Gentlemen,—Allow me in the first place, on my own part and that of my confrères, to thank you for the very great compliment you have paid the members of the Medico-Psychological Association who are in the Irish asylum service, through me, by doing me the honour to select me as your President for the ensuing year. For myself personally, I regret your choice has not fallen on one better able to fill such a high position; and I feel I have no claim whatever beyond your kindness in wishing to extend your friendship to your fellow-workers in this country. In their name, therefore, I bid you a hearty welcome to the fair city of the South, and trust that your visit may not only be attended with present pleasure, but that you may carry with you pleasing reminiscences of your stay amongst us.

The title of the paper which I am about to have the honour of reading before you indicates of itself my non-belief in the existence of a change in the osseous system which is the result simply of the fact of general paralysis, this change exemplifying itself in a greater tendency of the bones to fracture.† This opinion coming in opposition to that now prevailing, I propose to make you the arbiters of the question, and will lay before you the arguments which have convinced me.

In my work on “The Factors of the Unsound Mind” I gave a condensed account of the case of Mr. H. as forwarded to Charles Dickens, editor of “All the Year Round,” now nearly a quarter of a century ago, and published by him in No. 128 of that Journal, October 5th, 1861. It is headed “Mr. H.'s Own Narrative,” and it was forwarded to the editor, much to his surprise, in correction of the first of “Four Stories” published in an earlier number. That it is a genuine narrative, and no fiction, I have every reason to believe.

At the general meeting of the British Medical Association, held at Belfast last autumn, I read a paper in the Psychological Section “On Insanity connected with Spasmodic Asthma.” In that paper I described some cases as appearing “to point to an occasional connection between Insanity and Spasmodic Asthma, the nature of which seems to be—if the term may be allowed —metastatic, or alternating.” I also stated that though I was aware Dr. Savage had had some cases of a similar nature, yet up to that date the subject had excited little attention, and no mention of it was to be found in English medical literature.

It has long been recognised that a sympathetic connection exists between the body and the mind; irritability of temper from a sluggish action of the liver, and the hopeful view phthisical patients frequently take of their ultimate recovery (the “spes phthisica” of some authors), are familiar examples of the influence of abnormal conditions of the body upon the mind.

At a period like the present, when lunacy legislation is attracting much attention, it is interesting to note the various peculiarities of the law as it now exists in various countries. I have no doubt that most of those who listen to me have seen the Blue Book which the Government caused to be published giving some account of the laws dealing with lunatics in several lands, but many who have not practised in Ireland are unacquainted with the very remarkable features which the lunacy law of that part of Her Majesty's dominions presents. It is true that geographical proximity, or even membership of the same kingdom, does not always connote similarity in social conditions; and the social conditions of any country are as important an element in legislation for the insane as for the sane. Nevertheless even from Ireland instruction may sometimes be obtained, though perhaps some will say that that land more often affords examples for avoidance than for imitation.

The important clinical researches on Epilepsy during the last decade have contributed to afford a sound criterium for a correct discernment of the curious physical phenomena connected with this dreadful neurosis, in cases where it becomes of great moment, for a legal decision, to establish the positive grounds for a just estimate of the sanity or insanity of a culpable act committed by an epileptic. To the important bearing of the matter to be here briefly discussed, we have been fully alive for many years past, laying upon it particular stress, in the light in which we present it, as our contributions on the subject testify.

Most of you are aware that not many months ago the Editors of the “Journal of Mental Science” invited communications from members of the Association of which it is the organ on a subject which never loses its interest, simply because events are frequently occurring which force medical psychologists to direct their attention to it. I refer to what usually passes under the name of Moral or Emotional Insanity. The very fact that it is thus forced upon our notice proves it to be a practical, not a merely speculative question. I offer no apology, therefore, for making it the theme of my paper to-day, especially as I have not joined in the discussion which has taken place in the Journal, and which now has terminated. I say “discussion,” but one of the most marked features of these communications is their essential unanimity.

