There is a growing disposition in some quarters to look on every criminal as an unsound person having a special neurosis; to discover, diagnostic evidence of the criminal nature in the conformation of the head and face, and in defective structure of brain; and to demand in consequence that criminals should not be punished as responsible, but treated as diseased, beings. It is a tendency against which, in the interests of true psychology, a timely protest may well be made; for its interests cannot in the end be served by pretensions to a knowledge which it is far from possessing and by unwarrantable claims to authority based upon such pretensions. If all criminals are, as the theory postulates, of defective or diseased mental organization, we must needs go on to acknowledge that few, if any, persons are well formed or sound mentally. Every Christian who listens reverently to the reading of the Ten Commandments and prays devoutly that God will incline his heart to keep them, feels, or ought to feel if he be in earnest, that he has in him the potentiality of committing every crime or sin forbidden by them. That he does not commit a particular crime which another person does is not owing always to a stronger and better nature in him, nor to an opportune infusion of prevenient grace, but to the absence of the adequate temptation in the circumstances of his life and calling. Time and the occasion count for much in the production of crime, as in the production of other human events; and it is quite possible that behind the crime of one who succumbs to an overwhelming temptation there may sometimes lie more merit than in the open virtue of another who has never been greatly tempted.

Makrizy, an Arabic historian, who wrote in the year 1421, tells us of the first hospital and lunatic wards with which Egypt was endowed. It appears that in 1278, a.d., a mamaluke called Kalaoon was attacked by a violent colic at Damascus, and, being cured by medicines from the hospital there, he vowed in gratitude that he would build a similar hospital should he ever come to the throne of Egypt. The following year he commenced a reign of eleven years, during which he seized Tripoli, recaptured Damascus, and governed his subjects at home by alternate acts of cruelty and beneficence. In one of his fits of anger he is said to have delivered up Cairo to sword and plunder for three days. He bartered one of his buildings for an old palace, turned the latter into a hospital, and built close by a school, and a mosque for his own burial place. His architect worked with such energy that the whole was completed in less than twelve months; but his excessive zeal made him unpopular with the ecclesiastics of the day. This is not to be wondered at, for he compelled all the artisans to work exclusively for him; he looted the citadel of Roda of granite and marble columns, and he used to stand on the scaffolds himself, and, by the aid of mamalukes in the streets, compelled passers by of every rank to carry stones for the building, so that no one would come that way if he could help it! Kalaoon endowed the hospital with money for wards and out-patients, and desired that all should make use of it—rich and poor, great and small, bond and free. His arrangements included doctors with fixed salaries, male and female nurses, beds and bedclothes, special wards for fevers, ophthalmia, wounds, diarrhoea, obstetrics, and phthisis, kitchen, wine, dispensary and medicines, and even a medical lecture-room. Fifty readers of the Koran were provided for the mosque-tomb, to lecture to thirty students of theology belonging to all the four sects, also a library with six eunuch attendants, and a school for orphan children.

The object of the present paper is to bring under the notice of this meeting the present state of Scotch Lunacy Legislation, especially as it affects our Chartered Asylums. For some years back efforts have from time to time been made to introduce various Bills into Parliament, calculated, more or less, to interfere with the present position of these institutions, and during the past Session one of these Bills has passed into law. It was evident to those who took any interest in this measure, that a strong feeling existed in regard to the extent to which Parochial Boards had control over their patients, and it was evident, sooner or later, that more extensive and more comprehensive legislation would ere long be forced on the notice of the public. That we should be prepared for this, it seems very desirable that we should know exactly our position, or how existing institutions are likely to be affected by such legislative efforts. But to understand this thoroughly, it will be necessary to consider the changes which have taken place in the Statutes affecting lunacy in Scotland since these were enacted in 1857, and this I will now do as briefly as possible.

Section I. Difficulties of the Subject.—I find that I have not made my opinions as to the nature of Post-Epileptic States clear to many of my medical brethren. I may plead in extenuation that, as the subject involves consideration of Psychology, the Anatomy and Physiology of the Nervous System, and Clinical Medicine, it is not easily presented in a simple way. It would be an absurdity to attempt to simplify it by ignoring its difficulties, and, before such an audience as this, it would be impertinent to deal with it in a popular way.∗ In the investigation of so large a subject, having the several very different aspects mentioned, we ought to take into very particular account many things which are, I think, commonly little regarded in connection with it, or which are passed over as being irrelevant to it. As I deal with post-epileptic states as they form part of the subject, Comparative Study of Insanities, I must consider the three topics recently mentioned; and, as one of my aims is to show that the same general principles apply to diseases of all parts of the nervous system, I shall frequently take cases of non-mental diseases for illustration.

