The general object of the Criminal Justice Bill, now before Parliament, as set out in the explanatory Memorandum, is to improve the methods of dealing with persons found guilty of offences, including adolescent offenders and persons who commit repeated offences. It so happens that the Home Office has recently issued, as a Stationery Office publication, a Report on the Psychological Treatment of Crime which was made to the Secretary of State by Dr. Hubert and myself. The present position of psychiatry in relation to crime, therefore, seemed a fitting subject to discuss at this Conference.

Under the heading of “Injury before Mental Symptoms” it is desirable to consider first the surgical conditions of concussion, cerebral irritability and states of compression with their associated mental symptoms, for these must form a solid background for our consideration of all those cases where there is a head injury and mental disorder supervenes. It is, of course, possible to get an unrecognized fracture of the skull following a slight injury which will cause no further disturbance than, say, a headache. An example of this is supplied in a recent report, where a prospective member of Parliament sustained a fissured fracture of the skull as a result of bumping his head against the roof of a car when going over a hump-backed bridge; but nevertheless went about his business for a month afterwards, ignorant of the fact of the fracture, although experiencing a headache, which eventually sent him to a doctor who, by radiography, was able to make the diagnosis.

That medico-mental science is often at variance with the doctrines and decisions of the courts of law is a fact too well known and too generally admitted to need formal proof. It is almost as generally assumed that the scandalous failures of justice, which too often result, must be attributed to the defective education and knowledge of the profession. It is alleged that, as a body, we are for the most part ignorant and theoretical in matters relating to insanity, and if not ignorant, then presuming, and often using the little knowledge we possess, rather with the intent to rescue thieves and murderers from the legal consequences of their crimes than to help the administration of justice. It is certainly a fact which many of us lament that the corporate bodies of the profession generally, including the general medical council, ignore the subject as a distinct department of medical education; and consequently medical practitioners, not being duly trained, do sometimes appear to great disadvantage in courts of law. Medical shortcomings are not, however, the subject of my paper, but certain fundamental defects in the principles and procedures of the law which render medico-mental science sometimes even worse than useless, and always less useful to the commonweal than it might be, if rightly adapted to the needs of modern society. Nor would it be difficult to show that some of the crime and folly which occupies our courts and fills our reformatories, prisons, workhouses, and lunatic asylums, is capable of prevention by a well-devised use of medico-mental science. As these matters are wholly beyond the powers of the profession, I shall ask leave to move at the close of the discussion that a committee be appointed, with power to take such steps as may be thought necessary to secure a thorough inquiry by the Government into the relations of medical science to the administration of the law in regard to all persons mentally disordered or defective, with a view to such improvements as may be practicable.

If I were asked the especial and characteristic features of this present day, I should most certainly take good care to enumerate that one (feature) which seeks to modify or even undo the legislative acts of our progenitors, that is to say, of those who, living in the new or early times—not the old times—were without that needful experience and knowledge wherewith to realise the truth. As you know well, the science of our forefathers was, at its best, a poor and sickly thing—sadly misshapen and badly used; and as to Psychology, it was, indeed, at a miserable discount.

The ingestion of a pint of milk by a normal fasting individual is followed by certain blood changes, the most important of which are an increase in the leucocyte count and a slight rise of blood pressure. In the condition known as anaphylaxis, or protein shock, the general symptoms are accompanied by a fall in the number of blood leucocytes, a reversal of the differential count, and a lowering of the blood-pressure.

I wish to bring under the notice of the Association the case of a gentleman who some years ago became notorious through the graphic pen of Charles Dickens, and whose recent death has drawn fresh attention to his strange mode of life. Already nearly 10,000 copies of a biographical sketch of the hermit have been sold, and a brisk sale, I am informed, is still going on, while a large quantity of crockery, tea services, &c., representing his dwelling, have been sold. Being familiar with the residence of Lucas, the so-called Hermit of Red-Coat's Green, near Hitchin, and having visited him, I feel considerable interest in the question of his insanity (if indeed a medical psychologist could question it), and in the larger question whether, if insane, the character of the mental disorder in this and similar cases calls for any interference with the individual's liberty.

