Seven years ago Dr. Clouston read a paper to this Association “On the Question of Getting, Training, and Retaining the Services of Good Asylum Attendants.” Such a paper could scarcely fail to attract considerable notice and elicit a very hearty discussion, for the subject is one of far-reaching importance to us as asylum physicians, and of very great moment in the interest of the insane. To get the best raw material possible, and to manufacture out of it the best asylum attendant possible, were two great aims suggested by Dr. Clouston, and the subsequent discussion of his paper showed that the Association was fully alive to these, and the serious obstacles which lay in the way of their accomplishment. If the aims here indicated should be more fully realised in the future than in the past, we will probably find that the third desideratum, viz., the keeping of our attendants for a reasonable length of time, will be realised in like proportion as the others. We all willingly admit that the first serious difficulty is how and where to get them. What will attract the best raw material into the asylum market ? or, putting the question in a negative way, what is it that does not attract the best raw material into asylums? These questions will admit of a variety of answers, many having their root in the idea of non-respectability. Undoubtedly the status of an attendant is at present an inferior one in the industrial scale. Some common popular notions are that the rougher and stronger the material the better is the attendant; that it is not a trade for men, and is suited only for the coarser types of women; that it leads to nothing reliable or desirable as a permanent occupation; and that as a life-work it is not sufficiently respectable to satisfy an average ambition. These and other considerations materially affect the supply of good attendants. Seeing, therefore, that in attendants themselves we find the best advertisement, and through them may command the highest success, it is worth considering, whether or not it is possible for us to advertise asylums, in such a way as to attract to them the better raw material which we crave so much after, and which we need so much. If the public mind must be educated to better purpose we must go upon a new tack. We shall require to bring more elevating influences to bear upon our attendants. In raising their social and industrial status we shall raise them in the estimation of the public and themselves, and may reasonably expect a more marketable article by-and-bye. It is surely fair, in the interest of all concerned, that attendants should receive from us the best possible training of which they are capable. There is reason enough for it in this, that as medical helps they will then develope more fully, and their work will become a life-work worthy of the name.

The question of the legal responsibility of the insane has been frequently under discussion both by legal and medical writers; and its conditions and limits must, I fear, still be regarded as far from settled; divergent views being held, perhaps naturally, according to the standpoint respectively taken up by the lawyer and the physician. “A lawyer, when speaking of insanity,” says Sir J. F. Stephen, “means conduct of a certain character; a physician means a certain disease, one of the effects of which is to produce such conduct.” It is somewhat remarkable that the legal responsibility of the idiot, and of his milder congener, the imbecile, has hitherto hardly been deemed worthy of discussion; but a recent law case, in which several patients under my care were concerned, has led me to think that a few remarks on the subject may not be altogether uninteresting or unprofitable.

An old teacher of mine, in days gone by, used frequently to remark in his lectures on Logic that the test of accurate knowledge is the ability to give an exact and comprehensive definition. Now, if this criterion were applied to us, alienists, in regard to the subject we are supposed to know most about, the result would, I fear, be somewhat disastrous, and not at all likely to shed lustre on our speciality.

In investigating the complicated phenomena of mental action, normal and abnormal, it is not sufficient that we confine our attention to the nervous system in its latest stage of development, but we must direct our thoughts to the manner in which it has been built up; in other words, if we wish to understand how the nervous system acts, we must see how it has been developed.

It has been stated by some that it is syphilis originally mild and benign in its manifestations, that is most apt to cause cerebral syphilis; one saying that the subjects most liable to cerebral syphilis are those in whom the secondary symptoms have been slight or transitory; another asserting that often one can find no history of preceding cutaneous or other affection of either the secondary or tertiary order; another, that any syphilis may be followed by specific cerebral affections, the original mildness of a syphilis being no guarantee against future cerebral affections of syphilitic origin, and that the great majority of the cerebral affections are furnished in examples of syphilis which is of medium severity, or (less often) is benign. This last observer, in 47 cases of cerebral syphilis, found three after severe or grave syphilis; 30 after syphilis of medium severity, and 14 after syphilis benign in its manifestations. As stated by myself in a paper published more than seven years ago: “It is particularly in instances where syphilis affects the nervous system that its evolution is sometimes insidious; that its later lesions are not preceded by its usual characteristic development on the exterior of the body, or by only a partial, or slight, or transitory development; and that the diagnosis is surrounded by obscurity. This is the opinion of several writers on the subject, and more than once the fact has forced itself upon my attention.”

The motives that impel me to take up the cudgels against Prof. Cleland are written in the thirty-second chapter of the Book of Job. Far better would it have been had the challenge been accepted by someone whose authority and standing were comparable with those of Prof. Cleland, but in default of such a champion my feelings are those so vividly described in the seventeenth and three following verses of the said chapter, by Elihu the son of Barachel the Buzite, of the kindred of Ram.