In studying epilepsy we see and study symptoms only. The pathology of the disease is very obscure, and it is mainly from its clinical features that we are able to assume the presence of detrimental changes in the more highly specialised tissues of the cerebrum. These changes may be primary or developmental as in the idiopathic type; or they may be accidental, and due to toxic agencies or traumatic injury; or they may be senile, as seen in rare cases (not accidental) occurring in late adult life or old age. Whatever the origin, a condition of nervous instability is set up, which may vary in every possible degree, from simple molecular disarrangement, giving rise to perverted functional action for a brief period of time only, to more lasting effects which conduce to morbid energising of a permanent nature.

It has occurred to us that on the occasion of your visit to an asylum which has been in active work for upwards of a century, and which has shared in and felt many changes in the treatment of lunacy, it would interest you to hear a little of its history.

Literary apologies, it has been said, are either superfluous or impertinent—superfluous if the matter apologised for is of itself worthy of public regard, impertinent if it can lay claim to no such merit. Therefore it does not seem necessary on the present occasion for me to introduce the subject of asylum management with any deprecatory language. It will suffice simply to recall the fact that in this city the question has come up in an acute and even controversial form, and is deeply interesting the community in whose midst we are assembled. We may well hope that the impulse given by this discussion will leave a permanent impression throughout the length and breadth of Ireland. One thing, at any rate, we may expect—the abolition of the standing scandal that has so long permitted the insane poor to be huddled together in workhouses without the benefit of scarcely one of those ameliorative agencies elaborated by modern science wedded to a genuinely philanthropic spirit. It is an oft-told tale, and need not be repeated here. The Poor Law guardian who takes for his axiom “keep down the rates” must shut his eyes to the uncleanliness, the untidiness, the lack of discipline, the absence of proper scientific supervision, the utter discomfort which reigns everywhere—characteristics that have made the name of workhouse a byword and a reproach even among the most degraded. If at any time he is visited with a qualm of conscience, he reflects, perhaps, that the unfortunates in his charge owe their sad destiny to God, or Fate, or Nature, and that anything done for them robs the ratepayer of that which, not enriching them, leaves him poor indeed. These institutions are cheap, but if there is any warning writ more largely than another for the behoof of all future lunacy reform in Ireland, it is surely that supplied by our workhouses against a parsimonious and pettifogging spirit in our provisions for the insane.

Some writers lately have been inclined to drop this name, and although the matter has been investigated pretty fully, I do not think it has been much inquired into from the pathological point of view. The following notes will therefore probably not be uninteresting, and they may lead to the subject being more thoroughly investigated.

We are doubtless of one mind in believing that change of scene and surroundings is necessary for those whose work lies amongst the insane, and I am sure that our thoughts must turn towards the monotonous lives of our patients during our holidays, spent procul negotiis. They are still in the same wards, with the same neighbours, tied to the same narrow round.

This is the third or fourth time that I have been the occasion of bringing the subject of Punishment before your notice, and my justification for treating of it again is that I am given to understand you are not yet—all of you—of my opinion. On the first occasion I had but one adherent, but that one, Sir William Gairdner, was in himself a host. On the last occasion a good many voices were raised in my favour, and to-day I hope we shall be unanimous. You will remember that the first time I brought the subject forward, it was in connection with the thesis that every lunatic is not necessarily to be considered exempt from punishment; that most lunatics ought properly to be punished for some of their wrongdoings; and that the practice in every asylum is to punish lunatics upon occasion. To this it was objected that although the fact was admitted that we do pursue towards lunatics the same course of conduct that is called punishment when applied to sane people, yet, when applied to lunatics, it is not punishment, because we dare not call it punishment. This led me to a disquisition upon the nature of punishment, in which I arrived at the conclusion that punishment is the painful consequence of conduct; and to this conclusion I still adhere, but subsequent meditation has shown me that although it is the truth, it is not the whole truth, but that there is another aspect of punishment of equal importance. Moreover, I think that the chief reason of the disagreement between my critics and myself was that, while I looked at one side of the shield and maintained that it was black, which it was, they were looking at the other side and maintained that it was white, which it may have been—in parts. In other words, I was looking upon punishment from the point of view of the punishee, which some of you, at any rate Dr. Noott, will consider was the proper point of view for me to take; while others regarded it from the point of view of the punisher.

The subject to which I invite your attention is not of a scientific nature, but it is, I venture to submit, of considerable importance to the gentlemen directly interested, to specialists in mental science, and to the public in general.

Both in physiology and pathology the study of simple, incomplete, and degenerate forms usually sheds a light, sometimes very clear, on more complex and perfect types. For example, such works as those of Spencer, Maudsley, Laycock, and Carpenter show how much the relation of mind to organisation is elucidated by careful observations of the nervous system in the lower orders of the animal kingdom, and of its condition in the abortive and morbid specimens of the human species. In pathology, more particularly, it is not usually where disease has attained full maturity or has advanced to its last stages that we may expect to find its point of origin, mode of progress, or essential nature; rather it is where pathological change is only beginning, in tissue that deviates but little from the healthy standard, or in function that is but slightly disturbed: so in the special pathology of the nervous system much may be learned regarding the more serious diseases by minutely examining and considering the features of the slighter and less striking disorders.

In directing your attention to the usual histological methods employed in the investigation of cerebral disease, I have the hope that those who are not already active workers in the field of pathological neurology may be stimulated to become skilled observers, and to encourage others who, like myself, have long been deterred from undertaking work of this character under the misapprehension that such investigations were profitless or impossible to any but the favoured workers in large and costly laboratories.

