The dominating motive which for more than a generation has directed the activities of the asylum authorities in Scotland has been the desire to make the asylum in that country an institution, inspired by the same exalted principles and conducted on the same medical and nursing methods as those existing in our great general hospitals. That ideal has the supreme merit of being simple and tangible as well as high, for the voluntary hospital is the most perfect embodiment of practical humanitarianism and science at present known to us, and the position it occupies is unique among medical institutions. The more nearly this ideal is reached, the more closely will the care of those suffering from mental disorder approximate to a state of perfection, and the more completely will the asylum be transformed into a hospital for the treatment of a special disease. This is what is understood by the phrase, “the hospitalisation of the asylum,” which was first used in 1902.

Mr. President, Ladies and Gentlemen,—Last year I had the honour of delivering the Maudsley Lecture, and I brought forward a certain amount of evidence in favour of the genetic causation of dementia præcox. I have continued these investigations and published the results in papers entitled “Further Pathological Studies in Dementia Præcox, especially in Relation to the Interstitial Cells of Leydig,” Proc. Roy. Soc. Med., 1922, vol. xv (Section of Psychiatry), pp. 1–30; also “The Reproductive Organs in Relation to Mental Disorders,” Brit. Med. Journ., March 25, 1922. The former investigation included 27 cases of dementia præcox, the onset occurring in adolescence; also the results obtained in 9 cases of psychoses other than dementia præcox occurring in post-adolescence, and 4 cases of primary dementia, in which the demential symptoms came on in post-adolescence. From these investigations, and from others which I have been pursuing, I have come to the conclusion that it is better to speak of primary dementia, which may occur either in the pre-adolescent period, adolescence, or post-adolescence; moreover, I am of opinion that all the psychoses belong to one group and are genetic in origin. In those forms of psychoses in which recovery takes place—for example, confusional insanity or exhaustion psychosis, benign stupor, periodic insanity, or manic-depressive insanity—we may assume there is a suspension of neuronic function in the highest psychic level; but all these conditions I have found may end in a terminal dementia, in which the changes in the reproductive organs and in the brain do not differ from those met with in the primary dementia of adolescence, the dementia indicative of a suppression of function. In the primary dementias, naturally, the symptoms may be partially due to a suspension, and partially to a suppression of function, and I would explain partial remission of symptoms by a partial restoration of function in neurones in which the nuclear change was either not present or not advanced.

The influence of the internal secretions is exerted by means of chemical substances—very few of which have been isolated or satisfactorily examined. Many of these substances closely resemble in their action that of medicaments, especially such drugs as the alkaloids. So far as their physiological action is concerned drugs can be classed in two divisions, viz., those which increase the excitability of irritable tissues, and incidentally induce their activity when quiescent; and those which diminish their excitability, and incidentally produce quiescence if administered during activity. As instances of the action of those two kinds of drugs on the nervous system strychnine and morphine may be mentioned; similar examples may be found in the action of antagonistic drugs upon the secreting glands, upon skeletal, plain, and cardiac muscle, and upon protoplasm in general. The principle is of extensive application, some drugs being definitely excitatory, others definitely inhibitory, the effect, whichever it may be, being produced by a reaction between the chemical substance which forms the active constituent of the drug and a constituent of the living tissue, this being in certain cases represented by a special material, termed by Langley “receptive substance,” which has in all probability been formed under the influence of the nerves which pass to the tissue. The action of the internal secretions is due to specific chemical substances which act upon or react with constituents of the cells. Such reaction, as in the case of drugs, tends either to increase or to diminish the excitability of particular tissues, either stimulating the living substance to activity or increasing its activity, or decreasing or arresting any activity that may be present. The expression “chemical messenger” was employed by Bayliss and Starling in their work on the action of secretin upon the pancreas to denote any material circulating in the blood which tends to excite a tissue to activity. Subsequently the word “hormone” was invented by Starling as a short equivalent—not, as he is careful to insist, to be confined to the chemical principles of the internal secretions, but to be used also for any chemical substance, of whatever nature or origin, which acts as an excitant; e.g., Starling gives as an example of a hormone the CO2 of the blood, which, when conveyed to the medulla oblongata, excites the activity of the nerve-cells composing the respiratory centre. Subsequent writers, e.g., Biedl, have displayed a tendency to restrict Starling's term to the active principles of the internal secretions, in place of using it, as he himself proposed, for all chemical substances exciting activity—a proposition in strict accordance with its derivation, which is from the Greek word μαω, I excite. This restriction of the term is the more unfortunate because it has become customary by most authors to include under the term of hormones or excitants substances which have exactly the opposite effect—that, namely, of restraining or inhibiting activity, the custom having arisen probably from the fact that at first the existence of such substances was not sufficiently recognised. Since it is obviously improper to apply the term “hormone” (or “excitant”) to inhibitory substances, I have ventured to propose that an analogous term, “chalone,” derived from the Greek word χαλω, I restrain, should be employed to designate such substances, and that a general expression denoting their drug-like character should be used to describe all the specific principles contained in the internal secretions which promote changes in other organs, whether in the way of excitation or inhibition. Such an expression is appropriately found in the term “autacoid,” which is derived from the Greek words oA, self, and kP, drug or remedy, i.e., a drug-like substance produced within the body itself: the latter part of the expression being already in general use in the form “panacea” or universal remedy. A striking example of a chalone or restraining principle is furnished by the ovary, which produces in its internal secretion a chemical substance—not as yet isolated—which restrains the development of the male characteristics in the female. When this restraint is lacking, as occurs after removal of the ovaries, a tendency to development of male characters makes its appearance. A hen, for example, deprived of its ovary develops the bodily form, the tail, comb and wattles of a cock, crows like the male bird, and even attempts to “tread” other hens. And if the ovary of another individual is successfully transplanted into such a bird, the chalone which is contained in its internal secretion inhibits the tendency to develop male characters, and these presently disappear, so that the animal again assumes all the characters of a hen. Nor is this occurrence of a chalone in the generative glands confined to the hen. There is one variety of Sebright fowls in which the cocks are hen-feathered. In this breed, as has been shown by T. H. Morgan, the testis contains cells, similar to certain cells in the ovary, which apparently yield a chalone, similar to that of the ovaries of ordinary breeds of fowl. And when the testes are removed from the hen-feathered Sebright cock, the castrated animal assumes the plumage characteristic of the ordinary cock-feathered variety of Sebright. Since, therefore, there are two principles of opposite character yielded by the internal secretions, I shall in speaking of their action upon the nervous system employ the expression “autacoid” as a general term to denote the active chemical agent of any secretion, and the special terms “hormone” and “chalone”—with their adjectives “hormonic” and “chalonic”—to express the mode of action of particular autacoids according to whether this is excitatory or inhibitory. These preliminary remarks are introduced to enable those members of my present audience who are not familiar with the history of the subject, and especially with its nomenclature, to understand exactly what is meant by the expressions I propose to use, in order to avoid the confusion which would otherwise result from the employment, as is so frequently done, of the same term—hormone—in opposite senses.

