Within recent years it has become a recognised practice to perform lumbar puncture on cases suffering from cerebro-spinal disease; the practical value of the procedure is generally admitted as an aid to diagnosis; and in some diseases, such as tetanus and cerebro-spinal meningitis, the operation is resorted to for therapeutic purposes. It must, however, be admitted that it is only in such diseases of the cerebro-spinal system as are due to the presence of well-recognised organisms that the diagnostic value of lumbar puncture approaches scientific accuracy, in such diseases, for example, as tubercular meningitis, cerebro-spinal fever, pneumococcal meningitis, and sleeping-sickness. The value to be attached to an examination of the fluid for the syphilitic reaction is minimised when one considers that for this test the blood-serum is preferable.

We have ventured to bring forward the following case for various reasons. The first is the unusual distribution of the lesions found post-mortem, namely, in the supra-renal capsules and the pituitary body. The second is that during life the clinical features of the case were not sufficiently pronounced unmistakably to suggest any affection of the parts shown to be diseased at the necropsy. The third and most important consideration is that a narration of the facts raises the question of the significance of pathological changes in the ductless glands in the insane.

Recently, Browning, Cruickshank and McKenzie have described a new method of performing the Wassermann reaction. It depends on the fact that a syphilitic serum in the presence of an emulsion of lecithin plus cholesterin absorbs much more complement than in the presence of an equivalent amount of an emulsion of lecithin alone, whereas a negative serum absorbs equal amounts with both emulsions.

Medical science on the experimental side has been productive of no more interesting or fruitful results than those which have appeared in connection with the study of hæmolysis. The groundwork of this subject was laid by Bordet (1) in 1900 by the discovery of the fact that an immune serum contains a thermostable substance (immune body), which, in the presence of the original immunising agent (blood-corpuscles or bacteria), is capable of absorbing complement; that is to say, a hæmolytic or bacteriolytic serum heated to 57° C. for an hour will lose its power of lysing the homologous blood or organisms, but it will retain thermostable substances whose activity can be restored by the addition of fresh non-immune serum.

Dr. J. S. Bolton has shown that in dementia the seat of greatest wasting of the cerebral cortex is commonly the prefrontal region, a region which (following Flechsig) he regards as a centre of higher association, the great development of which constitutes a leading character of the brain of man. This is a region which in man is one of the latest to myelinate (thirty-fifth in order, according to Flechsig), and if the order of myelination, as a part of ontogeny, may be taken as an approximate recapitulation of the order of phylogeny, then we might infer that the prefrontal region of man is a new region, of late development, absent or poorly developed in animals lower than man. Upon this assumption the predominant wasting of this region in dementia would be readily explained in accordance with Hughlings Jackson's doctrine of evolution and dissolution—dissolution following the inverse order of evolution. For an understanding of the pathology of insanity it is obviously important to inquire how far a study of comparative anatomy, especially of the primates, lends any support to such a conception. The aim of my discourse is accordingly to present, first, a brief survey of the recent observations of Dr. K. Brodmann, of Berlin, upon the comparative histology of the frontal cortex, and then some observations of my own upon naked-eye anatomy of the brain of man and higher apes.

The subject of heredity in relation to the mental evolution of the race and to mental disease is of such supreme importance that I plead no excuse for making it the subject of my paper. It is a subject which has not in the past received that amount of attention from us as alienists which its momentous-ness demands. But the work of Galton, the revivified monumental experiments of Mendel, and the investigations of the school of biometricians, headed by Karl Pearson, have latterly given a great impetus to this line of study.

Gentlemen,—The subject which I purpose bringing up for discussion to-day appears to be one which is well suited to debate by such a meeting as this. The various proposals are comparatively new in literature, and more so in open debate by learned societies. It is a matter which you, as mental experts, are eminently fitted to give valuable opinions upon, few other associations having any knowledge of, or interest in, the conditions of mental life and growth which are alone responsible for the origination of these proposals.

Clinical psychiatry is at present passing through a period of transition; to this two influences have largely contributed:

1. (1) The adoption of the biochemical theory of the origin of disease as a working hypothesis in our speculation and investigation.

2. (2) The recognition by the clinician that he must study each case as a whole, and suspend judgment until he has all the facts of the alienation, onset, course and termination before him.

Some psychiatrists attribute great importance to the neuro-insane diathesis as a factor in the causation of insanity, whilst others belittle its influence. The term is misleading, for it suggests that this diathesis is confined solely to the mentally afflicted, and, further, its precise meaning is vague. A person is generally accused of possessing the neuro-insane diathesis if he presents a temperament which appreciably diverges from the mean of the sanguine and of the phlegmatic; if his actions are unduly strenuous or torpid, his expressions unwarrantably enthusiastic or lukewarm, his moods very variable or religiously constant; in brief, the neuro-insane diathesis may be resolved into a tendency to psychic or motor reaction disproportionate to the exciting stimulus. In common speech the person is emotional. But every person who is emotional is not an incipient lunatic. The faculty of conceiving undue enthusiasm, of persevering unfalteringly in ambition, in order to attain the acme of success in any sphere of life, demands an emotional power in excess of the normal. It is ridiculous thus to brand the best men of all nations as possessors of the neuro-insane diathesis. The term, with its plausible air of scientific accusation, is misleading and vague, and should be wholly discarded. All that psychiatrists wish to convey by it may be more accurately and more descriptively called the emotional diathesis.

The object of this paper is to set out briefly some of the chief clinical points observed during an epidemic of dysentery at the Devon County Asylum, as the treatment of this disease still leaves much to be desired with a mortality of nearly 1 in 5 for all asylums in England. The epidemic started two years ago, and although the number of cases has much diminished during the past few months, there are as yet no certain indications that the epidemic is drawing to an end. Personally I have only seen those cases which have occurred since October, 1909, i.e., 142 in a period of twelve months.

The subject of marriage and insanity is one which is at present beyond practical legislation in this country, but is of immense importance for the social stability and for individual welfare. Though we cannot legislate we have to advise, and our advice is sometimes taken. The lay public as a whole, and the majority of medical men, would at once reply to the question as to the insane ever being allowed to marry in the negative, but I shall contend that a dogmatic statement of this kind is unscientific and unpractical. Such a declaration is taking it for granted that all insanity is alike and is to be treated as of equal value. I shall begin, then, by saying that in my belief certain persons who have suffered from a degree of mental disorder which may be classed as insanity may yet recover and marry with no real increase of risk to their partner or to their children. If I say this, you will next expect me to give examples of the forms of insanity which I should consider as not being of vital importance.

M. D—, æt. 30, servant, was admitted to the Limerick Asylum on April 28th, 1910, from the Limerick Prison, suffering from recurrent mania with delusions. This woman was tried at the Connaught Winter Assizes, held in Limerick in December, 1909, for the manslaughter of her illegitimate infant by throwing it into the fire, and was sentenced to nine calendar months' imprisonment with hard labour.

One of the subjects of the following remarks, J. R—, was shown at the Spring Meeting of the Scottish Branch of the Medico-Psychological Association, held at Gartloch Asylum in March, 1910. This case is reported in the Journal of Mental Science for July of that year. The other patient, J. S—, came under my care in May, 1910, and his history is so far unrecorded. As there are many points of similarity in the two cases, it will save time to describe them together in so far as they resemble one another, and then later to indicate the differences between the two.

The following are a few notes of an interesting case of a male patient, who was admitted here in July, 1910, after giving himself up to the police, because he had an uncontrollable desire to set fire to haystacks: