psychological point of view is prominent in the most recent methods of dealing with the criminal. Preventive detention for the habitual, probation for the first offender, Borstal training for the juvenile delinquent, etc., all recognise the mental aspect of the offender as fully as any system that can be evolved by the mental pathologist. That the mental abnormality of the habitual major offender is a more complex affair in its origin and treatment than is insanity will, I am sure, be amply verified by the future experience of the preventive detention institutions, where grave disorder can only result if the treatment views too much in this light of irresponsibility the vicious tendencies of the inmates. From whatever point of view we look upon the habitual and professional criminal, it is certain that many of this type may be safely left to the law which is rightly concerned with the protection of the public, and continually progresses in an endeavour to fit the punishment to the individual.

The 100 cases were reported from Stafford Prison between the dates September 26th, 1911, and August 20th, 1912, i.e., a period of about eleven months. During this same period, there were received into Stafford prison 2807 males and 611 females (excluding debtors, and penal servitude prisoners who were sent to Stafford from other prisons). Some allowance would have to be made in these figures for the same individual having been received more than once during the period under review.

The question of suicide is one that has exercised the minds of most persons at one time or another, as cases are of such common occurrence, and present such a variety of features, that anyone interested in present-day social conditions cannot fail to give the matter some amount of consideration.

The prime importance of classification of patients in asylums with a view to securing the best results of treatment cannot be denied. By classification is meant, not a rigid division of patients strictly according to their form of mental disorder, but rather a selective grouping of patients in wards and villas, where the amount of supervision, the nature of treatment, the extent of freedom and the general environment is best calculated to promote recovery, to discourage mental excitement, and to secure contentment and the highest possible standard of conduct in each case.