Medical science on the experimental side has been productive of no more interesting or fruitful results than those which have appeared in connection with the study of hæmolysis. The groundwork of this subject was laid by Bordet (1) in 1900 by the discovery of the fact that an immune serum contains a thermostable substance (immune body), which, in the presence of the original immunising agent (blood-corpuscles or bacteria), is capable of absorbing complement; that is to say, a hæmolytic or bacteriolytic serum heated to 57° C. for an hour will lose its power of lysing the homologous blood or organisms, but it will retain thermostable substances whose activity can be restored by the addition of fresh non-immune serum.

The way in which schizophrenics react to physical illness and injury is a problem worthy of study, especially at the present time when schizophrenia is being so widely treated by methods which bring about profound changes of the physical state. Although schizophrenics, recent and chronic, are very susceptible to physical illness and form a considerable part of the sick population of the average mental hospital, this question has not attracted a great measure of attention. A survey of the schizophrenic population of a mental hospital suggests that there is an apparent lack of specific psychotic reactions to physical illness, so that it would seem as if schizophrenics react to physical illness either in a normal way or more commonly with indifference. It is true that certain paranoid patients include complaints of physical disturbances in their systems of delusions, but as a rule, even in these cases, there is no specific reaction to physical illness, which like other experiences enters into the world of imagination in which the patient exists.

Examples of true hysteria are relatively rare in asylum populations, and in the present series of cases there are but six instances amongst the 728 patients, and all these are of the female sex. The writer has, however, during his asylum experience, seen more than one case of genuine hysteria in the male sex.

In a recent lecture on “Individual Psychology and the Bases of Science,” Dr. Crookshank declares that Adler “like Socrates … condemns … the pursuit of knowledge for its own sake, as a futile attempt to transcend the limits of human intelligence” (p. 54). Again (p. 48): “… the real problem is that of right living—the pursuit of knowledge for its own sake is a delusion and a snare, a delusion inasmuch as absolute knowledge is unattainable, and a snare inasmuch as it draws us away from the study of conduct”.

The following observations are founded upon the records of 301 autopsies performed by myself at Rainhill Asylum. They are concerned principally with certain abnormal and morbid manifestations which occur within the crania of the insane. Of these the chief are, on the one hand, indications of subevolution, as shown by macroscopic structural defects of the cerebral hemispheres, such as deficiency of weight or of convolutional complexity, and on the other, evidence of dissolution as exhibited by wasting of the cerebral hemispheres. The relationship existing between these abnormal and morbid manifestations and certain other intracranial appearances is also discussed. No attempt, however, has been made—for reasons which will afterwards be given—at any close correlation between these abnormal and morbid manifestations and the mental states recorded during life. The observations, therefore, are of a pathological rather than a clinical nature.

I have been frequently obliged to give expression to my views on asylums and their future organisation. These views are expressed in official documents and private letters, which have never been published. A few observations which I made cursorily at the Naturforscher-Versammlung, in Hanover (“Zeitschr. f. Psychiatrie, “XXII., p. 390), as an indication of my point of view, were much too briefly and aphoristically given not to be subject to misconception. I therefore propose to devote the following pages to a connected, though necessarily brief, explanation of what I believe to be necessary or advantageous in the immediate future arrangement of lunacy matters in Germany, and to indicate towards which side I lean in the undoubted crisis which the question of the public provision for the insane has now reached. I apprehend neither detriment nor danger in this crisis, which is merely the progress towards more complete organisation. To wish to ignore it would not improve the matter. The predetermined conclusion to see the only good and right possible in things as they now exist is a far greater hindrance to the discovery of truth. If science can present new points of view, if urgent wants are brought to light, which cannot be satisfied by the present means of publicly providing for the insane, the requirements must not, in such circumstances, be ignored or denied, but the means must be made to suit the necessities. It was in this way that things were treated when the present asylums were founded; and is it possible that at the present time no further advance can be made ? It is, however, to be remarked, as was said a few years ago by Damerow, who was for the most part an authority with the opponents of reform (“Zeit-schr. f. Psychiatrie, “XIX., 1862, p. 187), “There is nothing further to be obtained in the future with the present public institutions for the cure and care of the insane.”

We have seen that Simple mental weakness, the first form of weakmindedness, is neither more nor less than a want of mind, in some degree. In it the higher emotions are blunt, perception is dull, and all the processes are backward or sluggish.

The injudicious defence of two lady thieves on the plea that they were subject to that form of mental unsoundness to which Mathey and Marc have given the sounding title of kleptomania, has attracted public attention to this form of mental disease, and has given rise to a considerable amount of written and spoken nonsense upon the subject. Even “our facetious contemporary” has had his jests and his caricatures thereupon, and in the slang of the day a burglar has become a kleptomaniac, and a prison a kleptomaniac hospital. Alienist physicians have of course received their full share of sarcastic remarks, as theorisers not over-wise nor over-useful to society, who would willingly provide for every crime a decent veil, by referring it to some strange form of mental disease. Now there is such a tiling as theft which is the result of mental disease; and also, let us boldly avow our conviction, though we write within the precincts of a madhouse, that there is such a thing as theft which is simply a crime, an attack made by the selfishness of one individual upon the rights of another. Let us even take the broader ground, and avow our profound conviction that insanity and crime are distinct and separate entities, wide as the poles asunder in all instances where their distinctive characters are well marked; although undoubtedly there are instances which are divided by partitions as thin as those which Dryden places between wit and madness, or rather instances in which the qualities of crime and insanity are so intimately combined that the task of analysing the nature of the act becomes no easy one either to jurist or physician.

The occurrence of micro-organisms in the urine is well known to be associated with a variety of pathological conditions, among which mental diseases have been included. A definite connection between urinary bacteria and insanity, however, does not seem to have been made out, the subject being even more obscure than the relation of the intestinal flora to mental disease, which has been much more frequently investigated.

It is remarkable, considering the advance which has been made in the study of the diseases of the mind during this century, that so little is still known concerning idiocy and idiots. With an increasing population, there is no decrease in the numbers of these helpless beings; their origin is connected with the, apparently, inevitable results of our social system; their very existence is, in most instances, a natural protest against vexatious and unreasonable interference with those great laws which govern the well-being of communities; and, both in a scientific sense as well as in a philanthropical, they have great claims for consideration.

As katatonia, “a mental disorder,” writes Spitzka, “well marked but not generally recognized,” has hitherto received but scant notice in this country, the following observations, based on the study of a group of cases which well illustrated its alleged characteristics, may not be devoid of interest.

Since the following Paper was commenced, the appearance of the “Report from the Select Committee on Lunatics, ordered by the House of Commons to be printed, 27th July, 1860,” of which Committee Mr. Walpole is the respected Chairman, has, in a considerable degree, relieved the minds of physicians practising in the department of insanity, from the apprehensions occasioned by the draft of a Bill ordered to be printed in February, 1859. It would seem that the evidence brought before the Select Committee in disparagement of the proprietors of asylums for the insane, and in support of the alleged fact of the improper detention of persons in a state of sound mind, was deemed insufficient to warrant the meditated additions to stringent restrictions already existing. All the obnoxious clauses relative to the appointment of Medical Examiners, a kind of unqualified auxiliaries to the Commissioners in Lunacy, and who were to make secret reports, have been abandoned; as well as some other clauses, which had been the source of great and just dissatisfaction.

The first duty of your President is to say thank you and this I do with great sincerity. To be elected President of this historic association is indeed an honour, and I very much appreciate it.