Gentlemen,—I must again express my deep sense of the distinction conferred upon me in my election as your President. It is a great honour to occupy a place which has been held by so many eminent men, masters in mental philosophy, distinguished in science, and in literature, taken in its wider sense, as well as in that strictly medical. I am fully conscious of inability to follow them with equal steps, but supported by some of you, whom I am privileged to call my friends, and by many other valued associates, I venture to hope that your interests will not suffer in my hands. I say this, reckoning confidently on the ready help which the less advanced among us have always received from the honoured heads of our Association; one, especially, is present to my mind, by whose friendly encouragement many probationers have been induced to put forth their powers for the advancement of mental science. Distinguished in medicine, in science, and in general literature, the Founder of our Journal, and as its Editor for many years, ever courteous, considerate, and just, no one has done more for the best and highest interests and objects of this Association, than our esteemed colleague and former President, Dr. Bucknill.

I take this my first public opportunity of thanking the Patron of the Morisonian Lectureship on Insanity, for the honour of nominating me to the appointment of lecturer. Permit me also to say that I feel very highly gratified and honoured in addressing the Fellows of the Royal College of Physicians in their own hall. This gratification is, however, alloyed with a very strong conviction of my inability to do justice to my subject or myself in this course of lectures. It would be absurd in me to give to you a systematic course of lectures upon insanity, the subject being one with which you are all, as physicians, more or less familiar. The duty devolving upon me is, I presume, that of giving you any special opinions I may have formed from my point of view, and from my long-continued and very large opportunities of observation.

The application of electricity to the treatment of various diseases of the brain and spinal cord has for a number of years been a regular method of treatment with some of our best known neurologists and electro-therapeutists, and the value of such treatment, when rightly administered, is now questioned by very few advanced students in these departments. It is not, however, so well recognised that in diseases of the brain and spinal cord, where the mind is seriously affected, the electrical treatment is also indicated. In some of the asylums of England, United States, and Germany, electricity is now, and for some time has been used as an adjunct to other remedies for the treatment of different forms of insanity; but with a few exceptions the treatment is not systematically carried out, and, partly through ignorance of the methods of application, partly through want of sufficient medical assistance to supervise the necessary details, the results have not been entirely satisfactory, and the cases have not been fully recorded.

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 object of this paper is to discuss some of the opinions which have recently been expressed as to the nature of Epilepsy; and in particular, the views of Dr. Hughlings Jackson, who regards the epileptic phenomenon as the result of a “discharge” from a damaged portion of the brain, which he speaks of as a “discharging lesion.”∗

Some time ago I employed my leisure in hunting up all facts which might throw some light on the condition of lunatics in Great Britain in former times. In my then position it was extremely difficult to obtain access to the class of books most likely to yield me the information desired, but from such as did fall in my way all matter of the least value for my purpose was excised. The labour connected with this pursuit was much greater than most might be inclined to credit, and some men of a utilitarian frame of mind may be inclined to believe that labour on such a subject was wasted, and might have been much more profitably expended on other branches of research.

Emotional Display in Prisoners.—In proceeding with, our investigation into the rationale of their angry and destructive outbursts, it will be necessary for us to keep in view the exceptional circumstances in which prisoners are placed, and the fact that their passionate demonstrations are frequently but repetitions of the same series of acts in consequence of the limited scope of action afforded by prison life. The readiness with which such emotional conditions are stirred up, and the extravagant results to which they lead, are among the best evidences of mental inferiority among criminals as a class. Indeed, wherever we find such a relative want of proportion and adjustment between states of feeling and their cause on the one hand, and states of outward activity and their consequences on the other, we must look upon it as an indication of inferiority.

The annual account of their stewardship rendered by the Commissioners in Lunacy is always interesting, both to those who make Lunacy a study, and to those who make it a living. Many persons go to these reports keenly interested in the facts and figures set forth, and their medical significance; others see only the social and economic bearing of the statistics, while perhaps a still larger number look with anxious eyes at the praise or blame of themselves or their institutions that is published to the world in those volumes. No thoughtful man can take up one of these reports, however, without having some new ideas suggested to him. To see the records of the mere numbers of our poor human kind of every class and in every place affected with the direst of all diseases has a very saddening and humbling effect on most minds. Who can think of 68,145 insane men and women—the number in the United Kingdom at the end of 1872—and endeavour in the remotest degree to realise the broken hearts, the blasted hopes, the blighted ambitions, the unfinished work, the dead affections of this great army of stricken ones, and their belongings, without feeling very sad at heart? And these things do not half express the true seriousness of the case to the medical mind. The latent and milder cases not included in this list, the vast mass of nervous and bodily disease that has necessarily accompanied so much insanity, the mental eccentricity and obliquity, the degeneration, the immorality, and the crime, which we know must have existed in so many of the families where the insanity occurred—all these things help to darken the picture that rises in one's mind when thinking of the sixty thousand. Two or three bright spots there are it is true. All this misery has roused up a pity that is almost divine, a pity that has assumed a most practical form, and done very much for the care and cure of the disease. Medical science has not been idle in the study of the nature of the disease, and of the best means of its prevention and treatment. Through—as some would say in consequence of, as we would say in spite of—all this disease, we have in every generation a great light rising, a genius among the degenerate, a god among those that are tending to the brutes, to repay all the compassion and care that have been expended on his blood relations by giving new ideas and great thoughts to all the world. The last, and most unquestionably the truest comfort in the matter, though it may seem to the unthinking to savour of the cold heartlessness of pure science, is that all this mass of disease of man's highest organ is one of Nature's ways of keeping the general mass of human kind brain-whole. She cuts off a hand that the whole body may not be destroyed; that the fittest may survive, the unfitting must die.

