What asylum physician is there, who, in prescribing drugs for his patients, has any approach to a feeling of certainty that these drugs will have the effect he anticipates? I refer more particularly to sedative drugs. Is there any such physician who will lay down a rule by which it may be known whether opium, hyoscyamus, Indian hemp, or bromide of potassium is the best medicine to be given in a particular case? We have the statements of individual authors in regard to the right mode of giving some of these drugs, but after all those are merely opinions founded on most limited observations, and lack the exactitude of research, and the numerical basis on which alone scientific truth is founded. It is no wonder that many of our specialty are sceptics in regard to medical treatment in insanity, when we generally find that the advocates of particular medicines, or of special modes of administering them, merely give us “selected” cases. To anyone who has read something of the history of medicine, it seems a mere waste of words to advocate any new treatment of a disease, except it is clearly shown that the spirit of fairness and scientific impartiality has regulated the observations on which the would-be conclusions are founded. And as for discussing and quarrelling over the general question of the good effects of medical treatment versus moral treatment, surely the energy and acuteness so expended would be employed to far more purpose in observing and recording facts, so that we might have something certain on which to base an argument on the one side or the other. And by observing facts, I do not mean vaguely noticing the course of certain random cases subjected to unsystematic and desultory treatment, and accepting the confused impression of the result left on the mind as scientific truth, on which an argument may be founded or a boon to humanity conferred. It is surely possible for the physicians of asylums to combine their opportunities for observing the treatment of disease in one vast and systematic effort, all working on the same plans, and all adopting the same conditions. What accuracy might we not acquire in our notions as to the effects of morphia given in melancholia, if the drug was tried in the case of every melancholic patient in all our asylums for a year, and an accurate record of the results drawn up? The idea may seem in many respects chimerical and absurd, but it seems questionable if much accuracy in therapeutics will ever be attained until something of the kind is done. There is no single man who has opportunity sufficient to solve such a problem, except by careful experiments extending over years, and we know how difficult it is for a physician to continue careful experiments over long periods. And surely this exact, scientific, and statistical age will not allow the present state of utter doubt to continue much longer without making at least an effort to dispel it. We require to know the full and true result of giving drugs in every case, and not merely in a few favourable cases which may be natural recoveries.

Perception we define to be the intellectual and presentative consciousness of objects of any kind, internal or external, and the primary gateway of knowledge. In every perception the object is a most prominent feature. It is in the invariable presence of the object in perception, and its absence from memory and imagination, that we behold the striking difference which there is between it and the latter; and it is on this distinction the universal assurance is grounded that what we perceive is different from what we remember or imagine. In every perception there is an intellectual and a sensational element, and memory proper is the persistence of the intellectual element after the sensational element has disappeared from consciousness, or after the peripheral nerves have ceased to excite the sense-centre. In no instance have we been able, by any amount of effort, to make an act of memory or imagination seem a perception; yet Hume divided perceptions into two classes, as distinguished by their different degrees of force and vivacity. The less lively he named thoughts and ideas; the more lively, impressions. Professor Bain seems to take the same view of the question. In reference to the recalling of past feelings, he says:—“The renewed feeling occupies the very same parts, and in the same manner, as the original feeling, and no other parts, nor in any other manner that can be assigned.” It is the opinion of some, then, that memory and imagination only differ from perception in being less lively. The latter is a vivid picture, the former are faint reproductions of it. We fail to see that this is precisely the case. In every perception there is an object present, and cognized as distinct from the consciousness of it—in special instances, as even distinct from the perceiver altogether. When we gaze at a picture, the picture is regarded as one thing, the knowing of it as another; whereas when we only think of the picture, we do not recognize any object as really distinct from thought itself. An imagined external object is still detected to be a mental object. “A representation considered as an object is logically, not really, different from a representation considered as an act. Here object and act are merely the same indivisible mode of mind viewed in two different relations… The same may be said of image and imagination.” “Imagination, regarded as a product, may be defined, the consciousness of an image in the mind resembling and representing an object of intuition.” Though we do not exactly hold with these opinions, we quote them in order to show what view is taken by some psychologists in reference to the distinction between presentative and representative consciousness, or between knowing a thing immediately in perception, and knowing it mediately through an image of the mind's collecting. How is it possible, when contemplating a mountain which one is on the point of ascending—albeit the mountain is to us, as immediately known, in a sense-centre—to regard it as identical, except in vivacity, with the recollection which we afterwards have of it? Perception is, so to speak, a bi-une fact, a synthesis of cognition and object, whereas memory and imagination are not bi-une, for the object is not present in them, in the same manner, at least, as it is in perception. But let us now proceed to adduce facts and deductions confirmatory of this view of the question.

That medico-mental science is often at variance with the doctrines and decisions of the courts of law is a fact too well known and too generally admitted to need formal proof. It is almost as generally assumed that the scandalous failures of justice, which too often result, must be attributed to the defective education and knowledge of the profession. It is alleged that, as a body, we are for the most part ignorant and theoretical in matters relating to insanity, and if not ignorant, then presuming, and often using the little knowledge we possess, rather with the intent to rescue thieves and murderers from the legal consequences of their crimes than to help the administration of justice. It is certainly a fact which many of us lament that the corporate bodies of the profession generally, including the general medical council, ignore the subject as a distinct department of medical education; and consequently medical practitioners, not being duly trained, do sometimes appear to great disadvantage in courts of law. Medical shortcomings are not, however, the subject of my paper, but certain fundamental defects in the principles and procedures of the law which render medico-mental science sometimes even worse than useless, and always less useful to the commonweal than it might be, if rightly adapted to the needs of modern society. Nor would it be difficult to show that some of the crime and folly which occupies our courts and fills our reformatories, prisons, workhouses, and lunatic asylums, is capable of prevention by a well-devised use of medico-mental science. As these matters are wholly beyond the powers of the profession, I shall ask leave to move at the close of the discussion that a committee be appointed, with power to take such steps as may be thought necessary to secure a thorough inquiry by the Government into the relations of medical science to the administration of the law in regard to all persons mentally disordered or defective, with a view to such improvements as may be practicable.

Having in the preceding pages endeavoured critically to review the question of the localisation of the faculty of speech, as illustrated by the labours of the French, Dutch, and German pathologists, as well as by those of the different branches of the Anglo-Saxon race, I now proceed to place on record a certain number of cases which have been observed by myself, and in several of which the clinical history was completed by a careful post-mortem examination.

Of all the subjects legitimately belonging to the specially of psychiatry, or immediately connected with it, no one has, for the last few years, occupied a more prominent position in the United States, or called forth a larger number of words, oral, written, and printed, than the proper provision for the custody, care, and cure of the insane.

AGENDA:—I. Meeting of the General Committee, at 10.30 a.m.