The time allotted for the delivery of a lecture did not allow me to state, when we last met, the appearances found on dissection in the thorax and abdomen in cases of insanity.

I will now do so very briefly, and will afterwards speak of that which I had proposed more particularly to form the subject of my present lecture, viz. the treatment of insanity.

Insanity is a disease at once so interesting, and so important, that it is not surprising that the subject should have been chosen by some who have preceded me in delivering the Croonian Lectures. In 1832, Dr. Seymour lectured upon the Medical Treatment of Insanity; in 1848, Dr. Conolly referred in his Lectures, more particularly to the Moral Causes and the Moral Treatment of the Disease; and in 1853, you, Mr. President, delivered your valuable Lectures on Medical Testimony and Evidence in Cases of Lunacy.

In my last lecture I endeavoured to explain the reasons why no one of the present theories of insanity was able to account for all the varieties of the disease. I founded this opinion partly upon the nature of the disorder itself, and partly upon our ignorance of the manner in which the minute internal structure of the brain and cord is altered by the symptoms, and partly upon the uncertain light which the present state of science throws upon the subject, and I pointed out the manner in which I hoped that future investigations might aid us in solving this difficult problem. In my present lecture I propose to speak of the morbid anatomy.

The new position in which you have done me the honour this day to place me, entails upon me the duty of passing in review the varied interests and difficult problems of social and medical science, which are necessarily involved in promoting that which is the primary object of this Association, the welfare of the insane. The welfare of the insane! What a world of interests does not this small phrase include; what questions of individual happiness or misery; what questions of the prosperity or ruin of families; what questions of morality and law, of religion and politics; in fine, does it not ‘inferentially include the welfare of the human race. From time when Nebuchadnezzar ate grass, the happiness of the human race has often been at the mercy of the not metaphorical insanity of its rulers; and how often does not madness in lower stations imperil all that is precious. A mad orator on the floor of the house, or in the pulpit, may do comparatively little mischief, for opinion breaks no bones; but madness in a man of action, in an admiral for instance who commits suicide in the heat of an engagement, or an engineer in charge of a railway train; to what fearful disasters may it not give rise? In the world there is nothing great but man, in man there is nothing great but mind, says Hamilton. How vast, how wonderful a subject of study, therefore, is mind, whether in its integrity, or its decadence and ruin, in its health or its disease! Mental physicians, are we pledged to devote ourselves to the contemplation, and, as far as may be, to the full appreciation of this great subject, that we may oppose decay, and relieve disease ? Would it were possible to prevent it! Mental hygiene is, indeed, a subject vast as that of human progress. The highest and lowest stages of human development, those of the savage and the practical philosopher, are, perhaps, almost equally free from this direst scourge of human pride; the one with passions undeveloped, the other with passions under subjection. But the line of progress from one to the other of these termini, is strewn with those who have fallen in their weakness to linger and to die. Madness, the Nemesis of that ill-directed, ill-regulated development that we call civilization, what if it were to increase until the tendencies to mental disease overweighed in the community the conservative powers of health! There have been communities and times in which physical disease has threatened, or actually put an end to a race of men; and there have been communities and times in which folly and passion and delusion have been so widely endemic, that the fabric of society has been torn down, and even its very foundations shaken; and were it not for the resiliency of nature, the benign law of adjustment, by which deviations from law are a check upon further deviation, it is possible to conceive that the tendencies to mental infirmity and disease should increase; that passionate selfishness and insane folly should have continually augmenting power to reproduce themselves until acquired, and hereditary tendencies to madness should overbalance the forces of self-control and sanity, so that an observer, neither cynical nor metaphorical, might justly exclaim upon the “mad world,” and races, like families, become impotent for all except mischief and disaster, until time, the great physician, brought the only cure in extinction. Such speculations as these are not without their use, impossible as their realization may appear; they at least serve to make us value rightly the blessings we enjoy, blessings which from their commonness we are too apt to over look. We have no earthquakes in this country, and we calculate upon the stability of our buildings; we have no dead calms, and that world without motion, whose stagnant putridity has been painted by Byron and Coleridge, is to us a dread but impossible imagining. But the stability of our dwelling-place, and the restless agitation of the elements, although among those simple elementary conditions upon which our being depends, are also conditions which it is most easy to conceive might have been otherwise.

