There is a constant endeavour in psychiatry, as in other branches of medical science, to distinguish between organic and functional disorder. Year by year, in most of these other branches, the organic group becomes larger, the functional group smaller. But unfortunately the same cannot be said for psychiatry. When all is said and done, the term “functional disease” is largely a cloak for ignorance. Where there is disease there must be something to show for it, but if the changes are so subtle as to escape detection, we at once label the condition “functional.” General paralysis was considered a functional disease until it was proved to have a very solid anatomo-pathological basis; indeed, until this proof was forthcoming it could hardly be said to exist as a definite entity at all. Until this process is extended to other forms of insanity, clear thinking in psychiatry is impossible. We are still far too prone to look only upon the mental side of the cases which come under our care, whereas we ought diligently to search for some physical causal factor that may be at work, and for corresponding physical changes that may give us a clue to such a factor.

Our conception of the ætiological significance of myxœdema in reference to those forms of mental disorder generally known under the name of “insanity of myxœdema,” has undergone considerable modification since the time when hypothyroidism was regarded as the principal causal factor. The almost dramatic effect of thyroid treatment gave rise at first to a justifiable optimism. This for a while tended to obscure the possibility that a deeper-lying disorder of mind might exist, which would be naturally brought into prominence by the peculiar disturbance in the functioning of the brain associated with this state of disordered metabolism.

Double personality is a fascinating subject, and has always possessed a peculiar attraction both for the professional psychologist and the layman—owing, no doubt, to the strange and often dramatic character of its manifestations.

Certain features of the speech defects commonly seen in general paralysis bear a resemblance to aphasia, e.g., inability to find required words, and the tendency to omit syllables or words without noticing it, or to transpose syllables or the vowels of successive words. More definite aphasia, however, may occur in general paralysis either as a transitory or lasting symptom. Though it may arise under a variety of conditions it is distinctly uncommon.

The subject of the few remarks I have to offer is one with which those who attend the insane soon become familiar. No other class of physicians can speak of it with more authority. It is not a wide field, and at the first blush would not appear to lend itself to much divergence of view. Yet from the opinions one occasionally hears expressed, I think it is expedient that our attitude towards the questions associated with artificial feeding should now and again be reviewed. When to feed artificially, its relative dangers, its moral effect, or even the best method to adopt, are points upon which observers differ.

The important part played by heredity in the causation of insanity has long been recognised. Much has been written on the subject and investigations have frequently been made to show its influence. Owing to the complexity, variability and general indefinite character of insanity these inquiries have been mainly statistical. It is recognised that no form of insanity is of such definite and simple nature as to be readily available for study in its hereditary aspect by Mendelian methods. As has been repeatedly stated by various writers on the subject, it is not insanity, recognisable as such, that is inherited, but an abnormal nervous system liable to the development of the various conditions included in the term “insanity.”

In Dr. Turner's paper on the classification of insanity in the January number of the Journal occurs this passage: “It is from cases of this class” (epileptic insanity, psychasthenia, morbid obsessions, and impulse) “that subtle dialecticians seek to prove there may be disorder of conduct without disorder of mind.” As I am the only person who has ever made any distinction between disorder of conduct and disorder of mind, or has ever said that the one may be disordered without disorder of the other, it is manifest that I am the subtle dialecticians referred to by Dr. Turner, and I must express to him my obligation for justifying me in the future use of the royal We. We must point out to him, however, that after the manner and habit of members of this Association, he attributes to Us views that We have never expressed and never held. We have, indeed, taught for many years, and iterated and reiterated, that disorder of mind may exist without disorder of conduct, and this view is again expressed in Our paper published in this Journal in October, 1910, but We have never expressed the opinion, subtle dialecticians though We may be, that disorder of conduct ever exists apart from disorder of mind. Perhaps Dr. Turner will be so good another time as to verify his references.

We are apt to consider that, as the object of medical examination of school-children is the improvement of the national physique, such an object is already brought much nearer by the adoption of medical inspection. That it can only be reached through the individual and that these individuals are not responsible for their condition is apt to be overlooked, as is also the necessity for educating that part of the population responsible for the children in the various factors concerned in deterioration. At present the majority of children have parents uninterested in the means adopted in their education—they are at school, ergo, they will be educated; they have a physical instructor, a hygiene teacher, and now a school doctor, ergo, they will be made healthy or kept healthy.