In the department of mental diseases some men have won distinction by their writings, such as Pinel, Esquirol, Guislain and Morel on the Continent, or like Laycock, W. A. F. Browne, Winslow, Maudsley, Bucknill, Skae and Clouston in our own country, but the subject of this obituary gained the respect and esteem of his medical brethren and the public by his unfailing courtesy, his resolute devotion to duty, his kindly disposition toward the officials of mental hospitals and his generous personal interest and sympathy with the patients, whose welfare he ever strove to ameliorate. Moreover these were qualities which found ample scope throughout the length and breadth of Scotland in his long official connection with the General Board of Lunacy as Commissioner and Deputy Commissioner.

With perhaps the exception of the youngest in our ranks, there can be no member of the Association or, indeed, of our branch of Medicine, who learnt of the death of Sir Frederick Needham without realizing that an important link was thereby severed in the sequence of those who, in our time and in their respective spheres of action, have rendered great service to psychological medicine, especially in bringing about the many improvements that have taken place during the past three-quarters of a century in the conditions under which insane patients are housed and treated.

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.

During the past ten years, largely perhaps as a consequence of the tremendous mental strain to which the nations of Europe have been subjected, myriads of people who previously left the great questions of life and destiny to the priesthood, and contented themselves with their daily round of duties and pleasures, have begun seriously to think. These, seeing their own ignorance in the minds of others, have set to work as raw recruits to cultivate their own little holdings as if the whole world were virgin soil, and they were the first pioneers.

For some time past there has been an increasing use of laboratory methods in the diagnosis of mental disorders. The following aims at offering further proof of the undoubted value of this method of approach in such cases. There seems, however, to be a growing tendency, not devoid of danger, to ascribe diagnostic specificity to one or other of the many tests in use for such examinations. Although it is undoubtedly true that an exhaustive analysis of a spinal fluid may in many cases lead to a correct diagnosis of the clinical condition of the patient from whom the specimen has been taken, it only requires a study of the literature to show that none of the reactions or group of reactions obtained from the spinal fluid can be regarded as pathognomonic of any disease of the central nervous system.

The object of our investigations has been to find out if carbohydrate metabolism is disordered in the different forms of insanity.

To this end we have determined the sugar tolerance of 100 insane patients by observing the variations in the blood-sugar content after the ingestion of a known amount of glucose.

So much has been written on the nervous and mental troubles induced by the conditionsof servicein the Great War that the subject seems almost threadbare at this time of day. But as no special account has appeared, so far as I am aware, of the measures taken in Ireland for the treatment of those whose reason had become impaired in the course of war service, I venture to think that a short contribution to the subject, dealing more particularly with what was done locally, will not be inappropriate either to the place or the occasion.

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.

The hæmoclastic crisis is the name given by Widal and his col laborators to the vasculo-sanguinary crisis which occurs following the ingestion of milk by patients with hepatic disease and in certain anaphylactic conditions, and was originally described as a test for liver inefficiency. Its occurrence has also been noted in certain cases of psychoses and epilepsy.

Numerous articles have appeared within the last few months in both Continental and English literature describing the value of the malarial treatment in cases of general paralysis. Thus Yorke and Macfie state that out of 84 general paralytics treated with malaria, 23 (or 27.4 per cent.) had been, or were about to be, discharged, at the time of writing, from the mental hospitals. Weygandt in 50 cases obtained good remissions in 48 per cent., and Kirschbaum in 51 in 58.8 per cent. Scripture states that in Wagner-Jauregg's clinic complete remissions were obtained in 44 per cent, out of 141 cases treated. This percentage of complete remissions is still being maintained, Gerstmann reporting recently that 40 per cent, show complete remissions with ability to work, 30 per cent, improvement, and 30 per cent, no improvement. If only early cases are treated Wagner-Jauregg states that nearly 100 per cent. of cures can be obtained. These figures compare very favourably with the percentage of spontaneous remissions recorded by Kirschbaum. This writer found that spontaneous remissions occurred in only 11.4 per cent. of untreated general paralytics. At present it is too early to make any definite statement with regard to the permanence of the remissions, although the three oldest successful cases in Wagner-Jauregg's clinic have now shown complete remissions for years.

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.

Encephalitis, a disease to be defined as any non-suppurative inflammation of the brain, has been recognized for many years. Crookshank (I) points out that clinical occurrences of the nature of what we now ascribe to encephalo-myelitis and encephalo meningitis have been recorded for the last 450 years.

The problem of delinquency has a peculiar interest for the alienist as well as the social reformer, for it is now accepted that intelligence and mental disorder have a close relationship with antisocial conduct.

The family physician is occasionally called into consultation when one of his patients, a hitherto respected citizen, becomes arrested for a sexual offence. In such circumstances the relatives, friends or legal advisers of the accused are often prompted to raise a defence of insanity, mental disorder or defect in answer to the charge. On examination the physician may find such evidence. If not he may regard the patient as being psycho-pathological, but unless he has devoted time to the consideration of the subject, and is also well acquainted with insanity, amentia and border-line states in his daily work, he may not feel sufficient confidence in his general knowledge and medical experience to face with equanimity the prospect of a severe cross-examination in the witness-box on an admittedly difficult and controversial subject. I know the family physician may, in such cases, feel embarrassed, and I propose to attempt to bring before you certain matters for consideration which it seems well to bear in mind when inquiring into the mental condition of persons accused of sexual crime, and which I suggest throw some light upon actions that otherwise appear unusually obscure.

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 antiquity of psychotherapy is in great measure responsible for the difficulties which involve this branch of medicine at the present time. For it comes to us trailing clouds of superstition, pervaded by implications of the most unscientific order.

When in the year 1917 Dr. Wagner-Jauregg, Chief of the Psychiatric Clinic of Vienna, inoculated nine patients suffering from general paralysis with the blood of a case of benign tertian malaria, he was only testing a theory he had formed many years previously. In the interval he had been treating his cases of general paralysis by injections of tuberculin, typhus vaccine, etc., and with encouraging results. Remissions produced by these efforts were more frequent and more lasting than those which occurred in untreated cases, but a lasting remission only rarely followed.

Within the last two or three years a considerable amount of work has been done in this country in the treatment of general paralysis by malarial inoculation. While it is yet too soon to form a final opinion on the results of the experiment, the present seems to be an opportune moment for reviewing what has been done, and for reaching at least some tentative conclusions. In this connection it is important to remember that the method is not altogether new, as it has been in use on the continent for the last seven years with but short interludes.