Unquestionably the most usual and frequent ground for assuming a causal relation which is not immediately apparent is the similarity of the case in hand to other cases in which the causation has been ascertained. As it is the most frequent, so it is the most direct application of the fundamental Axiom of Causation, that Like causes in like conditions produce like effects, from which we obtain, by a logical process that is unknown to logicians, the immediate inference that Like effects in like conditions are due to like causes. It is by the application of this method not only that causation is most often established, but also that some of the most important discoveries of causes in the various sciences have been made. It is in perpetual use, both in the most recondite problems of science, and in the commonest affairs of daily life.

Ten years ago I was requested by the Secretary of the Medico-Psychological Association to open a discussion at the annual meeting of the Association on this subject. It was then regarded by some asylum medical officers as “the topic of the hour,” largely because of certain views on administration which I had expressed, and certain innovations in methods I had made at the Stirling District Asylum.

The sceptics maintain with some show of plausibility that medical treatment—the therapeutics of mental disorder included—has made little progress with the passage of the centuries; and that what is called progress is really pretentiousness, and is more verbal than actual. Some of the new schools of dogmatists certainly give reason for criticism of this kind; they bandy high-sounding phrases one against the other, until the plain man becomes confused with the welter of verbiage. It were invidious to specify too accurately. Each one according to his predilections can annotate the context. If he favours the neologisms of that school in which the new oneiromancy and the modified confessional bulk so largely in their dealings with the mentally disordered, he will exempt them from criticism; and he who considers that treatment should pass along lines less airy and less tenuous will, for his part, look elsewhere for firm ground from which to aim his darts at the flitting shadows beloved of the practisers of psychomancy. Yet, all this granted, a look backwards suffices generally to convince us that, when ephemeral and transient notions are regarded in their proper perspective, there has been a real and valuable progression towards clarity and truth—even, in some cases it may be, attainment. If there is, therefore, such good to be derived from this process of retrospection, one may be forgiven for directing attention for a short space to former times. As we look backwards, however, we are almost dismayed at the similarities which we notice between the errors and follies of those who lived many centuries ago and those of our time. At the first glance it appears that almost do we move in a circle. The same old errors, the same old superstitions in other guises. We are almost prevailed upon to say, with La Bruyère, “En effet les hommes n'ont point changé selon le cóur et selon les passions, ils sont encore tels qu'ils étoient alors,” more than two thousand years ago. There seems to be little abatement of what were designated as the “animal passions”; and along with that there has been an accompaniment of credulity which the few master-minds have not been able to overcome. Superstition holds its ground in many civilised communities, and as to war—in a time like the present—it is needless to speak. Yet withal we are prepared to maintain that enlightenment is being brought about.

The problem of hysteria, although for some years past it has engaged the special attention of the best neurologists and psychologists, is yet very far from being solved. The chief object which authors have had in view at recent congresses has been to obtain a satisfactory definition of this affection. A definition, however, as Claparéde justly observes, being only a citation of the characters which constitute the nature of a thing, should be the crown and not the foundation of the study of any malady. Hysteria cannot, then, be defined without first establishing the nature of this affection, without studying the mechanism of its morbid phenomena. Now, an essentially pathogenic study of this disorder has not yet been made. It has been supposed to be the consequence of a narrowing of the field of consciousness (Janet), the suppression in consciousness of painful impressions of sexual origin (Freud), of suggestibility (Babinski), of an exaggeration of the plastic power of the imagination (Hartemberg), of torpor of the organic cerebral mechanisms (Sollier), of a tendency to reversion, to atavism (Claparéde), of disorder of the cortical or sub-cortical reflexes (Raymond), of an exaggerated emotional reflex (Bernheim), of perversion of the highest cerebral functions (Bastian); but it has not been explained by what mechanism all these conditions are produced, and provoke the morbid phenomena. It is just here that the chief difficulty of all these theories lies; it is the point by which we may judge of their respective value. Even if we assume, for instance, that hysteria is due to a limitation of the field of consciousness, what, we may ask, is the primary cause which determines this modification of the personality? By what mechanism does a suggested idea or a painful representation translate itself, or become converted, into somatic phenomena, or into an exaggerated emotional reflex? It does not suffice to tell us that this affection is characterised by a flexile suggestibility or by an exaggeration of a plastic imagination; we require also an explanation as to what determines the plastic properties in the case of these patients. What is the cause which induces the torpor of the organic functions of the brain as in Sollier's theory, the disorder of cortical or sub-cortical reflexes as in that of Raymond?

The following investigation deals with 400 children (200 boys and 200 girls) between the ages of 7 and 14, considered by the teachers, and after examination by myself, to be dull and backward, but not to fall within the meaning of the definition of feeble-minded as given in the Mental Deficiency Act of 1913—i.e., persons in whose case there exists from birth, or an early age, mental defectiveness not amounting to imbecility, yet so pronounced that they require care, supervision, and control for their own protection, or for the protection of others; or in the case of children, that they by reason of such defectiveness appear to be permanently incapable of receiving proper benefit from the instruction in ordinary schools.

At a time when there is a gradual but certain change spreading through our methods of treatment of the insane, and chemical compounds are being replaced by other methods, it may appear unneccessary to record results obtained by the use of drugs. But this short paper is intended only to give my experience as to the effect that nucleinate of soda has upon the progress of acute mental disorders.

On first coming to the Federated Malay States I was led to believe that general paralysis of the insane was unknown. Seeing that syphilis is very common, it seemed strange that general paralysis of the insane should not occur. Very shortly, however, after the Central Asylum was opened I noticed some cases which were extremely like general paralysis of the insane. These I watched and studied very carefully, and in a short time became convinced of the existence of the disease. I have mentioned the presence of general paralysis of the insane in each of my annual reports, but think it is now time to go further, and demonstrate, as far as reports of actual cases can, the existence of general paralysis. Probably the best way to give proof of its existence is to quote three cases which can hardly be mistaken for anything else.

The question of the adaptability or suitability of the method of female nursing of male patients in asylums, which is the all but universal practice in general hospitals, if not exactly what might be termed a “burning” question, has been forced into unexpected prominence during the present crisis of affairs. The military and naval requirements of a great country fighting not merely for a great ideal, but for, if perhaps the less noble, certainly the more urgent and so to say personal object of maintaining its own existence, necessitated the raising—and at very short notice—of our two great services to their maximum strength, and, therefore, a demand on the male population of the British Empire of such magnitude as has never been experienced before. This demand has, as we know, been promptly and liberally responded to, and by no class of men perhaps more readily than those serving on an asylum staff, over 3,000 of whom, as shown in the Journal of October last, have joined the colours. Such a drain on the at no time very ample nursing resources of these institutions could not fail to cause very serious inconvenience. The shortage occasioned had in some way or other to be compensated for, if even to only a limited extent. In some cases men of mature age have been employed to replace those who have left, but these are probably not procurable in any great numbers owing to the demand for middle-aged men for munitions and other work connected with the war, and also for doing the enormous amount of business—trade, agriculture, etc.—which must be carried on throughout the country generally. Consequently, resort to the employment of women as substitutes for male nurses has had in many instances to be adopted.