The gradual rise in the yearly incidence of encephalitis lethargica, culminating in the serious epidemic which marked the first half of the past year, and the tragic results which so often follow, have invested this disease with a sinister importance. But there are other reasons which make this infection peculiarly suitable for consideration at a meeting of the Medico-Psychological Association. These reasons have been well described in a recent paper by von Economo, who gave the name to the disease in 1917.

The study of chronic septic or latent infection has in general medicine and surgery advanced to such an extent that it is here only possible to deal with a moiety of the subject, and I consequently propose to deal principally with the chronic sepsis met with in the head and female genital tract, my object being to demonstrate and discuss a few of the clinical types met with in those parts of the body.

Delinquency is a big subject, but the time available now is limited, so I shall be able to put only a few facts and a few ideas before you.

First I ought to direct your attention to the Birmingham scheme for dealing with abnormal cases before the courts. This was inaugurated in 1919, thanks to the energy and intuition of Mr. Gerald Beasley. The principle established was that there should be a whole-time medical officer at the prison specially experienced in insanity and mental defect, who could, when called upon by the justices, examine persons remanded in custody, who might be not fully responsible, either through mental defect, or some other mental abnormality. At the same time there should be available a part-time psychological expert to examine similar cases remanded out of custody. This makes expert investigation possible in every case of doubtful responsibility. In the opinion of some a weak point is that the decision as to which cases should be examined rests with the justices. It is a question, however, whether the decision ought to rest with anyone else in the present state of public opinion.

I propose to deal briefly in this paper with a group of cases which isa largeone, although ill-defined. The group is of much social and medico-legal importance, and its consideration raises questions of fundamental moment. As generally described, the group is heterogeneous. But I shall try to show that the conditions comprised in it are related to each other, as also to other kinds of mental abnormality. The members of the group are characterized by their inability to make satisfactory social adjustments. But I must not be taken as meaning that all social maladjustment is due to this cause.

The problem of the treatment of defectives is somewhat different from that met with in regard to the patients in mental hospitals. In the case of mental hospital patients most of them have filled useful positions in the world, and also the percentage of possible recoveries is hopeful, and many of them are able to resume their former occupations. But mental defectives are social misfits, many with anti-social traits, others neglected and ill-treated, and again others of a much lower grade, many of whom are helpless and even cot-cases.

At the Annual Meeting of this Association held at Belfast last July, Sir Frederick Mott gave you an address on the thyroid gland and promised a further contribution with regard to the iodine content. This paper is an attempt to correlate the iodine content with histological structure and with the mental and bodily condition of the patient. I must apologize for the work being far from complete, as most of the time since then has been taken up with the examination of the published methods for the estimation of iodine in the gland, and owing to certain objections to these methods it has been necessary to invent a process without these objections, and which, at the same time, is carried out with a minimum expenditure of time and material.

The great improvement in the staining of spirochætes devised by Jahnel and others so simplified their photography that ordinary flat-print microphotographs of these organisms became familiar to most of us years ago.

For many years the treatment of epilepsy has been a grave problem, and it may truthfully be said that, until the pathology of the so-called idiopathic cases has been worked out, we area long way from treating this condition in anything like a satisfactory manner.

Post-mortem examination of brain.—The dura and leptomeninges are normal and there is no excess of fluid. The right hemi-cranium is health. Section of the left shows a large area of rather recent hæmorrage into the substance of the white matter of the left occipital lobe. This area is confined to the white matter of the lobe, and does not communicate with either the posterior horn or the descending horn of the lateral ventricle, or the exterior.

A case of hydrocephalus, in many respects similar to the one described by Dr. Fred Wilson in the Journal of Mental Science for April, 1925, was also observed in the Asylum at Bangalore in December, 1924.