VIII.—Turning from the living mechanism and its energies, to the energies derived from without that move it—the “strings of the puppet”—to use the mechanical phraseology, we come upon another class of words and phrases which are ambiguously used in the “old metaphysics,” but which have a definite and wholly different meaning in studying the organic bases of mental life. These are such words as impression, irritation, suggestion, and the like. I may be permitted to state, somewhat dogmatically, what is now admitted generally, that all changes in the constituent matter of living things result from the operation of physical or molecular energies therein. This being so, the cerebral series of changes involved in mental states of the individual, and constituting the process termed cerebral reflex action, are due to as purely physical causes as those on which spinal reflex action depends. And this is true, not less as regards feelings like corporeal pain, and sensations, than as regards the highest work of the intellectual faculties. This operation of physical energies, however, was not recognised by Marshall Hall and Dr. Carpenter in 1838, nor, indeed, by physiologists in general. One source of the difficulty experienced in doing this is in the imperfect appreciation of what is physically included under the word impression. Thus, an anonymous defender of the views of the eminent physiologists named observes, in 1846, in opposition to my views—

In 1843 the subcutaneous injection of morphia was introduced into this country by Dr. Alex. Wood, of Edinburgh, as a means of treating nervous disease. He found it remarkably efficacious in relieving neuralgia, but believed its action to be almost, if not entirely, local. His results as to the relief of pain have received almost universal confirmation; but subsequent experiments have shown that the drug acts on the nerve-centres, and thus indirectly soothes the pain of an irritated nerve, and not by causing direct anæsthesia of the seat of pain. To Dr. C. Hunter is due the credit of having first demonstrated that local injection is not necessary for the relief of local pain. He employed the hypodermic injection of morphia very successfully in controlling the spasms of chorea, in subduing the excitement and overcoming the sleeplessness of Delirium Tremens and Acute Mania, and in alleviating the restless wakefulness of traumatic inflammation. (His experiments were published in the “Med. Times and Gazette,” for 1859.) Two years later, in 1861, Dr. W. C. McIntosh, now Superintendent of the Perth District Asylum, then Assistant Physician of Murray's Royal Asylum, Perth, employed morphia, subcutaneously, in almost all forms of insanity, and found it, to use his own words, “a sedative to the furious, a calmative to the depressed and despairing.” His observations were published in the “Journal of Mental Science” for 1861; and although this mode of using morphia rapidly became known, employed, and esteemed in many asylums, and by many alienists, the results, so far as I am aware, were published only as isolated notes till Dr. J. B. Ward's paper appeared in the “West Biding Asylum Medical Reports” for 1871.

As the Hospitals for the Insane in the United States of America have recently been prominently brought before the medical profession in England, it may not be uninteresting to the readers of this Journal to have a slight historical sketch of what may be called the past asylum movement in the States. I am not aware that this has been given before in any journal or work published in Great Britian. The peculiar difficulties of a new country, peopled by different races, and the constantly disturbing influence of immigration, ought to be borne in mind in this narrative. These difficulties are too frequently overlooked. In a letter I received from Miss Dix two years ago, she writes—“We have an amazing burden in all our charitable institutions of every class of disabled foreigners of all ages and in all stages of feeble or quite broken down conditions of health.”

The disheartening aphorism, in which Hippocrates summed up the experience of his life—“Art is long and life is short, the occasion is fleeting, experiment is dangerous, and judgment is difficult”—is more true of the study of insanity than of any other department of medicine. Were any proof needed of this, it would be sufficient to point to the classification of mental diseases, the symptomatological plan adopted until recently corresponding to the earliest nosology of ordinary medicine, while the schemes which task the ingenuity of a Skae or a Bucknill have a great likeness to the “Phthisiologia” of Morton, or to the nosologies of Sauvages and Cullen.

In thinking over a subject on which to write a short paper for this meeting, it seemed to me that it would be better to select one connected with my own specialty, as more likely to possess elements of interest and novelty to the members, than if I chose one out of the ordinary domain of Medicine or Surgery, in which they have a much wider field of observation than I can have.

Few countries, if any, afford better opportunities for the study of insanity, as exhibited among different races, than British Guiana. Here, gathered together in one asylum, are West Indians, Coolies from India, Chinese, Portuguese, and Africans; and, although the types of insanity are very similar in all, yet there are some distinctive features, worthy, I think, of being noted. Many difficulties arise in investigating the subject, owing, principally, to an inability to converse personally with some of the patients, more especially with Chinese. Consequently, a refinement in classification is unattainable; the strongly-marked features of the case alone giving an index to the form of mental disorder.

Although we have, for some time past, begun to emancipate ourselves from the idea that insanity is a disease of the mind, and admit, in theory at least, that it is strictly a disease of the body, as much so as typhus, or any other disease involving perturbed mental phenomena, yet we have scarcely hitherto begun to investigate the pathology of insanity from this point of view. Even yet we classify the forms of the disease by the mental manifestations it presents, and speak of mania, melancholia, dementia, &c., when our aim ought to be to differentiate the physical or chemico-vital somatic conditions; we describe the insanity of fear, of pride, of exaltation, &c., much as if we should classify ulcers as those of the hand, the arm, the leg, and the trunk, instead of attending to the more important characters of ulcers in general with their true specific differences. For, I venture to think, that Professor Ferrier's researches point strongly to the view that the differences in direction, so to speak, taken by the mental phenomena depend to a great extent upon the differences in the portion of brain-tissue principally affected. The investigation of the physical causation and conditions of insanity will doubtless be laborious and tedious work, but there can be no doubt that the results to be obtained will more than repay the labour which must be expended in the investigation.