Prefatory Remarks. It is necessary to preface the part which here commences, by stating that we must suppose that the reader has acquired an ordinary knowledge of the technicalities of logic, and has some acquaintance with the speculations of modern logical writers, especially with those of the late Sir W. Hamilton, and those of Mr. J. S. Mill. To be obliged to explain all the terms which we shall have occasion to use, would be inconvenient and irksome, and not at all in consonance with the brevity which it is necessary to observe in this place, and especially with that distinctness which is so needful to the successful exposition of what we have here undertaken. And why should we exercise our ingenuity in varying descriptions of mental processes already expressed with such abundant variety in the works of able logicians? Since then we do not seek to afford a systematic account, but merely to record the leading results which we have yet obtained from examining the landmarks on ground not recently explored by the investigators of logic, much minuteness will not be demanded from us. And we desire to state that all that is peculiar in these contributions arises from adopting this separate course.

That a uniform statistical method should be generally adopted by all those connected with the insane is greatly to be desired, for though statistical researches have met the fate of all other methods (‘Annales Psychologiques,’ July, 1856), have been received with un-reflecting infatuation, or been the subject of unmerited reproach, according as they have given us useful facts or have led us into error, yet everything leads us to expect that the extension of a statistical programme, would furnish us with useful data, for the examination of some of the most important questions relative to mental alienation.

Dr. Laycock's volumes present a formidable aspect. The correlations of consciousness and organisation is a sufficiently puzzling title. Open either volume where we will, we meet in the head lines such expressions as “mental dynamics,” “cerebral differentiation,” “teleotic homologies,” “correlations of the will,” “unifying functions of the brain,” and other hard words enough to make the hair on the head of him who is to read by compulsion, stand on end. Nevertheless the book is a readable book. Dr. Laycock, beyond doubt, has a metaphysical turn. He deals with the most abstruse topics with the easy air of a man whose life and conversation have been spent in speculation. We say this without prematurely pledging ourselves to the belief that he is even only for the most part sound in his opinions; for such is the nature of metaphysics, that a man may be a prodigious genius in that line, and yet it may be the fortune of the age in which he lives, never to discover that his works rest on some wholly baseless principle.

It has been suggested to me by a professional friend, in whose judgment I place much confidence, that I shall aid in demonstrating the value of night nursing in the moral treatment of the insane, and perhaps remove prejudices which yet exist against its use, by laying before the members of this Association a record of my experience of the system at the Sussex Asylum during the first half of this year.

The diversity of phenomena which compose the universe is but apparent; the physical forces, however varied they may appear, are but diverse manifestations of the same principles, always active, but the effects of which often vary their mode of application as well as the duration of their action. In like manner, the most simple phenomenon requires the co-operation of a multitude of diverse actions regarded by us as so many distinct forces. Thus there is not an isolated fact in nature, nor one in disagreement with universal order. Every phenomenon is one of the consequences of universal laws. If these laws are not clearly known in the complexity of their applications, the facts which are ever before us indicate at least their character and the direction which they take. Thus critical minds, enlarged by the school of scientific experience, refuse to accept speculative systems and supernatural theories which involve the existence of phenomena in the universe in disagreement with the principles which govern it. A fact of this sort is proclaimed, science subjects it to scrutiny, and generally recognises that it is but the effect of forces analogous to those which occur in phenomena already observed, but acting in a different manner.

Within the last twenty years, the influence of German literature and science, previously little felt, has operated strongly upon English thought and English society. German literature, popularized by translation, finds a multitude of admiring readers; yet, compared with German science, its effects on the opinions and, consequently, on the practical habits of our fellow-countrymen have been trifling. In the modern history of metaphysics, German works occupy a most prominent place; and in religious thought, such has been the influence of the productions of the German press, that the prevailing theology is deeply imbued with what are called the rationalistic or neological principles of German professors. So when we look to modern physic, we also find its principles intimately connected with the researches and hypotheses of German physicians; so much so, indeed, that there has arisen in the medical profession a rational school, ignoring many an old-world theory of the principles and practice of medicine. What has been more popular, more readily received in this country than German physiology? It is not only represented by translated treatises, but actually forms the basis of home-produced works. The German writers furnish, in their elaborate treatises and monographs, the quarry from which the material is mainly drawn for the construction of English works; and this we can safely assert, after giving credit for much good English matter and for skill in modelling the whole structure to the English taste. German physiology, having preceded, has latterly been followed by German pathology, foremost among the teachers of which stands Professor Virchow, whose remarkable treatise on cellular pathology has recently appeared in an English dress, and commends itself by the mass of facts it contains, as well as by its ingenious hypotheses, to every pathological student.

