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.

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.

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.

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.

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.

While elaborating a test for cholesterol in the cerebro-spinal fluid, 0. H. Boltz (I) observed and investigated a reaction which occurred predominantly in cases of neuro-syphilis, and which he named the acetic anhydride-sulphuric test. To I c.c. of spinal fluid was added 03 c.c. of acetic anhydride, drop by drop, and after mixing the fluids by shaking, [email protected]. of concentrated sulphuric acid was added in drops, and the mixture shaken again. The development of a blue pink or lilac colour characterized a positive reaction. The test has been studied in this country, and it has been claimed that the reaction is positive in almost every case of general paresis, and negative in almost every other type of mental disorder, except certain cases of non-paretic neuro-syphilis. As this constitutes a surprising degree of specificity of an apparently simple chemical reaction for a single disease, I have carried out the reaction in association with the routine tests in a series of cerebro-spinal fluids with a view to ascertaining its value. One hundred and sixty fluids were examined—a comparatively small number on which to base conclusions, but the results will show that the claims previously advanced for the value of the test require considerable modification.

There is no lack of evidence that a subconscious measurement of the lapse of time takes place. For example, domesticated animals are often strikingly punctual; some idiots manifest an accurate faculty for time measurement; many men can judge the hour correctly without looking at a clock; others can wake at a predetermined minute; and, as a rule, post-hypnotic suggestions take effect with startling and cryptic punctuality. Investigators are agreed that time-gauging is much more accurate during sleep and trance than in the waking state—in other words, is now more a subliminal than a supra-liminal faculty.