As a rule novelists have not been very successful in their delineation of mad people. They usually overdo it; their maniacs are too maniacal, and their melancholics too melancholy. Even when descriptions of milder cases of mental disorder have been attempted, as in those of Miss Flite in Bleak House, or Mr. F's aunt in Little Dorrit, they have not been altogether satisfactory. Neither have the dramatists been more fortunate. One of the first plays that I ever saw on a London stage was a dramatised version of Jane Eyre, and the character of Bertha, the mad woman, as featured by the actress, was a very terrible exhibition. It is only fair to say, however, that in several modern French plays, where a person of unsound mind has been included in the dramatis personæ, the character has been a fairly natural study of the disease.

When two persons meet together to discuss some enterprise or future event, or other speculative matter, without coming to an agreement, they may separate by one thinking or calling the other an optimist and the other thinking or calling his opponent a pessimist. Thereby they settle the matter temporarily, although of course they leave it undecided and agree only to differ. What they really settle is that two congenitally different temperaments necessarily view the subject from two different aspects and conclude accordingly. They do not stay to enquire which is the true view, the one being inclined by his temperament to look on the dark side of things and see the evils, hates, strifes, sufferings, failures and follies in the world, the other inclined by his temperament to look on their bright side and accordingly see the good, love, joys, and successes in it. Why, indeed, should they stop to enquire? Every mind in the world necessarily construes it in terms of itself, and therefore feels and thinks its individual world—the mind of the fool a different world from that of the sage, the mind of the sinner from that of the saint, the mind of the Andaman Islander from that of the Anglo-Saxon, the mind of the particular person from that of his neighbour. There must naturally be one common world in the necessarily common notion of a like-structured species, but there are as many particular worlds as there are persons in it.

I have long felt that the relationship of Dr. Jackson's teaching in reference to nervous disorders has not been sufficiently considered from the psychiatric side. I fear that I shall not be able to do justice to the subject, yet I believe it to be almost a duty for me to attempt it.

When a great pillar is removed, the structure which it supports, if happily it does not fall, seldom escapes without a tremble; and it speaks well for the construction of the fabric if, without outward sign of damage, it can withstand its loss until a new pillar has been inserted in its stead.

In insanity hallucinations are frequently present. This is no recent observation and has been duly noted in the literature since the dawn of medicine. Hippocrates, Asclepiades, and Celsus make mention of them in their writings.

It may seem out of place, whilst we are face to face with so grim a reality as a war for our very existence, and a war which has so deeply affected the life of every individual in this country as well as within the Empire, that we should be discussing the realms of dream-land; but we may claim that the “Bowmen,” in the early days of the war, laid particular emphasis upon dreams—for to these of our brave warriors, appeared the “Angel of the Mons,” and the “unconscious mind” has been drawn, in literature at any rate, into the tragedies of the war.

Mr. President, Ladies and Gentlemen,—A new epoch in military and medical science has arisen in consequence of the employment of high explosives, combined with prolonged trench warfare, in this terrible war.

I. In pursuance of the intention, signified in my “Notes on the Mental Deficiency Act” in the Journal for July, 1916, to consider, as practically as may be, the subject of mental defect as a factor in the production of crime, I find it desirable to make some introductory remarks concerning the recently increasing literature of what is known as “Criminology.” This term may be properly applied to investigations undertaken with a view to giving such an account of criminal conduct and criminal men as may assist in the formation of practical measures towards the prevention of the one and the appropriate treatment of the other. Most of the more modern discussions on crime and criminals have either directly or indirectly been occasioned by the efforts of persons concerned in some way with prison administration, or otherwise specially conversant with convicted criminals, who strive to discover just principles on which to base their practice. But the growing bulk of doctrine and debate on the causation of crime, the genesis and treatment of the criminal, the meaning of “responsibility,” and even the State's “right” to “punish” offenders at all, consists to a great extent of definitely formulated theories largely based on preconceived assumptions regardless of fact, and often mutually contradictory. This occasions much difficulty to those who aim at any clear understanding of the subject; and the difficulty is increased by the frequently indefinite and equivocal use of the words “crime,” “criminal,” and “punishment,” which denote the very subjects of discussion. Thus the handling of the whole matter becomes widely diffused, leaving no firm ground on which to rest any useful conclusion. Sundry kinds of topics, sociological, ethical, psychological, and biological, become involved in the dispute, and the student may even be landed and left in the midst of such perennial controversies as those about the “freedom of the will,” and the nature, and even existence, of the relation between mind and matter.

