It has not been given to many of those whom I have the privilege of addressing to watch the course of the scientific investigation of the pathology of the psychoses for a period of thirty-four years. Many of my hearers are scarcely old enough to feel the pangs of dis appointment. It will be some twenty-five years ago that, in general, the attention of workers in the domain of the pathology of insanity began to slacken in respect of that aspect of the work which, till then, had mainly interested them, viz., the morbid anatomy of the brain. The output of work in this field about then showed signs of diminishing. Attention began to be directed to the problem of pathological causation. Search began to be made for the pathological factors which expressed themselves in the morbid histological conditions found in the brain-cortex, and, passing on, if we note the interests of young graduates studying for a diploma in psychological medicine, we shall, I think, find that they are not in the direction of histo-pathology, but rather in that of, for example, the function of the endocrines, of the autonomic nervous system, possibly of bio-chemistry. My experience of published work from foreign clinics in psychiatry is that the same drift from histology is noticeable. Nevertheless, it would be unphilosophical to take the view that research in morbid histology of the brain is not worth while, and a perusal of the literature shows the work in progress in the field of the normal histology of the nervous system. Improvements in technique—in the main due to German, Spanish and Italian workers (how comes it that this branch is so little cultivated by the British?)—will add to our knowledge, and thus research in morbid histology will be constantly stimulated.

It is difficult to give this lecture as a whole, for it is in two halves, the first dealing with normal experimental psychology, the second with psycho-pathology. I have seen few writings which bridge the gap between these two aspects of imagery. It is because this gulf may be spanned in the future that I chose visual imagery as a subject related to the interests of this Association.

My attention was sharply drawn to this subject by the submission to me recently of a case for decision as to whether abortion should or should not be induced as a prophylactic measure in regard to the possible recurrence of mental disorder.

The subject of artificial heliotherapy is at present attracting much attention in both scientific and lay worlds. The Board of Control report for 1925 states that there were only five installations in mental hospitals at that time, but doubtless there are more now. I venture therefore to place before you some notes on ultra-violet therapy in the hope that they may be of interest to those thinking of taking up this line of work; and that by their criticisms and observations I may learn from those who have already done so.

The Lunacy Acts of England and of Scotland are in urgent need of amendment. The parent Act for Scotland dates back to 1857, since when great changes affecting its serviceableness have taken place in the social life of the country as well as in the scientific world. It, however, definitely recognizes the paramount position of the medical profession in the treatment of mental diseases, for under its provisions no layman or magistrate is called upon to interview the patient before he is placed in a mental hospital, and no layman or visiting committee is held to be responsible for his removal when recovered. Medical men discharge these and all similar duties, and to this feature must be ascribed the success of the Scottish system. It has gained the confidence of the people' and in place of misgivings and suspicion, there is pride in our mental hospitals and in their management. No case of improper detention has ever been recorded in the law courts. The Act of 1857 has served its day and generation well, and its principles of medical responsibility and of reliance on the honour of the Medical profession are established in Scotland.

Prognosis in psychiatry, and particularly in schizophrenia, is in a somewhat chaotic condition. The dearth of literature concerning prognostic landmarks is convincing evidence as to the truth of this assertion. For many years an unadulterated pessimistic outlook was almost a psychiatric boast. While such an attitude is no longer general, there still tends to be a more or less rigid dependence of prognosis upon diagnosis. Sometimes, and perhaps often, this dependence is so slavish that in a given case a favourable result is interpreted as a sure signal for diagnostic revision.

The part played by sepsis in producing nervous and mental disorders of all degrees of severity and the degree to which these can be prevented, checked, or controlled by antisepsis are singularly opportune subjects for discussion on an occasion marking the centenary of the birth of Lister. We are not only commemorating past achievement, but inaugurating a new campaign against sepsis in one of the greatest domains of medical diseases—that which bears the ill-omened title of insanity.

A Study of the hospital registers of the Limerick Mental Hospital over a period of five years prior to September 12, 1926, reveals the fact that, among an average population of 624, only i case of acute nephritis was recorded. In the three months following that date no fewer than 17 cases of acute inflammation of the kidneys were observed, presenting very interesting problems in ætiology and epidemiology. A consideration of the infective and clinical data of such an unusual outbreak, presenting, as it did, some remark able characteristics, cannot fail to be of interest.

A great amount of work has now been carried out in regard to epidemic encephalitis, which has led to a better understanding, not only of this disease, but of mental disorders generally. It is hoped that our investigations at this hospital can be regarded as a small contribution towards this more complete understanding.

