My choice of subject for this address has not been altogether fortunate, and what I have to say will need your indulgence. Having fixed the subject hastily when I had the honour to receive your secretary's invitation, I soon found, on taking stock of my knowledge, that I had no clear idea what the new psychology was, what it had done, and on what the claim sometimes made for it to supersede an old and effete system was grounded. A new method of study making large promises was evident enough, but of the new conquests which are to revolutionize psychology I must confess ignorance. My remarks, then, will be critically interrogative, on purpose made to elicit definite information. If that light be forthcoming it will prove how little mere theoretical criticism is worth.

While this subject is being discussed in the Journal of Mental Science, a short account of an attempt to carry it out may be of some interest.

First let me thank you very heartily for the high honour you have done me by electing me to the Presidential chair. When one looks over the names that have preceded me, from the time of Conolly downwards, one finds that it has been occupied by men of high talent, well known as workers in psychiatry, not only in this country, but abroad. To emulate them will be my endeavour, and I shall certainly do everything in my power to uphold the dignity and welfare of this Association.

I have no intention of tracing the history of tuberculosis in asylums through the official obscurity of the past fifty years. This point has already received careful investigation at the hands of Dr. Crookshank in the admirable essay he has recently published; nor are we here concerned with any comparison between the mortality from tubercle among asylum inmates and the mortality from tubercle among the general population, inasmuch as deductions drawn therefrom are liable, among other errors, to those fallacies which occur when two communities whose environment and susceptibility differ are compared as regards the mortality of any particular disease.

I desire in this paper to focus your attention upon certain pupillary anomalies as observed in a class of patients who in this respect have not been the recipients of that amount of attention which to my mind is their due.

We are all prepared to grant that alcohol is a poison in a general sense, and that any use of it for the pleasurable sensations it produces may lead to discomfort, to folly and to disease, and yet the majority of our adults persist in its habitual use, and readily take the risks of future suffering for the sake of present daily enjoyment.

It is convenient to regard the mental part of man, or his ego, as being made up of feeling, will, and thought. Feeling I place first, because it takes precedence in evolution, and because it may be said to constitute the foundation of mind.

In the Revue Philosophique de la France, tome xlv, 1898, there are three articles filling eighty-seven pages on this subject, by Dr. G. Dumas. In order to appreciate their importance it may be well to give a short review of what was previously made known of the mental aberrations of that philosopher by his friend and biographer, M. Littré.

When East Sussex determined a year or two back to build an asylum for its sole use, a Visiting Committee, appointed for the purpose, was fortunate enough to find in the centre of the county a suitable estate which the County Council purchased. It is situated at Hellingly, a village about nine miles north of Eastbourne. The area is four hundred acres, compact, as you will see on the plan, having within 400 yards of its western boundary a railway station which we propose to connect with the main asylum by a full gauge tramway. It slopes gently upwards from the south towards the north, where it attains its highest level of about 130 feet above the sea. The subsoil is most favourable, being, with the exception of two patches of clay, of a sandy or gravelly nature. The water supply is adequate, and the general contour lends itself readily to an efficient system of drainage, which will be bacterial. The views are excellent, extending to the sea and the south downs. It would be difficult to find a more suitable site for an asylum. A sub-committee was authorised to travel about the country to inspect other asylums, I being appointed its chairman. We visited the Hartwood, Lenzie, Gartloch, Hawkhead, Cheddleton, Burntwood, Glamorgan, Dorchester, Isle of Wight, and Chichester Asylums.

The Asile St. Luc at Pau is indeed an Institution which deserves to have its story told. Through the kindness of the authorities this story is now for the first time made public. It is in effect that, starting with a capital of £12,000 and a small farm of some twenty acres, a nearly perfect asylum with 900 inmates and a staff of over 100 assistants has been built up by degrees, now not only self-supporting but last year showing a profit of £2000, spent mostly in structural improvements and additions and in the purchase of adjoining land. The Medical Superintendent has a free hand, being responsible only to the Conseil-Général of the Department, who, as they find him no funds, merely exercise a benevolent supervision. How such a satisfactory state of affairs has been brought about it is the purpose of the present article to briefly indicate, by way of an object lesson in asylum management.

The speech faculty of the epileptic has hitherto received very little attention, though passing references to it have been made from time to time by several writers, viz. Kussmaul, Ross, Wylie, and others. Wylie has stated the well-known fact that temporary aphasia appears sometimes as the “aura,” sometimes as an immediate consequence of a fit. Kussmaul confirms this, and Ross writes, “In some cases the warning of an epileptic attack consists of a sudden inability to speak, and it is very probable that word-deafness and word-blindness are by no means uncommon auræ.” While saying so much, Ross admits what is certainly true, that motor aphasia is the more readily noticed, and, as obscuring the question of aphasic auræ, he admits the mental confusion attending the onset of unconsciousness, a factor of some importance. Bradylalia (slow speech) and echolalia (echo speech) have also been noticed by observers at home and abroad. They are, however, so frequently observed in developmental speech, and in other nervous and mental diseases, that too much may be made of their significance.

