I propose in this lecture to pass in review the various forms of insanity which you find in the Table, and by a brief reference to their history and symptoms to show you how they really are distinct forms of disease, and that in each or nearly so there will be found some peculiarities in the symptoms or progress of the case which render it somewhat different from other forms of insanity; such in fact as in many instances would lead you to detect the cause, and such certainly as to justify us in classifying it as a distinct form of insanity.

I trust to be excused if in these days of pathological and anatomical research, I ask you to examine with me to-night a group of symptoms. I need hardly say that the study of symptoms must ever be of importance in the treatment of disease, and especially of that disease with which we are all concerned, and although to the general medical public the subject of hallucinations of hearing may have no special interest, yet the members of this association know that they characterize a very peculiar and well-defined class of patients, and that, common as they are, their nature and pathology are uncertain and mysterious. I have, therefore, chosen them, as the subject of a paper, chiefly for the purpose of promoting discussion concerning them, and eliciting the opinions of those here present.

The power or process by means of which Time is mentally recognised and estimated independently of, or before, its external and artificial measurement, has not received a clear or comprehensive solution at the hands of those who have dealt with the subject. Certain metaphysicians connect the idea of duration with that of extension, and conceive that the child, or the savage, may have acquired a notion of intervals, or interrupted extension, from seeing and feeling through the muscular sense the alternate extension and flexion of his limbs; all comparison of such events with the successive changes in objective phenomena, as in days and nights, being the result of subsequent experience. Certain others conceive that our notion of Time originates in our consciousness and observation of succession in our thoughts, feelings, and mental states, a succession which necessarily involves a series of changes separated in time, and order, and nature. Sir W. Hamilton, apparently aware of the difficulty of the problem, says that “Time is a form of thought,” and “if we attempt to comprehend Time, either in whole or in part, we find that thought is hedged in between two incomprehensibles.” Other philosophers, belonging to a more practical school, who may be claimed as psychologists, contend that the subjective element of Time is imparted by the communication of impressions upon the external senses to the sensorium, coming as these must always do in succession with intervals of different length, and, as they often do, of regular length and intensity. It will be observed that in all these hypotheses it is taken for granted that the mind is capable of directing attention to its own conditions, and, to a certain extent, of analysing these, of marking their course, their swiftness, or slowness, their regularity, or irregularity. On the other hand, the phrenologists contend that there is a primitive and special faculty connected with a portion of the anterior lobe of the brain, by which Time, or the succession of events and intervals, is perceived or becomes known to us. My own speculations formerly led me to the theory that the perception of rhythm, or regular sequence, in sensorial impressions was conveyed by the pulsations of the cerebral arteries, either to the whole brain, or to such portion of it as may take cognisance of internal movements or changes. Sir H. Holland, that noble veteran, that learned and travelled and philosophic physician, who has just passed from amongst us, dedicated a chapter in his “Medical Notes and Reflections,” p. 499, to the exposition of “Time as an element in Mental Functions,” in which his chief object is to show that ideas or different modes of mentalisation arise and are propagated in different degrees of velocity and intensity in Time in different temperaments, and in the same individual at different periods, in accordance with the predominant physical or mental condition.

The seclusion in which the women of Athens lived naturally made the elder dramatists shrink from exhibiting them on the stage as under the influence of violent passion. Euripides departed from this rule, and was lashed for it by his merciless satirist; but even he, who depicted a Medea and a Phaedra, did not venture to bring a raving woman before his audience. There was just one case in which the Greeks would not be justly scandalised by such a presentment— where madness was supposed to be supernatural in its origin, and consecrated by religion, and an instance of this has been happily left us in the Bacchó. My readers have been made acquainted with that beautiful sketch of an epidemic of religious insanity, and I have now to describe an incidental portrait of a “wise woman,” when the spirit of prophecy is upon her, and she speaks as one raving, yet possessed by the God.