As it has ever been the custom of man to act as if he were eternal, and lavishly to scatter the limited force which he embodies as though the supply were inexhaustible, it produces no unaccustomed surprise to witness the useless expenditure of force which is so frequently made at the present time. It may even, perhaps, be deemed a token of some modesty, that the being, who since his first formation has been continually occupied in metaphysical regions with the investigation of the origin of all things, should be content for a while to amuse himself with physical theories concerning his own origin. That which is to be regretted in the new and comparatively praiseworthy occupation is the old evil of hasty theorizing on the one hand, and on the other hand, the evil, scarcely less ancient, of an impetuous eagerness to demolish any theory, however plausible, which comes athwart a favourite prejudice. What though the anatomist does discover a very close resemblance and very slight differences between the structure of a gorilla and the structure of a human being; there is no need, on that account, that mankind in a feeling of injured dignity should angrily rouse up and disclaim the undesired relationship. Whatever may be said or written, it is quite plain after all that a man is not a gorilla, and that a gorilla is not a man; it is furthermore manifest that gorillas do not breed men now-a-days, and that we have not the shadow of any evidence to guide us in forming; an opinion as to what they may have clone in times past. The negative testimony of Du Chaillu, who says that he searched in vain in the gorilla region for any intermediate race or link between it and man, scarcely adds anything to the conviction of the non-existence of any such link, which has long been universally entertained.*

1. The question propounded.—The members of the Association under whose auspices the ‘Journal of Mental Science’ is published, having done me the honour to elect me an honorary member of their body, I think I cannot better express my strong sense of the compliment thus paid to me, than by a cordial co-operation with them in their labours for the advancement of mental science. The subject I have ventured with this object to bring under their notice, is one of the highest importance to their professional success; it is to determine how far a mental science in the true meaning of the term science is possible, and capable of practical application to mental pathology, therapeutics and hygiène, and the needs of society in general. For more than twenty-five years, I have carefully studied mental science in these its practical relations, and have from time to time made my views public. My friend Dr. J. S. Bushnan, has questioned the value and validity of those views in the journal, on two recent occasions', with special reference to two of my latest publications.* It appears from his last communication, (‘Journal of Mental Science,’ October, 1861), that he has come to the conclusion that my systematic views elaborated after so much labour and thought, and carefully applied, not only to the practice, but also to the teaching of both the practice of medicine in general, and of psychiatry in particular are, “in no sense practical.” This, to me, startling conclusion, has led me to examine into the mode by which my friend and critic came by the notion, and I find that either he or I must be under a singular misapprehension, both as to what is scientific and practical, and as to how it may be attained. I know of no other method for testing where the error lies, than a comparison of Dr. Bushnan's principles and method with mine, in reference to the objects for which the journal is established. Now Dr. Bushnan states his doctrine very explicitly at the outset.

We have in two previously published papers† promised to discuss the following questions, and now attempt to fulfil the promise in the following pages. The questions are:

1. 1. What false ideas are still prevalent among the public at large in relation to lunatic asylums and their superintendents and psychological physicians in general?

2. 2. Are the mode and description of state supervision and control, as exercised over asylums, sufficient and satisfactory?

3. 3. To what persons, and under what conditions, shall the privilege be exclusively conceded to establish, superintend, and carry on establishments for the insane?

4. 4. Ought lunatic asylums to be entrusted to religious corporations?

5. 5. May not families of position and competency be lawfully permitted to retain the charge and management of their mentally afflicted relatives, under the “patronal or family régime”?

The Chair was taken by Sir Charles Hastings, d.c.l. The following members, among many others, were present:

Gentlemen—My first and most agreeable duty, on taking possession of this chair, to which you have called me, is to express to you the gratitude which I feel for the distinguished honour with which you have invested me. I cannot hope to enable you to estimate the sincerity of the feeling by the force of its expression, for I can only, in very simple terms, assure you that I heartily appreciate your great kindness; and I can only very briefly acknowledge the eminent favour which I have received at your hands.

Since the following Paper was commenced, the appearance of the “Report from the Select Committee on Lunatics, ordered by the House of Commons to be printed, 27th July, 1860,” of which Committee Mr. Walpole is the respected Chairman, has, in a considerable degree, relieved the minds of physicians practising in the department of insanity, from the apprehensions occasioned by the draft of a Bill ordered to be printed in February, 1859. It would seem that the evidence brought before the Select Committee in disparagement of the proprietors of asylums for the insane, and in support of the alleged fact of the improper detention of persons in a state of sound mind, was deemed insufficient to warrant the meditated additions to stringent restrictions already existing. All the obnoxious clauses relative to the appointment of Medical Examiners, a kind of unqualified auxiliaries to the Commissioners in Lunacy, and who were to make secret reports, have been abandoned; as well as some other clauses, which had been the source of great and just dissatisfaction.

