There are questions upon which the sagacity and ingenuity of observers have been vainly exercised since the beginning of time. They remain for examination, waiting a definite solution, which may never be discovered. Such is the question of the nature of epilepsy.

Gentlemen,—Each member of this Association, if placed in the honourable position of President, would, I presume, have his own special views as to the nature of a Presidential Address, although the selection of a subject might be attended with difficulties. Within the last few years you have wisely determined that such Address shall be a theme for discussion, and it appears to me expedient under these circumstances that the President should aim at bringing before you material of a debatable character, and at the same time that he should endeavour to suggest subjects which may lead to further progress in the special work we all have at heart. Such thoughts give rise in the first place to a feeling of personal inability, and next to a sense of the great responsibility which you have placed upon me. It seems presumptuous on my part to attempt to point out to you new fields of labour, yet I cannot help thinking that the assumption of less reticence as to our individual experiences, and the conclusions such experiences force upon us, would tend towards the development of greater and more beneficial progress.

I hope that you will agree with me that it is well to seize the occasion of our meeting in this locality to recall the memory of two remarkable physicians who practised for many years in Bristol—one, Dr. Prichard, who distinguished himself not only as an ethnologist, but as the author of by far the best English work on insanity in his generation, who was the most celebrated Medical Commissioner that ever sat at the Lunacy Board, and who produced a profound sensation in the legal and the psychological world by enunciating the doctrine of so-called “Moral Insanity,” the echoes of which have not yet died away, nor are likely to do so as long as crimes are committed, and the question of human responsibility has to be determined. The other, who will be ever remembered by those who knew him as the beloved physician, the late John Addington Symonds, the friend of Prichard, and one who, although not an alienist, felt a keen interest in, and had a great capacity for psychological research, having written several Essays, quite remarkable for their insight into some of those problems in psychology which we are yet far from having solved, and which we discuss with some heat even at the present moment.

These results are tabulated after weighing 400 brains as follows:—

1. 150 cases of Paralysis.

2. 70 cases of Atrophy.

3. ISO other causes.

Divided according to sex, thus:—

1. Males—126 cases of Paralysis.

2. 36 cases of Atrophy.

3. 108 other causes.

4. Females—24 cases of Paralysis.

5. 34 cases of Atrophy.

6. 72 other causes.

My apology for reading this short paper must be, my belief, that at our meetings too few communications are made bearing upon the medical treatment of mental disease.

The attention of those interested in mental diseases has lately been directed towards theories of the causes and origin of these diseases. In two recent works, widely differing in scientific scope and aim, though respectively instructive and powerful, theories of the genesis of melancholia and mania based upon the latest psychological and physiological knowledge have been advanced. To my mind, these theories, though containing much statement that is incontrovertible, stop short of conclusive, satisfying argument. At the same time, I was much surprised to read the following remarkable passage in a review of Dr. Mercier's book in the pages of the last number of this Journal:— “It is well to have a devout follower of Hughlings Jackson and Herbert Spencer, or, perhaps, one ought to have said a follower of Darwin and of evolution, giving his views upon mental order and disorder…. We ourselves are still inclined to believe in the unknowable.” Is the clinical and scientific work of the past few years, based upon the writings of, to put them in their proper order, Herbert Spencer, Darwin, and Hughlings Jackson, to be undone and disregarded, and are we to calmly fold our hands and wait with the reviewer for a new revelation? It will be strange, indeed, if any future theory of “mental order or disorder” can exist without having to reckon with the theories of Herbert Spencer and of evolution.

The relation of criminality to the other forms of pathological and abnormal humanity is one of degree. If we represent the highest degree, as crime, by A6, A5, say, would stand for insane criminality, and A4 for alcoholism, perhaps, A3 for pauperism, A2 for those weak forms of humanity that charity treats more especially, and A for the idea of wrong in general, particularly in its lightest forms. Thus, crime is the most exaggerated form of wrong; but these forms are all one in essence. A drop of water is as much water as is an ocean.

My hearers will remember that in 1889 the London County Council, appalled by the multitudes of insane persons committed to its charge, formed a strong and compact Committee to inquire into the means of dealing with this damnosa hæreditas. The Chairman of this Committee was a medical man who possesses in exceptional measure the qualities needed for such a post. A general inquiry into the means of treating insanity being, I presume, regarded as too large a commission, it was decided to concentrate the inquiry upon a proposal to build in London a hospital with a visiting staff for the study and treatment of insanity.

A distinguished historian well said “Before you attempt to write on any subject, be quite certain that you can say something fresh about it.”

The operation of counting is so familiar to us, and so easily brought under mental observation, that a definition of what it is in learned terms does not make anything clearer to our minds. The abstract idea in numbers is as many as, five, that is, as many fingers as I have, as many as you have, as many as your mouth and eyes and ears together, or as many as the sepals of the rose.

Sir Henry Holland, in his chapter on Sleep, considers its investigation should include causes which prevent as well as those which favour or produce it. In the investigation of sleeplessness we assume the converse of this as true, and advert briefly to what experimental physiologists regard as causes and accompaniments of sleep before engaging on its pathological condition, for the therapeutics of sleeplessness imply a knowledge of both. Disturbances of sleep are so constantly the heralds and associates of mental disease as to make insomnia, more than any other condition, common to all, or pathognomonic. The object of sleep, says Sir Henry Holland, is reparation, and sleep itself repose of sensibility and volition, whose cause is a change of condition of the nervous substance closely related to these functions, probably never to be ascertained by investigation, “yet,” he continues, “not the less real as a change on that account.”

Possibly the impressions received by an American during a visit to Gheel, may have an interest for some of the readers of the “Journal of Mental Science.” Its very unique organization seems still worthy of study, and suggestive, at least, in its teachings to the candid and unprejudiced observer.

The object of this paper is two-fold. First, it is a protest against the widely-spread notion that nearly all insanity is due to direct neurotic heredity; secondly, I wish to point out my belief that as much insanity depends upon surrounding conditions, so the general treatment by conditions rather than by drugs is the more reasonable and more efficacious.

I feel greatly honoured by being allowed to open a discussion on the working of this Act; but as Bethlem admits more private cases in the year than any other institution in the kingdom, and as the chief alterations in the law concern the admission of private patients, it is perhaps appropriate that the discussion should be opened by someone resident at Bethlem. I feel I cannot do this better than by bringing before your notice facts which have occurred, and if in doing this I weary you, it will be merely a small reflection of the weariness we have experienced in the last six months from this new law.

Gentlemen,—Having received a notice from our secretary that a paper was needed for this meeting, I felt in duty bound to comply with his request that I should supply one. It was easy to promise and not very difficult to decide on a subject, but since giving the promise I have found that there was very little new or worth my saying about the very important subject which is the theme of my paper.

For many years past the Retreat Committee, whilst constantly improving the structural condition of their hospital, have entirely ceased from extending it by the former practice of adding wing to wing and corridor to corridor.

The after-care of the male insane, to which I venture to draw your attention, with a view to discussion, is so closely allied to the objects of this Association that I trust its consideration may be not only of interest, but even of some practical usefulness. Although at present lying beyond the limits of our sphere of action, the time may arrive when our resources shall have so far developed that the annexation of this adjacent province may be both practicable and desirable.