It will not be my desire to enter upon a full discussion of internal secretions; still it will be touched upon sufficiently in an attempt to link some disorders of nervous origin with a condition clearly defined by Eppinger and Hess as vagotonia.

It is an acknowledged fact that in the whole annals of mankind the most eventful period of a nation's psychology is that during which its people is passing through the crisis of war, and the history of nations, from the earliest dawn of society, presents continuous records of warlike operations. The present war, which has already lasted over two and a half years and which is without any immediate prospect of cessation, has disturbed the mind and altered the course of life of whole continents; yet all of us are agreed that it should never be possible for this “malady of princes” to occur again, and it is with the view of preventing its recurrence that civilisation (which means the united culture of all the Allies as well as of the “benevolent” neutrals) is now making a final and intense effort.

It is considerably more than a quarter of a century since I first promulgated the doctrine that madness and unsoundness of mind are not the same thing; that madness includes more than unsoundness of mind, and that unsoundness of mind very often occurs in the sane, and is, indeed, one of the most frequent disorders of the sane. This doctrine has always seemed to me as manifestly true as the doctrine of natural selection, and, like the doctrine of natural selection, needs, it appears to me, only to be stated to secure the adhesion of every reasonable mind. In fact, I have found by experience that to the immense majority of my acquaintance it does only need to be stated to secure their adherence. Nearly everyone—everyone outside the membership of this Association—to whom I have stated it, without a single exception, has, in fact, accepted as self-evident that what matters in influencing our judgment of madness or sanity is not what a man thinks or feels, but what he says or does; not his mind, but his conduct. Even within this Association the doctrine has many adherents among the younger members, for I often receive letters from them, telling me how great an assistance it has been to them; so that things are moving, and I trust that before long we shall reach the stage that I predicted in a correspondence in the British Medical Journal, when not only will the doctrine be universally admitted to be true, but also we shall all declare that we never held any other, and that any claim of mine to have originated it will be strenuously denied. However, litera scripta manet. The minute-book of the Educational Committee will show that when I urged that conduct, as being the most important factor in madness, should be systematically studied, I could not secure even a seconder. When I subsequently brought the subject forward in this Association I had not one supporter. Nor had I when I brought it before the Royal Society of Medicine three years ago. In the third edition of Dr. Craig's book on Psychological Medicine, which has just appeared, the doctrine is not so much as even mentioned, and Dr. Craig says that insanity cannot be defined. This he says in face of the fact that at the Royal Society of Medicine I showed that there are several different concepts confused under the name of insanity, and I carefully defined every one of them; nor has any one of my definitions ever been impugned. I venture to assert that if these definitions had emanated from a German source they would have been welcomed with enthusiasm and received with reverence.

Gowers states that the morbid state causing epilepsy “consists in some trifling alteration in the chemical constitution of the grey matter of the brain on which the instability spoken of depends.”

Confusion is a hallmark of the effects of toxin upon the cerebrum. When very slight, special tests are required to elicit it. Interference with neuronal conductivity is the chief pathogenetic factor. The topical incidence of this is one of the determinants of the form taken by the psychosis, whether hallucinatory, disorientative, depressive, delusional, or what not. Another factor is the state of the body secretions as affected by the toxins; a third factor is the patient's psychological status, as determined by the capacity and the opportunity for experience.