The anomalies of the physical functions of idiots, are often quite as striking as the defects and peculiarities of their minds, and it is found that the amount of mental incapacity bears a direct relation to the physiological disability. It may be stated as a rule, that the greater the physical defect, the greater the idiot; and the reverse holds good—that an idiot with very slight intellectual power, has chances of rising in the scale of intelligence, commensurate with his physical abilities and freedom from physical defects.

The case, to which the observations I am about to make refer, is not, I think, without some interest to us, both as medical men and a? the proprietors or superintendents of private or public asylums. It is calculated, as I believe, to illustrate the not very enviable position we may be, under circumstances, placed in, in reference not only to the Commissioners in Lunacy, but to the public; whose servants the proprietors and superintendents of asylums, of all kinds, are to be considered. The case, moreover, follows, and very properly, the paper of Dr. Conolly's, entitled “On the Prospects of Physicians practising,” in our specialty.

Upon a recent occasion we took some pains to review the various significations in which the word “psychology” has been of late employed. We found that among some writers the use of this word had absolutely run wild. We pointed out that the word had not been very long established in the language of science, and that its significance, even at present, admitted of some latitude. We expressed our opinion that the most warrantable use of the word is to signify the phenomenology of the human mind, including—1, the phenomena of knowledge; 2, the phenomena of feeling; and 3, the phenomena of effort; but that it seemed still possible to give an extension to its meaning, so that it should include the psychology of man in the sense just indicated, or anthropo-psychology, and the psychology of the dumb creation, or eneo-psychology. If such an arrangement as this were adopted, it would nearly correspond with that which may be termed metaphysical psychology. The epithet metaphysical, as here applied to psychology, is not to be regarded as tautological or superfluous, because it is designed to denote that old form of the science of the pneumatology of the human mind which rests exclusively upon what is taught by consciousness; while physiological psychology includes all that can be determined upon probable evidence of the phenomonology of the functions of consciousness in the animal kingdom at large.

A System, called the cottage system, has of late years been attracting the attention of many of those interested in the construction of our lunatic asylums. The careful study of the requirements of the insane, which distinguishes many of the beautiful structures recently erected by the English counties has succeeded in producing what may be regarded as nearly the perfection of our present system; and unless it can be shown that an arrangement based on entirely new principles ought to be adopted, there remains little to be done in the way of improvement. Every proposal, therefore, which suggests a new principle of construction deserves the serious consideration of our profession; and the cottage system has been so highly commended by many respectable authorities that an examination of its merits will not be unacceptable to the readers of the Journal. The following pages are intended to be devoted to this object, as well as to the consideration of how much, if any, of the peculiarities of the system should be adopted in future arrangements for the accommodation of the insane; whether it should be adopted in place of our present system, engrafted upon it, or rejected altogether as unsuitable or impracticable.

