Your teacher has asked me to address you. I have complied with this request, chiefly from my respect to him, partly in order to realise the sort of sensational antithesis of lecturing to one of the largest classes ever assembled, in the same room where the first complete course of lectures on Mental Disease was delivered in this country, now nearly twenty years ago, to perhaps the smallest class ever addressed.

Considering the present state of Psychological Medicine, there are certainly few of us who may not be well satisfied. No one would have believed fifty years ago that in our day so many magnificent establishments should have been created throughout Europe. The legal position of these unfortunate persons has been secured; the abolition of the strait-jacket in English asylums has been accomplished;—results long before attempted by Pinel, Esquirol, Daguin, Tuke, Langerman, and by other reformers in mental science.

My attention to the cottage system for the accommodation of chronic lunatics was revived soon after my appointment to the Gloucester County Asylum, by my finding that institution in a crowded condition; and although it possessed one cottage which answered well, there were no means of increased accommodation. The visiting magistrates of the asylum personally inspected the different workhouses belonging to the several unions in the county, and reported that they were not in a fit condition to receive harmless and chronic cases. Upon this, I addressed several questions to my brother superintendents, in order that I might have their opinions as to the best means to be provided for receiving the increased numbers that annually come to the portals of the county asylum for admission. I felt considerable diffidence in giving my opinion in favour of any innovation which had for its object the important plan of an altered system for the provision and treatment of any of the insane poor, or the so-called “chronic and harmless” lunatics. I have since then given the subject considerable thought and attention, the result of which has been to convince me that the cottage plan for asylums is the best means for the provision and treatment of the insane, as well as for relieving the present overcrowded condition of some of the county lunatic asylums. Previous to laying my plans and observations before the members of the association, I would take this the earliest opportunity that has arisen of acknowledging the kind and ready way in which so many of the members replied to the questions which I sent to them in reference to this subject.

I do not know that a more useful question can occupy this our last hour of meeting together than that of the legal responsibility of the insane, and how it affects us in our relations to our patients, more especially in regard to moral treatment. Our visits to Millholm have enabled us to judge of the value of that method, as carried out in the largest private asylum in Scotland. At the Crichton Institution, where we were so kindly entertained by Dr. Gilchrist and the directors, at our late visit, we witnessed its highest present development, and learn, moreover, of what it is further capable. Dr. Browne was the first to introduce the method into Scotland, when appointed to be the medical superintendent of the Crichton Institution, at a time when the lunatic was treated worse than a felon. With the sanction of the Board of Lunacy he most kindly consented to accompany us on our visit, and to give us a discourse on the moral treatment of the insane.

There are few cases more distressing for a physician to witness, or difficult for him to manage, or in which he incurs greater risks or responsibilities, than those varieties of insanity in which refusal of food is a marked and prominent feature. To fix the exact moment when exhausted nature must be replenished; to determine when persuasion shall be given up and force, as a last resort, had recourse to; to estimate the quantity and quality of food required; to distinguish where medicines are life or death; to recognise the variety of medicine necessary to meet the requirements of the particular case; and, lastly, to decide on the mode of administration, are all matters of such primary importance, and require such a sound knowledge and extended experience, that one might deprecatingly exclaim, Nemo tenetur ad impossibile.