Before addressing you, I have formally, however imperfectly, to express my full appreciation of the high honour conferred upon me at your hands in thus placing me in the Presidential Chair of your beneficent Association. I say beneficent advisedly, for when men have banded themselves together for the cultivation of science and the improvement of the condition of the insane, they associate to fulfil these functions as practical philanthropists. These good intentions have been realised in fruitful performance in words and deeds, and we hold our Annual Meeting to-day with a desire, an ability for good work that cannot fail to mark the year as one of humane progress.

Those who have watched a larval cod about 4 mm. in length nimbly avoiding the forceps following it for capture are in a fair way to estimate the brain-functions of an adult measuring three feet. Still more is this appreciation of such functions strengthened by the behaviour of a large grey skate in its endeavour to escape over a trawl-beam more than fifty feet long which had been arrested in its rise—just above the surface of the sea—by a temporary block in the machinery. The dexterity with which it skimmed to and fro along the beam to find where it dipped sufficiently during the movements of the ship to enable it to glide over was a study, and relief was felt when at last its intelligent perseverance was rewarded. The observation of a group of salmon on a spawning-bed, and the acquired skill of young trout in passing up a model of a salmon-ladder, are corroborative of both intelligence and memory. Moreover, if those who have given a green cod of six or eight inches a particular kind of “scale-back” (a kind of worm), and noticed, firstly, how eagerly it seized it, then tested it in its pharyngeal region, and soon ejected it, never again taking that species into its mouth, would be slow to deny that fishes, and even very young fishes, have a memory. It is well known that fishes prefer certain kinds of bait to others, probably because they retain the pleasant sensations of former occasions. Thus it is that anemones are a fatal bait for cod, lob-worms and certain Nereids for plaice, the toothsome mussel for most marine fishes, and the stripe of silvery skin (like a young rockling or mackerel-midge) so eagerly sought by the mackerel. Muddy water, again, obscures the nature of bait, and misleads both observation and memory, so that a lure which would not so readily capture in clear water is now effective, because no suspicions are roused. On the other hand, the presence of phosphorescent organisms on a mackerel- or herring-net is said to prevent a successful haul.

Although ancient writers have given short descriptions of mental diseases affecting children, it was not until the commencement of this century that the subject began to attract attention. Since then Esquirol, Guislain, Delasiauve, and others have written on the matter, and in 1856 Le Paulmier, in a thesis, gave the most complete description of the affection which had previously been published. Numerous authors in England, Germany, and France have since 1856 written on the subject, but still there seems to be a good deal of want of knowledge regarding the mental affections of children.

Two Treatises∗ recently published contain the views of Professor Flechsig, of Leipzig, upon the present state of our knowledge of brain function. The first is in the form of an oration delivered in 1894 in the University Church of Leipzig, of which a new edition appeared last year. The second is a shorter pamphlet, which contains an account of the most recent researches in the structure of the brain. In the oration the notes occupy three times the space of the text; in the other treatise the notes are not so long. In both these notes are important, and form in some passages the most interesting part of the work. He holds that the time has now come when the old introspective psychology must turn for guidance to anatomy and physiology. It is only within the last few years that such claims could be entertained. The localisation of mental operations in the brain was made by Hippocrates from observations of the loss of function caused by diseases or wounds of the head. Polybos, the son-in-law of the great Greek physician, held that the brain was the centre of the nerves and the central organ of the thinking soul; and Erasistratos, of Alexandria, first taught that the superior intelligence of man depended upon the greater size of the human brain, and the more complicated structure of the convolutions. A new era began with the experiments of Fritsch and Hitzig in our own day. Since then experimental physiology and clinical observations, going hand in hand together, have led to the accumulation of a large fund of knowledge about the several functions of the nervous centres. Another path of discovery was opened by Golgi through his new method of differentiating the finer structure of the grey masses of the brain by his silver colourings; and also by Kölliker, who, working with low powers, was able to demonstrate the course of the motor and sensory nerve paths and of the association system in the brain.

Chapter XIII.

