Gentlemen,—In taking the chair of this Association allow me to offer to the members, whether present or absent, my sincere thanks for the honour they have done me in electing me their President. I frankly confess that I was not at all prepared for this honour, nor do I see quite clearly even now how it came about that a body of men devoted, both by personal tastes and by official position, to the cultivation of one particular branch of the great medical art and science, should have thought fit to honour with their confidence one whose relations with that special work are only those of the profession at large. At all events, it may justly be said that in having thus acted, you have most emphatically pronounced for the doctrine that the profession of medicine, and the healing art on which it rests, are one, and not manifold; and that as among the different churches, and even sects, we may hope to find a common Christianity, so among all the distracting specialisms of our own profession, we may reasonably hope to find one faith, one object, one discipline of the mind, and, to a great extent, one great science, both of mind and of bodily function, underlying all the diversities of our various careers as physician, surgeon, gynæcologist, oculist, aurist, alienist, &c.

The perusal of Dr. Savage's most interesting article in the July number of this Journal has suggested to me, as no doubt to all who read it, some important reflections. If I venture to submit my own thoughts on the subject, it is mainly in the hope that their consideration may lessen the “abstract metaphysical difficulty” (to which our President confessed in his address) “of conceiving moral as distinct from intellectual insanity.” I may say at once, that I believe the difficulty chiefly arises from our disregarding the number and complexity of the mental processes involved in even the simplest moral acts. Let it be remembered that all recent physiological psychology has gone to show how numerous, almost beyond belief, are the factors of even the most rudimentary perception. The ground, indeed, seems almost to fail from under one's feet when one realizes how such an apparently elementary act has been shown to be the sum of numerous observations and differences, of which many are, perhaps, unsuspected, and all are unknown to our direct consciousness.

The question of the revision of legislation in regard to the insane is, at this time, under consideration both in England and in France. In England Parliament has been occupied with various projects of law, results more or less direct of the parliamentary inquiry of 1877. In France the Government has charged a Commission composed of Senators, Deputies, Administrators, and Physicians, to study the improvements that might be introduced into this legislation.

It is not the object of this paper to give an exhaustive account of the pathology of general paralysis, but rather to describe what appears to us, as the result of our own observations, to be the most prominent histological feature of this fascinating and fatal disease.

In a former paper read to a meeting of this Association I attempted to gather together what has been handed down to us about the nervous disorders and hallucinations of Mahomet, of Luther, and of others great in history. It gave me much gratification to see that the paper formed the text of an interesting discussion. As we learn more of the influence of external circumstances and physical conditions on human belief and conduct, the records of the past are read in a new light. As science shows us the relation of events previously unknown, we see more surely how things really occurred; what was perplexing becomes clear; embellishments and additions fall off; and we are confirmed in the belief that the past was governed by the same laws as the present. Thus the knowledge of nervous diseases, and the experience gained by the study of hallucinations, illusions, and the errors and deceptions of the human mind, may explain some of the difficult problems of history.

I submit the following suggestions in reference to the Decoration and Furnishing of Asylums in response to the appeal of Dr. Savage at last year's General Meeting of the Society—his request that members should take up subjects connected with the everyday practical details of asylum management. I trust that this may prove helpful, and that the limits imposed upon a single paper will not be meagre to baldness.

6. In 1630 Alexander Hamilton confessed to having met the devil in the likeness of a black man riding on a black horse. He renounced his baptism, and engaged to become the devil's servant, on receipt of four shillings sterling. The devil instructed him how to be revenged of his enemies, and further gave him a spell by which he hilled the Lady Ormestone and her daughter in revenge of the lady's having refused him the loan of a mare, and having called him nicknames. Lastly, he declared he had many meetings with the devil, from whom he once got a severe drubbing for not keeping an appointment.

If I fix a square peg into an oblong hole, the fact that they do not fit is instantly perceptible; but it is manifest that the. several percepts of the peg and of the hole must precede the perception of the relation of non-adjustment subsisting between them. Furthermore, if I want to determine how much the peg lacks in size, I must measure separately both the peg and the hole before I can calculate the amount of the hiatus between them. What is true of this simple case of adjustment is true of the complex case of the adjustment of the organism to its environment. However rapid and apparently immediate may be the cognition that a patient is insane—is unadjusted to his environment—yet that cognition must be preceded by a previous knowledge both of the organism itself and of the environment with which his adjustment has failed. The truth of this statement, which is involved in the definition of Insanity, may not be at once apparent, but a little consideration will render it clear. It is manifest that before pronouncing a man insane, we must first know something about him, but that we must also take into account his environment is, perhaps, not so self-evident.

A study of the so-called reflexes, both superficial and deep, is of considerable interest in general paralysis of the insane. Of these the knee-phenomenon, knee-jerk (Gowers), or patellar tendon-reflex, is one so easily examined, so well known, and of such valuable import, that what follows will mainly be devoted to the consideration of this physiological phenomenon.

