I fully appreciate the very great honour which has been done to me this afternoon in asking me to speak of the experience which I have had in nearly twenty years of work amongst those who are suffering from alcoholism. Of courseyou will forgive me if I speak in an altogether unscientific way. I can only say exactly the experiences I have met with, and as I now live, summer and winter, in their midst, I can give you at any rate the result of my personal experience among such people. Thirteen years ago, when we first started the colony which we have for inebriate women at Duxhurst, the Amendment to the present Inebriate Act was not in existence, that is to say, there was no means of dealing with such people other than by sending them to prison. The physical side of drunkenness was then almost entirely overlooked, and the whole question was dealt with more or less as a moral evil. When the Amendment to the Act was passed it was recognised, at any rate, that prison had proved to be a failure for these cases, and this was quite obvious, because such women were consigned for short sentences to prison, and then turnedback on the world, at the end of six weeks or a month, as the case might be, probably at the time when the craving for drink was at its height, and therefore when they had every opportunity for satisfying it outside the prison gate they did so at once. It is nowonder therefore that women were committed again and again, even to hundreds of times. When I first realised this two cases came distinctly and prominently under my notice. One was that of a woman whose name has become almost notorious in England, Miss Jane Cakebread. She had been committed to prison over 300 times. I felt certain when I first saw her in gaol that she was not in the ordinary sense an inebriate; she was an insane woman who became violent after she had given way to inebriety. She spent three months with us, and I do not think that I ever passed a more unpleasant three months in my life, because when she was sober she was as difficult to deal with-although not so violent-aswhen she was drunk. I tried to represent this to the authorities at the time, but I wassupposed to know very little on the subject, and was told that I was very certainly mistaken. I let her go for the reasons, firstly that we could not benefit her, and secondly that I wanted to prove my point. At the end of two days she was again committed to prison, and after being in prison with abstention from alcohol, which had rendered her more dangerous (hear, hear), she kicked one of the officials, and was accordingly committed to a lunatic asylum. Thus the point had been proved that a woman had been kept in prison over 300 times at the public expense during the last twenty years before being committed to a lunatic asylum. The other case, which proved to me the variations there arein the classifications of those who are dubbed “inebriates,” was a woman named Annie Adams, who was sent to me by the authorities at Holloway, and I was told she enjoyed thename of “The Terror of Holloway.” She had been over 200 times in prison, but directly she was sober a more tractable person could not be imagined. She was quite sane, but she was a true inebriate. She had spent her life in drifting in and out of prison, from prison to the street, and from the street to the prison, but when she was under the bestconditions I do not think I ever came across a more amiable woman. About that time the Amendment to the Inebriates Act was passed, and there were provisions made by which such women could be consigned to homes instead of being sent to prison. The London County Council had not then opened homes, and they asked us to take charge of their first cases. They were sent to us haphazard, without classification. There were women who were habitual inebriates, there were those who were imbecile or insane; every conceivable woman was regarded as suitable, and all were sent together. At that time I saw clearly that there would be a great failure (as was afterwards proved) in the reformatory system in this country unless there were means of separating the women who came from the same localities. That point I would like to emphasise to-day. We hear a great deal nowadays about the failure of reformatories, but unless you classify this will continue to be so.

Writing in the Nineteenth Century of 1889, in an article entitled, “Lunatics as Patients, not Prisoners,” Sir John Batty Tuke drew attention to the steadily increasing incubus of pauper lunacy, and raised the whole question of lunacy administration in England and Wales. In this paper he asked whether, commensurately with the increasing expenditure on the care and treatment of lunatics, even at that time enormous, there had been achieved an understanding of the hidden processes which underlie the insanities, and some means of arresting their occurrence, such as the ratepaying citizen might reasonably expect in return for the vast sums expended. These questions Sir John Tuke answered by a decided negative, and he adduced as his main reasons for this unsatisfactory state of affairs that, in the first place, asylums were merely asylums in the classic sense of the term, places of refuge, “model lodging-houses for the insane,” not great hospitals for the cure of disease; and, in the second place, that the medical men who had the direction of these establishments were occupied with administrative and economic duties to the practical exclusion of scientific investigation and their proper function of healers of the sick. He even staged that it was quite an open question whether, in a certain number of cases, asylum treatment did not tend to aggravate the disease and render it chronic. That a certain number recovered in consequence of it, that a certain number recovered in spite of it, and that a certain number became demented because of it, were, he believed, each and all equally true statements. “A man merged in a crowd of irresponsible beings, all under the influence of a common discipline, and under the control of common keepers, must lose his individuality, and cannot possibly receive that anxious care and attention at the hands of one physician which is necessary from the nature of the case. What every case of insanity demands as the primary condition for recovery is, separate and individual treatment and consideration.”