Glamorgan.—The feature of this report is the Medical Appendix. Although short, it is interesting, and embodies Dr. Yellowlees' experience of asylum management, &c., during the past five years.

In the “Zeitschrift für Psychiatrie,” xxix. Band, 1 Heft, Dr. Meschede gives a long, careful, and somewhat diffuse article on the Pathology and Pathological Anatomy of Pyromania, the tendency or impulse to set fire to objects. Dr. Meschede is not aware of any cases of pyromania where the morbid appearances found after death have been described.

Professor Betz, of Kiew, has lately produced brain sections, which have attracted very considerable attention in Vienna. His specimens are of vast extent. He appears to be able to produce thin sections of an entire hemisphere. We append his method of hardening and cutting as it is stated in the “Correspondentze Blatt der deutschen Gesellschaft für Psychiatrie und Gerichtlich Psychologie, Jan., 1873.” The method of hardening which we wish to bring into notice is as follows:—observing that differences exist in the treatment of the spinal-cord, cerebrum and cerebellum. The spinal-cord—after tbe careful removal of the dura mater, it is placed in spirit of from 75 to 80 per cent., which is tinged a clear brown colour by the addition of Iodine. After from one to three days, during which the preparation must stand in a cool temperature, the Pia Mater and the Arachnoid are also removed; the specimen remaining in the spirit, to which a few drops of Iodine must be added daily for three days, maintaining an ordinary temperature. It is then transferred to a three per cent. solution of Chromate of Potass, and back again to the cool temperature. Here it hardens thoroughly, which is known by the fluid becoming turbid, and by the formation of a brown deposit upon the preparation. When this occurs, it must be immediately thoroughly washed with water, and immersed in a solution of Chromate of Potass, from a half to one per cent. strength, in which it will not become too hard or brittle.

In Numbers CII. and CIII. of the “British and Foreign Medico-Chirurgical Review,” Dr. J. Batty Tuke publishes the results of investigations made in ninety-two Autopsies as bearing “On the Morbid Histology of the Brain and Spinal Cord as observed in the Insane.”

The Council met at the Royal College of Physicians at 10.30 a.m. Dr. Harrington Tuke, President-Elect, in the Chair.

The proper treatment of mental disease must always be considered as involving two distinct divisions. In the one, “moral” management, it is necessary to gain regard and willing obedience, to check wayward impulse, to beat away disturbing fears, to cheer the despairing, to restrain, not by force, bat by patience and firmness, the angry and the violent, and to catch the moment in which the swiftly wavering mind may be brought to rest, and its balance permanently retained. The other division embraces the correct employment of hygienic and purely medical remedial agents.

It will be remembered that a woman called Mrs. Petschler, who had been a patient in the Macclesfield Asylum, got a firm of solicitors in Manchester a few months ago to write a long anonymous letter to some of the principal daily papers, making very serious charges against the management of that institution, and its officials. The Committee of Visitors at once requested the Commissioners in Lunacy to undertake a special inquiry into the whole matter. This has now been done by Mr Cleaton and Mr Howard, and the following are the conclusions of their report:—

At a meeting of the Psychological Section of the British Medical Association held at King's College, August, 1873, Professor Gay called attention to the fact that John Howard was appointed High Sheriff of the County of Bedford exactly one hundred years ago (in 1773), and so obtained the opportunity of making those remarkable inquiries into the state of prisons, and the physical and moral condition of prisoners to which this country and the world in general are so deeply indebted. Dr. Guy also alluded to the controversies which had arisen as to the character of Howard and his treatment of his only son; and as, in his judgment, there is no biography extant which affords such full and trustworthy materials on which to found a psychological inquiry, he offered a prize of £10 to encourage and promote such inquiry.