Mr. Presidentand Gentlemen,–Inthe annual report of the resident physician of Bethlehem for 1864 the following observations on the comparative statistics of Bethlehem Hospital and the English County Asylums occur:–The attention of the Governors and of all those interested in obtaining accurate information on the important question of the cure of the insane is earnestly requested to the following statistics collected by Mr. James Ellis, Medical Superintendent at St. Luke's Hospital, from the admissions into forty-four public asylums in the united kingdom, and from actual returns from each asylum. It shows the total number of patients received into each institution, and distinguishes those which would be from those which would not be admitted into Bethlehem Hospital. It also shows the numbers and per centage of the cures and deaths of such admissible patients during the first year of residence. [Here follows Mr. Ellis's table.]

There are two methods by which an approximate analysis of the elements or constituents and of the laws of Mind may be arrived at. They may be submitted to examination in the mind itself; or they may be inferred from character, conduct, or individual acts. In both processes there are sources of error, and limitations. When subjectively considered, the nature and the accuracy of the result depend upon the original capacities to observe, abstract, report; upon those as affected by education, physical health and external circumstances, and upon the influence of preconceived opinions in estimating mental phenomena.

As mental disease is generally of longer duration than other diseases, especially as seen in asylums for the insane—as it may be of life-long duration, and may frequently recur, or threaten to recur, in a single individual—to obtain a perfect knowledge of insanity, its history should extend from the earliest symptoms, and its subject be traced throughout life. Hence statistics which are made from records extending over a greater number of years are much more valuable than those which embody the results of a shorter period. A perfect series of statistical tables would require to exhibit, as far as they can, the complete history of every case, from the commencement of the mental disease until the death of the individual. This, however, is almost impossible. Dr. Thurnam,∗ under peculiar circumstances, has been able to give a series of statistics which trace the history of individuals beyond the asylum walls; but in ordinary cases such completeness is not obtainable, and we must content ourselves with less perfect results. Generally the history of the patient ceases when he leaves the asylum, and any facts we may obtain in his subsequent career are so few, and possibly inaccurate, that they cannot be embodied as trustworthy statistics. The history of those dying in the asylum, and of those under observation for five years or more, is more complete; but such cases are only those in whom treatment has been unsuccessful. In the cases of readmission, however, we have generally more trustworthy data, and are thus enabled to trace many subjects of mental disease throughout life.

The question of the specific gravity of the brain has already engaged the attention of several British investigators, the results of whose labours have from time to time been made known, but with the exception of a few isolated observations little has been done to this subject by continental anatomists or pathologists. At a time like the present, when the attention of scientific men is directed with renewed interest to all details concerning weight, form, and configu ration of the human brain, it seems reasonable to suppose that more complete observations upon the specific gravities of its several parts would be of itself a matter of scientific interest, independently of the importance attaching to the subject on account of the probable light which such an investigation might throw upon the situations of change in brain tissue, in connection with certain obscure forms of cerebral disease. The observations of previous inquirers have been directed to the estimation of the specific weights of the cere brum and cerebellum as a whole, of the gray and white matter separately, and of the combined central ganglia of the cerebrum. These investigations have been made by some, upon the brains of sane, and by others, upon those of insane individuals; and amongst the forty persons whose brains I have myself examined, there are also representatives of these two classes, though a large majority is included under the former denomination. Whilst tho actual number of brains inspected by myself is, therefore, limited, still the examination of their several parts has been more complete, so that this communication contains a record not only of differences found to exist in the specific gravity of gray matter taken from frontal, parietal, and occipital convolutions respectively; but, also, I believe for the first time, of the specific weights of the optic thalami, pons, medulla oblongata, and different parts of the corpora striata, taken sepa rately. Some of the facts so ascertained are very interesting, and seem to justify their early publication. Owing, also, to the existence of certain discrepancies in the results arrived at by preceding inves tigators and myself, it seems desirable that these discrepancies as well as our respective methods should be considered, with a view, if possible, of ensuring greater uniformity of results for the future. Investigations of a delicate nature such as these, when conducted by different observers, are comparatively useless for the purposes of comparison, unless some uniform method be adopted. These considerations have induced me to make known the results of my own observations sooner than I should otherwise have done, and will, I hope, be deemed a sufficient justification for my bringing them forward before they are sufficiently numerous to enable me to draw any very safe deductions from them. The present paper may, therefore, be con sidered as a first contribution towards the elucidation of a subject, at which I hope to work more thoroughly in the future.