My Dear Dr. Laycock,—I am sorry that owing to constant occupation of my time by asylum engagements, I have not been able sooner to forward the cases of which I promised you a detailed history. This I have been at some pains in ascertaining as accurately as possible, and regret that I have not been able to put my materials into a more polished form. Both of them seem to be very typical examples of the forms of general paralysis which you differentiate, namely, the alcoholic and diathetic. Each affords a most perfect example of the sequence by which, from a perfect arthritic health, and sound arthritic modes of psychological manifestation, the invasion of paralysis gradually proceeded to sap and extinguish life.

The liberty of the subject, so dear to all Englishmen, is under certain conditions placed by the law of the land at the discretion of any two qualified medical men. That the confidence thus reposed in the members of our profession has not been abused is proved by the evidence of an unimpeachable witness, namely, that of the Earl of Shaftesbury, who, as Chairman of the Commissioners in Lunacy, asserted before the special Parliamentary Committee, that in his experience of nearly thirty years “there has not been more than one or two cases in which any person has been shut up (that is, in a lunatic asylum) without some plausible ground for his or her temporary confinement; but in every instance, with these exceptions, there have been certain plausible grounds in fact or in logic, sufficient to justify the temporary confinement of the persons, and their being submitted to medical treatment.” It is highly creditable to our profession, that a man of Lord Shaftesbury's position and experience should be able to give this strong and definite testimony, to the manner in which the statutory powers of medical men in giving certificates of insanity have been exercised; but at the present time it is not my desire to dwell upon the sound judgment and honest intention with which this great social responsibility has been discharged, but to direct the attention of the meeting to the abundant and constantly recurring errors of form, which are committed in filling up medical certificates, in the hope of affording such few hints as my experience may suggest, by which they may be avoided. So abundant are these errors, that I hear medical gentlemen connected with private Lunatic Asylums assert that it is the exception, and not the rule, to receive with a patient, admission-papers which require no amendment. Indeed, a physician in charge of a first rate private asylum assures me, that he has never yet received admission-papers which did not need amendment. This is a matter of great importance, for (to say nothing of the delay and expense incurred in procuring these amendments, which are so great that the proprietor of a large private asylum assures me, that he invariably prefers the expense of procuring altogether new certificates) any errors or omissions, not discovered and rectified, would leave the proprietor of an asylum liable to heavy damages, under an action for false imprisonment. The courts of law very properly require that these medical documents, under which men are deprived of their liberty, shall be drawn up in exact accordance with the provisions of the statute. An early illustration of this principle was afforded by the decision of Mr. Justice Coleridge, in the case of Mr. Greenwood, in which he declared that the medical certificates were invalid, and that the patient had been improperly confined, because the name of the street, and the number of the house, in which the medical examination had taken place, were not stated upon the certificate. The formal part of the certificate is indeed a very simple one, and contains no one thing which might be omitted.

It is remarkable, considering the advance which has been made in the study of the diseases of the mind during this century, that so little is still known concerning idiocy and idiots. With an increasing population, there is no decrease in the numbers of these helpless beings; their origin is connected with the, apparently, inevitable results of our social system; their very existence is, in most instances, a natural protest against vexatious and unreasonable interference with those great laws which govern the well-being of communities; and, both in a scientific sense as well as in a philanthropical, they have great claims for consideration.

Since the opening of this asylum on the 1st March, 1848, to the 1st December, 1860, one thousand male patients have been admitted, in which are included 130 readmissions, the actual net number of individuals admitted being 870.