Though medical science has made great advances during the nineteenth century, our knowledge of the mental functions of the brain is comparatively still obscure. Even as regards the elementary principles of mental science there is still a diversity of opinion. Thus when we state the first fundamental principle, that the brain is the organ of the mind, on which we are all agreed, we in reality differ widely according to the interpretation we give to the word “mind.”

Of the innumerable organs and tissues which have been made the subject of research since Brown-Séquard promulgated his doctrine of “internal secretions,” it may be broadly stated that there are practically two only in which the existence of such a specific secretion has been determined beyond controversy, viz., the thyroid gland and the suprarenal bodies. The place of the former in therapeutics is now more or less determined; at all events most have tried it and formed their own conclusions; but the uses of the suprarenal glands in treatment are still, to a large extent, undecided. It is true that in certain branches of surgical practice suprarenal extract has been found so useful as a local application that it may almost be said to have gained a position in the surgeon's regular armamentarium, and that it has been employed internally in Addison's disease by many observers, with somewhat conflicting results (1); while its use in cases of heart failure, and also in obstetrics, has recently been strongly urged (2). But beyond these more obvious applications of the properties of its active principle, there are certain other diseases, notably some forms of psychoses, in which it would seem probable that those properties might render it valuable, and what little use has been made of it in this direction to some extent bears out this expectation.

The district or county asylum patient spends nearly half his time in bed. As a rule he goes to bed at or before eight o'clock at night, and rises at six in the morning.

It is a recognised fact that nervous and mental disorders are more frequent after influenza than after any of the other zymotic diseases. Dr. Risien Russell has specially referred to the action of the influenza bacillus and its toxin on the nervous system. Dr. Clouston has expressed the opinion that the effects of influenza on the mental condition of Europe far exceeded in destructive powers all the continued fevers put together. An increase in the admissions of melancholic patients into several of the asylums of this country during the prevalence of influenza has been reported at Edinburgh, Hanwell, Birmingham, Nottingham, and other institutions. Dr. Macpherson and Dr. Farquharson have discussed the pathological aspects of depressed emotions, and the physical reduction caused by influenza, as favourable to the onset of melancholia.

Mr. Whiteway's paper on this subject in the October (1899) issue of the Journal, and Dr. Mercier's comments thereon in a later (April, 1900) number, are each of considerable interest.

All histologists who have worked with the silver and sublimate methods of Golgi have experienced the great inconvenience arising from the facts that the preparations are not durable, and that in mounting them a cover-glass cannot be employed in the ordinary way. Preparations by the silver method generally remain in good condition for a somewhat longer period than those by the sublimate method; Golgi has indeed stated he has some which have remained unaltered for nine years. The sublimate method is now most commonly employed in the form of the modification of Cox, in which only one fluid is required instead of two. In preparing sections of tissues that have been kept for the necessary time in this fluid, it is practically essential to blacken the originally steel-grey deposit by one or other of the several methods by which this may now be done. Such preparations, when new, are probably unsurpassed by those obtained by any other Golgi-method; but, unfortunately, when mounted in the orthodox manner without a cover-glass, and in spite of the most careful attention to various other technical details that have been recommended for the purpose of increasing their durability, they almost constantly show disintegration of the black deposit in from four to six months, and are certainly absolutely useless within a year. Ever since Golgi's methods came into use, histologists have been endeavouring to find some means of overcoming this great disadvantage of want of durability of the preparations. The only measure of success that has so far been achieved is that obtained by means of various processes of gold toning. All gold methods are, however, notoriously uncertain in their results. This, of course, simply means that in carrying them out it is necessary to fulfil certain very precise conditions, and that these conditions are as yet imperfectly understood. Certainly the gold toning processes that have been recommended for rendering Golgipreparations permanent are no exception to this rule. Our own observations and experiments have been made chiefly upon sections of tissues preserved in Cox's solution, because we are convinced that Cox's method is for various reasons the most trustworthy process of this class that has yet been devised, and therefore the one most likely to be of service in studying pathological changes. We have tried the methods of Obregia and Golgi for toning sublimate sections with gold. With that of the former we have not had any success. On the other hand, with that of the latter (as briefly described in Jack's translation of Pollack's Methods of Staining the Nervous System) we have obtained some very beautiful purple-black preparations, which have now remained unchanged under a cover-glass for considerably over a year. In the great majority of instances, however, the results have been unsatisfactory, the deposit rapidly undergoing disintegration.

This demonstration was a further report on the subject laid before the Association at the meeting at Claybury in February last, viz., the morbid changes occurring in the brain and other intra-cranial contents in amentia and dementia. In a paper read before the Royal Society in the spring of 1900, and subsequently published in the Philosophical Transactions, it was stated, as the result of a systematic micrometric examination of the visuo-sensory (primary visual) and visuo-psychic (lower associational) regions of the cerebral cortex, that the depth of the pyramidal layer of nerve-cells varies with the amentia or dementia existing in the patient. At the meeting of the Association referred to it was further shown, from an analysis, clinical and pathological, of 121 cases of insanity which appeared consecutively in the post-mortem room at Claybury, that the morbid conditions inside the skull-cap in insanity, viz., abnormalities in the dura mater, the pia arachnoid, the ependyma and intra-cranial fluid, etc., are the accompaniments of and vary in degree with dementia alone, and are independent of the duration of the mental disease. Since that date the pre-frontal (higher associational) region has been systematically examined in nineteen cases, viz., normal persons and normal aments (infants), and cases of amentia, of chronic and recurrent insanity without appreciable dementia, and of dementia, and the results obtained form the subject of the present demonstration. A paper on the whole subject will shortly be published in the Archives of the Claybury Laboratory.

The imperfect way in which the pathologist has been accustomed to test the competence of the mitral and tricuspid valves seems to be at variance with the careful and systematic observation given to other parts.