Science, whose high aim it is to investigate Nature, to under stand her secret workings, and thus to win for man the mastery of Nature, must set out with the conviction that Nature is intelligible, comprehensible, and conquerable. In the domain of biological science the problem of heredity occupies a position of great importance, one full of interest to every student of life. For the serious thinker who has not only looked backwards and studied the past of the human race but is inspired by ideals and desires for its future good, the subject of heredity provides an inspiring theme for contemplation and study. The development of our knowledge and the history of human endeavours to reach a complete understanding of the phenomena and conditions of heredity form one of the most interesting chapters in human evolution. Theories of heredity, like theories regarding other phenomena of life, have been expressed in three sets of terms: theological, metaphysical, and scientific. It required no skilled observation of early man to see that in the act of fecundation the male furnished the seminal substance, whereas the female seemed to furnish nothing except the receptacle or “mould,” in the form of the womb, within which the fótus was formed. Thus, what was more natural than to suppose that heredity was solely paternal, that the male element was the germ or seed, and the female organs the soil, in which, by some mysterious process, growth and development of the germ took place. This view of heredity has been expounded in the Manava Dharma-Sastra, one of the ancient sacred books of the Hindus (Delage, L'hérédité, 1903, p. 380). The same view, more or less modified according to the prevailing state of knowledge, was current among the ancient Greeks (Eristratos, Diogenes, and others). Galen and the school of philosophers of Alexandria also upheld the doctrine of the paternal factor of heredity, and thus constituted themselves the school of the Spermatists. Spermatist views prevailed for many centuries, and when towards the close of the seventeenth century Leeuwenhoeck discovered the presence of spermatozoa by the aid of the microscope, the spermatists had a season of rejoicing. Hartsoeker (1694) supposed that within the spermatozoon there was a little being, a human being, in miniature, with all its parts and organs complete, and figured a spermatozoon (highly magnified, of course) in which the little “homunculus” is to be seen seated within the “head” of the former with its arms and legs folded together in small compass, somewhat like a fcetus in utero. The theory of the spermatists was not destined to remain in undisputed possession of the field. The rival school of Harvey in the sixteenth century taught that the semen or sperm did not fertilise the ovum nor even enter the womb, but that it fertilised the entire constitution of the mother by a sort of contagion which rendered her capable of acting as the stimulus of development for the ova in the uterus, and Descartes, in the early part of the seventeenth century, entertained the same views. The ovists now claimed that all the organs of the future being already existed, preformed in miniature, in the ovum, as opposed to the spermatists, who claimed the same preformed structure for the spermatozoon. To the ovists, therefore, the act of fecundation was only an impulse or stimulus to development communicated by the male element to the ovum; the male contributed nothing material in forming the parts and organs of the fótus which existed, preformed in the ovum, so that the child was the product of the mother alone. Among the upholders of the ovist theory, in the eighteenth century were Malpighi, Haller, Bonnet, and Spallanzani. Difficulties, however, arose over both these theories of exclusive inheritance, for the ovists could not explain how the offspring sometimes resembled the father rather than the mother, and the spermatists could not account for cases of close resemblance between the mother and offspring, while neither could, again, account for cases of the mixed or blended resemblance of the offspring to both parents. The theory of preformation gradually lost its interest and its vitality, and received its death-blow at the hands of Wolff (1759), who, not only by theoretical arguments but by indisputable facts as to the nature and process of development of the hen's egg, demonstrated the baselessness of the fancies of the pre-formationists, whether of the spermatic or ovarian school. Finally, there gradually grew up in the nineteenth century the modem view that the male and female (germ and sperm) cells of the respective parents contributed in equal, or nearly equal, proportions to the constitution of the embryo, and that the environment and nourishment of the fertilised ovum during its growth and evolution in the womb was a third factor of importance, especially in the case of those animals which went through a long period of intra-uterine growth and evolution, as in the case of man and the higher mammals.

Gentlemen,—In the first place permit me to express my high appreciation of the honour you conferred upon me by electing me your President, when the office of President-Elect was rendered vacant by the resignation of Sir John Sibbald, whose death we now deplore. Let me assure you that nothing shall be wanting on my part to advance the welfare and prosperity of our Association, and to safeguard its interests to the best of my ability.

