There is great difficulty in finding a novel theme as the subject of an address to the members of an Association which rejoices in the maturity of its eighty-third year of existence. Still greater is the difficulty in finding a subject of common interest having regard to the varied branches of work covered by their labours, ranging as they do from the busy routine of a crowded day to the silent special research in the laboratory. And the greatest difficulty of all lies in the fact that in each of these fields of work there are many present who have had vastly wider opportunities than I have had, and who could treat their chosen subject with infinitely more skill in thought and language than I can command. Since, however, you have been good enough to give me the opportunity of addressing you I feel you will be no less generous in pardoning my shortcomings on this occasion.

The subject which I intend to bring before you to-day mainly relates to the thyroid gland, a part of endocrinology I have been interested in for some time past.

To ask this question is not to throw discredit on the great work that Prof. Kraepelin has done for psychiatry. Indeed, the opinion may be frankly recorded that no conception dealing with mental disease advocated during the last fifty years has been more fruitful of beneficial results than that of dementia praecox. Out of a symptomatology which before had been more or less chaotic and disheartening Kraepelin evolved a scheme which, if it did not introduce perfect order, certainly marked a very great advance. And not the least of the benefits that psychiatry has derived from him, has been the greater accuracy of observation that his views have enforced upon all clinicians who desire to make an exact diagnosis or prognosis.

It is some eight or ten weeks ago since I had the privilege of enjoying the hospitality of your genial secretary, and in an unguarded moment, doubtless stimulated by my host's genial company, I half committed myself to giving a further communication on this subject, and he committed me for the other half. The truth is I have no paper to read. I have very little further to add to what I have said before, and I have certainly nothing further of note worth publishing. At the same time I very gladly welcome the opportunity of reviewing the position, so far as it appears to me in the light of the further available records on the subject in the last two years.

This subject has caused much discussion among psychiatrists since the presentation of a paper dealing with this matter which was read before the American Psychiatric Association at its annual meeting held in Quebec City in June, 1922.

The symptoms dealt with in psychological medicine are largely those of faulty adaptation to environment. Certification has as its basis abnormal reaction to stimuli requiring the more complicated responses of the organism. For many years pathological investigation of the psychoses was chiefly confined to post-mortem examination of the brain, but the activity of the brain is dependent on the functioning of the rest of the body, and of recent years research has been conducted on a wider basis.

The following notes are derived from the case-records of the Royal Victoria Hospital, Belfast, by kind permission of the medical staff, and are placed before you on the suggestion of Col. Dawson. They are an analysis of a series of 42 cases of encephalitis lethargica treated as in-patients of the Hospital between October 5, 1918, when the first case was admitted, and December 31, 1923. Of these 42 patients, 14 died in hospital, and of 28 who survived 2 died within a year of leaving hospital; 18 replied either in person or by letter to my circular letter of inquiry, and I was unable to trace the remainder.

The history of the colloidal gold reaction is one of great interest. In 1901 Zsigmondy used the precipitation of colloidal gold by proteins as a means of determining quantitatively their amount in given solutions. He discovered that solutions of protein give protection to colloidal solutions of gold up to a certain point, and he determined the so-called goldzahl for various protein substances, by which is meant the number of milligrammes of protein employed, just sufficient to prevent the precipitation of 10 c.c. of colloidal gold of a percentage of .0053 in the presence of 1 c.c. of 10 per cent. sodium chloride. By this method it can be determined whether a given protein is absolutely pure, or, granted that this is the case, how much of the protein is present in a given solution.

Considerable interest has been shown of late in the occurrence of iron in the brain and its relation to certain nervous diseases. The existence of the iron can be demonstrated by placing a section of brain in concentrated ammonium hydrosulphide solution. After a few seconds the globus pallidus and the substantia nigra become a greenish-grey colour. Later, the red nucleus, the corpus dentatus cerebelli, the putamen and caudate nucleus also darken.

There being no law on lunacy in Egypt, all procedure is by administrative orders. The Government has the right to take any steps necessary to secure public order. There is no Habeas Corpus Statute in Egypt. The Criminal Code prohibits illegal sequestration, but if the sequestration is done by the Government with a proper motive, it is apparently justifiable legally. The existing public hospitals for the insane belong to the Central Government; the local municipalities and commissions have none. In the local general hospitals, however, under the Public Health Ministry, there are special rooms constructed for the temporary accommodation of insane persons awaiting certification, or too ill to travel. The Lunacy Division of the Ministry of the Interior administers the hospitals for the insane and issues the necessary orders, which are, however, signed by the Minister; it also proposes the annual budget, and expends the sums granted according to the regulations of the Ministry of Finance. Grants for buildings are made to the Public Works Department, which plans the buildings on the instructions of the Lunacy Division, arranges the contracts, and supervises construction. The Division is almost as autonomous as a Government Department can be; and subject to the technical regulations of the various Ministries and the approval of the Minister, can decide its own questions. The legal Counsellor of the Ministry of the Interior advises it in legal questions, and defends it when attacked in Court. For the present the Director of the Division also acts as Director of the chief hospital at Abbâsîya, but the arrangement should be altered on the passage of a Lunacy Act.