It is only of late years, and that in a desultory manner, that what is here meant by nervous dulness has been recognised. A few words on the subject may not therefore be unacceptable, particularly as it has bearings on questions of social interest.

In attempting a description of the School System as carried out in this institution, I am undertaking a task the accomplishment of which I feel at the outset must be very imperfect indeed; but considering how often I have had to answer such questions as the following—“What is the use of a school for lunatics?” “What can you possibly teach them?” I think it is due to my position to describe as well as my abilities permit our system, inviting at the same time all interested in the welfare of the insane to come and see for themselves its beneficial influences.

A recent holiday sojourn in Morocco having enabled me to complete certain information which I obtained some years ago while on a tour through Turkey and Asia Minor with respect to how far cannabis indica and syphilis are factors in the production of mental disease in the East, I proceed to record the following information which I have gathered on the subject:—

Only since advancing science has demonstrated the true connection between mind and body, and dispelled the illusory fancies of metaphysicians, has a rational philosophy sprang up regarding the nature of mental processes. The study ot psychology having at length been placed on a proper basis and freed from the spiritualistic haze with which it has so long been shrouded, there is now great reason to hope that much may be accomplished in elucidating the various phenomena of mental disease. No study of insanity that is not founded on a physical basis can be of any real value in throwing light on the many phases of mental disorder, or in assisting to a knowledge of the proper method of treatment and management of the insane.

In the next place we arrive at the consideration of—

B. The supposed cortical auditory centre. (First temporesphenoidal convolution.)

It is not less true now than when Dr. Watts sang, “Satan finds some mischief still for idle hands to do,” and two of the Commissioners in Lunacy, after their latest inspection of my asylum on the 18th of this month, said in their report, “Many of the gentlemen are usefully employed for some hours daily, and those whom we saw at work expressed themselves as well pleased with their occupations. We are extremely glad to find that Dr. Bower has successfully combated the difficulty of finding employment for gentlemen patients. Amusements in the shape of games are also found for both sexes.”

The second law of heredity is equal in importance to the first, and since it is of special importance in the study of insanity, and since both the law and its consequences have been hitherto almost overlooked by alienists, it is necessary to insist upon it with additional emphasis, and to discuss it at some length. This is the more necessary since there has been no formal enunciation of this law, although the several positions that it includes are very generally recognised. The following is the somewhat cumbrous expression of what I propose to call the Law of the Limited Dissimilarity of Parents.

I have sought to point out and to illustrate how all-pervading was the hold which the belief in witchcraft obtained upon all classes of society in the sixteenth and seventeenth centuries. I have pointed out how a species of criminal lunacy arose in connection with this belief; and how in the same connection, society might be said not only to have created a crime, but also to have manufactured the criminals.

I wish in the first instance to lay clearly down what are the objects to be attained in regard to alleged insanity in criminal cases; in the second place I shall speak of what is the course pursued in England to reach those ends, and point out its inadequacy and inconvenience; and, thirdly, I shall suggest certain modifications, or rather radical changes in our present system, which I submit will act beneficially in securing the objects I lay down as those we ought to have in view. I am not, of course, speaking here of the duties of the Expert; his rôle is much more limited in its range; but I am placing myself in the position of one who heartily desires to answer the question: Can the present method of ascertaining Criminal Responsibility in our Courts of Law be improved ?

The subject of the causation of insanity has recently attracted considerable attention; and with the abundant material which the Commissioners in Lunacy are annually accumulating, we may expect by-and-bye to learn something more of this large and complicated subject.

The conditions established to regulate the admission of patients into lunatic asylums have given rise, in every country, to a great deal of discussion. On the one hand, many unacquainted with medicine are inclined to dread the abuse of the power to confine individuals not really insane under the pretext of insanity, and with more or less criminal intent; therefore these persons contend that admissions to asylums should be preceded by intricate formalities and repeated inquiries, with the interference of some public authority, such as a commission of either judicial or administrative officers. On the other hand, physicians advocate the necessity of prompt recourse to an asylum, not only for the patient's own benefit, but for his family's welfare; they demonstrate that a man labouring under acute insanity cannot be left to himself during the time required to set in motion the working of such complicated machinery as that proposed to be brought into action prior to his admission into a hospital; they further reject all interference of the public authorities to this end, as hurtful to private family feeling and the maintenance of professional secrecy, demanding, likewise, the greatest facilities for easy admission, guaranteed, nevertheless, by any number of subsequent examinations, or other means of inquiry into the case; and, finally, they hold that such supposed illegal confinements do not exist, since it has not been proved that any one really of sound mind has ever been shut up in any asylum, and that, therefore, the liberty of the subject is in no danger whatever. So in this respect we may rest confident, seeing that the past gives us full assurance for the future. Such is, upon the whole, the main point of dispute in every discussion on the subject, which happens to spring up again and again in different countries.