In the second lecture I discussed the distribution of the neuroses throughout the various races of mankind, but the subject was necessarily curtailed for want of time and space. It would not, I believe, be a difficult task to prove that no race of man is free from very extensive affection by epilepsy or hysteria or many other nervous affections regarding which we have but an imperfect account When we come to inquire into the similar prevalence of insanity, however, the evidence is much more negative, and although there is no race of men who are known to be free from it, yet on the whole travellers are in too many instances silent. In many instances it is evident that the subject does not interest them, while in still other instances they simply say that they saw no insane people. Hence has arisen the mistaken idea that insanity is a product of civilisation and that it is rare or unknown among savage or barbarous people. I have taken the trouble to collect numerous references from the writings of travellers on this subject, and I shall read a few of them for the purpose of showing the unfounded nature of the belief which has arisen on this question. Dr. Felkin informs me that he has seen in all some thirty to forty lunatics on the White Nile. He also saw some maniacs chained. He was the first to tell me a curious fact, of which I have since had confirmation from other sources, viz., that the type of insanity among the African natives is different from that in Europe. The prevailing form of mania is a short acute kind, lasting only a day or two, during which the sufferer is driven away to the woods or voluntarily runs away, returning again in a few days apparently restored in mind. Idiocy was very common in his experience and so was suicide. Thompson, in his book Through Massailand, states that he found insanity very common. The myths and folk stories of the people are full of reference to it. Those affected by lunacy are driven away from the habitation of sane people or are otherwise isolated. He also found idiocy very common, especially among the dwarfs and albinoes, the latter of whom were numerous, and about the prevalence of mental defect among them there was no doubt. In a book entitled The Indian Tribes of the United States, edited by Francis S. Drake, reference is made to an Oregon Indian woman who appeared to be demented: “She sang in a wild manner, and would offer to the spectators all the little articles she possessed, scarifying herself in a horrid manner if anyone refused to accept her presents. She seemed to be an object of pity to the Indians, who allowed her to do as she pleased.” Captain Cook, in his Voyages, referring to the South Sea Islanders, says: “We met with two instances of persons of disordered mind, the one a man at Owyhee and the other a woman at Oneheeow. It appeared from the particular attention and respect paid to them that the opinion of their being inspired by the Divinity, which obtains among most of the nations of the East, is also received here” (in the Pacific).

In the two previous lectures of this course the subject of “Variation in its Relation to the Origin of Physical Malformations, of Congenital Mental Defect, and of the Neuroses, such as Epilepsy, Hysteria, and Alcoholism,” was considered. The correlation between congenital malformation and congenital mental defect was pointed out. The relation of the neuroses to one another, their heredity, and their distribution throughout mankind of all races, was insisted on. It was also shown that all these affections are genetic in origin and independent of so-called causes or influences due to the environment. For the environment is not, and cannot be, constant while the manifestations in question are, so far as we know, universal. It was further shown that congenital malformation and congenital mental defect are due to inherent processes, the nature of which is at present unknown, acting within the fertilised ovum. It is, moreover, certain that these processes must be independent of the environment of the elements contributed by either parent, of the immediate state of health of the parents or, with certain exceptions such as injuries or special disease, of the uterine environment. It is not asserted that diseases affecting the mother or even, on rare occasions, specific affections of the father may not deleteriously influence the growing embryo in utero. The fact remains, however, that in the majority of instances these defects are hereditary, that they may pass over several members of the same family, and in the case of animals over several members of the same litter—nay, even that they pass over one or more generations to re-appear in a succeeding one. In face of such facts, it is useless to speculate upon physical causes while the great innate cause remains obscure.

This group includes recurrent cases of insanity or cases subject to relapses from an apparently normal mental condition to one of mental alienation. The patients differ from those of the previous group in that during their lucid intervals they pass as normal sane individuals. They are, however, liable to become so far out of accord with an environment which would have little or no influence on normal individuals, that attacks of temporary mental alienation develop at regular or irregular intervals. In other words, the mental equilibrium of these patients is so unstable that it becomes upset by the various influences which constitute the normal “stress” to which the several members of a civilised community are necessarily subject. Though the cases in this group grade insensibly into and, during their attacks, exhibit a mental symptomatology similar to that of those included in Group II, classes (a) and (b), the fact that they are sane during a greater or a lesser portion of their lives affords a sufficient reason for placing them in a separate group as one of the types of high-grade amentia.

I now come to the important, and I am sorry to say the controversial, question of the causes of insanity. After what I have already said on the etiology of the clinical forms of insanity and on the fluctuations of statistical insanity in communities, it seems to me that I might conveniently dismiss this subject by adopting the laconic style of the student who was assigned the task of writing an essay on “Snakes in Ireland” by saying in three words, as he did, “There are none.” But as the great majority of people still believe in the validity of the numerous causes which are popularly believed to create insanity somewhat in the same way as violent exercise causes fatigue or eating salt fish causes thirst, it is necessary to refer briefly to the subject.

