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.

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 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.

That it would be impossible for anyone in a single paper to adequately treat of the mental symptoms occurring in bodily diseases is self-evident. For it must be remembered, as Maudsley says, “that it is impossible to be out of sorts physically without being out of sorts mentally,” so that the subject includes not only the slight emotional changes found in various diseases, but also the actual insanities produced by or accompanying them. All that I propose to do in this communication is to give a short account of the mental changes which I have noticed during a four years' residence in the Manchester Royal Infirmary, and during a longer experience as visiting physician to the Manchester Workhouse Infirmary, where I have charge of over 800 medical beds.

As modification of electro-shock is becoming a routine procedure in every patient undergoing this therapy, it is necessary to find a muscle relaxant, or as it has been commonly called a “curarizing agent,” which will be ideal for this purpose. Ideal should mean no toxicity, rapid onset, short duration and rapid termination of neuro-muscular blocking action.

Not uncommonly, schizophrenia seems to arise in close connection with the puberal years. This is sometimes attributed to psychological or physiological stresses at puberty, but there is no really adequate understanding of the phenomenon. One cannot predict at all dependably which personality characteristics or which stresses will result in a schizophrenic breakdown near puberty.

The after-care of the male insane, to which I venture to draw your attention, with a view to discussion, is so closely allied to the objects of this Association that I trust its consideration may be not only of interest, but even of some practical usefulness. Although at present lying beyond the limits of our sphere of action, the time may arrive when our resources shall have so far developed that the annexation of this adjacent province may be both practicable and desirable.

If I fix a square peg into an oblong hole, the fact that they do not fit is instantly perceptible; but it is manifest that the. several percepts of the peg and of the hole must precede the perception of the relation of non-adjustment subsisting between them. Furthermore, if I want to determine how much the peg lacks in size, I must measure separately both the peg and the hole before I can calculate the amount of the hiatus between them. What is true of this simple case of adjustment is true of the complex case of the adjustment of the organism to its environment. However rapid and apparently immediate may be the cognition that a patient is insane—is unadjusted to his environment—yet that cognition must be preceded by a previous knowledge both of the organism itself and of the environment with which his adjustment has failed. The truth of this statement, which is involved in the definition of Insanity, may not be at once apparent, but a little consideration will render it clear. It is manifest that before pronouncing a man insane, we must first know something about him, but that we must also take into account his environment is, perhaps, not so self-evident.