Before approaching the next subject I wish to avoid the reproach of departing from the rules of the inductive method by drawing conclusions from the complex to the simple; that is to say, in this case, by applying to the lower centres a conclusion drawn from the observation of the higher centres, instead of proceeding in the opposite way. I am obliged to proceed in this manner by the very nature of the problem which really cannot be treated any other way. As we have to deal with the subjectivity of central phenomena it is impossible to seek its conditions when we have no direct means of proving its presence or absence. Now in respect to the subordinate centres we are reduced exclusively to objective observation, which in no way can teach us anything of the subjectivity of the changes which take place in them; therefore, whatever conjectures we may make in regard to the consciousness or unconsciousness of the motor reactions furnished by the lower centres, they can have only a certain degree of probability when we study these reactions by the aid of what subjective observation teaches us relative to the consciousness or unconsciousness of the cortical centres. It is because they have not followed this method that writers disagree so completely as to the presence or absence of subjectivity in the sensori-motor centres, and especially in the spinal cord. Let us begin with the latter.

During the year ending 1883, I had rather an unusual number of escapes, and as two ended fatally from exposure, I thought it only fitting to glance over the escape-book and see the results of previous years. I may here mention that the two patients who died were dements, that one had been 17 years in Garland's Asylum, the other 15, that neither had shown a disposition to escape previously, that one died after two days' exposure, he having been found alive, and that the body of the other was found seven days after his escape; also that all means likely to be of avail in retaking these patients were made use of.

In the “Journal of Mental Science” for April, 1883, I presented some statistics as to the recovery and death-rates of asylums, especially directed to the question of the effect of the size of the asylum upon them. In that communication I stated an opinion (p. 9) that the dominant element governing the different rates of recovery in different asylums was to be found in the different classes of cases admitted into different asylums, and expressed a hope of some day being able to make a further research in this direction. Table VII. of the tables of the Association obviously afforded the most hopeful available means of doing so, but how much could not be seen until a laborious abstract of its contents for a number of asylums over a series of years was made.

In none of the more practical aspects of insanity, with the exception perhaps of that of pathology, does the alienist stand at so much disadvantage with the other members of the medical profession as in the matter of prognosis. In diagnosis we have, as a rule, an easy task, though now and then cases arise in which it requires much thought to come to a determination whether some unhappy event is due to insanity or to crime. Again, in treatment we fairly hold our own, taking into consideration the complex nature of the organs and functions that are affected, coupled with the impossibility of direct examination and treatment of them. But in prognosis we are distinctly less sure of our footing, and it is unfortunate that this uncertainty is accompanied by a most pressing demand for accurate forecasts from the relatives of those who are placed under our charge. This pressure, no doubt, arises in chief from the necessity in nearly every case for modifying, either temporarily or for good, those circumstances, domestic, official, and pecuniary, from which the patient has been removed; but there is this further difficulty, that while in cases of general disease, other than insanity, the friends have some sort of knowledge and opinion of their own as to the probable result, gained from insight into similar cases, in insanity such clinical experience is denied them by the necessity for withdrawing patients from the observation of the public. They are thus almost entirely without guides of their own, and in consequence they come to lean more heavily on the doctor. The strain and responsibility for error thus cast on us would be intolerable were there only the two eventualities of absolute recovery and absolute loss of mind; but, fortunately, there are many stages to fill up the huge gap between these two extremes, stages of partial recovery which allow of the restoration of the patient to various degrees of liberty and usefulness in the world. It is not too much to say that the problem of the future of the patient has to be faced never less often, generally more frequently, than that of treatment.

During the last four years, as medical officer in an asylum sufficiently populous to offer a fairly wide field for study, but not too large to prevent each individual case from receiving its own share of investigation, no subject has attracted me more than the occurrence of delusions of exaltation and optimism in the Insanity of Chronic Alcoholism. And this mainly for two reasons, viz., the divergence of opinion of good authorities as to the frequency of the association of such ideas with this particular class of insanity, and the difficulty which not seldom attends the accurate recognition of their true character and import. If in this paper I can report the salient features of these cases, they may, perhaps, have an interest to others to whom they present no difficulties in diagnosis; and if the inferences that are drawn from them seem occasionally to deviate from those of writers of experience, it must be remembered that the cases are too few to admit of any but tentative statements, and that such will be put forward as suggestions and not as dogmas, though at the same time the accuracy of the facts and descriptions from which they are deduced can be guaranteed.