I have felt no little difficulty in choosing a subject for the remarks which it is my privilege, in the honourable position of President, now to address to you. Those who have preceded me in the office have, in their several discourses, treated so fully of the most important matters relating to the department of the specialty in which we are engaged, that there seemed little left for me to say. As Editor of your Journal, my opinions, too, are for the most part sufficiently well known to you. On considering what I should do under these circumstances, I first resolved to select for my address the evidence of evolution and degeneration of mind which the study of psychology, healthy and morbid, reveals, with special reference to their bearing on the well-known views of Mr. Darwin. I am persuaded that some weighty facts and arguments in support of these views may yet be drawn from a scientific study of mind in all its manifestations—in animal as well as in man, in man savage as well as in man civilized, in disease as well as in health. Without giving an opinion upon the great question of the day—whether man be or be not descended from an arboreal baboon, it might be justly argued with no little force that, if he were so descended, or had so ascended, many of the psychological facts might be expected to be very much as they are now. The battle ground which the opponents of Mr. Darwin have chosen and hold cannot certainly be pronounced quite impregnable, if the attack be made in the right quarter. This design, though it was partly carried into execution, I thought it best, however, on reflection, to abandon as unsuited to the occasion, and, in the end, resolved to limit my remarks to matters of more immediate practical interest to us as physicians engaged in the care and treatment of insane persons. What I have to say will be of a somewhat desultory character, and for this I must bespeak your indulgence, my aim being to excite discussion and to elicit opinions on matters of great practical interest, rather than to treat them in an elaborate and systematic manner. Instead of attempting to make a scientific display, I shall hope to elicit a display of your scientific experience, by asking, in the Socratic spirit, what we really know, and what we only think we know, concerning some matters of weighty consequence in our specialty.

(II.) The Emotions act upon the Heart and non-striated muscles with a power equal to, if not greater than, that which they exercise over the voluntary or striated muscles; causing contraction, spasm, and paralysis.

It is a great pleasure to me to have the opportunity of speaking to a number of my professional brethren on the subject announced for to-night's lecture—a subject whose vastness and far-reaching connections with the problems, not only of practical medicine, but also of physical and mental education for the young, are daily presented to my mind with increasing force by the facts that I observe in hospital and private practice. The inheritance of the neurotic temperament, with its ever shifting modifications and transformations of outward form, I need hardly tell you is not exactly a new discovery. Commenced, as far as scientific research goes, by Morel, in his treatise, “Des Dégénerescences Humaines,” the investigation of the hereditary neurosis has been since carried out by many observers, and has been specially illustrated by one of the most eminent alienists of the present day, Dr. Maudsley. It has now been sufficiently demonstrated in a general way, that there is handed down, in certain families, a tendency of the individual members to inherit from their parents either a particular nervous disease—for instance, insanity—from which they suffered, or else—and this quite as frequently—some other disease of the nervous system. Thus it often happens in these neurotic families, that an insane progenitor will endow a variable number of his descendants respectively with epilepsy, with neuralgia, with insanity, with invincible tendencies to drink, with brain softening, or with chorea; the more fortunate of his descendants escaping with only some more or less strongly marked irritability of nervous system, which may express itself chiefly in mental sensitiveness and impulsiveness, or in the existence of some slight local spasmodic affection, or in a general eccentricity of character which it is impossible to define. Or it may be that the vicious circle of nervous degeneration began at an earlier stage; for instance, the insane progenitor was himself the child of a drunkard, whose habitual intemperance had been the starting point—as there is reason to believe it often is the starting point—of a lowered nervous organisation of the family stock, which will show itself in the various ways already mentioned. These general facts are doubtless familiar to your minds, and you are also well aware that this sad inheritance is a curse that seems to fall with special weight upon families, many of whose members are of a mental calibre that would fit them to be the salt of the earth, possessing quickness of insight, original cast of thought, genius for mechanical invention, or, it may be, delicate artistic faculties. These are the men that really make the world march; it is they who give society its impulses to progress of all kinds; but, unhappily, it must be also said that they are too frequently the victims of their inherited temperament, and that their lives, even when they are not interrupted by any positive catastrophe, are too often overshadowed by the gloom of hypochondriasis, or poisoned by some unhappy intellectual or moral weakness, which may be known only to themselves, but is to themselves a perpetual misery, perhaps even a perpetual terror. Of course I am not here referring to the possessors of the highest kind of genius, that rare excellence which flowers only once or twice in a century of a nation's history; such natures are calm and strong, the typical embodiment of the mens sana in corpore sano, at its highest and best. Tour Shakespeare or your Goethe is no weakling. But, unhappily, it is not such as these that bear the heat and burden of modern progress, and among the men of second rank, upon whom that burden actually falls, a lamentable number are the victims of that inherited defect of nervous balance which is at the foundation of those associated hereditary neuroses, respecting which I ask permission to say a few words to you. And if we farther reflect on the fact that for one such partial, even if brilliant and useful success, as nature achieves in the persons of these neurotic men and women of talent, she probably makes at least two failures in the shape of their relatives who are nervous, but not talented, we cannot avoid the conviction that the subject of inherited neurosis is one of the most important that engages the attention either of the physician or of the student of social science.