The following notes are the outcome of observations made during a recent period of six months upon ninety-two patients in the Royal Aberdeen Asylum.

Some day there may be found a medicine to cure epilepsy. After that day the treatment of the disease will be a simple affair. But for the present he who undertakes to treat an epileptic undertakes a very difficult and responsible task. He must takea broad view of the situation, and use remedies not mentioned in the British Pharmacopoeia.

I feel highly honoured in being invited to read a paper before you this afternoon on my experience in the treatment of morphia habit by the method published by Dr. McBride in April, 1904.

I Wish that the advocacy of what I believe will be one of the most important developments in the history of our specialty had devolved on someone occupying a higher position in our branch of medicine, someone whose opinions and views would carry more weight and influence than mine can aspire to; at the same time thirty years' experience as a medical officer in London and provincial asylums, public and private, perhaps entitles me to open a discussion on a subject on which I have spent some thought, and I am proud of the privilege of doing so before this Association to-day.

Dr. Clouston is indefatigable. He once more appeals to the charitable public in the columns of the Scotsman, for the establishment of wards in the Edinburgh Royal Infirmary for the treatment of incipient insanity. The editor of the Scotsman lends his powerful aid to the proposal, and various letters have followed on this inception. Six years ago the scheme was carefully considered and definite proposals were made, but financial difficulties compelled postponement. The unanimity of the medical profession and the apparent assent of the philanthropic public augured favourably for success; and it is hoped that the public interest is again awakened by the representations which have been made more recently. It would appear that the success of the special department of the Albany Hospital in the State of New York and the special wards established in Glasgow has been undoubted. The former is in contact with a general hospital and has all the advantages of such a connection, but the latter is specialised and separated from the general hospitals of the west. A suggestion has been made that Saughton Hall might be used for the purpose indicated, but we would strongly deprecate any arrangement of that kind. The whole intention is to avoid segregation and the very appearance of an asylum, to bring the early treatment of mental disorders into living contact with the medical work of a great hospital. It is not proposed to create an asylum within the Edinburgh Royal Infirmary, but to provide open wards for the early treatment of the insane, under the care of a skilled physician who will enjoy the active co-operation of the medical and surgical staff as may be found necessary in the circumstances of each particular case.

At a quarterly meeting of this Association held last year at Nottingham, we showed the results of our experiments with toxins upon the spinal cord and brain of rabbits. Our main conclusion was, that the central nervous system could be infected by toxins passing up along the lymph channels of the perineural sheath. The method we employed in our experiments consisted in placing a celloidin capsule filled with a broth culture of an organism under the sciatic nerve or under the skin of the cheek; and we invariably found a resulting degeneration in the spinal cord or brain, according to the situation of the capsule. These lesions we found to be identical in morphological type and anatomical distribution with those found in the cord of early tabes dorsalis and in the brain and cord of general paralysis of the insane. The conclusion suggested by our work was that these two diseases, if toxic, were most probably infections of lymphogenous origin.

Health is the most important asset of a nation or an individual, without which all other possessions are comparatively valueless, and it is astonishing that this fundamental truism has not been recognised by a people priding itself on its common sense and practicality.

The desirability of increasing the output of clinical work in British asylums has been frequently dwelt on in the pages of this Journal, but no apology is needed for again recurring to the subject, since there still remains very considerable need of further progress in this direction