The object of the following paper is to present the result of a number of observations touching certain aspects of the question of habitual inebriety, notably the rôle of maternal alcoholism as an agent in race degeneracy.

This question of the punishment of the insane is one which has gone through certain stages. You will remember that in Edinburgh I read a paper in which I laid down three propositions. The first was that no insane person should be punished with the same severity as a sane person; the second was that some insane persons ought not to be punished at all; and the third was that the majority of insane persons ought to be punished for a large number of their wrong-doings. To these I added a fourth as a rider, that, as a matter of fact, punishment is already largely used in the treatment of dealing with insane persons. To this it was retorted that certain measures are taken with respect to insane persons, which, if they were taken with respect to sane persons, would be punishment, but as taken with respect to insane persons they are not punishment. In other words, we do punish the insane, but we shrink from acknowledging that we do so. Now there is one aspect of this question which I have put several times, and regarding which I have never yet been answered in any way, and I desire to put it again, and in order that there may be no mistake about it I will put it in a very concrete form. Our excellent Treasurer is entrusted not only by us with the finances of this Association, but he is also entrusted by his county with a share in the management of the county affairs, and it is within the bound of possibility that Her Majesty might entrust him with the Commission of the Peace, if he has not already been so entrusted. It may happen that at the trial of a prisoner—we will say supposing a man has thrown a pint pot through a pane of glass—he will come before our Treasurer, and he will be fined a certain sum of money, or, in the alternative, will be awarded certain imprisonment; we will say he is fined 5s. or seven days. Then our Treasurer quits the bench and goes back to his own institution, and finds there a patient who has thrown a mug through a pane of glass, and he says to that patient, “You have destroyed this pane of glass, you will have to pay for it;” or “your pocket-money will be stopped for the amount.”

It is probably not an exaggeration to say that no physicians have so many favourable opportunities for pathological observations as those connected with asylums. Post-mortem examinations are generally expected to be made on all patients who die in asylums. There are in most, if not in all the asylums, well-appointed mortuaries for conducting these examinations, and every facility is available for preparing and preserving morbid specimens and making microscopical and other observations. In some asylums special pathologists have been appointed.

I feel that some apology is due for again opening a subject which seemed to have been disposed of by the report of a special committee of this Association, which sat at the latter part of the year 1894.

Elsewhere I have dwelt on the occurrence of beri-beri in temperate climates and on the clinical features of that affection as I have seen it. At an early date I hope to be able to publish in detail the clinical records of a number of interesting cases. It is not my intention on the present occasion to dwell, save incidentally, on the symptomatology of the disease, nor to indulge in any speculations upon its origin or essential nature, for these latter points are, unfortunately, still in the region of speculation, and the light which I can throw upon them is scanty and indirect.

There are several causes which may induce refusal of food, and these have to be carefully considered before attempting to forcibly feed an insane patient.

Anorexia is one of the earliest and most common symptoms of general bodily disease. It is always present in anæmic conditions and severe affections of the stomach. It may arise from nausea, the food not being properly digested, fœtid eruc–tations are produced, and so the patient loathes the idea of food.

I desire to-day to show, to some extent, the difficulties the general practitioner of medicine has to contend with in the treatment of lunacy; difficulties certainly unknown in public asylums, and only partially appreciated in private institutions.

The subject of aphasia is one which has offered some of the most interesting problems presented to the physician for solution, and, although many remain unsolved, yet the study of aphasia has been more fertile of great discoveries as to the function than that, perhaps, of any other brain symptom or group of symptoms. The researches of Broca, indeed, were the beginning of localisation, and, as far as the cerebral cortex is concerned, formed the starting-point of any scientific knowledge which has since been attained.

In giving advice concerning the marriage of a person who has had an attack of insanity or who belongs to a family with a hereditary predisposition to insanity, on what considerations should our opinions be based? Firstly, on the welfare of the individuals who are about to marry and of their families present and prospective. Secondly, on the welfare of society. Our advice might have far-reaching consequences if we were only agreed on common principles.