Continuing the recapitulation, begun in the last chapter (which dealt thus with the more general morphological states), we next resume in brief the several Chapters, III to VIII, on

I. General Remarks. — It has frequently appeared to me that a rapid and easy method of staining according to Nissl would be of great advantage. It has been my routine practice to cut a fresh section and to stain according to Bevan Lewis in every case of insanity in which an autopsy had been obtained, and from that to record a few microscopic notes. A fairly complete description of neuroglial changes could thus be recorded, but only in a minor degree the changes which had occurred in cell protoplasm, i. e. cytological changes and various degenerations. For this one has to stain according to the method of Nissl, a method which stands out supreme for this purpose. But even Nissl's method is by no means perfect, and there are many drawbacks and imperfections. Hardening in alcohol causes considerable shrinkage; in fact, the main part of the cell is occupied by the nucleus. Alcohol also largely dissolves out fat, and therefore fatty degeneration cannot be shown. Again, it is not every asylum laboratory that has equipment for Nissl's method, but every asylum has the means of making a Nissl preparation according to a way I am about to describe.

It is not my purpose on the present occasion to relate a series of observations. I merely desire to ask your attention to a field of work hitherto little cultivated, either abroad or in this country, especially the latter. I have not, indeed, come across any account from which it is to be gathered that anthropological methods—which are what I now refer to— have been adopted systematically in any asylum for any length of time, although of late such have been in use in certain asylums of America, and also of Italy. In respect of France and Central Europe I have no certain information; but I have not seen any notice in the journals of the speciality of the employment of these methods in the asylums of those countries. That the grosser stigmata of degeneration have been observed in the course of ordinary clinical work in asylums for some time, we are all aware. It is common to hear at clinical examinations that a particular case has a “narrow” or “sloping” forehead, a “flat” occiput; possibly we are at times more venturesome, and describe the head as “dolico-” or “brachy-cephalic” (our remarks thereby acquiring a certain nuance of scientific gravity). Or perhaps the palate is noted to be “arched” or “Gothic,” “semi-V-shaped” or “semi-saddle-shaped;” or the chin to be “receding;” or, employing a dramatic generalisation, we pronounce the patient to be of a “simian” type. I need not illustrate further, my object being simply to bring to mind the fact that it has for long been thought worth while to record conditions ascribed to imperfections of development. I pass to the representation that if it is worth while to record such conditions at all, it is proper that there should be some system whereby they may bo recorded. There are pathological forms, as you are aware, in many asylums, on which systematic records of autopsies are kept; and if at some future period it is desired to ascertain with what frequency a particular diseased condition occurs, or whether the supposed significance of such condition is real, the accumulated facts are available for consultation. But if one desires to ascertain to what extent it is true that certain anomalies of palate or ear occur in the insane, or that they occur particularly in certain states of mental perversion, one looks in vain for records. and if, haply, observations on the point be forthcoming, what is their scientific value?

The care, training, and education of physically and mentally defective children is now an accepted public duty undertaken by the State at the public cost, to the extent at least of providing the necessary schools and institutions, and other needful arrangements. Blind and deaf and dumb children are provided for by legislation, which was passed as the result of the facts of the case relating to the special needs of those children having become apparent by the general enforcement of compulsory education. Imbecile and idiot children have also been provided for by laws passed during recent years; but inasmuch as all the laws relating to those classes of children are either Lunacy Statutes, or have as their object to make provision for weak-mindedness viewed as a special or modified form of insanity, they have been found to be inadequate for providing the necessary facilities for the proper care and education of children of defective intellect, but devoid of those insane characteristics which distinguish true imbecility and idiocy. The probable reason for this hiatus in the legal provision for the education of weak-minded children, is that it has hitherto been assumed that a child who is not a certifiable imbecile is capable of being taught in an ordinary school. That such is a mistaken view many who have had experience among children of defective intelligence have recognised, and the Committee on Defective and Epileptic Children, whose report has just been published, recognise the distinction between the two classes of feeble-minded children and base their recommendations upon it. Indeed, the Committee was appointed to consider the case of such children, because it was found in practice that many children of school age were unable to profit by the instruction of ordinary schools, and yet were not imbeciles or idiots, and the reference to the Committee was limited to that class of children. The Committee say in their report, “the word ‘feeble-minded’ as used in the report denotes only those children who are not imbecile, and who cannot properly be taught in ordinary elementary schools by ordinary methods.” It is clear that if legislative sanction is given to the recommendations of the Committee, a great benefit will be conferred upon non-imbecile feeble-minded children, and upon their parents; and an important step in advance will also be taken in the direction of making more reasonable use of existing facilities for the care and training of imbeciles and idiots.

Points of similarity between alcoholic and epileptic insanity are referred to by many writers on psychology. These short notes, which I bring before you to-day, refer to cases of criminal acts of violence committed by epileptic and alcoholic maniacs, and, I think, exemplify in a very striking manner the similarity above referred to—a similarity in the mental phenomena which preceded and which led up to the specific acts of violence in a series of cases.