The accompanying designs have been prepared by Messrs. Berry and Burmester, architects, London, in consultation with myself. We do not claim that it is in all respects a model asylum, great economy both in construction and in subsequent administration having been carefully studied throughout. It is believed, however, that it provides at a reasonable cost all the requirements of a modern asylum for the pauper class, that its arrangements comprise everything which is essential to the most approved methods of treatment of insanity, and that it presents novel points and advantageous combinations which render it specially worthy of attention. The design is suited to the requirements of either a small county or a borough, for it contains, in due proportions, accommodation for all the classes of the insane found in our public asylums.

Few, I think, will attempt to deny that it is desirable that all medical students should attend a course of lectures on the important subject of Mental Disease. And further, that these lectures should be compulsory, no matter what the university or medical school may be at which the students matriculate, or where they may intend to take their degrees or diplomas. Some there are who may object to these lectures being compulsory, for the reason that this course of lectures would be the addition of another subject to the already lengthened curriculum of medical studies. I think we are all agreed that the medical student of the present day has enough, and more than enough, of subjects to occupy the short term of four years that is usually allotted to his studies.

A. B., a prisoner with two or three aliases, aged 40, strongly-built, of short stature, with dark complexion and pockmarked face, was admitted into the observation ward at H.M. gaol, Darlinghurst, early in August, 1884, with the following history. He had served one sentence certainly, and perhaps more, in the neighbouring colony of Victoria, was reported to be an old offender, and was sentenced to seven years for arson in U.S.A., in March, 1884. He was sent at once to undergo the usual nine months' solitary and separate treatment with which all long sentences commence in Berrima—the special gaol set apart for this—and at the beginning of May was reported by the visiting medical officer of that gaol as unfit for this treatment, because he was an epileptic.

Dr. D. Hack Tuke in his interesting work, “Chapters in the History of the Insane in the British Isles,” has shown how the asylum of to-day was evolved from the madhouse of old. Originally the madhouse was simply a prison in which persons who had shown themselves dangerous to their fellows because of madness were confined and punished. With the general advancement of knowledge and civilization, the lamentable lot of the madman improved. One barbarous and inhuman custom after another was dropped, and at length it was dimly recognised that madness was a disease. Then for the lunatic the day of salvation was at hand—the cell, the chains, and the whip became things of the past, and he stood emancipated from all but his terrible disease.

When I was at the Kingston Asylum, Ontario, last August, a male patient had just escaped from the institution, and made a criminal assault upon a little girl in the neighbourhood. From the inquiries I made, I found that the case was one of much interest in its bearing on moral insanity (or imbecility), and I was allowed to read the notes in the well-kept case-book of the asylum. Dr. Metcalf, the medical superintendent, has very kindly permitted me to make use of them, and the farther particulars of this patient's history and acts, which he has given me. A photograph was subsequently taken, which I have had reproduced by the London Autotype Company. (See Plate.).

Having availed myself of the opportunity afforded me of visiting Gheel a second time when attending the Psychological Congress at Antwerp in September, I propose to describe this remarkable insane colony, as I think it cannot fail to suggest important questions and considerations, in regard to which much difference of opinion still exists.

While on a short visit to Madrid some little time ago I determined to find out how Spain treated her lunatics. I visited the public asylum of Santa Isabel at Leganes, but was refused admission, as there was no resident physician, and the village doctor, who was supposed to make his rounds at 9 a.m., was away ! A friend, however, kindly gave me an introduction to the leading Spanish alienist, Dr. D. José Esquerdo, who, he told me, had a private asylum at Carabanchel, and thither I went. This little village is about three miles from Madrid, and easily reached by tramcar. Dr. Esquerdo's asylum stands on an elevated, sandy plain, about 200 métres from C. Alto, and is approached by a steep, rugged road. In external appearance it is most unlike our ideas of a private asylum: not a tree to be seen for miles, and the whole block of buildings is enclosed by wooden palisades.

Case I—B., æt. 53, son of a highly-respected and well-to-do city merchant. One paternal uncle was insane for a short time after business losses; another uncle married a servant, and among his children was a “ne'er-do-well.” Other members of the family have decided musical and artistic genius.