Section VIII. Need of Wide Clinical Knowledge.—If anyone thinks that the study of Diseases of the Nervous System as they are Dissolutions will take his attention from their clinical or practical consideration he is mistaken. I urge two methods of study, one scientific and one clinical. Without a considerable clinical knowledge of cases no one is fitted to begin the scientific, comparative, study of nervous diseases. For the scientific study of insanities a very wide clinical knowledge is necessary. It would never do to confine attention to cases described in text-books by Alienist Physicians, to what I may call “orthodox” cases of insanity. Not being an Alienist Physician I say this, and what follows in the present Section, under correction by the Members of this Society, who of necessity know very much more of “Diseases of the Mind” than I do. I should not presume to address Alienist Physicians on their special subject had I not the hope that from a long study of simpler diseases of the Nervous System, I might contribute something of at least indirect value for the elucidation of the most complex problems they have to deal with. In a later section I shall urge a study of cases of abnormal mental affections, many, of which are not, in a clinical regard, cases of insanity at all, and, so far as I know, are not dwelt upon in books on Insanity.

I think that the foregoing statistics, and those which follow, together with the large number of cases which I quote, and which connect general paralysis with almost every form of neurotic manifestation, will prove conclusively that neurotic inheritance is a striking feature in the causation of general paralysis. I question whether a distinction between “the cerebral and the insane element” in general paralysis can be maintained. If general paralysis is not a degeneration of the mind-tissue, then the pathology of insanity has no existence, and I would say that the subtle influence for evil, which is transmitted from parents, whose brains are deteriorated by neurotic outbursts, or soaked in alcohol, or wrecked by physiological immorality, tends strongly towards such degeneration. If insanity is, as Dr. Savage says, a perversion of the ego, then a general paralytic is the in-sanest of the insane. We know that the children of a melancholic parent, for example, may develop any form of neurosis—in other words, it is not that melancholia or general paralysis, or any other definite disease, is transmitted, but that a certain tendency to deviate from normal development is transmitted. This tendency to deviate is the neurotic diathesis, and the form of its development is determined by collateral circumstances, and a certain series of collateral circumstances determine the development of general paralysis. Perhaps neurotic inheritance may mean in some cases a limited capital of nervous energy, and if this is wasted recklessly the individual breaks down suddenly and pathologically, as we all do slowly and physiologically. I would also point out that considering the number of histories of insanity which owing to ignorance or reticence we, do not receive, and considering that we never receive information as to the existence of the slighter neuroses, it is marvellous that we get so high a percentage as 51. Of the 145 general paralytics with a reliable history, 38 had a family history of insanity, 28 a family history of drink, 8 of both, 43 had a personal history of drink, 8 of a previous attack too remote to be considered, at least, according to our present ideas, as part of the disease, and the vast majority had a history of some physiological irregularity which must be considered as conducive to the creation of an acquired neurosis. We may now pass to some further statistics.

Having thus pointed out the difference between the singular and the general relative to the Law of Similarity, we may understand with greater clearness how Induction, though coming in common with every other mental process under this same law, nevertheless at the outset, namely, in the whole of comprehension, is never concerned with the comparison of similars, that is, two or more individual chains of identity, and cannot therefore, in its origin, be generalization from experience.

The Commissioners in Lunacy have lately recommended the erection of detached hospitals for the treatment of infectious disease at most of the English County Asylums, and it would seem that at least twenty of these institutions are already equipped in this matter. These hospitals differ greatly as to size, form of construction, adjuncts, distance from the main building, and, in fact, in all their features. Some resemble villas rather than hospitals, others are attached by corridors to the asylum. The most of them are of one story only, but one or two are of two stories. Some are divided into blocks, others are in one continuous building. The causes of this endless variety are, firstly, that there are no model plans of asylum hospitals published, and, as far as I am aware, no plans published at all, if I except that lately built at the East Riding Asylum, described in this Journal for April, 1887; and, secondly, that these hospitals being for the most part small affairs, architects are rarely invited to send in plans, so that there is a total absence of the stimulus of competition.

The subject of boarding-out is not in any way a new one. In 1864 Dr. (now Sir Arthur) Mitchell described very fully the condition of the insane in private dwellings in Scotland, and while exposing the many abuses that then existed, showed also that, under proper regulation, domestic care for a certain class of lunatics possesses many advantages, and urged that in it there could be found one very suitable method of providing against the accumulation of chronic insane in asylums. Since that time the subject has always been more or less prominently receiving attention from those who are concerned in providing for the insane. Therefore I cannot hope now to lay before you any fresh facts in reference to it. My object is rather, in the short time at my command, to draw attention to some of the outstanding features of the system, in the hope of raising a discussion and eliciting the opinions of members regarding it, especially the opinions of our friends from the other side of the border and from Ireland, where the conditions influencing the provision made for the insane are somewhat different from ours, and where boarding-out has so far not been practised to the same extent as in Scotland.