Of all the consoling illusions which mankind have harboured to irradiate, hearten, seduce and dupe them in their onward way to the perfection, universal peace and brotherhood which they hope and expect to approach, if not attain—after the devastating deluge of this long war for an unknown Divine event is over—none is perhaps more wildly irrational than that of a complete regeneration of human nature, and the coming of a perfect transformation scene on the troubled earth; for all the world as if the method of vital progress which has been since the beginning of life is appointed to come abruptly to a stop, or to be reversed; with the optimistic belief, too, that life shall be thereby exalted and glorified immeasurably. Could the fatuity of egotistic optimism go farther? Was the universe specially created to be a stage on which man—equally with other species and the rest of animate nature—lives, suffers, decays, and dies, might play his transitory part? Was that the illusive goal which at its outset launched it on its transcendental aim and its mysterious career, along which it has groaned since in long protracted travail? Naturally in that matter the devotees of religion believe the most, hope the most, cry aloud the most; otherwise their faith might be rudely shaken.

The ordinary biological teaching is to the effect that the inheritance of the child is not affected by the education of the parent. That dictum is not based upon a direct investigation of the matter itself, nor is it based upon an investigation of anything which is related to human intelligence. The dictum is nothing but an unwarranted deduction from observations on the colours of animals, and some experiments on amputating the tails of mice.

I purpose giving first of all a short description of the steps taken in connection with the conversion of this institution into a war hospital, and of the necessary additions to the staff. No structural alterations were required to the buildings, as they were to be used only for mental cases, and the changes therefore required were very slight in comparison to what, for example, took place at Bangour or at other asylums. Most of you will have read the minute and vivid description by the President of our Association, Lieut.-Col. Thomson, when the Norfolk County Asylum was converted into a war hospital for the sick and wounded, but the radical changes described there in the buildings and amongst the staff were quite unnecessary at Dykebar, as it was taken over as a going concern. Consequently we were able to admit soldier patients almost at once when the others had been removed. It happened by good luck that the new nurses' home had just been completed, otherwise it would have been impossible to have accommodated all the female staff. With the exception of four orderlies who are billeted with the married orderlies, and tradesmen, all the others are housed in the institution. The daily routine in the institution is much the same as you are all accustomed to, except that there is here a certain liveliness, as the majority of the patients are young, strong, active men, and a march out here is quite a different thing to the slow and decrepit walking parties formerly in vogue, and in the farm and garden there is displayed energy never seen before. Work, and especially outside work, is encouraged, but of course there is always a certain proportion who cannot be persuaded to do anything.

There is nothing new in the symptoms comprising the syndromes—generically dubbed “shell-shock”—arising from the circumstances of battle. But to those of us who have had large numbers of these cases passing through our hands, new ideas have been suggested, or the confirmation of old theories brought home.

Mlle. Joséfa Ioteyko in her learned articles on La Théorie Psycho-Physiologique de la Droiterie, which were published in the Revue Philosophique, June and July, 1916, and of which an epitome appears in this number of the Journal, quotes largely from the works of Mlle. V. Kipiani, an enthusiastic educational reformer, who advocates a certain method of reading and writing, the object of which is the avoidance of unnecessary eye-strain. The method, which is fully described in the epitome, is not new. It is simply the boustrophedon mode of writing employed centuries ago by the Ancient Greeks, and abandoned by them for the method which is now used by European nations.

[The following article from the pen of the eminent biologist, M. Yves Delage, was brought under the Editors' notice through the kindness of Sir Bryan Donkin. The vein of irony and caustic humour, more or less scathing, which runs through it will, no doubt, be distasteful to those who have accepted in their totality the theories of the Freudian school, but it is as well that the teaching of that school should be presented for the nonce from a different standpoint from that adopted by its whole-souled adherents. And while it may perhaps offer some rather “strong meat” for our readers' consumption, and while, in particular, the interviews so graphically described may seem too out-spoken and realistic for some ultra-sensitive British minds, it can hardly be questioned that they are, unfortunately, true to fact; and it might be a blunder on the part of psychiatrists who cannot bring themselves to admit the soundness of the principles of Freudism to content themselves with the adoption of a merely passive attitude towards them, and, ostrich-like, to shut their eyes to an aspect of a movement which is spreading with more or less rapidity in our own and other countries outside Germany, and which in the view of many sober thinkers is, in much of its theory, scientifically unsound, and at least capable of becoming demoralizing in practice; and if, through a no doubt pardonable repugnance to anything savouring of prurience or salacity, they were to allow themselves to drift into the opposite extreme of a too meticulous and hardly justifiable prudery.