My Lord Leigh and Gentlemen,—Your presence here so far shews your interest in the subject on which I have had the honour to be called upon to address you, that I have confidence you will extend to me your patient attention while I enter into details which may not at first seem to be attractive except to medical men.

Gentlemen,—I must again express my deep sense of the distinction conferred upon me in my election as your President. It is a great honour to occupy a place which has been held by so many eminent men, masters in mental philosophy, distinguished in science, and in literature, taken in its wider sense, as well as in that strictly medical. I am fully conscious of inability to follow them with equal steps, but supported by some of you, whom I am privileged to call my friends, and by many other valued associates, I venture to hope that your interests will not suffer in my hands. I say this, reckoning confidently on the ready help which the less advanced among us have always received from the honoured heads of our Association; one, especially, is present to my mind, by whose friendly encouragement many probationers have been induced to put forth their powers for the advancement of mental science. Distinguished in medicine, in science, and in general literature, the Founder of our Journal, and as its Editor for many years, ever courteous, considerate, and just, no one has done more for the best and highest interests and objects of this Association, than our esteemed colleague and former President, Dr. Bucknill.

The way in which some diseases seem to confine themselves to particular localities and classes of persons, and the reasons for this have always been favourite studies in medicine; and year by year such questions attract more and more attention. The reason of this is obvious. Those problems have some of the definiteness of pure physical science about them: their study throws a direct light on the nature of disease, while their solution tends to its immediate prevention. Hence the prominence which they have assumed in the new branch of preventive medicine. There is scarcely any word which means so much in this science as the localisation of disease, in its active and in its passive phase. To know why a disease breaks out in a certain place, and to be able to keep it from spreading farther may be said to be the two first aims of public medicine. The first thing to be done is, of course, definitely to connect the disease with its habitat. This can be done far more readily in the case of some diseases than in that of others, but there is no disease that is not more or less localised as to places or the class of persons whom it attacks. The weak points of man's constitution are so many, and the trials to which it is subjected vary so widely with locality, climate, food, work, and circumstances, that this must be so. The infinitely numerous seeds of disease and dissolution are of many species; and while each seed only germinates as it finds fit soil, each species also requires suitable conditions. This is as true in regard to the brain, and the departures from the normal performance of its higher functions, as in regard to every other organ of the body, though as yet but little attention has been directed to this fact. The wide series of diseases which are at present called Insanity prevail more in some places than in others, attack some classes of persons in preference to others, are hurried into actual development, or retarded where latent tendencies to them are in existence, by certain things which have a local prevalence, and they evidently assume one form rather than another through local influences. The extent to which this is the case is as surprising as it is certain. When one comes to look carefully into the reports of lunatic asylums in different parts of the country it is found that there are forms of brain disease (or varieties of insanity as they are called) present in abundance in one place which have almost no existence in another. Diseases of the brain which kill more than a third of all the patients in the asylums of some of our counties do but kill 5 per cent. of them in others. But I shall not anticipate the numerical proof of what I have been stating. This investigation must be very largely conducted on the numerical method, and fortunately the distribution of insanity and its varieties can be more thoroughly made out in this way than that of almost any other disease. When it attacks in a decided form any person in the classes which constitute nineteen-twentieths of the inhabitants of this country its treatment is so difficult and costly that if it is of long duration it almost necessarily must be done at the public expense. This implies that it is publicly recorded in the official documents of the Commissioners in Lunacy and the Poor Law Board. In this way a fairly trustworthy account can be got of the number of persons in every county and district of England and Scotland who are suffering from this disease in any one year. It is true that these numbers include also the persons who are chargeable to public funds on account of idiocy or marked imbecility, dating from birth, and the numbers of the latter cannot be distinguished in these documents from those who labour under insanity. But as congenital brain defect and acquired brain disease certainly have the closest connection hereditarily and in their essential nature, this does not seriously affect an investigation into the local occurrence of insanity founded on the numbers recorded in the official documents I have referred to. The numbers of the insane who are paid for out of their own funds or by their relations, and who appear in those documents as private patients, are left out of the account, because those numbers are comparatively small, and it is impossible to fix correctly the local occurrence of this class of insanity, it being determined in these official records more by the presence or absence of the institutions for its treatment than anything else. This omission affects slightly the scientific accuracy of the results obtained, but does not affect their practical value and medical interest.