Disease, in the great majority of its forms, consists, according to the most scientific pathologists, in either an excess or deficiency of those transformative processes by which new structures are built up and the old dissolved and carried away, and on the continuance of which the healthy growth and sustenance of the organism depend. Until an animal is full grown the constructive processes are in their maximum state of normal activity; while, relatively, the destructive processes are at their maximum of abeyance. But for the continuance of healthy adult life the balance of organic change must remain always even: growth must be equalled by decay; the agents of each must do equal work. If after the attainment of maturity the relative activity of the composing and decomposing processes should continue the same as before in any part of the organism, hypertrophy or abnormal growth would be the result. If, on the other hand, that relative activity is reversed–the destructive metamorphoses becoming predominant, either locally or generally–there is corresponding atrophy. Moreover, as one of the essential conditions of normal life, the co-ordinate action of the constructive and destructive agencies must range, within certain degrees of rapidity, beyond those limits in either direction the regions of disease are entered on. If that action be unduly slow, the physical frame is weak, the emotional nature is apathetic, the intellect lacks energy–systematic thinking being a toilsome or impossible task; if successively slower still, corresponding phases of vital degradation are passed through, until at length death itself ensues. If, on the contrary, the transformative processes be unduly rapid, there is exuberance of activity, both muscular and mental: repose is suffering; the feelings are intense, but quickly changeable; the intellect exhibits an excess of energy– ideas too rapidly formed to admit of adequate development chase each other through the mind in quick succession, and, having no stability, fail to become effective forces, shaping the life of the individual to some great or definite end. The physical and mental calm of conscious strength which the most healthy natures experience is wanting, existence being impulsive, restless, tumultuous, feverish– a sort of border land between normal activity and the most temperate zones of inflammation.

Enumeration of physical symptoms (continued).—With regard to the contraction of the pupil which in the first instance takes place, it is doubtless due to the act of shortening the focal distance when gazing at a near object.∗ Dilatation succeeds, and continues even during the early stage of the nervous sleep, but after some time has elapsed, the pupils contract as in ordinary sleep. During both periods—that of dilatation and the subsequent contraction — the pupils, according to Mr. Braid, are insensible to light.

The prognosis in mental disease involves two separate questions. In the first place, does the existing disease endanger life? And in the second place, if life be continued, whether, and to what extent, may recovery from the mental derangement be hoped for?

The various forms under which morbid impulses and perverted instincts present themselves have generally been classed by authors under “Moral Insanity” † and “Emotional Insanity,” † or each has been titled a mania or monomania. Their occurrence is found to be regulated by the degree of civilisation, mode of life–whether in town or country–and the prevailing tendencies of the age, which indelibly stamps them with its characteristic features. The classification adopted in the following pages is that of Professor Laycock, § which leads us first to examine those connected with the nourishment of the being.

The present seems to be a favorable moment for directing the attention of the profession to the condition of those insane paupers who are confined in workhouses. A general disposition to criticise the management of these establishments exists in the public mind, and the profession has given unequivocal evidence that it shares in this feeling and is determined to carry out the inquiry thoroughly. If may be safely affirmed that, if this is to be done, there is no part of the subject which demands earlier attention than the condition of those workhouse-inmates who are insane; for the circumstances which call so loudly for reform in the management of “indoor” paupers, especially those who are sick, exist in an extreme degree in the instance of the insane. The upshot of all careful inquiries into these matters, and notably of that inquiry now proceeding in the columns of ‘The Lancet’, is to make prominent the fact that those workhouses which are situated in populous cities are rapidly becoming great hospitals, instead of refuges for tired or lazy vagrants: while, as yet, the guardians who manage them cannot (or will not) understand that this is the case, but persist in treating the inmates as much as possible on the old system, by which the workhouse was a penal residence intended to disgust and repress the applicants for public relief. Under such a régime it has been shown that numbers of acutely sick persons suffer great hardship and have their chances of recovering health and strength materially interfered with; while as for the patients suffering from chronic disease and debility, it can hardly be said that they receive any proper care at all; and it is my purpose in the present paper to show particularly that the insane are the most deeply injured of all classes of indoor paupers by the system usually followed.

