The honourable position which your courtesy rather than any merit on my part has placed me in, carries with it the privilege of addressing you, and in offering you a few remarks on some of the problems of heredity, more especially with reference to their bearing upon insanity and allied conditions, I am fully conscious how inadequate my knowledge is to treat with satisfaction so important a theme. I venture to hope, however, that a few facts and theories bearing on this subject may not be devoid of interest, and may possibly serve as a stimulus to additional inquiries in this direction.

An inquiry into the condition of the various organs of those dying insane cannot fail to be of interest to those who believe that mental disease and physical disorders are, in the majority of cases, closely associated.

The title of my paper is almost a platitude, for we all know from experience that stimulus is essential for the generation and regeneration of nerve structures and function; and that the importance of stress (excess of stimulus) incidental to modern civilisation and town life in the production of nervous diseases and insanity is beyond dispute; yet when we are asked to give precise data to prove these premises, the matter is not so easy.

Mr. President and Gentlemen,—While recognising the undoubted fact that what may be called ordinary insanity has no demonstrable lesion, the disorder being in the “subtle chemistry of the nerve-cells, and that no surgical procedure can correct aberration in tissue chemistry,” I still think there are a small number of cases, not only of traumatic but also of non-traumatic origin, in which surgical treatment may have beneficial results.

Dr. Clouston said: I shall endeavour to keep in mind that my duty is to initiate discussion, and not to attempt to read anything like an exhaustive paper. Since my friend Sir John Sibbald has treated this subject in a full and careful manner from the historical and other points of view, I shall put it in the form of a series of questions and short answers.

In many, the very word “statistics” rouses a feeling of distinct repugnance or distrust. Repugnance, because not a few people dislike this method of expressing information, which indeed is not to be wondered at, bearing in mind that the study of statistics is now a science in itself, and requires considerable training to appreciate. Distrust, because it must be confessed that deplorably misleading statistics have been frequently and unblushingly set forth; this being either the result of ignorance of certain statistical laws and fallacies, or owing to a proneness possessed by some to be carried away by an apparently happy “working hypothesis,” and to then endeavour to make statistics support their theory.

I wish to-day to direct the members' attention to the neuroglia cell and its processes, although time does not permit me to do more than refer in the briefest manner to the present state of knowledge respecting the subtle relationship of the changes of these glia cells to insanity.

True diabetic insanity is a rarity, and when it occurs does not always take the same form. But it is by no means uncommon to meet with certain lesser mental abnormalities in diabetes which are very constant in character; and what is usually regarded as the typical variety of diabetic insanity is simply an intensification of these abnormalities probably due to inherited or acquired cortical instability. Hence this psychosis derives its interest from the definiteness of its aetiology and the constancy of its symptoms.

The question of better provision for the care of idiots and imbeciles has of late been one of some prominence in the more thinly populated counties, and in several of these the county authorities are being urged to act in the matter. In large centres of population, where the number of the congenitally deficient is sufficiently great, and is under a single authority responsible for their care, it is more economical to provide for this class in separate institutions; but where you have, say in a county, a number of authorities, each responsible for the maintenance of only a few cases, it is on the face of it an expensive business for each of them to provide special and separate accommodation; still, it is highly desirable that some steps should be taken to put this class of case under more favourable conditions than at present.

During the last few years great importance has been attached to the consideration of the treatment of those patients who, though not permanently insane, presented mental symptoms requiring immediate and active treatment. Physicians who are brought into contact with large numbers of cases of bodily disease are generally agreed that many of them exhibit mental symptoms concurrently with their bodily illness which are entirely due to the disease itself, such as the initial delirium of pneumonia or the profound depression of influenza.