The institution of the new Diploma in Psychiatry by the Universities of Edinburgh, Durham, and Manchester, with the coincidence in my case of entering on my fiftieth year of membership of the Medico-Psychological Association—I find, alas! there are now only four names above those of Dr. Yellowlees and myself—has made a strong impression on my mind. The diploma seems the beginning of another stage of progress of our branch of science. We have in the half-century advanced all along the line, in our original research work—the core of the matter after all—in our literature, in our teaching, in our professional status, in our nursing, and in our salaries and pensions. The rate and amount of progress have been steady and considerable. Many of our younger men, I find, take that progress for granted. They scarcely realise the conservatism of the powers that be, medical and otherwise, in Great Britain, nor the former deep-rooted neglect of the public and of our profession towards anything connected with “Lunacy.” It is not, I am convinced, our administrative work nor our public usefulness alone that have helped us. It is the glamour which our science has lately cast on the public mind. Its inherent interest and its mystery have, almost more than anything else, aided our cause. I never yet had an audience of students in the class-room, or of ordinary citizens in the lecture-hall, or of the élite round a dinner-table whom I could not interest in the marvels of the human brain and the disturbances of its mental functions from the scientific point of view. The subject in its social relations is in the air at present. The man among us who fails to use this leverage for the ends of progress does not know his power. I have always cultivated an optimism in regard to the future of brain knowledge that has been unchanging and incurable. It seems to me that a retrospect and review of our position may be of interest to some of our workers. The new diploma gives me a chance of such a review.

The sero-diagnosis of a syphilitic infection, commonly known as the “Wassermann reaction,” is based on the work published by Bordet in 1899, and Bordet and Gengou in 1901. It was there shown that the absence of hæmolysis could be made available as a naked-eye test indicative of a specific infection, and that the occurrence of hæmolysis negatived the existence of such infection. This reaction they showed was due to the fact that the anti-bodies produced by an infection were able to fix complement in the presence of the corresponding antigen, so that an attempt to complete an hæmolytic system after complement had been absorbed was ineffectual, and the homologous red blood-corpuscle remained intact, though exposed to the action of an inactivated homologous hæmolytic serum.

For some time after the introduction of sulphonal, so highly appreciated was this new drug as a sedative, that every meeting of the Medico-Psychological Association resolved itself into a choir for singing its praises. It then seemed as if the qualities it possessed were ideal for calming the motor excitement of the insane. It was believed to be without danger, as very large doses had been taken suicidally or by misadventure without any more harm than unconsciousness lasting a day or two. As it was insoluble in ordinary media, it was tasteless, and it could be thus given to resistive patients without their knowledge. This property also made its action less evanescent than that of the other sedatives in use, and this was an advantage in the treatment of chronic excitement. Finally, by skilful dosage, one was able to exercise almost any degree of sedative effect, from the production of slight lethargy to almost complete paralysis. It was possible to tone down the restlessness of the simple maniac so mildly as to make life endurable to others living in the same apartment with him without any discomfort to himself. On the other hand, it was possible to paralyse voluntary movement so completely that the most excited patient became motionless and lay in a semi-stuporose state in bed, with little more than power to breathe and to swallow. If opium be entitled to the name of “the gift of God” in the eyes of orientals, from its power over pain and sensory disorder, eighteen years ago it seemed as just to apply this designation to sulphonal, by virtue of its action on motor excitement.

In the following communication, it has been attempted to make a comparison between the opsonic indices obtained from the blood of the insane and those from the blood of normal individuals, and to draw the conclusion that in the case of those patients suffering from an abnormal mental condition we have a slight but nevertheless perceptible lowering of these opsonic indices. As only fifty-two cases have been examined, it is doubtful if one would be justified in drawing any definite conclusion from such small data.

It has long been known that in certain circumstances the dye-stuff indigo, or substances very nearly related to it, may appear as products of animal metabolism, and this fact has not failed to attract attention from physiologists, chemists and medical men. Indigo, in fact, possesses a “fatal gift of beauty,” which has always made it a focus of interest. Of no substance is the history easier to trace. In the earliest times it was obtained from the plant Isatis tinctoria, and served as dye and pigment under the name of woad, being no doubt a striking feature at meetings of the wild Silures in this locality some 2,000 years ago. More recently, during the past half century, the problem of the production of synthetic indigo has absorbed enormous sums of money and the energies of an army of chemists, and the successful competition which it now wages with the vegetable product forms one of the best instances of the return eventually obtained by those who cast their bread upon the waters, financing research in the hope of a return which they cannot definitely foresee.

Undoubtedly in the past, the prominence of the major seizures in epilepsy led to a focussing of attention on the fit itself, while the accompanying phenomena were ignored or received scant attention. More recently the study of the phenomena associated with the seizures has increased our knowledge, and we realise that by epilepsy we refer to a “symptom-complex” (1). With regard to metabolic processes which occur, and which appear to be of importance, very little has been elucidated, although much work has been done on examination of body fluids, etc. With the hope that it may induce others to join in an endeavour to throw some light on these processes, this is presented, as a preliminary contribution from work done here on the study of epileptic metabolism. The paper is devoted mainly to the consideration of the indoxyl voided in the urine. The clinical examination of the urine of epileptics has been carried on since December, 1905. In the paper attention is drawn to brief summaries which show some of the variations in the output of indoxyl, and a modification of Jaffe's test submitted, which, it is considered, makes for greater clinical accuracy.

When Dr. Goodall suggested to me that I might bring before this Association some details of gynæcological work we have been doing in this Institution, I felt it to be a compliment and opportunity I could not fail to take advantage of. Let me, however, premise that I am a gynæcologist, and do not possess more than a general knowledge of the problems in medical psychology which present themselves to you daily, and that whatever, therefore, I may put before you is more from a gynæcological than a mental standpoint.

The investigation of the problems of metabolism has now become almost exclusively the domain of the chemical physiologist. Much valuable information regarding the method of utilisation of the food-stuffs which enter the body has been ascertained by a study of the excretions. The physiological chemist has, however, passed beyond the boundaries connecting the income and output of these substances. He now seeks to trace the different transformations and combinations which take place in the body, and to connect up all the links of the chain. These changes are intimately bound up with the individual cells, and their metabolism. Unfortunately our knowledge of the cell is at present very limited, but it will be seen how important even this scanty information is to the subject under discussion. It becomes more and more evident every day that pathological changes in the tissues and cells of the body must be considered not only from a morphological point of view, but also from the purely metabolic standpoint. A disturbance in the metabolism of the cell may in time make itself evident, but it is quite conceivable that such changes are taking place without any definite anatomical signs. On the other hand, a morphological change may produce only a very slight derangement of cell metabolism, so slight as to escape recognition. The study, therefore, of pathology with physiological chemistry for its foundation, offers a wide field for further investigation. The object of the present communication is twofold, namely, to correlate the known facts with regard to metabolism in the insane, and to emphasise the importance of studying cellular metabolism in its relation to pathological disturbances.

A relationship between malignant growths and mental disturbance has been established in a variety of ways. Some writers have approached the subject from a purely general standpoint. Thus Knapp has noted an increased liability to cancer in individuals who show signs of mental instability and has suggested a possible correlation between the two disorders which are both associated with grave metabolic changes. (1) Proceeding on similar lines, Snow instituted an inquiry which revealed a considerable difference of opinion as to the incidence of cancer in the insane, and concluded that its occurrence is relatively rare. (2)