My choice of subject for this address has not been altogether fortunate, and what I have to say will need your indulgence. Having fixed the subject hastily when I had the honour to receive your secretary's invitation, I soon found, on taking stock of my knowledge, that I had no clear idea what the new psychology was, what it had done, and on what the claim sometimes made for it to supersede an old and effete system was grounded. A new method of study making large promises was evident enough, but of the new conquests which are to revolutionize psychology I must confess ignorance. My remarks, then, will be critically interrogative, on purpose made to elicit definite information. If that light be forthcoming it will prove how little mere theoretical criticism is worth.

I desire in this paper to focus your attention upon certain pupillary anomalies as observed in a class of patients who in this respect have not been the recipients of that amount of attention which to my mind is their due.

The Asile St. Luc at Pau is indeed an Institution which deserves to have its story told. Through the kindness of the authorities this story is now for the first time made public. It is in effect that, starting with a capital of £12,000 and a small farm of some twenty acres, a nearly perfect asylum with 900 inmates and a staff of over 100 assistants has been built up by degrees, now not only self-supporting but last year showing a profit of £2000, spent mostly in structural improvements and additions and in the purchase of adjoining land. The Medical Superintendent has a free hand, being responsible only to the Conseil-Général of the Department, who, as they find him no funds, merely exercise a benevolent supervision. How such a satisfactory state of affairs has been brought about it is the purpose of the present article to briefly indicate, by way of an object lesson in asylum management.

It not infrequently happens that the senior assistant medical officer of a modern institution for the insane is elected medical superintendent of an old asylum. Such was my lot when early in 1887 I was chosen by the Court of Aldermen of the City of London to fill the post of chief officer to their asylum at Stone, and I entered upon my duties with no light heart, because it was early apparent that many structural and administrative changes would be necessary to bring this institution abreast the times. The asylum is constructed on the gallery or corridor plan, in linear form, extending from east to west, with projections north and south at several points. This linear form is modified by semi-detached laundry and workshop blocks, which are connected by covered ways to the central administration situated midway between these blocks, and at right angles to the line of the wards, which it intersects as it runs north and south. The style of architecture is Gothic, of white brick with Suffolk quoins, stone mullions, and dressings to the gables; the roof is of Broseley tiles. There is a handsome tower of white brick and stone with embattlements; the central portion of the tower is an iron smoke shaft, the part intervening between this and the outer wall being a heated extraction shaft for removing the foul air from the galleries and single rooms. The buildings are of two stories, except to the south of the central administrative block, where there is a third story for the old chapel (now being converted into a recreation hall), and for some of the staff bedrooms of either side. The estate comprised in 1887 thirty-three acres.

The time at last comes when, sooner or later, the old work has to be given up—work of various kinds in different cases. But the special sphere of occupation referred to is that in which the Journal of Mental Science is chiefly interested.

It is obvious that it would be quite impossible within the short limit of time at our disposal to enter into a full and complete account of all the data collected with reference to these admissions, which commenced on January 1st, 1892, and terminated on December 31st, 1899; I will therefore confine my remarks to the more important features presented by them.

The modern conception of asylums as hospitals for the treatment of those diseases whose salient phenomena are mental, and the fact that insane patients are peculiarly liable to be attacked by ordinary physical diseases, for which they must be treated in asylums, render it essential that these institutions should in their organisation and equipment be approximated to general hospitals as closely as their peculiar circumstances allow. In general hospitals nowadays the pathological department takes a position the importance of which is increasing every year, owing to the extraordinary progress in all branches of pathological science, and it is just as important that this department should be efficiently worked in asylums. Its functions may be said to be twofold, clinical and what we may roughly call anatomical.

This subject is of such magnitude and it presents so many aspects that it would not be possible to develop it at all satisfactorily within reasonable limits, if one were to attempt to deal with it comprehensively. I shall therefore be excused if I pass very cursorily over certain systems of treatment which do not, and dwell more upon certain others which do fall within my competence. The selection will by no means represent the order of importance.

Very perplexing to the student of insanity is the question as to how states of exaltation or depression arise. On the physical side to what changes in the nervous system do they correspond? And are these changes localised in different parts of the nervous system in mania and in melancholia; and, if so, what is the site whose disarrangement issues in exaltation or depression?