Gentlemen,—I have three important duties to perform this afternoon. The first is once again to offer you a most hearty welcome to the City of York and to the Retreat. The second duty is an equally pleasurable one, namely, to thank you, from the depths of my inner consciousness, for your courteous thoughtfulness in spontaneously offering to revisit York this year, in celebration of the Retreat Centenary, and for your great goodness in conferring on me, just before my retirement from office, the high honour of the Presidentship of our Association. The third duty, however, is more difficult; indeed, the thought of it has been ever present with me during the past year. The more I have thought of the best subject for a presidential address, and the more previous presidential addresses I have re-read and studied, the more difficult and onerous my task has seemed to me.

In celebrating the Centenary of the York Retreat, the first question which arises in everybody's mind is, why was it established, and why at one time rather than at another? Further, it is natural to inquire what were its objects, and what influence has it exerted?

Mr. President and Gentlemen,—Whilst I feel very much honoured by the presence here to-day of the members of the Medico-Psychological Association of Great Britain and Ireland to listen to a paper from me on the “Cerebrospinal Axis as a Thermal Centre and Water Power,” I am, I confess, not a little anxious respecting the result of my labour. I know I stand before a body of listeners who, from their daily avocation as well as from their accomplished training in mental and physical science, form naturally the most critical audience I could address on the subject to be discussed, and this alone is a cause of grave concern. But there is something more before me. I am about to bring forward an entirely new line of research and observation in so elementary a stage that the simplicity of the thesis itself may, at first sight, seem to imperil its âceptance. I must, therefore, with special emphasis, claim, at the onset, your kindest indulgence.

I must confess that I approach the consideration of the relationship between general paralysis of the insane and syphilis with a certain degree of diffidence, seeing that here we have to deal with a question which is constantly being made the subject matter of discussion by modern alienists, and which in itself presents points of surpassing interest.

The subject of hypnotism has attracted great attention of late amongst the medical profession and the public. The accounts of its phenomena have sometimes been so extraordinary, and have bordered so closely on the miraculous, that intense interest was excited in them. As these statements were attested by men of science and of reputation, and as it was said that hypnotism had such enormous therapeutic possibilities before it, it was essential that serious attention should be given to the study of this subject by those interested in scientific medicine. This study was, however, commenced in this country with feelings of great distrust and reluctance, as it was notorious that for years unprincipled persons had imposed on the public by pretending to all manner of occult powers as mesmerists. They had so offended by these means the feelings of right-minded people, and had produced such a disgust of these phenomena, that many felt it was impossible to investigate hypnotism without contamination. In addition to this, discredit was brought on the subject by the fact that there were two schools in the field with opposing theories, observations and practice, whose pupils carried on a bitter warfare in the press. The most contradictory statements on matters of observation had been made by distinguished physicians, and phenomena had also been recorded which, if true, seemed to overturn the established laws of Nature and all our fixed ideas of things. In spite of the antipathy produced by these facts, one instinctively felt that underlying this mass of contradiction, absurdity and imposture, there lay important truths, and so, impelled by a mixture of scientific and idle curiosity, I paid a visit to the principal teachers in Paris and Nancy, to see with my own eyes what hypnotism was, and what use was being made of it. In the accompanying notes of my visit I have not attempted to draw up a systematic account of hypnotism, as this may be found in books, but I have merely given a plain description of the phenomena I myself witnessed.

In the study of genius and insanity we shall endeavour to follow the empirical rather than the polemical method. This will require the statement of many facts, gathered from different sources, but principally from the instructive works, “L'Homme de Génie,” by Cesare Lombroso, and “Psychologie Morbide,” by Moreau (de Tours).

Griesinger says: “The onset of psychosis after influenza follows in all cases after the disappearance of bodily symptoms, and when the increased temperature has passed off. The character of the psychosis varies from slight to profound depression, hallucination, typical maniacal disorder, and the like.”

Dr. Hughlings Jackson remarks that in every case of insanity there are negative lesions of the highest centres, which cause some paralysis, sensory or motor, or both (“Journal Mental Science,” October, 1888). Evidence that this is so has been brought forward by him, principally, however, in relation to the insanity of epilepsy and postepileptic states.

The dangers to be apprehended from the abuse of cocain are probably hardly yet quite realized, at least in this country. A great deal of harm has undoubtedly been done of recent years by the use of cocain as a help to break off the morphia habit. An exaggerated estimate of the assistance to be obtained from the former drug has been formed by such writers as Freund, and although Lewin and Erlenmeyer have warned us not to fly from Scylla to Charybdis, still it is to be feared that the notion lingers that cocain may be used advantageously and safely for this purpose. Nothing can be more mistaken. Cocain is more seductive than morphia; it fastens upon its victim more rapidly, and its hold is at least as tight. Cocain solutions are probably somewhat too freely prescribed in cases of disease of the nose and naso pharynx. Patients who use the drug in this way become very soon acquainted with its agreeable effects. Several cases have been recorded by American authors of cocain habit arising thus. That cocain has not been even more extensively misused is probably due to its being still a comparatively new drug, and also in part to its costliness. Up to the present time the largest number of its victims appear, unfortunately, to have been medical men.

Ten years ago Mr. Jonathan Hutchinson said that the description of a fresh diathesis was almost as easy as the discovery of a new nerve centre or the revelation of a new bacterium. Yet no new diathesis, so far as I know, has since then become generally recognized in our special branch of medicine. To-day the neurotic diathesis stands as god-mother to a large family of diseases, and little has been done to differentiate their ætiology, or to trace their genealogy. On the contrary there seems to be a tendency to exaggerate the importance of environment in the ætiology of many of the diseases of the nervous system, and to ignore the hereditary factor. Especially is this the case with general paralysis. Excepting the writings of a few, a course of reading on the ætiology of general paralysis would incline one to believe that there is no evil under the sun—from syphilis to the cessation of lactation—that may not sufficiently account for the onset of that disease. It seems almost as if the observers had first tried to find an acknowledged raison d'être, and, failing in that, had adduced as “cause” anything in the recent history of the patient at all out of the common, or which had ranked as important in the estimation of his friends.