I propose in this lecture to pass in review the various forms of insanity which you find in the Table, and by a brief reference to their history and symptoms to show you how they really are distinct forms of disease, and that in each or nearly so there will be found some peculiarities in the symptoms or progress of the case which render it somewhat different from other forms of insanity; such in fact as in many instances would lead you to detect the cause, and such certainly as to justify us in classifying it as a distinct form of insanity.

I take this my first public opportunity of thanking the Patron of the Morisonian Lectureship on Insanity, for the honour of nominating me to the appointment of lecturer. Permit me also to say that I feel very highly gratified and honoured in addressing the Fellows of the Royal College of Physicians in their own hall. This gratification is, however, alloyed with a very strong conviction of my inability to do justice to my subject or myself in this course of lectures. It would be absurd in me to give to you a systematic course of lectures upon insanity, the subject being one with which you are all, as physicians, more or less familiar. The duty devolving upon me is, I presume, that of giving you any special opinions I may have formed from my point of view, and from my long-continued and very large opportunities of observation.

Although a certain number of those who are subject to epilepsy may pass through life without displaying any sensible diminution in mental capacity or power, it is nevertheless true that in a vast majority of the sufferers from this disease the mind is rapidly and seriously damaged by the recurrence of the seizures which are characteristic of it. Epilepsy, indeed, is one of the most prolific causes of insanity in this country, and fills our lunatic asylums with patients of a dangerous and intractable class. It would not, perhaps, be going too far to say that it invariably exerts a prejudicial influence on the minds of those who are afflicted by it, and that the statements which have been made to the contrary have arisen out of imperfect observation. Unfortunately, we have as yet no test types by which to gauge the scope and accuracy of the ‘mind's eye,’ and hence serious impairment in its range and precision of action may readily exist without detection. Apprehension may be dimmed, judgment confused, and memory shortened, while no suspicion of mental failure has occurred to the patient or his friends. Then, again, modifications of disposition and temper are apt to be attributed to outward circumstances rather than inward derangements, so that when essentially morbid in origin they may fail to be recognised as such. Hence it is, I think, that epilepsy has often been credited with a blamelessness to which it has no just pretension. Its evil effects have not been found out, or have been traced to some other source, and it has been concluded that epilepsy may co-exist throughout life with perfect intellectual and moral integrity. Nay, some authors have gone further than this, and have written of epilepsy as if it were a thing to be desired, and, like the goitre of the Roman ladies, added a new charm to its victims. Falret says that epileptics sometimes evince real intellectual activity, and a rapid circulation of ideas, which corresponds to a certain degree of cerebral excitement. A roll of eminent epileptics has been drawn up, including the names of Cæsar, Mahomet, Napoleon, and Molière, and a connection has even been suggested between fits and genius. Dr. Morel has referred to a marvellous quickness of conception and imaginative intensity as distinctive of the epileptic condition in some persons. Surely, however, such qualities are not to be regarded as the fruits of epilepsy, but rather as characteristic growths of that kind of soil in which the pernicious plant is most likely to take root and flourish. Surely the fact—if it is one—that some great men have suffered from epilepsy in peculiar forms does not establish any causal relation between epilepsy and greatness, for how much greater might they not have been but for epileptic limitations? And surely the wild whirl of epileptic excitement is not to be confounded with the well-ordered evolutions of genuine intellectual activity. The experience of those who have seen most of epilepsy, will, I believe, confirm the assertion that no good thing can come out of it, and that it entails a blight and a blemish upon the mind of everyone who is affected by it. It robs the brain of its cunning; it strips the mind of its ornaments, of its garments of delicacy and gracefulness, and reduces it to savage rudeness and unrestrained movement. And then it wraps round it its own strong web of disease, fold after fold, layer after layer, more and more confining it, and becoming at last its inevitable cerement. Esquirol has ably summed up the effects of epilepsy on a man's physical and psychical nature. He has shown that it shortens life, deranges nutrition, that it degrades the mental faculties, and that it undermines rectitude of character, and disposes to suicide, violence, falsehood, venery, and onanism.

