Gentlemen,—My first duty is to convey to you my grateful appreciation of the honour you have done me in placing me in this chair. I am not unmindful of the great names which, in the course of more than half-a-century, have gone to make up an honourable tradition in the history and work of our Association. That tradition has assuredly lost none of its dignity whilst in the keeping of Dr. Conolly Norman, our retiring President, who has just now placed in my hand the “hammer” of office.

Up to the present time the experimental movement in psychology has been directed chiefly to the study of methods by which mental phenomena may be subjected to exact investigation, and by which they may receive for purposes of comparison some kind of quantitative expression. So far as these methods have been perfected they have been directed mainly to the investigation of general psychological laws, and of the relation of psychological to physiological processes. Comparatively little has been done in the way of application of these methods to elucidate practical questions; little attention has been paid to individual psychology and to the exact nature of the differences which distinguish the various types of normal and abnormal mind. The more theoretical work of experimental psychologists has naturally a great interest for students of insanity, and must affect their conceptions of abnormal mind, but the special question which I intend to consider is of a more direct and practical kind, viz., the possibility of using the methods of experimental psychology to help directly in the study of the problems of insanity.

I believe it is an absolute matter of fact that at the present time different physicians, both in private practice and in asylum practice, use different methods in regard to their newly-admitted patients, as far as in their treatment rest and exercise are concerned. I do not recollect that we have discussed this important question, nor do I recollect any definite paper on the subject by any competent authority. It therefore seems clear that the subject is one which demands our consideration.

There is at the present time great need of more complete and definite knowledge as to the pathology of the very marked structural changes that so commonly affect the pia-arachnoid in the insane. The subject is one of much importance to all of us as medical psychologists, for not only is the condition in question one of the most conspicuous lesions associated with mental disease, but it implicates a structure of primary importance in the economy of the central nervous system. It is by way of vessels that course through this membrane that nutriment is conveyed to the brain cortex, and the waste products resulting from metabolism in the cerebral tissues are mainly conveyed away in the fluid that circulates in its lymph spaces. Therefore it is evident that these morbid changes may very seriously interfere with the functions both of nutrition and excretion in the brain.

In the “Journal of Mental Science,” January, 1895, I published the results of thyroid feeding in thirty cases of insanity. Since then we have treated at least sixty cases at the Royal Edinburgh Asylum.

My apology for bringing forward this subject at the present time is that considerable interest with regard to it has recently been evidenced by correspondence and comments in the medical journals, as well as by inquiries set on foot by the Lunacy Commissioners and the Local Government Board. The former have published in their 49th Annual Report, just issued, a “Return showing the Number of Pauper Idiot, Imbecile, and Epileptic Children in the Asylums, etc., on 1st September, 1894,”† and a return of similar character as to such children in workhouses has been issued by the latter. The upshot of the whole matter is that, according to these returns, there are in lunatic asylums 525 children of this class (335 males, 190 females), and in workhouses 485 (281 males, 204 females). The latter number includes, however, 93 children returned as “epileptic only,” so that of idiots and imbeciles in workhouses under 16 years of age there are but 392. Adding together those in lunatic asylums and in workhouses we find that a total of 917 youthful idiots and imbeciles are provided for by the Poor Law in these institutions. The Local Government Board return, however, gives us no information as to the large number of such children living with poor parents who receive on their behalf some parochial relief. In the Commissioners' return the children are classified as idiots and imbeciles respectively, 399 in the former, 126 in the latter class; and 154 are said to be in the opinion of the medical officers likely to be improved by special training. In the Local Government Board return the children are classified as “imbecile only,” “epileptic only,” and “both imbecile and epileptic;” and the number of children who, in the opinion of their medical officers, would be likely to be improved by special training is set down as 178. Consequently if we are guided solely by these returns we should be led to the conclusion that in England and Wales—excluding the Metropolitan district, for which separate arrangements exist—there are no more than 332 improvable pauper idiots and imbeciles under 16 years of age remaining to be provided for in addition to the 225 paupers already accommodated in voluntary institutions for the training of imbecile children. Indeed, deducting 52 now resident in the special idiot block of the Northampton County Asylum, there remain but 280, a number insufficient to fill a decent-sized special institution!

In dealing with insane patients the question of forcible feeding comes up for consideration very frequently. It embraces various points of great interest and importance, on each of which much could be said; but in the present paper I wish to confine myself to some short remarks under the following heads:—(1) The Methods of Forcible Feeding; (2) Feeding by the Œsophageal Tube; (8) The Kind of Food used: and (4) A Reference to some Illustrative Cases.

Dr. Maudsley opened a discussion on “Criminal Responsibility in relation to Insanity,” in the Psychological Section of the Annual Meeting of the British Medical Association, held in London on 1st August, 1895. He said—I cannot help feeling that I am undertaking a task which is likely to be somewhat barren, for there is little to be said that has not been said over and over again, and will, I fear, have to be said over and over again; for, notwithstanding that the legal test has been condemned by eminent judges and that it has no foundation in science, it still flourishes in full vigour.

“Set me as a seal upon thine heart, as a seal upon thine arm: for love is strong as death; jealousy is cruel as the grave: the coals thereof are coals of fire, which hath a most vehement flame. Many waters cannot quench love, neither can the floods drown it; if a man would give all the substance of his house for love, it would utterly be contemned.”

It is worthy of notice that just as inquisitions de lunatico inquirendo are steadily receding before the advance in public and judicial favour of the summary powers of management and administration created by Section 116 of the Lunacy Act, 1890, so the question whether a prisoner is fit to take his trial is coming more and more to be determined by the Home Secretary on the advice of his experts, under the wide powers of the Criminal Lunatics Act, 1884, without waiting for arraignment. This was the course taken by Mr. Asquith both in the Bethnal Green murder case (“Reg. v. Matthews”) and in the case of Covington, who threatened to murder Cardinal Vaughan, and it is a humane and a wise one. On the other hand it has to be kept in view that this summary procedure deprives a prisoner of his right to have the fact of his sanity tried by a jury. There are, however, ample safeguards both in the Criminal Lunatics Acts and in the pressure of public opinion against any abuse in the exercise of the summary powers with which the Secretary of State is invested.