I give the details of five cases of Idiocy where the observations were completed by an examination after death. The greatest advantage of such studies as can be made in an Institution for the Training of Idiots is the careful analysis of the mental symptoms, and for this I am much indebted to the teachers for their patient attention and intelligent remarks. The absence of microscopical observations in all the pathological descriptions, save one, is a source of regret to me, though I have been so fortunate as to obtain the report of so competent an observer as Dr. J. Batty Tuke in the case of K. I. The object kept in view in reporting these cases is to throw as much light as possible on the relation of the mental deficiency to the pathological lesions. It is not, therefore, to be expected that they should be reported in the same form as clinical cases published with the intention of illustrating the treatment of ordinary diseases, or the action of new remedies. It is true that the existence of idiocy often modifies the symptoms of ordinary disease, and requires a corresponding modification in treatment; but it would unduly complicate our reports, and probably lengthen the paper to a tedious degree, were commentaries of this kind introduced.

The term narcoanalysis may be applied to a technique whereby psychotherapeutic principles are applied and analytical investigations are conducted with the patient under treatment in a mild narcotic state.

The following report is based on 150 men treated in hospital, and 300 patients, 50 of whom were women, seen at a diagnostic and advice centre.

As a rule, stresses and precipitating factors were more obvious or easily discoverable than in civilian life, adverse situations were more superficial, diagnosis and treatment were easier. Anyone who has conducted civilian clinics finds the change-over comparatively easy. Nevertheless, much of what follows is applicable to civilian work.

In my first lecture on the nomenclature of varieties of insanity I dwelt upon those phraseologies which have already been in use. The first of these was the old well known classification, which was grounded on the physical temperament, and conduct of the patient; and which confined itself very much to the question, whether he was violent, low spirited, or silly. Mania, melancholia, and dementia, being applied to these states; monomania and moral insanity, arising in after years as auxiliary to these terms, and being a refinement on the idiosyncracies of various cases. The second phraseology was one which Dr. Noble has developed, if not originated; it dwelt upon the metaphysical position of diseased mind, discarding the consideration of conduct and temperament. It tells us which part or faculty of the mind is diseased; it contains, in short, a geographical sketch of the mind and its diseases, and gives us some ideas of the exact position of each case in the history of diseased mind. Emotional, notional, and intelligential insanity are the chief terms of this vocabulary. I stated my belief that a consideration of both of these histories, the physical and the metaphysical, the state of the conduct and temperament, as well as a history of the part of the mind diseased, were necessary, for a terminology which should represent a fair history of the varieties of diseased mind; and I proposed to compile a nomenclature of the varieties of the disease, constructed from the conjoint consideration of these two histories.

This paper has, at least, the quality of the unusual. It is a protest from a criminologist of repute against the holding of post-mortem examinations in cases where the cause of death can be inferred with reasonable probability from other evidence. The author is particularly opposed to the provision of the Prussian law which requires autopsies for legal purposes to be performed by two doctors in the presence of a magistrate. The grounds of objection appear to be partly sentimental and partly economical. If such a thing were conceivable about a German professor, one might suspect a ponderous jeu d'esprit.

In this university the study of medical psychology and mental diseases is wholly voluntary. None of the faculties require candidates for degrees to attend the course I deliver, or examine them in the subjects discussed. Doubtless the faculties of arts, theology, and law, might reasonably object to so great an encroachment upon vested interests and established traditions; but it is different with the faculty of medicine, because moral philosophy has only been added to the curriculum of medical studies since I commenced to deliver this course. I have therefore thought it would be expedient (and suggested it, indeed) to permit students of medicine going up for their degrees to choose between medical psychology and moral philosophy; nevertheless the course is still without even this modified recognition. Nor do any of the other medical boards of examiners of the United Kingdom require it. The Senate of the University of London has, however, very lately recommended the practical study of mental diseases to candidates for medical degrees; but valuable and important as this step is, yet, inasmuch as it excludes medical psychology, it falls very far short of what must ultimately be required in the interests of society of all students seeking general culture or to enter any of the learned professions. I entertain a deep-rooted conviction that mental science, in the modern and practical sense of the term, will sooner or later be forced on the attention of political economists and statesmen as one of the needs of the time; and I am equally convinced that no such science is possible except by the observation and study of morbid mental states. I therefore propose on this occasion to plead for the general study of medical psychology or mental science developed according to this method in this classroom, and although I may not hope to be successful in my pleading, I trust I shall at least encourage you who engage in the study voluntarily to pursue it ardently, as offering its own full reward for any labour you may bestow upon it.

The opportunity I have of speaking to you is for me both a pleasure and a privilege, but it is also, I fully appreciate, a responsibility.

The field of psychiatry to-day is not unfruitful and not a few discoveries of lasting worth appear to have been made, while certainly claims to progress of more doubtful value, both as regards letiology and even more with regard to treatment, are so numerous as to be rather bewildering, particularly when they become the subject of articles in the popular press, whereby relatives are enabled to make a diagnosis and decide on a line of treatment without any reference to the medical man.

This research was undertaken to establish, as far as possible, Drs. Ford Robertson's and McRae's ætiological hypothesis for general paralysis of the insane. It is hardly necessary to emphasise the importance of giving the fullest consideration to this theory, being, as it is, the first serious attempt of its kind to bring mental disturbance into the category of physical disease, to establish the wealth of histological observation in its place as an effect, and to break from the bugbear of metaphysics and perversion of psychic function. I should like to make it clear that though this research may controvert the ætiological significance of the bacilli of Ford Robertson, it in no wise attacks the fundamental theory of a toxic cause acting through the very definite channels of infection established by Drs. Orr and Rows.

We have before us several papers and documents referring to this well-known hospital for the insane. Those who have paid the attention they deserve to the annual reports of the Commissioners in Lunacy will remember that, year by year, the site, the building, the internal arrangements, and the management of this institution, have been therein the subjects of censure and of earnest remonstrance, which the governors of the institution appear to have borne with remarkable equanimity, or perhaps more truly, with stolid apathy. In the earlier reports, the Commissioners put their recommendations in the mildest possible form; for instance, in June 1852, they suggest that “perhaps the governors may be disposed to consider favorably the hiring some land, &c.,” but during the past year, in which they visited the hospital twice, the Commissioners speak much more decidedly, “they regret very much to find that their suggestions have not been carried out, it is painful to them to revert so often to the various defects of the institution;” “the temperature of the galleries was much below what is usual in establishments of this nature; in the male wards being as low as 33° on February 29th, 1855; the extreme coldness of the hospital, together with the entire absence of furniture, presented a very bare and cheerless appearance, the means of occupation and amusement appear to be very scanty, &c.” We quote at length the report of the special inspection made by the noble Chairman of the Board, and two of the Visiting Commissioners.