Though many writers have advocated the use of digitalis in various forms of insanity—such as acute, paralytic, or epileptic mania—yet there appears to be great diversity of opinion as to its efficacy, great variety in the methods of administering it, and a wide range in the quantities prescribed. While one has been content to order five to ten minims of the tincture three or four times a day, another has given, in similar cases, single doses of half-an-ounce of the same preparation.

I trust to be excused if in these days of pathological and anatomical research, I ask you to examine with me to-night a group of symptoms. I need hardly say that the study of symptoms must ever be of importance in the treatment of disease, and especially of that disease with which we are all concerned, and although to the general medical public the subject of hallucinations of hearing may have no special interest, yet the members of this association know that they characterize a very peculiar and well-defined class of patients, and that, common as they are, their nature and pathology are uncertain and mysterious. I have, therefore, chosen them, as the subject of a paper, chiefly for the purpose of promoting discussion concerning them, and eliciting the opinions of those here present.

The tale of Pentheus had long been familiar to the Greeks, and had been already handled by æschylus, when Euripides was led to undertake it. Towards the end of his life he resided at the court of Archelaus of Macedon, and was evidently greatly impressed by the fresh scenery and customs which came before him; like a true poet, he was inspired by these to choose a theme in which he might best represent his newly gained experience, and produce one of the most striking and beautiful of his plays, in which both the subject itself and his mode of treating it are to my purpose.

Is consciousness something distinct from the intellectual operations named perceiving, conceiving, reasoning, recollecting, imagining; or do these operations ever take place in the absence of consciousness? In order to answer this vital question it is necessary that consciousness should be examined with a microscopic nicety, rarely, as we take it, attained to since Reid explored this field of science. When we consider that, for forty years, Reid, with an enthusiastic admiration for that inductive method which the genius of Newton and others illuminated with such brilliancy, questioned Nature, Nature in man, as to the character of perception, and decided that the objects disclosed by it were not mentally possessed; investigators are bound, for their own credit's sake, to show beyond doubt that Reid is in error before they flippantly accuse him of being singularly wanting in penetration. Yet the conclusion which is forced upon us by the present aspect of psychology and cerebral physiology, not to mention metaphysic, is to the effect either that Reid was singularly wanting in analytical ability, or that the living race of psychologists must be going far astray on a most vital point. We have lately been forced to believe that Reid is on the right road; yet, sooth to say, during many years objects have been to us, as it would seem to psychologists in general, a most fertile source of perplexity and confusion. It is only very lately we have succeeded in realising the fact that the object, or the known, is not an element of the knowing; that knowing is not knowing plus known, but knowing purely and simply, a single fact, not a double one; not a synthesis of consciousness and object, but consciousness only, that and nothing more.