Considering the closeness of the ties which the existence of such bodies as the Medico-Psychological Association have created between alienists throughout the world, it is surprising that so little attention has been paid to the comparative side of the medical jurisprudence of insanity. In the spring of 1898 there was published in New York a treatise by Dr. Clevenger and Mr. Bowlby, an American barrister (Medical Jurisprudence of Insanity, or Forensic Psychiatry, 1898, Lawyers' Co-operating Publishing Company, 2 vols., pp. 1356), in which excellent work in this direction, so far as England and the United States are concerned, was done. The book is a monument of labour. Every conceivable branch of forensic medicine is discussed with learning and ability, and an admirable index, both of cases and of subjects, renders fairly accessible to the reader the otherwise bewildering mass of legal information which the editors have so industriously accumulated. It is not, however, specially of efforts of this kind that it is desired to speak in this paper. The problems of lunacy law and lunacy administration with which civilised countries have to deal are, to a great extent, similar. It would obviously be of immense international importance if the solutions attempted of these problems in different parts of the world and the results of such experiments were systematically chronicled from time to time, so as to give the lunacy authorities, lawyers, and experts of the chief countries of the globe the benefit of each other's experience. It may be of interest to select some instances of the manner in which different countries have dealt with questions that are constantly arising. Take first interdiction and curatory. The voluntary and judicial interdiction of Scots law is sufficiently familiar to alienists (for full information on the subject see Stair, i, 6, 37; iii, 8, 37; Bankt., i, 7, 118; Ersk., i, 7, 53; Bell, Com., 139, Prin., S. 2123; Fraser, P. and C., 554).

At the last February meeting of the Manchester Pathological Society we made a preliminary communication upon this subject, limited to a description of the changes found in the cortical nerve-cells and the descending degenerations in the spinal cord. Since then we have examined a much larger number of cases, and can therefore give a fuller description, with observations upon other points in the morbid anatomy of general paralysis of the insane.

It not infrequently happens that the senior assistant medical officer of a modern institution for the insane is elected medical superintendent of an old asylum. Such was my lot when early in 1887 I was chosen by the Court of Aldermen of the City of London to fill the post of chief officer to their asylum at Stone, and I entered upon my duties with no light heart, because it was early apparent that many structural and administrative changes would be necessary to bring this institution abreast the times. The asylum is constructed on the gallery or corridor plan, in linear form, extending from east to west, with projections north and south at several points. This linear form is modified by semi-detached laundry and workshop blocks, which are connected by covered ways to the central administration situated midway between these blocks, and at right angles to the line of the wards, which it intersects as it runs north and south. The style of architecture is Gothic, of white brick with Suffolk quoins, stone mullions, and dressings to the gables; the roof is of Broseley tiles. There is a handsome tower of white brick and stone with embattlements; the central portion of the tower is an iron smoke shaft, the part intervening between this and the outer wall being a heated extraction shaft for removing the foul air from the galleries and single rooms. The buildings are of two stories, except to the south of the central administrative block, where there is a third story for the old chapel (now being converted into a recreation hall), and for some of the staff bedrooms of either side. The estate comprised in 1887 thirty-three acres.

The analysis and arrangement in a statistical form of the various entries made in the case-books of the different asylums would form a valuable synopsis of clinical, therapeutical, and pathological significance. But the labour involved would be something enormous, and might dishearten the most enthusiastic statistician; even the work of arranging and tabulating the entries in the case-books of one of the large asylums would be very great.

It is disappointing to anyone trained in modern clinical methods, and accustomed to hear alienists urge with so much insistence that insanity is a brain disease, to find so little apparent attention paid to what may be called the physical signs of insanity.

The time at last comes when, sooner or later, the old work has to be given up—work of various kinds in different cases. But the special sphere of occupation referred to is that in which the Journal of Mental Science is chiefly interested.

The preparations I am about to exhibit are taken from cases that have occurred during the past three months at Claybury. The first three are, I am afraid, of no neurological interest, but they are somewhat rare. The first is a case of aneurysm of the thoracic aorta. The patient died suddenly from hæmorrhage. Her age was forty, and she had had three attacks of hæmorrhage previously to the fatal one. She was a chronic drunkard and had had fits. The shape of the clot is rather curious. It is more or less cylindrical, and seems to have burrowed down into the chest, pushing the lower lobe of the left lung forward as its sac. The next specimen is one of rupture of the first part of the arch of the aorta. This patient was an old woman of eighty, who had been resident for about a year, and then developed an attack of bronchitis. In the course of two or three days she got rather worse, and one evening told the nurse she thought she was going to die the following morning. She did die, and the interesting point about it is, that the only other case of rupture of the aorta I remember seeing occurred in a man of about forty-five, and he, also, the day before he died, said he thought he was going to die. The blood had ruptured the aorta in a T-shaped manner about an inch above the coronary arteries, and passed down between the pericardium and over the wall of the aorta and ruptured into the former. The next specimen is an exceedingly rare one. The man was about seventy-seven years of age, and he had symptoms of sensory asphasia. He was quite unable to remember even his own name, or any other name, but if a name was mentioned to him he at once recognised it. In the same way, he could not write a single word, but he at once recognised a word which was mentioned to him, and he was able to write it. The aphasia was associated with symmetrical lesions of the angular gyri. The man died quite suddenly one evening while talking to another patient, and the cause of death was heart failure due to aneurysm of the left ventricle. I do not remember ever before seeing, except in a museum, an aneurysm of the left ventricle. The true wall of the ventricle is about two to three millimetres in thickness, the pericardium is generally universally adherent, and the anterior part of the left ventricle is about an inch in thickness, owing to the existence of this aneurysmal clot.

It would be quite impossible during the few minutes at my disposal to deal in an exhaustive manner with the numberless varieties of skin affections met with in asylum practice. I have therefore selected from an immense mass of material a few of the rarer affections, and shall deal with them in such a way as to call for your experiences and criticisms rather than make any personal attempt to lay down the law with regard to any of them.

In the following paper it is proposed to study the influence which alcoholism exerts upon suicide in this country, so far as that influence can be traced in recent statistics of the movement of these social phenomena. Our discussion will aim more particularly at determining the rôle which alcoholism may have played in the late increase of suicide in England, and at establishing the distinctive characters which constitute the type of alcoholic suicide.