The more modern and advanced opinion of the present day, not of necessity the most correct, regards toxic action as the most important factor in the pathogenesis of insanity. According to this view insanity is not regarded as primary disease of the brain, but secondary, and due to toxins derived from elsewhere acting upon the cortical nerve-cells, disordering their metabolism, and thus affecting their functional activity, damaging, or destroying them. The older psychologists are evidently disinclined to accept the toxic theories of the younger school, and cling with pertinacity to their opinion that mental disease is as a rule primary, and that the physical manifestations of ill-health result from a disordered central nervous system, and undoubtedly many of the facts they produce in support of their argument are difficult to refute; on the other hand, it is necessary for those who advance the theory of toxaemia as the essential factor in the production of insanity to marshal facts supporting their contention. By the term “auto-intoxication” we indicate toxins evoked within the body as a result of disordered metabolism, first, such as takes place in chronic Bright's disease, myxcedema, diabetes, etc.; and secondly, in the contents of the gastro-intestinal tract. Within the limits of this paper I propose only to deal with the second division, viz, auto-intoxication from the gastro-intestinal canal, for the cases coming under this group are by far the more numerous and important. For a long time I have strongly held the opinion, as a result of my own observations, that a very large proportion of cases suffering from melancholia are due to auto-intoxication resulting from the absorption of toxins from the alimentary tract, for in depressed states generally there are various symptoms referable to disordered metabolic processes in some part of the gastro-intestinal tract. The symptoms in question that I consider as evidence of a state of toxaemia are as follow: foul breath, coated tongue, indifference to and often refusal of food, marked constipation, foul stools, anaemia (varying in degree), a sallow dirty skin, profuse perspirations and of offensive odour, skin irritations, eruptions, disorders of sensation, often leading to flesh-picking, and headache. Of course we do not in any one case find all these symptoms, but there are several common to all cases of acute melancholia. It may be suggested that the signs and symptoms that I have mentioned as those of toxaemia are but those of lowered general health, and do not in themselves afford any direct evidence of the absorption of toxins, but I have observed that the signs and symptoms that I refer to as constituting toxaemia so commonly present in states of mental depression are constantly associated with the presence in the urine of indoxyl, in greater or lesser excess.

Workers in the finer structure of the nervous system are suffering from a plethora of observations. New and more searching methods are being discovered every day, and no sooner does he who sets about constructing a scheme of the central nervous system arrive at something which appears to be satisfactory than he has to pull it to pieces and reconstruct it, to fit in further detail which has been brought to light in the meanwhile. Until this vast array of observations has been properly digested, a process which may well take years, we can scarcely hope to obtain a scheme of the relationship of the nerve-cells to one another which will be more than a working hypothesis.

The following paper consists of further instalments of a research which has been conducted by the author for several years and which deals with the general pathology of mental disease from both clinical and pathological standpoints. The essential bases of a scientific general classification of mental diseases are a morbid anatomy and a general pathology. Before the latter problem could be successfully attacked a prolonged study of the structure and mode of development of the cell-layers of the cortex was necessary. This was commenced by a lengthy investigation of the region of the cortex concerned with the special sense of vision, and a paper on this subject was published in 1900.(1) This paper dealt, by the method of micrometric examination, with the general histology of the regions of the cortex cerebri concerned in the immediate reception (projection centre) and the elaboration (lower associational centre) of visual impressions; and the research resulted in the exact localisation of the primary visual area of the cerebral cortex. This region was described by the author as the “visuo-sensory” area, and to the surrounding area of visual association he applied the term “visuo-psychic.(2) The results obtained from this study of the cortical areas concerned with one special sense were considered sufficient for the purposes of the research, and the region of the cortex cerebri which occupies a higher plane in the hierarchy of cerebral function than those concerned with sensory reception and elaboration was then taken into consideration. Before, however, it was possible to apply the same method to the region of the cortex cerebri concerned in higher association and the general orderly co-ordination of psychic processes, it was first necessary to satisfactorily determine the particular part of the cortex which possesses these functions, as this is the subject of grave dispute on the part of different authors.(3)

It is currently admitted that the state of intoxication in neuropathic persons differs from that of normal individuals or of habitual drunkards. Of this peculiar state Bonhoeffer has lately given an excellent account, but when one attempts to gain a clear conception of it the clinical cases scarcely bear out the general description. It will, therefore, perhaps be not inappropriate to go over some cases of this pathological form of intoxication which are not yet numerous and endeavour to gather them into a more definite group.

The object of the paper is to urge the establishment throughout the country of institutions for the treatment of nervous cases and of early uncertifiable insanity. The fact of certification leads to an erroneous view of insanity, for it does not make a person insane, nor does the absence of it prove sanity. The boundary line of certification is a purely arbitrary one, and, from the nature of the illness and our present ignorance of it, this is bound to be so. Certification does not necessarily mean that at such a moment a person became mentally upset, but rather that at such a time, after observation showing them not to be responsible for their actions, it became advisable, in the interests of themselves or others, to control them, if required, by force.