The power or process by means of which Time is mentally recognised and estimated independently of, or before, its external and artificial measurement, has not received a clear or comprehensive solution at the hands of those who have dealt with the subject. Certain metaphysicians connect the idea of duration with that of extension, and conceive that the child, or the savage, may have acquired a notion of intervals, or interrupted extension, from seeing and feeling through the muscular sense the alternate extension and flexion of his limbs; all comparison of such events with the successive changes in objective phenomena, as in days and nights, being the result of subsequent experience. Certain others conceive that our notion of Time originates in our consciousness and observation of succession in our thoughts, feelings, and mental states, a succession which necessarily involves a series of changes separated in time, and order, and nature. Sir W. Hamilton, apparently aware of the difficulty of the problem, says that “Time is a form of thought,” and “if we attempt to comprehend Time, either in whole or in part, we find that thought is hedged in between two incomprehensibles.” Other philosophers, belonging to a more practical school, who may be claimed as psychologists, contend that the subjective element of Time is imparted by the communication of impressions upon the external senses to the sensorium, coming as these must always do in succession with intervals of different length, and, as they often do, of regular length and intensity. It will be observed that in all these hypotheses it is taken for granted that the mind is capable of directing attention to its own conditions, and, to a certain extent, of analysing these, of marking their course, their swiftness, or slowness, their regularity, or irregularity. On the other hand, the phrenologists contend that there is a primitive and special faculty connected with a portion of the anterior lobe of the brain, by which Time, or the succession of events and intervals, is perceived or becomes known to us. My own speculations formerly led me to the theory that the perception of rhythm, or regular sequence, in sensorial impressions was conveyed by the pulsations of the cerebral arteries, either to the whole brain, or to such portion of it as may take cognisance of internal movements or changes. Sir H. Holland, that noble veteran, that learned and travelled and philosophic physician, who has just passed from amongst us, dedicated a chapter in his “Medical Notes and Reflections,” p. 499, to the exposition of “Time as an element in Mental Functions,” in which his chief object is to show that ideas or different modes of mentalisation arise and are propagated in different degrees of velocity and intensity in Time in different temperaments, and in the same individual at different periods, in accordance with the predominant physical or mental condition.

The application of electricity to the treatment of various diseases of the brain and spinal cord has for a number of years been a regular method of treatment with some of our best known neurologists and electro-therapeutists, and the value of such treatment, when rightly administered, is now questioned by very few advanced students in these departments. It is not, however, so well recognised that in diseases of the brain and spinal cord, where the mind is seriously affected, the electrical treatment is also indicated. In some of the asylums of England, United States, and Germany, electricity is now, and for some time has been used as an adjunct to other remedies for the treatment of different forms of insanity; but with a few exceptions the treatment is not systematically carried out, and, partly through ignorance of the methods of application, partly through want of sufficient medical assistance to supervise the necessary details, the results have not been entirely satisfactory, and the cases have not been fully recorded.

The seclusion in which the women of Athens lived naturally made the elder dramatists shrink from exhibiting them on the stage as under the influence of violent passion. Euripides departed from this rule, and was lashed for it by his merciless satirist; but even he, who depicted a Medea and a Phaedra, did not venture to bring a raving woman before his audience. There was just one case in which the Greeks would not be justly scandalised by such a presentment— where madness was supposed to be supernatural in its origin, and consecrated by religion, and an instance of this has been happily left us in the Bacchó. My readers have been made acquainted with that beautiful sketch of an epidemic of religious insanity, and I have now to describe an incidental portrait of a “wise woman,” when the spirit of prophecy is upon her, and she speaks as one raving, yet possessed by the God.

The Mad Hercules is not one of the best of Euripides' tragedies; but it has a particular interest for us, because it is the only one extant in which madness is personified, and introduced on the stage. This had been already done by æschylus, in his version of the story of the Bacchæ, and was adopted by Euripides amongst the terrifying effects borrowed from the elder dramatist for this play.

In 206 cases of pulmonary phthisis, 132 in males and 74 in females, published in the “Ed. Med, and Sur. Journ.,” I found scrofulous tumours and tubercles in the brain in two males and two females.

I give the details of five cases of Idiocy where the observations were completed by an examination after death. The greatest advantage of such studies as can be made in an Institution for the Training of Idiots is the careful analysis of the mental symptoms, and for this I am much indebted to the teachers for their patient attention and intelligent remarks. The absence of microscopical observations in all the pathological descriptions, save one, is a source of regret to me, though I have been so fortunate as to obtain the report of so competent an observer as Dr. J. Batty Tuke in the case of K. I. The object kept in view in reporting these cases is to throw as much light as possible on the relation of the mental deficiency to the pathological lesions. It is not, therefore, to be expected that they should be reported in the same form as clinical cases published with the intention of illustrating the treatment of ordinary diseases, or the action of new remedies. It is true that the existence of idiocy often modifies the symptoms of ordinary disease, and requires a corresponding modification in treatment; but it would unduly complicate our reports, and probably lengthen the paper to a tedious degree, were commentaries of this kind introduced.