Mr. President, Ladies and Gentlemen,—In view of what has already been said to-day I am afraid that anything which I may be able to contribute to this discussion will be superfluous, but perhaps, by approaching the subject from the point of view of the influence of certain chemical substances on the general function of the animal organism, an additional side-light may be obtained on this subject. It is difficult to separate many of these chemical actions, as the functional activity of the endocrine glands and the nervous system are so intimately connected. In addition the active principles of some of the endocrine secretions are now identified as definite chemical compounds closely allied to other substances which may possibly be produced in the organism under pathological conditions.

The object of this paper is to raise the question whether the endocrinoses are not secondary to psychical disturbance but primarily caused by it.

The intention of the present paper is to give an impressionistic account of the cases seen rather than a detailed and analytical description which is necessarily beyond its scope.

Among the many important advances which have taken place within recent years in the science of medicine, none have surpassed in value or in extent those affecting the nervous system. One of the principal points which these have established, no matter from what direction the subject has been approached, is the recognition of the essential unity of the sciences of neurology and psychiatry. In the domain of psychological medicine, the researches of Freud and Jung on psychopathology and their theories of the subconscious and its manifestations have provided a common meeting-ground; the investigations of Campbell on the cell lamination of the cerebral cortex, and later of Shaw Bolton, have aimed at the elaboration of a scheme of cerebral function based on clinico-histo-pathological proof; the studies of Elliot Smith on the comparative anatomy of the brain and the development of the cerebral cortex peculiar to the mammalia have demonstrated some of the factors which have contributed to the attainment of man's distinctive mental aptitudes, and eventually made possible the emergence of the human intellectual abilities culminating in the development of speech, and the attainment of intellectual pre-eminence within the human family; equally important is the recognition of the integrative action of the nervous system by Sherrington, and his views on the importance of the simple muscle-nerve preparation in explaining the processes involved in cerebral association and the significance of excitation, inhibition and the latent period; and still more recently we have the investigations and publications of Schafer on the influence of the endocrine glands on the nervous system, and of Mott on the relationship of the reproductive and endocrine glands to mental disease, and the light which this has shown on the ætiology of dementia præcox.

The subject of biochemistry is so closely related to physiology that any advances in the former science are bound to have important applications to the practice of medicine.

A unique account of the character reactions observed and experienced during Antarctic exploration. The writer deals with the reactions of (1) the party as a whole, and (2) of sections isolated on special duties, or by misfortune. The life shows well-defined phases. The journey south and the approach to the initial goal is a time of high resolve, anticipation, and exhilaration. Quickly there follow periods of intense labour in which physique is searched to the outmost, but these are followed by times of untrammelled relaxation; these contrasts persist throughout, and produce the fascination so characteristic of polar journeys.