For the treatment of general paralysis of the insane by induced malaria, the Board of Control, in consultation with the Ministry of Health, decided, at the end of 1924, to make an official arrange ment by which a pure strain of the benign tertian malaria parasite would be cultivated in mosquitoes, and would be made available for inoculation by mosquito-bites instead of by the direct inocula tion of blood from other patients. In consultation with the Mental Hospitals Department of the London County Council, the Horton Mental Hospital was selected for the work of pre paring and maintaining the strain of malaria in mosquitpes, and Col. J. R. Lord, C.B.E., Medical Superintendent of the Hospital, undertook the necessary arrangements in collaboration with Col. S. P. James, of the Medical Staff of the Ministry of Health. An isolated villa in the hospital grounds was selected as a treatment-block and laboratory; the Horton Mental Hospital authorities caused it to be mosquito-proofed and furnished, and the Ministry of Health supplied the scientific equipment of the laboratory. The Ministry also arranged that the routine laboratory work should be done by one of their laboratory assistants, Mr. P. G. Shute, under Col. James's supervision. I undertook the selection of cases suitable for treatment and their clinical care and management. The arrange ments were completed in April, 1925, and since that month 33 batches of infected mosquitoes have been prepared and utilized for the inoculation of more than 300 patients in 69 hospitals in England, Wales and Scotland.

The teaching that the brain is the organ of the mind is not often referred to by psychiatrists, no doubt because of the relatively barren results which followed attempts to link up psycho-pathological theories with neurological facts. It is, however, I think, essential that we should keep this fundamental doctrine in the forefront of our minds, and that we should remember that some day an anatomical or a pathological verification may be required for our psychological or psycho-pathological theories.

In the organic and toxic psychoses in which a symptom syndrome is known to be associated with gross brain changes or a definite toxin, it is hard enough to correlate the physical and mental. As McCurdy writes (i): “To find what cell change corresponds to the delusion of having a ship full of rubies is much more of a task than that of looking for a needle in a haystack.” In the case of the so-called functional psychoses—schizophrenia, the manic-depressive psychosis and paranoia—this difficulty is enhanced. It is only possible to treat the matter in the broadest manner, by considering the reaction between the organism and the environment.

This subject should not be discussed, least of all in Scotland, without a tribute being paid to the work of Dr. Lewis Bruce, of Murthly, whose book, Studies in Clinical Psychiatry, published twenty-one years ago, is devoted to a consideration of the toxæmic causation of mental disorder.

Tryparsamide, the sodium salt of N-phenylglycineanmid-p-arsonic acid, was first prepared by Jacobs and Heidelberger in 1915 in the laboratories of the Rockefeller Institute. Following on the excellent reports of its efficacy in the treatment of neuro-syphilis in America, it was distributed to various research centres in this country through the agency of the Medical Research Council prior to its liberation for general use.

In recent years a large amount of literature has been published dealing with the treatment of mental disorders by means of gland extracts, and I take this opportunity of bringing to your notice some of the results I have obtained while treating patients with these extracts. I shall confine my remarks mainly to the treatment of the psychoses with ovarian extract, as, according to some authorities, the results following the administration of this gland extract have been highly gratifying, and we have therefore made use of it to a great extent in suitable cases. It is a well recognized fact that there is normally a perfect balance between the various endocrine glands, and that any disturbance of this balance tends to produce a disturbance in the mental and physical states of the person so affected. Thus there is a functional harmony and compensatory interaction between the ovaries, thyroid and pituitary glands, the secretion of one gland helping the action of another. It is also found that if the secretion from one of these glands is deficient, one of the other glands in the same series attempts to take over its function by hypertrophying and pouring out an increased secretion into the blood-stream. Thus, after removal of the ovaries, the thyroid and the pituitary glandtend to increase in size in order to compensate for the loss of the ovarian secretion. It is also a recognized fact that the corpusluteum, placenta and mammary gland secretions tend to depress ovarian function, and, therefore, to diminish the ovarian secretion. This is seen during pregnancy, when the ovarian secretion must be held in abeyance; if this were not so there would be an influx of pituitrin into the blood-stream which would cause uterine contractions and the inevitable termination of the pregnancy.

Happily it is not expected that in opening a discussion the speaker should make a systematic survey of the subject under review. He may assume that those who may take part are already familiar with the main facts and features of the subject, and it is his business to make appropriate and, if possible, provoking remarks, thus focusing attention on some of the problems suggested by his own experience.

In spite of the inability of organic arsenical compounds to stem the course of general paralysis, nevertheless, as each new member of this group appears it is given a trial in the hope that it may do good. This has been done in many cases in the, absence of evidence supporting the use of the drug, and where the only justification for its use appears to have been its relation to salvarsan. The results have always proved discouraging, and indeed in many cases the dissolution process has actually been hastened.

In 1913 the late Sir William Osler made the prophetic statement that the glands of internal secretion would open up many fields of endeavour in the science of medicine within the next two decades. In view of subsequent events it must be acknowledged that he thereby displayed even more than the usual vision for which he was famous.