Having been invited by our indefatigable Secretary to give a contribution to the present meeting, and having been recently engaged in looking over the earlier records of the Old Asylum of Dundee, it occurred to me that a few remarks on the early history of this institution and the means then in use in the treatment of the patients might not prove uninteresting, as the Asylum was erected at a very important period in the history of psychological medicine, namely, that period when it had dawned on the public mind that harshness and chains were not the proper remedies for the insane, but that much might be done in the treatment of this affliction by kindness, gentleness, and especially by healthy occupation.

Puerperal Insanity has been my chief clinical study for the last seven years, and the present paper comprises the results of this experience. My observations will be founded on a minute study of forty cases.∗

Five cases of fatal lead poisoning occurred between 1884-6 among the employés of a certain white lead factory in the East of London. The cases presented the following common characters. They were all adult women, aged from 18 to 33. They had all worked at the factory for short periods from three to twelve months. They all exhibited mild symptoms of plumbism, such as a blue line round the gums and more or less ill-defined indisposition; paralyses were absent. They were all in their usual state of health within a few days or hours preceding death. Death was unexpected—mostly sudden. In four cases it was preceded by epileptic fits and coma, but in the fifth case no convulsions were noted, although they may have occurred during the night.

I propose to consider this subject exclusively in its relation to the insane of the better class. The pauper asylums throughout the country have long been admirably organized in this particular. Every such institution has attached to it a farm, gardens, a multiplicity of workshops, and the appliances for the pursuit of various trades—frequently those special to the locality, as weaving sheds in the West Biding Asylums. In one or another department, all the labourers and artisans, who comprise the majority of the inmates, can find congenial occupation. Manual labour, thus systematically provided for those able and willing to engage in it, is coincidently the source of immense benefit to the mental and physical health of the patients, and of considerable profit to the institution; the pauper lunatic, by one and the same effort, works out his own salvation and helps to pay for his care and treatment; the recovery rate is raised, the rate per head diminished. There is obviously danger of regarding the financial and not the remedial as the paramount consideration; but no instance of such an abuse of therapeutics has ever been brought forward. To the county patient hand-work is neither a novelty nor a hardship: even though his mental obliquity or confusion be such that he fails utterly to comprehend or appreciate the motives of those who urge him to employ himself; yet he is glad to exchange the monotony of ward, airing court, or aimless country walk, for the bustle and activity of farm or shop, with the prospect, may be, of working at his own craft or even acquiring a fresh one.

The problems which present themselves to any community in regard to insanity at the present day, are much more complex than that presented to primeval society—which was simply self-protection. Primeval society canonized or exterminated the insane as they were given to ecstatic visions or violence. Even in Anglo-Saxon lands at the present day, while one portion of the community starves and freezes the insane and calls out for their blood, another portion makes them its religious leaders.

Considerable diversity of treatment has hitherto obtained, especially with regard to sedatives. No systematic experiments are recorded, and no very conclusive data have been published. The following quotations from some of the best authorities, placed side by side, will summarise our present knowledge of the subject.

The value of an examination of the urinary constituents in the present investigation depends on (1) the promptness with which it is made, and whenever possible it should date from the first warning of mental attack; (2) on qualitative and quantitative analysis; (3) on microscopic examination; (4) on fluid and solid measures.

Every “psychiater” knows that “psychoses” are divided into two great groups: primary “psychosis” and hereditary “psychosis.” These two groups differ very much in their manifestations, in their course, and in their final issue. Such a classification can therefore be considered as rational, logical, and satisfactory.

When we examine the purpose and the progress of the animal world from the scientific standpoint, we find that “life is a cycle, beginning in an ovum, and coming round to an ovum again,” and the history of the human race, the failures and triumphs of nations, the loves and hates, the baseness and nobility of individuals, appear to be “the mere by-play of ovum bearing organisms.” Whatever other purpose is served by our existence, we are certainly placed here to reproduce our kind, and to furnish human figures to play their part in the next scene of the perpetual panorama of life. Moreover, we make man in our own image, after our likeness, and endow him with the characteristics we have inherited from our ancestors, and with those which we have created, for good or evil, in our own life. One of the oldest of books teaches us that the sins of the fathers will be visited upon the children to the third and fourth generations, and we might go further and say that physiological sins will penalize the race for many generations, and even lead to its utter extinction, unless counteracted by the strong antidotes of physiological morality, perfect hygienic conditions, and judicious intermarriage with untainted breeds.