It will not, I think, be disputed that, in an investigation into the nature or pathology of any disease, some light may be thrown upon it by producing a similar disease artificially. If we ascertain how we can produce it, and what are the fewest conditions required for its presence, we have gained an important step in the inquiry. and if, aving learned how to cause certain symptoms, we can carefully examine the state of the bodily organs when these symptoms have supervened, and compare it with their condition previously, we undoubtedly have an opportunity of acquiring knowledge which no one accustomed to such investigations will despise. If, by adding caustic ammonia to the jugular vein of a living sheep, the lining membrane is afterwards found to be studded with pink fibrin, we see at once that a fact has been ascertained of great interest in the study of the adherent clot of phlebitis. The same may be said of rheumatic endocarditis, if deposits can be produced upon the valves of the heart by injecting a known substance into the blood of an animal. I might refer to other examples, but these will suffice to illustrate my first position.

As it appears that man is created in the image of the ape, it can not but be counted creditable to him that he strives so perseveringly to transcend his apehood.† Certainly, Transcendentalists, who, like Mr. Disraeli, are “on the side of the angels,” are not willing to acknowledge their humble parentage; but Transcendentalists like Mr. Disraeli are men of mystery, and not indisposed, consciously or unconsciously, to ingenious tricks of conjuring: one cannot always be sure whether they are acting or are in earnest. To those who do know themselves to be idealised monkeys it must be a matter

“On en est même vena aujourd'hui admettre que tons les épileptiques, sans exception, presentent, à certain degré, des perturbations de l'intelligence ou da caractère, et qu'aucun d'eux ne peut être considéré comme absolument sain d'esprit, [p. 661.] ∗ ∗ Cependant tous les auteurs sont d'accord pour reconnaître que la plupart des épileptiqnes présentent, à divers degrés, des troubles de I'intelligence et du caractère dans le cours habituel de leur existence, en dehors de leurs attaques convulsives.”–“De l'Etat Mental des Epileptiques,” par le Dr. Jules Fahret; ‘Archives Générales de Médecine,’ t. ii, 1860, p. 668.

Certainly it would have been more agreeable to those gentler feelings which the occurrence of death rarely fails to produce in men, and more in harmony with that charity which willingly covers over the sins and evil behaviour of an erring creature, once he has paid the last debt of nature, to have made no mention more’ of the convicted murderer, George Victor Townley, but to have allowed him to pass in silence to his suicidal rest. That he whom an audacious intrigue saved from the extreme penalty which the law metes out to the murderer should have become his own executioner, was, perhaps, the last small act of justice which he could do to outraged society; and of him, therefore, it may not untruly be said that nothing in his life became him so well as the leaving of it. But it has been the misfortune of Townley–a misfortune which pursues him even after death–to have been cursed with injudicious friends, and to be the helpless victim of some who, after the manner of parasites, would feed upon his notoriety and make to themselves capital out of his crime. It becomes then a duty not to keep silence under these circumstances, but truthfully to expose the passionate, though unsuccessful, attempt which has been made, by taking advantage of his suicide, and the vulgar prejudice in regard to such act, to set up a sort of justification of that foul disgrace into which, not the medico-psychological speciality only, but the whole medical profession, was mercilessly dragged on the occasion of his trial, and subsequently to it. Furthermore, since Townley's eventful life now constitutes a pathological fact in the annals of great crimes, and since tender feelings of compassion can have no place in pathological investigation of a felon's nature, it is necessary, in the cause of science, however much we may regret the necessity, to present the issue of a case the previous course of which has been recorded and discussed in the numbers of this Journal for January and April, 1864, and more fully in a special pamphlet on ‘Insanity and Crime’ by the Editors. The following is the account of his death and of the inquest upon his body as given in the daily papers:

In the ‘Journal of Mental Science’ for January, 1866, I published a paper containing a few remarks ‘On the several means of providing for the yearly increase of Pauper Lunatics.’