Some years ago I published a pamphlet (reprinted, with slight alterations, from the “St. Andrew's Medical Graduates' Transactions,” vol. iv., 1868) on Nervous Affections in Inherited Syphilis. At that time I had had bat one post-mortem examination. The patient was a girl, the daughter of the patient Joseph Mx., whose case is the second of two related by me in this Journal for July, 1874. She had epileptic fits. She died of typhoid fever, and no lesion of a syphilitic nature was discovered post-mortem. Thus I learned nothing from this case. In the “Brit. Med. Journal,”* May 18, 1572, I have reported a case of hemiplegia, previously unpublished, in a woman aged 22, who was manifestly the subject of inherited syphilis. That patient was in good general health, and is, I hope, still living.

Before the invasion of established general paralysis there is a prodromal stage, which ranges within wide limits as to its scope and duration. The clinical manifestations are many and various, and are symptomatic of either a rapid, or of a slow and insidious disintegration of the intellectual, moral, and affective life. Of all the prodromata, failure and decay of the moral sense are the most important, and are exemplified by acts of omission and commission against law, order, and propriety. The disease attacks all classes, and as the friends cannot nicely discriminate the changes in character, and are apt to look upon them as temporary aberrations, the disturbance to the social fabric caused by these sporadic displays of moral perversion is not inconsiderable. The nature and extent of the disharmony and distress occasioned by these moral lapses depend largely on the social standing, occupation, and opportunities of the diseased individual, and desolate homes, widespread ruin, and unenviable publicity often follow in the train of the predominant imaginative conceptions. The larger ambition may lead to wild speculation, the bolder schemes to fraud. Sobriety is turned into drunkenness, and sexual excitement may result in rape and acts of indecency. If thwarted or opposed, destructiveness or violence may ensue, but in this direction serious consequences are comparatively seldom associated with the expansive prodromata. The budding paralytic of this type is rarely vindictive; although easily roused to anger, he is easily calmed. Being, in his own estimation, so superior mentally and physically to his fellow-men, he can afford to pity and forgive.

Nearly twenty years have elapsed since Mr. Shand published in Mind an article entitled “Character and Emotions”; in this he formulated the hypothesis that the sentiments are complex derivatives of the primitive emotions. Thus, in the analysis of love and hatred he showed that “the same four emotional dispositions of fear, anger, joy, and sorrow, which are essential to the system of love, are present also in the system of hate.” Many eminent psychologists have adopted, or partially adopted, his views, among whom may be mentioned Professors Stout, McDougall, Westermarck, Sully, Caldecott, and Boyce Gibson. A great feature of this interesting work is its literary merit, and the infinite care and skill displayed by the author in his study of the emotions and tempers by an analysis of the characters portrayed by the great dramatists, poets, and novelists. Mr. Shand recognises the fact that the success of the dramatist and novelist depends upon the study of individual characters, and he gives numerous examples which we shall refer to later, but we will first call attention to two quotations which appear opposite the title page. “And this subject of the different characters of dispositions is one of those things wherein the common discourse of man is wiser than books, a thing which seldom happens. Wherefore, out of these materials (which are surely rich and abundant) let a full and careful treatise be constructed, so that an artificial and accurate dissection may be made of men's minds and natures, and the secret disposition of each particular man laid open, that from a knowledge of the whole the precepts concerning the cures of the mind may be more rightly formed. and not only the characters of dispositions impressed by nature should be received into this treatise, but age, country, state of health, make of body, etc. And, again, those which proceed from fortune, as in princes, nobles, common people, the rich, the poor, magistrates, the ignorant, the happy, the miserable,” etc. —Francis Bacon, De Augmentis Scientiarum, B. vii, Ch. iii.

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.

It is not surprising that the treatment of mental disorder should have brought in its train a clearer insight into the ordinary course of events in the human mind. In this as in every other department of medical experience the hidden processes of nature are revealed to advantage when they become manifest in some abnormal form. One has only to think of the importance of the part played by the recognition of heart-block and of muscular paralysis in elucidating the meaning of the successive phases of the cardiac cycle. In a wider field a greater claim can be made for clinical pathology in its contributions to knowledge of the structure and function of the nervous system. In the work of Hughlings Jackson (1) alone may be recognized the foundations of a new era not only of neurological medicine and surgery, but also in the more scientific spheres of anatomy and physiology. The subtle complexities that underlie the apparently even tenor of nature's average path may first come to light when disturbed by disease.