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.

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.

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.

“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.

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.