In the course of a walking tour, during last summer, I visited, en route, four of the Departmental Lunatic Asylums in the North-West of France, principally with a view to see how they would stand comparison with our own Provincial or County Asylums. Such a comparison, however, could scarcely, I find, be made on a fair basis; for though, undoubtedly, the great majority of the patients in the French Departmental Asylums are paupers, and maintained at the expense of the several Departments, yet, in all, there are associated with these paupers large numbers of pensionnaires, who are maintained by theirfriends and divided into four or five classes, and treated according to their rate of payment. It is obvious, moreover, that the better general and special arrangements, due to and supported by the higher rates of payment of the pensionnaires, would prevent such associated asylums as these from being fairly compared, as to their tout ensemble, with our own County Asylums—in which, as a rule, the patients are all paupers, and chargeable to the different unions, and in which the arrangements are for paupers only, and so constituted as to keep the maintenance rate as low as is compatible with efficiency. Seeing, then, that it was impossible to institute any fair general comparison between the French Departmental Asylums, which I lately visited, and our own County Asylums, I determined, whilst not failing to pay all due regard to the arrangements for, and treatment of, the pensionnaires, to pay more particular attention to the condition and treatment of the pauper patients in the Asylums visited, and to take my notes accordingly. These rough notes, instead of consigning them to the waste paper basket, as has been the fate of former notes of visits made by me to Continental Asylums, I have, this time, determined to offer to my professional brethren, in the hope that they may afford, perhaps, some few crumbs of information and of interest. It will be necessary for me, however, before going further, to state—that, as the principal object of my tour was walking and not mad-house hunting, I did not follow out any predetermined plan as to which particular asylums I should visit. Indeed, it was not until I had well started on my tour that I conceived the laudable idea of endeavouring to combine a little instruction with my amusement, and the result was that I merely visited those asylums which were in close proximity to the route which I had arranged for myself previous to starting. The asylums to which I paid these hap-hazard visits, then, were the following:—1st, “L'Asile de Lehon,” Dinan; 2nd, “L'Asile St. Athanase,” Quimper; 3rd, “L'Asile St. Méen,” Rennes; and 4, “L'Asile de Pontorson,” situated in the small town of that name; and I shall record my notes of them, seriatim, in the order in which they were visited.

J. McB., æt. 21 years. Admitted into the asylum 25th November, 1869. Married, with small family; no member of his family known to have been insane before; light hair, eyes and complexion.

I have designated the case, a description of which I have the honour of laying before you, as one of Insanity dependent on Syphilis, discarding the generally used term—Syphilitic Insanity. It will be better to state the reasons for so doing after I have given you an account of the patient. I will, however, premise that the Diagnosis is that of a syphilitic tumour or other affection, acting as a foreign body within the cranium. To substantiate this fairly, it seems to me that the presence of intercranial disorder should be made out, and then evidence be sought to determine the nature of that disorder. I have, therefore, endeavoured to classify symptoms as much as possible in accordance with this plan. The general history is as follows:—

B. A., æt. 52. Admitted January, 1873. Member of a liberal profession.

The subject of this case is a gentleman, 48 years of age, who contracted an infecting chancre in January, 1870. Nothing of any note occurred until the month of April, when a squamous syphilide made its appearance, and at the same time marked mental excitement came on, with an extreme amount of restlessness. This mental condition reached its height during August and September, almost amounting to delirium. The patient took almost no rest in bed, and was in the habit of riding and driving about recklessly during the night. Towards the end of October the excitement began to diminish until, in December, nothing remained to remind one of the dangerous mental condition the patient suffered from five months before. At this time all trace of the secondary syphilide had disappeared.

S. S., æt. 28. F. Admitted on the 28th July, 1873.

On the occasion of the annual festival of the Royal Albert Asylum for Idiots, the Earl of Derby, who presided, made the following thoughtful remarks concerning idiocy and insanity, and the establishments necessary for the care and treatment of those afflicted with defect or disorder of mind:—

In the “Lancet” of November 15th last, Dr. Bucknill has propounded a new classification of insanity. The criticisms which he passed upon the etiological system of Morel in a former number of this journal (No. 38, p. 286), may be applied in the main, he thinks, to Skae's similar but more elaborate one. He had at one time intended to criticise the system of natural groups which has been proposed by Dr. Skae, but, on re-consideration, he determined to construct a system of his own, “which might more fully answer the purpose for which we needed it—namely, as a nosological scaffolding of form for the guidance of treatment.” We append Dr. Bucknill's preliminary remarks, and the scheme which he has constructed:—

Mr. George Darwin contributes to the Contemporary Review of August last a very thoughtful paper on beneficial restrictions to the liberty of marriage. The following extracts which we make will serve to exhibit the author's stand-point, and to stimulate reflection upon a vastly important question which mankind will sooner or later have to face and answer. We do not think it has been proved that insanity has increased out of proportion to the population; but there can be no doubt of the influence of hereditary predisposition in the causation of such insanity as exists.