The following observations are mainly the result of the author's experience during twenty years in the Somerset. County Asylum; many of them have appeared from time to time in his annual reports of that institution.

“In all departments of investigation, it is right to commence with the study of that which is most common, simple, and regular: and thence to proceed to inquiries respecting that which is unusual and irregular.”

That our convict prisons should be the theatres upon whose stage are enacted day by day a varied round of farces and burlesques of a more or less tragical significance, is a thought whose development may be interesting, or simply amusing, according to the direction in which our fancy for the time being leads us.

Passing, now, from the consideration of the influence of emotion upon motility, we proceed to examine the interesting series of phenomena resulting from the operation of the same influence upon sensation. Ever tending to be confounded with the converse succession of events, the influence of morbid states of sensibility in producing emotional disorder, its consideration requires more discrimination than that of the previous section. We can scarcely avoid employing language which is not strictly scientific, and can be only understood in a popular sense. Indeed, with two elements so closely allied as the emotional and sensational—mental feeling and bodily feeling (so-called)—it must constantly happen that in our terms, as in reality, we confound the two together, and in this blending fail to discover which is cause and which is effect, or speak of the consciousness of bodily pleasure and pain as if it were not a mental state. It is, however, perfectly easy, in spite of metaphysical difficulties of this kind, to make clear what is meant by the influence of a powerful emotion upon sensation as a part of that influence of the mind upon the body, which we are endeavouring in these papers to point out and illustrate. For example, there can be no question as to the fact that moral disgust does in some instances cause the sensation of nausea, or that distress of mind may occasion neuralgia, or fright the sensation of cold, or that the special senses may, under fear, be stimulated centrally, so as to cause subjective sensations, whether olfactory, visual, or auditory. These facts remain of interest and importance, although the bare statement of them suggests some questions of difficulty. They are so, whether our physiology regards the functions of the hemispherical ganglia as comprising the sensational as well as the ideational elements of the passions—(see ante, July, 1870, p. 174)—or whether it relegates the former to the sensory ganglia. They are so, although not only do mental and physical sensations merge imperceptibly into each other—for we constantly witness the same results from emotional as from sensational excitement, physical and corporeal pain alike acting upon the body (as, e. g., in quickening the circulation)—but mental sensations are so united with their associated ideas that it is difficult to separate the purely emotional from the ideational elements of passion. It is a penalty which we pay for our classifications and divisions that, however convenient they are up to a certain point, they sometimes lead us to do violence to nature; to dissever that which is inseparable, to sacrifice in the present case, it may be, the intimate cohesion of psychical states to the idol of reducing everything in science to orders and classes.

If the term insanity, as applied to man, is one that it is difficult, if not impossible, accurately to define;—if human insanity includes a great number of the most diverse mental and bodily conditions or phenomena,—the term madness, as applied to other animals, is still more vague and unsatisfactory in its definition, and animal madness includes a much more heterogeneous group of the most opposite kinds of maladies. While the said term madness has been borrowed by veterinarians from human medicine, it is evidently regarded in a different signification when applied to other animals than man. So much so, that while the character of the mental phenomena in certain diseases of the lower animals must be, and is, admitted by all veterinarians, they deny, nevertheless, their parallelism to those of insanity in man, on the ground that animals have not sound minds, and cannot, therefore, possess unsound ones! Such a belief merely illustrates the utter ignorance and prejudice regarding the mental constitution of animals, which appear to be characteristic of veterinarians as a class.