As katatonia, “a mental disorder,” writes Spitzka, “well marked but not generally recognized,” has hitherto received but scant notice in this country, the following observations, based on the study of a group of cases which well illustrated its alleged characteristics, may not be devoid of interest.

Of late years considerable attention has been directed to the science now commonly alluded to as criminal anthropology. The workers in this field have been mainly continental alienists, notably the Italians, of whom one of the most prominent is Professor Lombroso; and the writings of Mr. Havelock Ellis have brought the subject into prominence in this country.

In the case of Ellen D., a female general paralytic in an advanced stage of the disease, whenever she was spoken to her features would be distorted by an exaggerated grin; the eyes nearly closed by the action of the lower part of the orbicularis palpebrarum, mouth opened and its angles retracted, the upper lip excessively elevated showing the gum, the tongue lolled out between the teeth always on the left side, and enormously deep naso-labial folds produced, curving round the angles of the mouth and blending with each other on the end of the chin.

The population of Norway in 1875 consisted of 891,000 males and 930,000 females. (The details of the last census, 1890, showing a population of two millions, have not yet been published). Of these were insane 2,186 males and 2,382 females, giving a ratio of 23 insane (20·4 males, 25·6 females) to every 10,000 of the population. The total number of admissions into asylums for the year 1889 was 756, a ratio of 4·15 per 10,000. These figures compare favourably with those given in the report of the Commissioners in Lunacy for England for the same year, viz, 29·2 insane (27·2 males, 31·2 females) to every 10,000 population, and a ratio of 5·18 per 10,000 on the admissions. Although Norway is a poor country, such extreme poverty and distress as is found in our large cities does not exist there, and this, probably, accounts for the considerably smaller ratio of insane to population. Of the 756 total admissions 32 per cent, were suffering from melancholia, 27 per cent, from mania, 24 per cent, from dementia, and from general paralysis and epilepsy, equally, 1·9 per cent. The marked preponderance of melancholia over mania is interesting, the opposite conditions obtaining in this country, where mania shows an excess of 24 per cent. The distribution of a small population over a large tract of country, the mountainous character of that country, the monotony of life, the lack of amusement, the phlegmatic character of the race, in contrast to the crowded condition of the people, the high tension of living, and the excitement of city life which prevails in this country probably explain the difference. The small number (1·9 per cent, of the admissions,—being 6·4 per cent, less than in England) of those suffering from general paralysis might be explained in the same manner.

I touched on this subject in a paper that I published in our Journal in 1883, and mentioned several changes which I had introduced into the diet scale of the asylum I have charge of. I suggested that an expression of opinion of various asylum physicians would be useful, and might with advantage appear in the columns of this Journal. Dr. Rayner, in the Presidential Address to our Society for 1884, made remarks somewhat resembling those I refer to, and called attention to the difficulties that exist in comparing diet scales, owing to their inaccurate and faulty construction, and instanced the diet scale of the asylum in which he acted as an illustration in point. In offering some remarks on asylum dietaries, I at once state that I do not consider my mode of dealing with the subject as at all complete or exhaustive—access not only to facts which I cannot possess myself of, but also an extended series of observations would be required to enable one really to deal with the subject as its importance merits. A paper such as I present is merely suggestive.

In the remarks which I am about to make I wish it clearly to be understood that, as I personally am not an accounting officer under the Act, I have no personal grievance to ventilate. In this asylum, not only I, but the other officials whose duty it is to make returns of an official nature, have always done so honestly, readily, and fully; and speaking not only for myself, but for others, we have formerly made, and hope in the future to make, all such returns in such a way as to comply with legal requirements, not only in the letter but the spirit of the law. And in such remarks as I make on our audit here, I wish to express myself plainly, but, at the same time, without the slightest suspicion of personal feeling to the auditor, who, I believe, acted conscientiously, and according to what he considered was the meaning of the law on the subject. At the same time, I doubt whether an auditor (in whom no legal or other qualifications are a necessity) is the fittest person to have the decision as to what is legal, expedient, and proper in the expenditure of a large county asylum. At present auditors certainly seem to think that their reading of the Lunacy Act should be accepted, no matter what the opinion of the committee and their legal advisers may be; and by surcharging items, they have it in their power to put committees and officials to such trouble that even if expenditure were proper, right, and in the interests both of the sane and insane inhabitants of asylums, yet one would hesitate about it with the knowledge of the correspondence, trouble, and annoyance which it might entail.

In view of the interest which the subject is at present arousing, a critical analysis of the historical development of the law of insanity in its relation to divorce may be neither inopportune nor uninstructive.

For some time past a considerable amount of attention has been directed, not only on the Continent, but also in the United States, to the provision for epileptics in separate cottages on the same estate, and this article has been written in the hope that it may lead to the early establishment of an “epileptic colony,” which shall be a home for the homeless, an industrial institution for those to whom ordinary avenues of trade are shut, a hospital where cure or some alleviation shall be possible, and an educational centre for the training of the young, thus creating a prosperous, industrious, and thriving community to serve as a model for many other such yet to be founded in this country. The word “home,” or “colony,” is suggested as being free from the repulsiveness which might attach to the name “asylum,” which would be somewhat of a misnomer.