Gentlemen,—In commencing the work of the office to which you have elected me, I desire to convey to you my sense of the honour conferred and of the responsibility which this honour entails. In heartily thanking you, I assure you it will be my constant care to maintain impartially the rights of members and the freedom of debate. While checking exuberant verbosity, I shall endeavour to encourage useful discussion and to expedite business at all our meetings, and shall look to you for the support which is necessary to preserve intact the dignity and privileges of the Chair.

The attention of the Council having been called to a statement that errors existed in the Statistical Tables prepared by the late Tuberculosis Committee, the Council inquired into the subject, and finding, as a matter of fact, that such errors did exist, decided to place the Tables in question in the hands of a statistical expert for detailed examination and Report. Dr. Chapman, late Medical Superintendent of Hereford City and County Asylum, whose reputation as a statistician is well known, most kindly, at the request of the Council, undertook the work, and the Council feels that the Association is greatly indebted to Dr. Chapman for so freely placing his talents and time at its disposal.

The following observations were made by my assistant (Dr. Peebles) and myself with the object of observing the physical symptoms of katatonia and hebephrenia. As the result of these observations we were led to make some experiments in the way of treatment, and we combined with this work some experimental observations on rabbits.

The question of utilising female nursing to a greater extent than formerly in the care of male patients in asylums has roused much interest of late years, and has been brought under the consideration of the Association on several occasions. In advocating the adoption of this form of nursing one is apt to give the impression that the method is something entirely new as applied to asylum patients. But that is not intended, for in reality the system has existed to some degree for a long time; and it is only the question of the advantages of extending it, and making it much more systematic and complete, that is now raised. In some places on the Continent it has been in use for a number of years, and is developed to a greater extent than is usual in this country. In April last I had an opportunity, in company with Sir John Sibbald, formerly Commissioner in Lunacy for Scotland, Dr. Fraser, Commissioner in Lunacy for Scotland, and Dr. Robertson, medical superintendent of the Stirling District Asylum, of visiting two institutions in Holland and seeing the method in practice; and I now venture to submit some notes, not by any means exhaustive, of what was observed there, and to make these, and my own further experience of the system at the Fife Asylum since 1896, when I had the privilege of reading a paper descriptive of it at the annual meeting of the Association, the basis of my remarks at this time.

This remarkable case of double consciousness was under my constant observation for about four years.

A seven weeks' visit to seven principal universities in the eastern States of America is a sorry qualification for talking to you upon this subject. Nor, indeed, is it easy during the brief time at my disposal to give you a satisfactory account of the impressions which I formed during my visit. I can only hope that the shortcomings and inaccuracies of this paper do not exceed what may be called their normal number under such circumstances, and that you may be induced some day to repeat for yourselves experiences which I have been the first to enjoy with such pleasure, interest, and profit. Nowhere will your colleagues extend a warmer welcome to you, nowhere will they take greater trouble in displaying and explaining to you their institutions.

From time to time one meets with the opinion, or with expressions and general phrases indicating the unavowed opinion, that “idiopathic” epilepsy results from a toxæmic state,—that is to say, that epilepsy the disease is caused by poisons circulating in the blood; or less positively that epilepsy the paroxysm is determined, the attack precipitated, by the transient presence in the blood of such poisons; and in both cases the unexpressed idea seems to be that these poisons get there, in the manner of other auto-intoxicants, by reason of the inefficient performance of the digestive function in some respect.

Fifteen years ago the late Professor Korsakow described an assemblage of symptoms met with most frequently amongst chronic alcoholics. He claimed that they represented a distinct disease, which he termed polyneuritic psychosis, and later cerebropathia psychica toxæmica. The cardinal features of this affection, according to him, were, besides the polyneuritis, amnesia and pseudo-reminiscence. We in England, perhaps wisely, are slow to accept new diseases; but as now a large amount of literature has accumulated around “Korsakow's disease” from physicians in all parts of Europe, it may be of interest to give an account of twelve cases among women which I have met with presenting the symptoms of this affection.

One of the most interesting points connected with the concept katatonia is its relation to the morbid phenomena included under the older term melancholia attonita. Many modern exponents of the former, especially in Germany, would deny the existence of stuporose melancholia altogether. Yet it seems to me that cases occur conforming to the descriptions of the latter which cannot be included in the category of katatonia without the merest straining of terms. In this connection I think the following two cases are instructive:

If we trouble ourselves to look back and study the treatment of insane persons in olden times, we cannot but be struck by the fact that our forefathers regarded insanity as a disease which needed active treatment, and it generally received such at their hands; and that, however much the weird and sudden outbursts of religious frenzies, sudden seizures, and mad impulses were regarded as evidences of demoniacal possession, or God-inspired action, the patients so affected, and rendered conspicuous by their conduct, received at the hands of their fellow-creatures treatment which, however curative in intention, must have tended rather to elimination than recovery, and in this respect differed little from that meted out to the physical illnesses, wounds, and accidents of the patients of bygone times.

The following case is one of chronic Graves' disease suddenly taking on an acute form with mania and resulting in death in fourteen days, with pyrexia during the last week, there being no pulmonary or other complications.