It being necessary to extend the accommodation of the Montrose Royal Lunatic Asylum, it was deemed advisable to erect a hospital entirely detached from the main building; in which all the bodily sick and other inmates who required special medical care would be brought together, and placed in circumstances more favourable to treatment than they could be in a ward of the asylum proper.

Section 5. Law of Latency.—A diathesis may be transmitted through a generation without giving outward and visible sign of its existence, and may appear in full vigour in the next; or a strong neurosis may manifest itself in the intermediate generation by a temperament (group 1); and in the third break out as one of the forms comprised in third or fourth groups. The neurotic diathesis is a creeping parasite, which though a mere line on the parent trunk, yet follows each branch to its uttermost offshoots, and here and there kills a delicate twig, or envelops a whole branch, and destroys it; but sometimes, under favourable circumstances, is itself eradicated by the vigorous growth of the stock.

Delusional insanity or monomania has long been looked upon as one of the chief forms or types of insanity, and it is so described in the leading works on the subject. It is doubtful, however, whether it would be considered by all to be a pathological entity apart from other forms of insanity; indeed, many consider it as simply a variety of mania, and in the returns to the Commissioners of Lunacy mania and monomania are classified under one head. So far, however, from these two affections being allied, I venture to consider them as fundamentally distinct, and having each a pathology of its own. To put the matter tersely, I would say that mania begins from the top, monomania from the bottom. This proposition, doubtless, requires some explanation. I have elsewhere given reasons for my belief that mania is an affection of the highest controlling and co-ordinating plexuses of the brain; that what indeed we know as mania is the manifestation of activity on the part of certain lower centres (the larger portion) of the brain, this over-activity being permitted by under-activity, or abeyance of function, on the part of the highest centres (or smaller portion) of the brain. This is what I mean by insanity commencing from the top.

Those who were present at the Glasgow meeting of the British Medical Association will remember that our Scotch members, especially Dr. Turnbull, endeavoured to get up an excursion to Kennoway. It was hoped that at least twenty would avail themselves of the opportunity, but the hope was not fulfilled; then ten, but this also failed; lastly five, but I am sorry to say there were not even five righteous men found in the Psychology Section of the British Medical Association. The excursion was therefore abandoned.

This subject will be best studied by first considering the evolution of reflex action on the lines laid down by Herbert Spencer.* Reflex action is first displayed in its crudest form in the contraction which occurs when the amoeba is touched, but not till there is a differentiation between the tissue which conducts and the tissue which responds to a stimulus, can reflex action be said to be thoroughly developed.

The question of the relation of epilepsy and crime acquired considerable prominence in the early part of the present year in connection with the trial of “Regina v. Hitchins.”* The defendant in this trial, the epileptic lad, who fatally shot his sister at Weston-super-Mare, is now an inmate of Broadmoor Asylum. A short time after his admission three other male patients were received who were also the victims of epilepsy; they, too, had committed acts of homicide which had engrossed a considerable share of public attention.

The following case illustrates the influence of heredity on the protracted types of insanity originating from or excited by self-abuse.

I count much upon your indulgence in presuming that you are willing to listen to the somewhat desultory remarks I desire to make in response to your invitation to contribute a paper to the Psychology Section of the International Congress.

In undertaking to introduce a discussion on this very large and important question, I am conscious of my inability to do it justice. No one can possibly cover the wide range of subjects comprised in it; and I am anxious rather to elicit the convictions of more experienced men than to obtrude my own crude and imperfect ideas. My purpose is, therefore, to state the case as briefly as possible, and to introduce questions for discussion in preference to merely ventilating my own ideas. In this way we may arrive at some common points of agreement and materially advance our knowledge of the subject. There can be no two opinions as to the advantage of bringing to a focus the collective experience and conclusions of the various sections of our profession interested in this field of research, and the present opportunity is a particularly good one. The title of the discussion embraces a great deal, and yet does not strictly include topics which might be considered relevant, particularly therapeutics. My aim at the outset will be to invite your special attention to a few questions only, and in order to make the most of our time and concentrate the discussion as much as possible I propose to take each division separately. The subject, viewed as a whole, is so far-reaching and practical as to possess uncommon interest, for it links together medicine and psychological medicine, it gives an open field of discussion to general medicine, obstetrics, and psychology, and it views insanity on its less speculative side, because the more materialistic functions are brought out in strong relief, and sometimes even overshadow the characters of mental disease.

The following relates to antifebrin as an antipyretic remedy. The cases were those of insane adult males. And what I shall have to say chiefly concerns phthisical pyrexia. Subsequently, I will briefly touch on the use of antifebrin in various inflammatory febrile maladies affecting the insane.