I am desirous of making a few critical remarks upon the address of its President, read before the Medico-Psychological Association in August last, as also upon some of the observations which were elicited thereby from various members at the time of its delivery.

The term “general paralysis” is not, it must be admitted, a satisfactory one, but, though many attempts have been made to improve upon it, nothing better has yet been agreed on. However faulty the term may be, it is best to have a clear understanding as to what the words may be supposed to imply.

Anyone who has attempted to work up statistical facts from a Pathological Record must have felt how much time and trouble were wasted in wading through case after case which had no connection whatever with the subject in hand.

The circumstances of this case appear to me to be so interesting, in a psychological aspect, that I venture to place them at some length before the readers of the Journal.

In June, 1867, a new era was begun in the Poor Law system by Mr. Gathorne Hardy's Bill, which comprised arrangements for meeting the epidemic requirements of London, and for relieving the workhouses and lunatic asylums of the imbecile, idiotic, and chronic patients, not dangerous or destructive, but quiet in their habits, leaving behind merely the infirm poor and the acute and violent lunatics, for whom the accommodation was thought sufficient. There was also another clause providing a bevy of dispensaries, which however has not been carried out, though it was probably one of the most promising parts of the Bill. As regards the arrangements for epidemics, recent events have shown them to be inadequate; it must be said, however, that in 1867 the idea of meeting visitations of severe epidemics by temporary structures was not even in its infancy, otherwise we might have been spared such structures as Stockwell and Homerton Hospitals, which will never be filled or even half-filled in times of ordinary public health, and which are too small for great emergencies. A rapidly expansive system, as by temporary hospitals or by tents, capable of enlargement and of folding up and packing away when done with, is the proper plan for treating epidemics. What then is the proper one for quiet lunatics and imbeciles ?

We have it on the word of Justinian, that “by the law of nature all men were born free.” Yet the Blue Book of the Commissioners in Lunacy, recently published, shows that 36,871 Englishmen are deprived of their liberty, and confined in lunatic asylums. And if we compare these numbers with those in the Report for 1869 it will be found that during the year 1870 the insane of all classes have increased in number by 2,042, or 174 private and 1,868 pauper patients. This increase is not exceptional, but has been going on for many years.

In the “Journal of Mental Science” for April, 1863, there appeared a paper by Dr. W. Carmichael McIntosh, entitled “Asylum Notes on Typhoid Fever.” In his introductory remarks, Dr. McIntosh notices the increased interest attached to the occurrence of physical diseases as observed in the insane, and the value of observations thereon, when the sane and insane suffer from the same disease and are under observation at the same time. There is then an opportunity of noticing the influence of such blood poisons as the scarlatinal and typhoid, as affecting two classes of the community; and as the patients are under medical observation from the very commencement of the illness, peculiar advantages are offered for a close investigation of all symptoms, mental and physical, from their first appearance. Dr. McIntosh further observes, “additional light might be thrown upon mental pathology and treatment, if such observations, sufficiently extensive, were correctly made and recorded. Alienists have long noted the influence of physical diseases in the course of an attack of insanity; and recently cases from foreign journals have been given by Dr. Arlidge, where recovery has followed wounds causing profuse suppuration in melancholia and general paralysis; scarlatina in suicidal melancholia; dysentery and acute rheumatism in monomania; dysentery and a compound fracture of the elbow in religious monomania; lastly, profuse intestinal hæmorrhage is mentioned by M. Baillarger, as ushering in recovery in a case of “painful hallucination of vision consequent upon injury from a railway accident.” It is with the view of adding a few cases to those which have already appeared in the various journals that the following examples of insanity, with intercurrent scarlatina, are published; so that when a sufficient number have been recorded they may be collected for comparison and further examination, and it may be that some useful and interesting results may be obtained. For as we are in the habit of watching the effects of drugs introduced by ourselves in cases of insanity, in the hope that ultimately we may arrive at a scientific method for such medicinal treatment, there appears no reason why we should neglect, but rather the reverse, the observation of cases in which, through contagion, a specific blood poison has been introduced into the system, and which produces characteristic and obvious symptoms. In the present state of matters one would scarcely feel inclined or be justified to run the risk of exposing an insane patient to the poison of typhus or measles for the chance benefit which might result to the mental state; but it is not unreasonable to think that some day we shall be able to modify the course of many diseases, perhaps mental among the others, as we now do in the case of small-pox through vaccination.