The mental processes in relation to vision are disordered in many cases of mental disease, particularly in such as present the symptom of disorientation. The normal individual orientates himself in his environment mainly by the help of definite trains of visual ideas—such, for example, as are aroused in us when we glance round our room, go about the house, or take a walk out of doors. If a patient in an asylum thinks he is in his own home, and mistakes the attendants for his relatives, he is clearly unable to see how the present environment differs in aspect from the former environment in which he imagines himself. While from one point of view such a disability presents itself as a failure of memory, from another it appears as a form of mind-blindness, demonstrable by appropriate tests, and resembling in some ways the mind-blindness resulting from circumscribed coarse damage of the brain.

“I Never saw anything like the English people,” remarked a foreign expert to me at an International Congress; “they have the best institutions for public assistance in the world, but they never have a word of praise for their own asylums: on the contrary, they are always criticising them.” My reply was: “Is it not because we are always criticising our institutions and trying to remedy their faults that they are the best in the world?” Our friends across the channel appear to be very much of the same opinion as the expert. They praise our asylums as being better and costing less than the French; specially do they praise the administration of them; the character of the attendants in our asylums as compared with their own comes in for warm commendation; even our lunacy law is—mirable dictu!—described as plus simple que chez nous. If it is, then the French lunacy law is decidedly complex; for it does appear to me monstrous that while under our present law we have only three medical inspectors for 100,000 patients under the care of the Lunacy Commissioners, we should have two for the care of less than 1000 Chancery patients, two thirds of whom are in asylums and therefore already under the care of the Lunacy Commissioners. The system is wrong, and in my opinion it is a mistake to place one class of cases suffering from mental disease under one authority, another class also suffering from mental disease under a second authority, and a third class of cases under the Local Government Board, for that is what our present system amounts to.

In the last number of this JOURNAL, I gave reasons for concluding that the table of forms of insanity, suggested by the Statistical Committee, was unsatisfactory, and suggested a new classification of cases of insanity to be substituted for their arrangement. Certain objections that are likely to be taken to the classification that I have proposed are worth considering, and would have prolonged the previous communication to an unwieldy length if embodied therein; I propose, therefore, to consider them now.

Kahlbaum in 1863 described a form of mental disease occurring at puberty and rapidly terminating in dementia; this he called “hebephrenia.” In 1874 the same author described the condition known as “katatonia” or the “insanity of rigidity.” These terms do not appear to have been adopted till 1891, when Pick, under the heading of “dementia præcox,” described cases, including hebephrenia, characterised by maniacal symptoms followed by melancholia and rapid deterioration. This term has now been extended by Kraepelin to include the “hebephrenia” and “katatonia” of Kahlbaum, together with certain forms of paranoia which undergo early deterioration.

The present division of this paper consists of a clinical description of those types of mental disease which are classed by the writer under the heading Amentia. Under this term he includes, from the standpoint of morbid anatomy, all cases of subnormal cerebral development, and from that of clinical symptomatology, all cases of subnormal, and hence frequently abnormal, mental manifestation. He thus uses the term amentia to connote in the widest sense the mental condition of patients suffering from deficient neuronic development.

Perhaps no other condition or disease is more frequently referred to than Dementia Præcox in the Journal of Mental Science for April, 1905. It might almost be thought that it holds the same position in psychiatry that the Fiscal Question does in modern politics. and though I may not be able to throw any new light on the subject, let me try to harmonise or conciliate some apparently discordant views.

The following paper is an attempt to deal with statistics in insanity according to a scheme which observes the fundamental canon of statistical accuracy, which interprets the true spirit of lunacy legislation, and which serves the essential purpose of medical utility. I may divide the paper into three parts:

In these days of ever-increasing progress in pathological research, carried out to a great extent by a body of enthusiasts, who devote their lives to the study of the post-mortem room, we are apt to have the important clinical aspect of our cases somewhat neglected, while with the present craze for building gigantic asylums for our insane we are tending more and more to lose sight of the individuality and personality of our patients.

Normal humanity has never taken kindly to the idea of annihilation. As far back as anthropology has pushed its researches traces of a belief in a survival after death have been found. We have but to open the tombs of the men of the neolithic period to discover idols, mystic symbols, traces of food and clothes, with which our far-off progenitors sought to express their belief that the dead still lived and were open to the ministries of pious affection. The truth is, the thought of annihilation is too abstract to be intelligible to the primitive mind. Wordsworth's “little maid” could not conceive death except in terms of life, and her inability is a universal mark of undeveloped thought. Savage man has no knowledge of death as a fact or process of nature, only as the product of some hidden and malevolent energy which, though it may destroy, cannot annihilate. The dead are not really dead. They haunt the spot which on earth they loved, mingle with the dreams, and affect for good or evil the fortunes of the living. Out of this instinctive impulse, through the growth of mental faculties and the reaction of environment, have been gradually evolved the lofty hopes of religion and philosophy.