This paper is only intended to be a preliminary note upon the specific gravity of the brain in the insane, and contains the results of experiments upon thirty cases conducted at the West Riding Asylum, Wakefield, during the early part of this year. Over 1400 investigations have been made upon these brains, and as the inclusion of data from different parts of the country might cause scientific inaccuracies, it has been thought advisable to publish the present results separately, prior to the initiation of a further series of experiments.

The desire of visiting the institutions in Denmark for the education of the defective classes was aroused in me by the praises bestowed upon them by my friend Jakob Soethre and Dr. Frederick Starr.∗ I knew that they were both men well fitted to judge correctly, and not likely to be misled by appearances, which are often deceptive and sometimes are meant to be so. What indeed struck me was the statement that there was no attempt at show in the Danish Asylums. They must, therefore, I thought, depend upon their intrinsic merits. I crossed the North Sea from Hull to Amsterdam in the “Professor Buys,” a route which I can recommend for those who prefer a short sea passage. I travelled through Northern Germany, stopping with some friends at Bremen, where I visited several institutions. In the beginning of July I reached Copenhagen, and soon got into communication with my friend, A. Friis, the Medical Superintendent of the Custodial Asylum for Imbeciles at Ebberödgaard. Besides his eminent qualities as a physician and a man of literary culture, Dr. Friis has the especial merit of speaking English fluently, and, through his kind attentions, I escaped the difficulties and perplexities to which I should have been otherwise exposed.

The writings of Morel, Wildermuth, Binder, Gradengo, Vali, Frigerio, Eyle, Schwalbe, have familiarised us with several types of ear; and this, together with Bertillon's work, perhaps forms the bulk of our knowledge on the subject. Recently, in America, good summaries have been published by Meyer and Peterson.

There is but one important preliminary to my paper. It is that I wish to take this opportunity of expressing my most sincere thanks to the medical officers of Bethlem Hospital (Dr. Percy Smith, Dr. Hyslop, and Dr. Craig) for their great kindness and courtesy in putting every facility in my way while I was making the following observations, for the interest which they took in my work, and for the valuable suggestions which they so willingly afforded me from time to time.

I have investigated as far as possible the causes of insanity in the last 1014 patients admitted to the Bristol Lunatic Asylum, 507 being males and a like number females. My purpose has been to ascertain in what proportion of insanity heredity was the prominent factor in causation, and what influence was exercised by alcohol, traumatism, and certain other agencies, where no taint of bad heredity could be found.

The bacterial disposal of sewage has been so widely discussed during the past year or two, that possibly some apology is due to the Association for the introduction of a subject that has ceased to be novel. So far as Hawkhead Asylum is concerned the subject is still in the experimental stage, and the brief outline of the experiment contained in the following communication is the outcome of a correspondence with some of my friends who suggested that the question is not without interest to asylum superintendents.

The refusal of food by an insane patient is a troublesome and frequently a serious matter, partly because, from the absence of symptoms in most cases, it is difficult to arrive at a diagnosis of its cause. In many instances it may reasonably be supposed that subjective feelings of pain or discomfort in the stomach, leading to the refusal of food, arise from organic disease or functional disorder of that organ. That there is a centre in the brain, disorder of which causes a distaste for food, has been suggested, but is scarcely worthy of serious consideration. The cause is more likely to be some local affection, such as malignant disease, gastric ulcer, or simple gastritis, giving rise to pain on the ingestion of food; the refusal of food is then the translation of a protest from a stomach in an unfit state to receive any but the lightest food.

The important part played by alcoholism in the causation of suicide has been abundantly recognised by all observers of both these social phenomena; and so far as debate now touches the question, it is merely to deal with points of detail.

The period chosen is from the introduction of “The Criminal Lunatics Act, 1884,” to the end of the year 1896, and male cases only are considered.

“It is to be hoped and expected that with the spread of knowledge and education alcoholic intemperance may come to be regarded always and everywhere as vicious and reprehensible. It is a grievous matter that it should be lightly regarded in any quarter as a venial offence, and I should gladly support some more rigorous form of punishment for the vice of occasional intemperance than can now be meted out.

Introduction.—In these days of elaborate technique, it may not be without interest to record a method which enables us to demonstrate details of structure in the nerve-cells which have been practically untampered with by hardening fluids or other reagents.