Gentlemen,—Each member of this Association, if placed in the honourable position of President, would, I presume, have his own special views as to the nature of a Presidential Address, although the selection of a subject might be attended with difficulties. Within the last few years you have wisely determined that such Address shall be a theme for discussion, and it appears to me expedient under these circumstances that the President should aim at bringing before you material of a debatable character, and at the same time that he should endeavour to suggest subjects which may lead to further progress in the special work we all have at heart. Such thoughts give rise in the first place to a feeling of personal inability, and next to a sense of the great responsibility which you have placed upon me. It seems presumptuous on my part to attempt to point out to you new fields of labour, yet I cannot help thinking that the assumption of less reticence as to our individual experiences, and the conclusions such experiences force upon us, would tend towards the development of greater and more beneficial progress.

My hearers will remember that in 1889 the London County Council, appalled by the multitudes of insane persons committed to its charge, formed a strong and compact Committee to inquire into the means of dealing with this damnosa hæreditas. The Chairman of this Committee was a medical man who possesses in exceptional measure the qualities needed for such a post. A general inquiry into the means of treating insanity being, I presume, regarded as too large a commission, it was decided to concentrate the inquiry upon a proposal to build in London a hospital with a visiting staff for the study and treatment of insanity.

A distinguished historian well said “Before you attempt to write on any subject, be quite certain that you can say something fresh about it.”

The object of this paper is two-fold. First, it is a protest against the widely-spread notion that nearly all insanity is due to direct neurotic heredity; secondly, I wish to point out my belief that as much insanity depends upon surrounding conditions, so the general treatment by conditions rather than by drugs is the more reasonable and more efficacious.

The after-care of the male insane, to which I venture to draw your attention, with a view to discussion, is so closely allied to the objects of this Association that I trust its consideration may be not only of interest, but even of some practical usefulness. Although at present lying beyond the limits of our sphere of action, the time may arrive when our resources shall have so far developed that the annexation of this adjacent province may be both practicable and desirable.

Section 330 of the Lunacy Act, 1890, re-enacting section 12 of the Lunacy Acts Amendment Act, 1889, provides as follows:—

1. (1). “A person who before the passing of this Act has signed, or carried out, or done any act with a view to sign or carry out, an order purporting to be a reception order, or a medical certificate that a person is of unsound mind, and a person who, after the passing of this Act, presents a petition for any such order, or signs, or carries out, or does any act with a view to sign or carry out, an order purporting to be a report or certificate under this Act, or does anything in pursuance of this Act, shall not be liable to any civil or criminal proceedings whether on the ground of want of jurisdiction or on any other ground, if such person has acted in good faith and with reasonable care.

2. (2). “If any proceedings are taken against any person for signing or carrying out, or doing any act with a view to sign or carry out, any such order, report, or certificate, or presenting any such petition as in the preceding subsection mentioned, or doing anything in pursuance of this Act, such proceedings may, upon summary application to the High Court or a judge thereof be stayed upon such terms as to costs and otherwise as the court or judge may think fit, if the court or judge is satisfied that there is no reasonable ground for alleging want of good faith or reasonable care.”

The influence of mental distress in generating cancer of the breasts and uterus of women has long been notorious. The testimony of Dr. Walshe (“On Cancer,” 1846, p. 155), and of Sir James Paget (“Surgical Pathology,” 3rd edition, p. 800) is sufficiently emphatic; and in my own writings I have had occasion to lay great stress upon the significance of such conditions as antecedents to malignant disease of almost every pathological variety. Among Cancer Hospital in-patients, of both sexes, symptoms of mental unsoundness are far from infrequent. It occurred to me, therefore, that an inquiry as to the actual prevalence of cancerous maladies among the insane might prove of some value, especially as such developments are becoming so increasingly frequent among us, and as anything bearing upon their peculiarities of selection or of distribution cannot well be devoid of interest to the pathological inquirer. I accordingly instituted on my own account a miniature “collective investigation,” the net results of which I now venture to lay before you, with the expression of my great indebtedness to those medical gentlemen practising in this particular field who have so kindly assisted me by courteous, and often very full, replies to my questions.