In succeeding, as President of the Medico-Psychological Association, the distinguished professor whose term of office now expires, I beg to return you my best thanks for the honour you have conferred upon me. I must at the same time express my regret that I was unable to attend the last annual meeting of the Association, when I might, as on previous occasions, have pleaded my total unfitness for the office, and have again obtained your assent to the selection of one more suited for that honourable distinction. Having, however, been placed in what I consider a false position, I have now only to trust to your kind forbearance and beg your support in the fulfilment of the duties.

That great criminals are wholly without the moral sense, that violent and habitual criminals are, as a class, moral imbeciles—are startling propositions; but, nevertheless, they have been adopted and advocated with singular show of truth and much ability of late years. Such views are quite opposed to all the doctrines of divines, and philosophers, speculative and practical. That any man, however wicked, is utterly deprived of the moral sense, sounds very new and very strange to us. Our own consciousness tells us all, what Sir Thomas Brown has so finely told us in eloquent words—“Surely there is a piece of Divinity in us; something that was before the elements, and owes no homage unto the sun. Nature tells me I am the image of God, as well as the Scripture. He that understands not this much is yet to begin the alphabet of man.”

To some extent we have anticipated the consideration of the influence of emotion on spasmodic action of the muscles, in describing the effects produced by powerful emotional states, as terror, which often causes excessive or spasmodic contraction, sometimes amounting to tetanic rigidity. The sobbing of grief, the laughter of joy, afford daily examples of spasmodic muscular contraction from emotional stimulus. The spasm which chokes the voice and converts the fibres of the platysma myoides into rigid cords in terror, the convulsion and tremors of the facial muscles in despair, the clenched hands, the convulsive opening of the mouth and spasm of the diaphragm and muscles of the chest in fear, the spasm of the jaws in rage, the spasmodic rigidity of the muscles in a maniacal paroxysm, are they not written in the graphic pages of Bell ? With the exception of mania, these spasmodic contractions are consistent with health. We shall include under the present section all convulsive attacks, whether epileptic or not, whether infantile, puerperal, or hysterical, trembling palsy, chorea, spasms of the larynx and pharynx, nervous hydrophobia, and tetanus. Physiologically, when of emotional origin, they may all be referred to disturbance, more or less serious, of the functions of the sensori-motor apparatus, including the medulla oblongata.

The prominence which the question of the so-called puerperal insanity has lately attained through the medium of one of our law courts, in one of the most startling cases that have been tried form any years, is of itself sufficient warrant for now bringing it up for discussion, irrespective of its own special-interest on scientific grounds. It is, however, in its scientific aspect, rather than its legal bearing, that I purpose to present the subject to you, but I propose not to lose sight entirely of its legal interest.

If I were asked the especial and characteristic features of this present day, I should most certainly take good care to enumerate that one (feature) which seeks to modify or even undo the legislative acts of our progenitors, that is to say, of those who, living in the new or early times—not the old times—were without that needful experience and knowledge wherewith to realise the truth. As you know well, the science of our forefathers was, at its best, a poor and sickly thing—sadly misshapen and badly used; and as to Psychology, it was, indeed, at a miserable discount.

A very considerable portion of the large and increasing expenditure for the poor in Scotland, which has lately attracted so much public attention, has been incurred on account of pauper lunatics. Thus, while the entire cost of this class to the country in 1858 was &pond;80,652, in 1867 it amounted to &pond;117,186, having reached this point by a constant though irregular growth each intervening year. Possibly, after all the asylums which have been recently erected are in full operation, the annual addition may not be so great in future years; but in the meantime there is no indication of a reduction in the rate of increase. For the report of the General Lunacy Board for 1868 shows that the sum expended by parochial boards on account of the insane, in 1867, was &pond;6,382 more than in 1866; and it appears from the last report of the Board of Supervision for the relief of the poor, that during the year ending 30th June, 1869, the additional cost was &pond;11,136. The explanation of this constant growth of expenditure is not difficult to find, but it would be foreign to my subject to enter into the question. I shall, therefore, at once proceed to consider the measure of relief provided in the Lunacy Act for 1862, by which parochial authorities are empowered to lodge the insane in private houses. In doing so I shall confine myself almost entirely to a simple record of my experience. The propriety of the scheme has already been sufficiently discussed on theoretical considerations; the final appeal must be to facts.

The number of persons in Great Britain registered as insane is now 62,023. Of these 54,713 are English and 7,310 Scotch. Ten years ago the numbers were 39,647 and 6,251, or 45,898 in all. An increase of 16,125 lunatics in ten years in this country is a most noteworthy fact. It has hitherto received no thoroughly satisfactory explanation. We can conceive of no question the solution of which would be more interesting medically, socially, and economically. It is to be earnestly hoped that the Commissioners in Lunacy will soon attempt it. They alone have the materials for working it out. They have already put forward partial explanations, or rather theories, supported by a certain amount of fact. But the subject in all its bearings is still in want of a satisfactory handling. All the facts and figures that bear on (1st) the cases registered as insane for the first time each year, (2nd) the mortality among the insane, (3rd) their mode of accommodation and treatment in each district from year to year, and (4th) the cases left as insane at the end of each year, would require to be ascertained and carefully considered before a true conclusion could be arrived at. Under the first heading a comparison of the numbers of well marked cases of the different varieties of recent insanity occurring each year would require to be made. And all the truth could not be got until a similar comparison of the varieties of chronic cases for the first time registered as insane each year was made, and also an attempt to discover the original forms of their insanity, the treatment to which they had been subjected, and its influence on their malady. Under the second heading, the death rate in each variety of insanity under the different kinds of treatment and distribution, the prospects of life and “natural termination” of the chronic cases, would have to be studied and compared with the numbers of new cases registered each year, and with the death rate and rapidity of increase of the population at large. The third point referred to would enable corrections to be made for certain counties in which changes in the accommodation for the insane had been made, and then all the preceding vital statistics applied to the figures under the fourth heading would bring out the whole truth in regard to the subject. In the Scotch report there is a new and able effort to take the question of age into account in dealing with the vital statistics of the insane; but unfortunately the chief value of the facts are not brought out, by not comparing them with the returns of the Registrar-General in regard to the numbers of the general population of different ages.

In the same chapter are brought forward numerous instances of delirium produced by toxic agents. Among these is a striking case of mania in a patient—the subject of syphilis— in whom, at an apparently hopeless stage, a cure was effected by iodide of potassium; and there are several cases of delirium in rheumatic fever, in connection with which the essentially neurotic character of this affection is affirmed. Other varieties of delirium considered are febrile and postfebrile, epileptic, traumatic, and puerperal; in the last, a nutritive or even stimulant treatment is decidedly recommended. The treatment of delirium is fully considered; blood-letting, general or local, is admitted to have value in certain cases; the cold douche, combined with the warm bath, is reported as exceedingly well worth trial; tartar emetic, with opium, is affirmed to be useful, but as contra-indicated by a weak heart; the use of hydrocyanic acid has a similar caution attached to its recommendation.