It was a feature peculiar to the late Sir W. Hamilton's character to avoid writing on any subject, with a view to publicity, until he had mastered everything extant which had previously been written upon it. It is said that when Hamilton, on its first appearance, read Whately's Rhetoric, he accused the author of plagiarism. A mutual friend suggested that Whately most probably had never even heard of the sources supposed to have been laid under contribution. Then why, asked Hamilton, did he presume to write on the subject at all? Now it is just because Hamilton himself was so punctilious in this respect that his researches are of great value to the psychologist. The investigator who masters these, and builds on them, may feel confident that he does not break with the past, but that his conclusions legitimately spring, as all such conclusions should do, positively, out of the capital of knowledge which our forefathers have amassed, and negatively, out of the errors they have committed.

In my communication on General Paralysis in the previous number of the Journal, reference is made to tables, showing various particulars in 124 males and 31 females suffering from this disease, and in whom post-mortem examinations were made during a period extending over 20 years. As these tables were found to be too voluminous for publication in the Journal an analysis or summary only was given. A further reference to the subject may not be uninteresting, especially as relates to the spinal canal, the spinal cord, and investing membranes, since any notice of their condition in insane persons is entirely omitted, even by recent observers. These morbid changes, so frequently noticed by myself and colleagues at the Somerset County Asylum, and in many instances submitted to others for microscopical examination, can only have been overlooked in other institutions from the difficulty of exposing the spinal cord, so as to admit of its complete examination, the instruments in common use not being suitable for the purpose. Those I have been in the habit of using for dividing the spinal column, after laying it bare with a large-sized scalpel, are a common tenon saw, a chisel and mallet, the same as used in opening the skull, and both operations may be performed with equal facility after a little practice.

Most asylum physicians admit that in acutely excited cases in whom the ordinary means of inducing sleep, viz., out-door exercise and liberal diet, fail, sleep should be induced by some medical agent, in case the continued excitement may prove too much for the patient, and that in cases of mild melancholia and nervous irritability, where insomnia has been and is the most prominent symptom, that some sleep-causing medicine should be given. As to the medicine, the preparations of opium and the tincture of hyoscyamus long reigned supreme, for some time bromide of potassium was much extolled for its sedative and soporific properties, and latterly chloral has totally eclipsed every other sedative or hypnotic.

At the last annual meeting of the Medico-Psychological Association, held at the College of Physicians, London, in July, 1870, I brought forward a resolution which, after full discussion, was amended and agreed to, in these terms:— “That it is desirable to facilitate the early admission of all acute cases of pauper insanity into county (and borough) asylums, by providing for the proper care and treatment of chronic and harmless cases elsewhere.” The object of the resolution being to ensure for acute cases that prompt treatment which is so essential, and to prevent the overcrowding and overgrowth of asylums, by providing for the transfer of incurable and harmless cases to workhouses, or to lodgings, or to reside with relatives, under proper care, treatment, and supervision. In the absence of any such provision, the enlargement of asylums progresses—this will be shown by the returns of the increase of pauper insanity in England and Wales. Several institutions have attained such dimensions that the difficulty of proper management has become great. In such overgrown establishments the individuality of the curable patient is liable to become lost amongst the crowd of idiots and incurables. The delay in obtaining the forms required by the Lunacy Acts, prior to the admission of insane patients to pauper asylums, is a great hindrance to early treatment. As regards chronic cases, this delay is of little consequence, and from the comforts being greater in the asylum than in the workhouse infirmary, and it being to the interest of workhouse officials to send insane paupers to the asylum, the accumulation of chronic and incurable cases therein can easily be accounted for.

In every large asylum there are probably convalescents of two distinct classes. 1, Convalescents about to be dismissed nearly, or quite, recovered; and 2, Convalescents who, under favourable circumstances, would be discharged, but who are considerately permitted to remain, because they neither have friends able or willing to receive them—nor are themselves equal to the effort of procuring suitable employment—nor, again, are they, in many instances, persons who from their antecedents or habits can suitably be transferred to the Workhouse.