The inner world of prison life is one of the best fields for the study of psychological questions, speculative as well as practical If the circumstances are somewhat exceptional, they have the special advantage of being uniform in their application; and this uniformity represents a standard to which individual minds, or particular groups of mind, bear a relation, and at which they may be tested. Imprisonment is the very antithesis of social usage, an involuntary servitude taking the place of the liberty of the subject, and it is surely a matter of no little interest to watch how social beings, varying in moral and intellectual status, bear themselves under confinement and a complete change in their circumstances and surroundings.

The subject of a uniform system of asylum statistics has occupied the attention of some of the most eminent alienists in this country, among whom we may mention Dr. Thurnam, Dr. Conolly, Sir Charles Hood, Dr. Bucknill, Dr. Robertson, and Dr. Maudsley. In a very able paper on this subject, published in the January number of this Journal for 1861, Dr. Robertson gave forms of Medical and Financial Tables, and made suggestions as to the Domestic Statistics for an Asylum Report which are now very generally adopted in substance in the best English Asylum Reports.

In the course of a walking tour, during last summer, I visited, en route, four of the Departmental Lunatic Asylums in the North-West of France, principally with a view to see how they would stand comparison with our own Provincial or County Asylums. Such a comparison, however, could scarcely, I find, be made on a fair basis; for though, undoubtedly, the great majority of the patients in the French Departmental Asylums are paupers, and maintained at the expense of the several Departments, yet, in all, there are associated with these paupers large numbers of pensionnaires, who are maintained by theirfriends and divided into four or five classes, and treated according to their rate of payment. It is obvious, moreover, that the better general and special arrangements, due to and supported by the higher rates of payment of the pensionnaires, would prevent such associated asylums as these from being fairly compared, as to their tout ensemble, with our own County Asylums—in which, as a rule, the patients are all paupers, and chargeable to the different unions, and in which the arrangements are for paupers only, and so constituted as to keep the maintenance rate as low as is compatible with efficiency. Seeing, then, that it was impossible to institute any fair general comparison between the French Departmental Asylums, which I lately visited, and our own County Asylums, I determined, whilst not failing to pay all due regard to the arrangements for, and treatment of, the pensionnaires, to pay more particular attention to the condition and treatment of the pauper patients in the Asylums visited, and to take my notes accordingly. These rough notes, instead of consigning them to the waste paper basket, as has been the fate of former notes of visits made by me to Continental Asylums, I have, this time, determined to offer to my professional brethren, in the hope that they may afford, perhaps, some few crumbs of information and of interest. It will be necessary for me, however, before going further, to state—that, as the principal object of my tour was walking and not mad-house hunting, I did not follow out any predetermined plan as to which particular asylums I should visit. Indeed, it was not until I had well started on my tour that I conceived the laudable idea of endeavouring to combine a little instruction with my amusement, and the result was that I merely visited those asylums which were in close proximity to the route which I had arranged for myself previous to starting. The asylums to which I paid these hap-hazard visits, then, were the following:—1st, “L'Asile de Lehon,” Dinan; 2nd, “L'Asile St. Athanase,” Quimper; 3rd, “L'Asile St. Méen,” Rennes; and 4, “L'Asile de Pontorson,” situated in the small town of that name; and I shall record my notes of them, seriatim, in the order in which they were visited.

The object of this paper is to discuss some of the opinions which have recently been expressed as to the nature of Epilepsy; and in particular, the views of Dr. Hughlings Jackson, who regards the epileptic phenomenon as the result of a “discharge” from a damaged portion of the brain, which he speaks of as a “discharging lesion.”∗