(1) The Universal Symptomatology of an Epileptic Fit owing to discharge beginning in some part of the highest cerebral centres.—There is but little doubt that in a severe epileptic paroxysm (“genuine epilepsy”) there are effects, although very crude ones, produced in, or referred to, all parts of the body, animal and organic. Speaking figuratively, there is an endeavour to develop activity of all parts of the body excessively, and of all of them at once, and as rapidly as possible.

It has been said that recognition will come sooner or later to the man who can wait. With the gratifying exception of his long connection with this Journal, the writer cannot say that this has been his experience. In a work named “The Alphabet of Thought,” &c., published twenty-five years ago, was contained what he fully believes, after painstaking subsequent research, to have been the foreshadowing, at least, of one of the most important Laws of Thought. The late Dr. Mansel, Dean of St. Paul's, was acquainted with the writer's views, the work mentioned and the chief contents of this essay having been submitted to him, and the writer would here record his gratitude to the late Dean for the unusual courtesy with which he examined their contents. Since, however, the writer's views were strongly opposed to the Dean's, he never expected from that gentleman anything but adverse criticism. This fact has, however, completely failed to shake the author's confidence in conclusions which for nearly forty years he has submitted in vain to the most pitiless scepticism he could bring to bear upon them. Most of Mansel's strictures, together with the passages to which they refer, are here presented to the reader, and also extracts from letters received from the same gentleman bearing on the chief point herein discussed. Replies to both are given, combined with the later views at which the author has arrived.

The title of this paper implies the assumption that the current doctrine with reference to the condition known as pachymeningitis is not the true one; obviously the use of this term signifies that the pathological process underlying the morbid changes met with is one of inflammation, and that without the operation of this agency they would not occur. Now, without denying the possible occurrence of a condition to which the name of cerebral pachymeningitis might with appropriateness be applied, my endeavour will be to bring forward arguments and proofs to show that the condition which usually passes under that term is not the result of inflammation at all, but that all the phenomena met with may be explained as the simple result of effusion of blood into the subdural space (arachnoid cavity).

Among the descriptions which have appeared from time to time in the “Journal of Mental Science” of buildings arranged for the treatment of the insane, I have not observed any which show details of a building, in connection with an asylum, set apart for cases of infectious disease.

As the British Medical Association does not often visit Ireland, I think the present not an unsuitable time to lay before this Section a few facts which I think of special bearing on the management of Trish asylums, and largely affecting the interests of their inmates. My object, however, is as much to elicit the opinions of others as to impart information. When the Psychological Association met in Dublin in 1875 an interesting paper was read by Dr. Stewart on the “Obstacles to the Advancement in Ireland of Psychological Medicine,” and laid principal stress on the fact that 18 out of 22 Irish asylums had no assistant medical officer. Suffice it now to say that they have since been appointed to five other asylums, but that there are still 13 asylums without a second medical officer.

Certain therapeutic effects upon the human organism ascribed to cocaine,∗ occasioned me to make use of the drug in suitable cases of psychosis and psycho-neurosis. Stimulant action and exhilaration (Euphoria) on the one hand, and on the other depression of undue sensitiveness, these were the effects I looked for from the alkaloid. Unfortunately, I am able to record scarcely a single case of certain and permanent cure following the use of the drug.

The question of the value of electricity in the treatment of insanity is one concerning which much difference of opinion appears to prevail, although there seems to be a more or less general idea that it is, or ought to be, of some service. We every now and then read of cases which have progressed to recovery under the application of this agent, but, as far as one can judge from published records, very little has hitherto been done in this country to study the question at all thoroughly or systematically.

In the classification of the different forms of insanity, it has been agreed to distinguish two chief groups—the first including those recent and curable psychoses, to which the term diseased process is of a truth applicable—the second including those incurable cases which have run their course, and which, indeed, scarcely merit the term diseased process, representing rather, as they do, permanent vices, the results of past disease. Since, in the first group, the psychoses affect principally the emotional and psycho-motor elements of the nervous system, the diseases belonging to this category have been described as of the character or temper (in its older sense) as against diseases of the intellect, which constitute the second category—these latter being marked chiefly by failure of the intellectual powers.