What a painfully distressing feeling must that be which one who has faith in the doctrines of phrenology, and experience in the art of it, is compelled continually to undergo! In his converse with men, the most disagreeable suspicions with regard to their feelings, their motives, their abilities, and their whole characters must ever be obtruding their dark shadows over the serenity of his mind. As a judge on the bench, a counsel at the bar, or the foreman of a jury, it will be to him an irresistible conviction that no reliance can be placed on the evidence of that witness in the box, forasmuch as, on the top of his head, in the place where should gently rise a veneration-swelling, there appears a most palpable pit, in which clearly all faith in the sanctity of oath may be hopelessly buried. What a cold sweat of agony, too, must ooze out over the phrenologist's body, when, prostrate on the bed of heavy sickness, he sees written on the fore-head of the being into whose hands the event of his recovery seems placed, that there is no power there of tracing out the causes of his ill, no faculty there for comparing and judging the value of symptoms and remedies! And then to be so often obliged to feign an intimate intercourse or to transact confidential business with one whose cranial conformation proclaims that no intimacy, no confidence, no security can abide. Verily, if phrenological knowledge be true, it is a blessed want to be without it. Conceive, if possible, the angry consternation of a future mother-in-law, if, before definitely proposing for her daughter's hand, a polite but resolute claim was put forward to a careful phrenological examination of her daughter's head. And yet that would be the bounden duty of a faithful phrenologist. Nor would accurate craniological knowledge be any great blessing to the individual, as regarded his personal welfare. For, inasmuch as the majority of men are foolish, and a great proportion of them very foolish, it is evident that a great many heads must be of indifferent conformation. What, then, would be the result of a general knowledge of this? Why, the vacillator would be surely confirmed in his vacillation, for he would fancy he saw his want of firmness to be in the purpose of the universe; the sensualist would wallow deeper in the mire of sensuality, for he would challenge the fate of a necessity in his acts; the thief would steal with greater abandonment and more industrious infamy, for he would consciously bow before the inexorable tyranny of organization; and the atheist might, with a scoff, silence for a moment his antagonist, by summoning in the effect the testimony of a cause in which he dreamed that he disbelieved. It appears to be the right fulfilment of an individual's destiny upon earth not to trouble himself greatly about deciding what he can do, but to do what he can. No advantage ever comes to any one from an excessive attention to the elements of his own character, or the phenomena of his own mind. Great self-consciousness is more or less of a disease; and that which is appointed to each one is to do with all his might that which lies before him to do—to work with earnest, sincere, moral, and intelligent labour in harmony with nature's laws. It is of such labour that it has been said, laborare est orare; and to one so working there need be no fear of failure, for the laws of the universe are his support; beneath him are “the everlasting arms.”

The Sixteenth rule of our Association as amended at the Annual Meeting in July 1855, is to the following effect:—

“That to insure a correct comparison of the results of treatment in the several institutions, it is strongly recommended to those Members who have the superintendence of public asylums to keep registers of the cases admitted, according to the form agreed on, at a meeting of the Association held at Lancaster in 1842; and to append to their respective annual reports, tabular statements on, as far as possible, a like uniform plan.”

The regions of religion and philosophy are distinct, but by no means opposed. Some professors of the Christian faith may have fallen into the error that revelation and science are antagonistic, but such a position has neither any foundation in fact, nor any countenance in the Divine record. Warnings, no doubt, occur in the apostolic writings under the head of science and philosophy; but these are directed against “science falsely so called“, and such philosophy as is identified with “vain deceit.” There can be no opposition between nature and revelation, inasmuch as the author of both is the same God, who is “light“, and whose essence is “truth”. In examining therefore a mental phenomenon, such as that of Revivalism, as lately exhibited in the northern counties of Ireland, and during whose rise and progress so much of a religious element was developed, it would be, in a manner, impossible to do justice to the subject, without a direct reference to this element; nor will the interests of evangelical truth be injured, by an endeavour to discriminate between the false and the true, the genuine and the factitious, in this singular excitement; neither, I must presume, will the pages of a journal devoted mainly to subjects of a psychological character be diverted from their legitimate application if the Religious Aspect of Ulster Revivalism be introduced to them.

It is a fact, which few attentive observers of the state of society around will either deny or dispute, that while our “Hospitals for the Insane” enclose within their walls numbers of the class commonly known as “dangerous lunatics;” and while our prisons and houses of correction incarcerate a still greater number of the enemies of peace and order and the well-being of the community; and whereas our nosocomiums give shelter and treatment to the sufferers from bodily maladies, in all their terrible variety; there are yet at large, and to a sad extent uncared for, multitudes of persons who are the victims of a malady as dire as any in the entire catalogue of disease, and who are, moreover, as dangerous and damaging, by habit and act, to the best interest of society as any criminal or lunatic in existence. The class of persons referred to are those who, from long addiction to intemperance in the use of stimulants, have ceased to possess any available amount of self-control, and have thus become, in effect, to a great extent, if riot unaccountable and absolutely insane, at least closely allied to that unhappy class of mental sufferers. It is true that, with the exception of this one mental derangement, these persons may be in all other respects mentis compotes, and able to manage their ordinary affairs. But the same remark applies to nearly all monomaniacs. It is also true that the attacks of their malady, and their succumbing to it, are in many instances periodical, and that, unless during the prevalence of one of these attacks, the persons in question may be quiet and orderly, and to all appearance respectable members of society; but the like is the case with not a few forms of insanity which have their equally well-marked periods and paroxysms.