The honourable position, which, through your kindness, I am privileged to occupy to-day, associates the occupant of this chair with a long roll of distinguished predecessors, and unites him as it were to a confraternity of honour which oversteps time and unites generations. But whether the initial duty of having to deliver an inaugural address is a wise one, I will not venture to say; yet I do know that the consciousness of this time-honoured custom neither tends to produce peaceful repose, nor happy thoughts during the year of probation. My immediate predecessor, Dr. Robert Jones, having so diligently covered the field of evolution, from the time of King Saul to the latest conceptions of the London County Council, I have experienced no little difficulty in finding a resting-place in any of the ordinary fields of inquiry. Assuming that the members of this Association would not expect anything new in what I might say, I have speculated whether, perhaps in directions which are not new, I might say anything which would suggest useful thought to those interested in the aims and work of our Association. On the very threshold of my task I was, as if by chance, suddenly pulled up, and found written across my path these words: “I look into my glass.” Such is the title of the short address with which I purpose troubling you this afternoon. Would that this glass were the simple artificial mirror from off the reverse side of which you and I could re move the silver coating and look into the fathomless abyss beyond; but no, the glass is the human mental mirror of which all are possessed, some more, others less. If I propose to you to look with me into this glass at the question of the social aspect of insanity in a purely rural district, “far from the madding crowd,” and which has remained untouched from the influence of large communities, it is not as a mere theoretical exercise in race evolution, but because it contains within, a further inquiry, which even in this the early part of the twentieth century may be turned to profitable account in an Association like this.

During the past year I have systematically employed rest in bed in the open air as a special method in the treatment of all patients newly admitted to the Ayr District Asylum; and during the past six months I have carried out the same method in the treatment of all resident patients exhibiting relapses or phases of active insanity, the latter including the most difficult and most dangerous cases in the institution. At present, there-fore, all patients in Ayr Asylum who manifest their insanity in such active forms as marked morbid excitement, exaltation or depression, distinct delirium, confusion or stupor, vivid hallucination and delusion, active homicidal or suicidal tendency, impulsiveness and the like, are being treated by the method of rest in bed in the open air, a method which may be conveniently termed the sanatorium or open-air rest treatment of active insanity. Although it is yet too soon to speak as to the ultimate therapeutic value of this system, and several years must necessarily elapse before its effect on the recovery rate in insanity can be definitely ascertained, even a short experience has sufficed to demonstrate the immediate benefits and strong points of the system, and to show that it is a more satisfactory method of treating those who are actively insane than either the outdoor exercise or indoor rest procedures hitherto in vogue, and that, indeed, it secures the advantages without the disadvantages of the exercise and rest systems combined. The particular combination of rest in the recumbent position and in the fresh air of the open would indeed seem to be Nature's specific for at least the alleviation if not the cure of an attack of insanity; and the method is not only based on sound physiology and correct pathology, but it is so easily carried out in practice, it so obviously benefits the health of the patients–not to mention also that of their nurses–and withal it is so pleasant a remedy both in the receiving and the giving, that even a comparatively short experience of its employment has convinced me that the systematic open-air rest treatment of active insanity has come to stay, and that at no distant date it will secure a wide sphere of application in asylum practice, and in the treatment of the psychoses and neuroses outside of asylums. Before describing the sanatorium treatment of active insanity I wish to put before you the stages in its development, and to show how, after an apprenticeship in the exercise system of treating active insanity, I came to adopt the rest method, and by allying the latter with the open-air cure, as suggested by the modern treatment of pulmonary tubercle, I arrived at the combined method of rest in bed in the open air, which has been in vogue at Ayr Asylum during the past year.

The investigations that have led us to employ specific vaccines and antisera in the treatment of general paralysis and tabes dorsalis have been the subject of several previous papers, the last of which formed the basis of a discussion at a meeting of this Association on May 16th. It is necessary, however, to state here in a few words the more immediate reasons which seemed to us some eighteen months ago to justify the undertaking of these experimental observations of therapeutic aim. Prior to their initiation we had definitely ascertained that a threading diphtheroid bacillus, isolated from the brain and the bronchus of a rapidly progressing case of general paralysis, was capable of producing a subacute disease in rats, in which the symptoms were distinctly comparable to those of general paralysis, that on postmortem examination of the animals the brain showed the characteristic changes of general paralysis, and that there was also the characteristic invasion by the thread form of the bacillus. It was thus evident that among the various species of diphtheroid organisms that can be isolated from a general paralytic there is at least one capable of producing the disease general paralysis. We had also ascertained numerous facts which harmonised with this view. We had obtained cultures of a diphtheroid bacillus from the brain of the general paralytic in ten out of twenty-four cases; and whilst attempts to cultivate the organism from the blood and cerebrospinal fluid of the living patient had, as in the experience of most other observers, been in most instances entirely negative, we had succeeded in obtaining pure growths from the blood in four cases and from the cerebro-spinal fluid in two. We had also ascertained that diphtheroid bacilli, in a more or less advanced state of disintegration, are frequently recognisable in these fluids, even when a culture cannot be obtained, and that such altered bacilli are almost constantly present in the walls of the inflamed vessels of the brain in cases dying in a congestive attack. We had also evidence of the occurrence of a diphtheroid cystitis in all of several cases of tabes dorsalis examined, and of the existence of a high intracorpuscular bacteriolytic index to certain diphtheroid bacilli on the part of such patients and of general paralytics, which we interpret as denoting that they were defending themselves against the attack of an organism of this kind.

THE following is an account of a systematic examination of the coagulation rate of the blood of nine female epileptics and seven healthy women.