It still, I think, unnecessarily remains a disputed question, whether the mental affection in general paralysis does, or does not, precede the symptoms that mark enfeebled muscular power. Esquirol, indeed, distinctly states, in speaking of the corporeal paralysis, tantôt elle précède le délire, but it must be clear that this is after all negative testimony, it only means that Esquirol has been told so; it can only go to prove, as a close examination of the case quoted by Calmeil proves, that there were no symptoms observed by the friends of the patient, to lead them to suspect insanity, before the paralysis appeared. It has always been taught by Dr. Conolly, that the mental symptoms are synchronous with, or antecedent to the paralysis, and this is consistent with Esquirol's conclusion, that general paralysis is a “complication of insanity“; a definition called out by the not very lucid objection of Dr. Burrows, that he, Esquirol, seemed to think the paralysis to be the “effect, and not the cause of the insanity.” The real question to be decided is, whether in an undoubted case of ‘general paralysis,’ with mental aberration, the paralysie générale of Calmeil, there has ever been a period of the malady during which, with the muscular affection distinct, the mental powers were unaffected ? I have never seen such a case, and with my strong opinion of the special nature of the disease, should not expect to do so; it has already been pointed out that the statement of the paralysis existing with ‘weakening of the intellect,’ only widens the question into a consideration, of how small an amount of weakening constitutes unsoundness of mind. The existence of a case ultimately becoming insane, presenting paralytic symptoms, and yet showing undiminished mental vigour for some time after they appeared, if recorded by a competent observer, would go far to shake the opinion held by many of our leading physicians, as well as by myself, that general paralysis is a disorder, sui generis, and, though neither ‘cause or effect’ of unsoundness of mind, inseparably connected with it. At present, no such case is on record.

The remarks I have to offer for your consideration this evening relate to the subject of suicide, both in its medico-legal and social aspects. I am led to think that the every-day opinions entertained of suicide, its causes, &c., are altogether erroneous, and themselves a source of untruth and of much evil in society. If we will take the trouble to read the statements made in the newspaper press as to suicide and the parties implicated in the same, it is apparent that the act of self-destruction is, as a very general rule, viewed as one of a perfectly voluntary character—as one originating in the will—the normal will—of the individual most concerned. The world, so to speak, ignores the fact—the important fact—that every case of suicide is the accompaniment and consequence of a positive brain disorder, the effect of cerebro-mental disease. Need I add that a better acquaintance with psychological science—with the brain, its functions and diseased states—must, one day, cause this fact to be duly appreciated. Pending such a state of things, we must look for not only the false judgments of editors of public journals, but for the want of common justice on the part of Life Assurance Offices as towards their clients. I shall hope to prove to you, Mr. President, first, that the act of suicide is, at all times and under all circumstances, but one of the many indications of cerebro-mental disease—of, in one word, insanity; second, that the conduct of Life Assurance Societies towards their numerous clients, and in so far as suicide is concerned, is in all respects incompatible with an advanced psychology, and at variance with a due sense of right and common justice.

As considerable attention has recently been directed to the state of lunacy in Scotland, and much difference of opinion still exists as to the best method of providing accommodation for the insane poor, I have thought it not unlikely that it may interest at least a section of your readers, to know “how they manage these things in France.” You are aware there is no compulsory poor-law in this country; nevertheless, there is much charitable expenditure. Each parish or commune has its own resources, derived from the rents of land, the interest of money, local imposts, or charitable bequests; and its ability to provide for its poor varies with the amount of its revenue. In some communes, accordingly, the poor are well cared for, while, in others “they are steeped in misery to the very lips.” In 1838, the present French law of lunacy came into operation. It provides for the erection of departmental asylums, and for the maintenance therein of the insane poor. The funds for the buildings are voted by the Conseil-Général of the department, while those for the maintenance of the patients are found in this way:—The law determines that a commune possessing a certain income shall pay a certain proportion of the keep of its pauper lunatics; the remaining portion is defrayed by the department. The proportion paid by the commune varies from a sixth to a half; but as it is rare that a commune pays the highest rate, by far the greater share of the cost of maintenance falls on the department. It is the duty of the préfet to ascertain the income of the different communes within his jurisdiction, and to fix the proportion which each has to contribute for the pauper lunatics belonging to it. The rate of maintenance to be charged by the asylum is also fixed from time to time by the same official. At present, in the department of the Seine Inférieure, it amounts to one franc twenty-five centimes a-day for males, and to one franc fifteen centimes a-day for females. The poorest communes, accordingly, get their pauper lunatics maintained for a sixth of these sums, or about twopence a-day. Of course, as forming part of the department, they have to pay their share of the departmental expenses, but these fall in a much greater ratio on the wealthier communes—on such, for instance, as those of Rouen and Havre. The natural effect of this system is to stimulate the poorer communes to send every possible case to the asylum.