The olfactory organ in man appears in a rudimentary condition as compared with its highly developed state in certain macrosmatic animals. To comprehend the immense change that has taken place in the smell apparatus, together with the development of the higher brain, and which has attained its climax in man (of those animals still possessing a sense of smell), it is necessary to be acquainted with the anatomy of the limbic lobe in macrosmatic animals, and to follow the transitions occurring until the high mammal type of brain be reached. Moreover, in this process is to be found the only means of discerning in the human cerebrum the rudiments of an important organ and of allocating its present site of functional activity. The researches of Kölliker, and, still later, of Elliot Smith, have largely removed the confusion existing in respect to the true limbic lobe, and the definition of this and its constituent parts may now be safely attempted. The extensive and hardly yet completed work of the latter author, contained in a series of valuable contributions to the Journal of Anatomy and Physiology, and in the Transactions of the Linnean Society, N.S.W., has been used by the present writer in giving the following sketch of the constitution of the limbic lobe and the cerebral commissures.

In 1880 Lady Brabazon, now the Countess of Meath, offered a grant of money for materials to any workhouse or infirmary that would try her scheme. The scheme consists in teaching infirm and crippled inmates of workhouses to employ their idle hands usefully, and in this way “beguile many a weary hour, and add zest to their lives.” Carlyle's picturesque tourist well describes the condition of many a workhouse inmate: “They sat there near by one another, but in a kind of torpor, especially in a silence, which was very striking. In silence! for what word was to be said—an earth all lying round, crying, ‘Come and till me,’ ‘Come and reap me?’ Yet we sit here enchanted, we know not why. In the eyes and brows of many of these men hung the gloomiest expression—not of anger, but of grief and shame, and manifold inarticulate distress and weariness.”

Sulphonal has been extensively used in the Royal Manchester Hospital during the last two years. We have found the drug prepared by Bayer to be constant and trustworthy in action, converting noisy and turbulent patients into comparatively quiet and manageable cases.

In a reprint from the Neurologisches Centralblatt, No. 21, 1898, Dr. Paul Flechsig gives us some further investigations on the development of the fibres in the human brain. In his examinations he has used forty-eight hemispheres belonging to twenty-eight brains of all periods of early life, from the fótus of seven months to the child of fifteen months. He thus sums up the results to which he has arrived.

The subject of this paper is but a small part of a very much greater question—the responsibility of the insane. The query embodied in its title is one which, at the present day, it would seem necessary to propound with bated breath. To the minds of many very eminent persons, no doubt, the very fact of such a question being raised at all would indicate a want of sanity on the part of the querist who was rash enough to propose it for discussion. And yet the diversity of view, which is only too evident when the subject of the “responsibility of the insane” is brought before any assembly of alienists, shows that opinion on this matter is still very unsettled, and we seem to be as far from finality as ever. In proof of this I need only refer to the discussion on Dr. Reginald Noott's paper at the general meeting of the Association in London in October last, reported in the January number of the Journal of Mental Science.

The spiritualist was and still is the orthodox criminal jurisprudent. He believes in original sin, and when he sees a crime attributes its commission to the inherent wickedness of its author. The médecin-légiste looks first, not at the crime, but at its author, and brings an open mind to bear upon his inquiry into the reason for so strange thing having been committed. The former, therefore, starts with the assumption that each offender is responsible, and excuses him only upon pressure, as in the clear case of the lunatic, the child, and the idiot, when the evidence of irresponsibility is overwhelming, even to his prejudiced eye. On the other hand, the horizon of the man of science is less bounded and grows wider year by year. He knows the moral disabilities of the general paralytic in the first stage, of the epileptic and of the true degenerate, and he is usually able to recognise their respective disorders. Magnan and Serieux tell us that between 1885 and 1890, seventy-six general paralytics were transferred from prison to the Asylum of St. Anne within a very short time of their condemnation by criminal courts. Monod (Conseil Supérieur de l'Assistance Publique, fascicule 47) says that within the same period about 700 persons were sent to prison in France who were subsequently received into French asylums, and who were, in his opinion, undoubtedly irresponsible at the time of the commission of the offence for which they were severally condemned.