In the second lecture I discussed the distribution of the neuroses throughout the various races of mankind, but the subject was necessarily curtailed for want of time and space. It would not, I believe, be a difficult task to prove that no race of man is free from very extensive affection by epilepsy or hysteria or many other nervous affections regarding which we have but an imperfect account When we come to inquire into the similar prevalence of insanity, however, the evidence is much more negative, and although there is no race of men who are known to be free from it, yet on the whole travellers are in too many instances silent. In many instances it is evident that the subject does not interest them, while in still other instances they simply say that they saw no insane people. Hence has arisen the mistaken idea that insanity is a product of civilisation and that it is rare or unknown among savage or barbarous people. I have taken the trouble to collect numerous references from the writings of travellers on this subject, and I shall read a few of them for the purpose of showing the unfounded nature of the belief which has arisen on this question. Dr. Felkin informs me that he has seen in all some thirty to forty lunatics on the White Nile. He also saw some maniacs chained. He was the first to tell me a curious fact, of which I have since had confirmation from other sources, viz., that the type of insanity among the African natives is different from that in Europe. The prevailing form of mania is a short acute kind, lasting only a day or two, during which the sufferer is driven away to the woods or voluntarily runs away, returning again in a few days apparently restored in mind. Idiocy was very common in his experience and so was suicide. Thompson, in his book Through Massailand, states that he found insanity very common. The myths and folk stories of the people are full of reference to it. Those affected by lunacy are driven away from the habitation of sane people or are otherwise isolated. He also found idiocy very common, especially among the dwarfs and albinoes, the latter of whom were numerous, and about the prevalence of mental defect among them there was no doubt. In a book entitled The Indian Tribes of the United States, edited by Francis S. Drake, reference is made to an Oregon Indian woman who appeared to be demented: “She sang in a wild manner, and would offer to the spectators all the little articles she possessed, scarifying herself in a horrid manner if anyone refused to accept her presents. She seemed to be an object of pity to the Indians, who allowed her to do as she pleased.” Captain Cook, in his Voyages, referring to the South Sea Islanders, says: “We met with two instances of persons of disordered mind, the one a man at Owyhee and the other a woman at Oneheeow. It appeared from the particular attention and respect paid to them that the opinion of their being inspired by the Divinity, which obtains among most of the nations of the East, is also received here” (in the Pacific).

I now come to the important, and I am sorry to say the controversial, question of the causes of insanity. After what I have already said on the etiology of the clinical forms of insanity and on the fluctuations of statistical insanity in communities, it seems to me that I might conveniently dismiss this subject by adopting the laconic style of the student who was assigned the task of writing an essay on “Snakes in Ireland” by saying in three words, as he did, “There are none.” But as the great majority of people still believe in the validity of the numerous causes which are popularly believed to create insanity somewhat in the same way as violent exercise causes fatigue or eating salt fish causes thirst, it is necessary to refer briefly to the subject.

The mental processes in relation to vision are disordered in many cases of mental disease, particularly in such as present the symptom of disorientation. The normal individual orientates himself in his environment mainly by the help of definite trains of visual ideas—such, for example, as are aroused in us when we glance round our room, go about the house, or take a walk out of doors. If a patient in an asylum thinks he is in his own home, and mistakes the attendants for his relatives, he is clearly unable to see how the present environment differs in aspect from the former environment in which he imagines himself. While from one point of view such a disability presents itself as a failure of memory, from another it appears as a form of mind-blindness, demonstrable by appropriate tests, and resembling in some ways the mind-blindness resulting from circumscribed coarse damage of the brain.

The present division of this paper consists of a clinical description of those types of mental disease which are classed by the writer under the heading Amentia. Under this term he includes, from the standpoint of morbid anatomy, all cases of subnormal cerebral development, and from that of clinical symptomatology, all cases of subnormal, and hence frequently abnormal, mental manifestation. He thus uses the term amentia to connote in the widest sense the mental condition of patients suffering from deficient neuronic development.

In these days of ever-increasing progress in pathological research, carried out to a great extent by a body of enthusiasts, who devote their lives to the study of the post-mortem room, we are apt to have the important clinical aspect of our cases somewhat neglected, while with the present craze for building gigantic asylums for our insane we are tending more and more to lose sight of the individuality and personality of our patients.

The subject of tuberculosis in asylums is by no means a new one. On the contrary, many have written upon it, probably long before Dr. Clouston, forty-two years ago, published his well-known remarks. It would be neither profitable nor desirable to enter here upon a discussion of the individual views expressed from time to time, but for many interesting and instructive observations it is only necessary to turn to the papers presented to this Association of recent years by Drs. Crookshank, Blair, France, Weatherly, Drapes, and others. This being so, you will not expect to hear anything new from me; in fact, I do not think I can lay claim to a single original observation; but as no one paper deals with any large portion of the procedure to be observed in combating the spread of tuberculosis in our asylums, and as my attention has, for the last nine or ten years, been directed to the problem of how to reduce the death rate without any great expenditure of money, I have thought it well to introduce a discussion rather on the actual details of procedure than on the principles involved, in order to stimulate the expression of opinions of all sorts; for it is evident that there are many equally good and efficient ways of arriving at the object which every asylum medical officer desires.

Any drug which interferes with the workings of the higher cerebral functions is rightly regarded with suspicion, and the question of giving or withholding it is always open to doubt. Hence the difference of opinion with regard to the administration of hypnotics. In prescribing them the advantages have to be weighed against the disadvantages, and when that is done, and the former are in excess, then whatever disadvantages there may be have to be accepted since they are in the minority.

The last time I had the pleasure of addressing a meeting of this Division the subject I discussed was the different forms of insanity met with during the period of adolescence, and it was suggested that it would be interesting to investigate the cases at the other end of the scale—that is, those connected with the incidence of decay and old age, and to compare them with the previous cases.

There is a fairly general opinion amongst those engaged in asylum work that the classical type of general paralysis is less frequently met with relatively than formerly. This may be due partly to an increased number of so-called atypical cases, and possibly also to cases now being diagnosed as general paralysis, either ante or post mortem, which were not formerly looked upon as such. With a view to finding out the frequency of the chief phenomena of the disease as it is now met with in asylum practice, the following data, both pathological and clinical, have been compiled. The cases examined were (1) all the male cases admitted to the West Riding Asylum, Wakefield, from January 1st, 1896, to December 31st, 1902; (2) all the male cases admitted to the London County Asylum, Horton, Epsom, from its opening in the early part of 1902 to March 31st, 1905; and (3) all the female deaths at Horton.