On November 21, 1822, a young man named A. L. J. Bayle presented a thesis for the Doctorate of Medicine to the Faculty of Paris. It was entitled “Recherches sur les Maladies Mentales,” and it was sustained. In this thesis Bayle recorded the opinion that general and incomplete paralysis and mental disorder, when they developed side by side, were caused by chronic arachnitis. In other words that these two groups of phenomena—a certain form of paralysis and disorder of the mind—were the associated symptoms of a definite disease, having a distinctive pathological anatomy. This was an opinion never expressed before by anyone, and it has since then been proved to be true in its essential features. The disease he referred to is now known as general paralysis of the insane.

The average mortality from tubercular disease in mental hospitals is over nine times that of the outside population, and as regards dysentery, which is rarely met with among the sane community in this country, the Board of Control state that “during the second half of 1921 some 728 persons were attacked by the disease in mental hospitals and of these 126 died.” It is a most serious reflection that consequent on admission to a mental hospital a valuable life may be lost, such as, for instance, that of a young mother suffering from nervous shock after confinement, as a result of infection with one of these pathogenic organisms. It is therefore a matter of most urgent necessity that everything possible shall be done in order to eliminate dysentery from our mental hospitals and to reduce the mortality from tuberculosis; and now that the voluntary boarder principle is likely to be adopted for public mental hospitals it becomes more than ever necessary.

When approached by the President of the Medico-Psychological Association to give a short address at the Annual Meeting I chose the above title. On reflection, however, I find it is somewhat over- ambitious and cannot be dealt with in the time at our disposal. It would be better, perhaps, if I endeavoured to place before you some broad principles relative to the close association between neuropathology and psychiatry, and indicate the data in support of the view that anatomically, physiologically, and pathologically the entire nervous system must be regarded, along with its endocrinic appendages, as a unit, each of whose component parts reacts upon the others.

We attribute great psychopathic significance to the stresses incident to the adjustment of the individual to his culture. Everyone is supposed to bear the marks of this conflict. In fact, this disharmony is blamed for all human unhappiness and inefficiency not due to famine and disease. If this opinion is justified how is it that culture, the product of the mind, is not better adapted to the needs and natural capacities of its creator?

I greatly appreciate the honour which the Society has done me in asking me to read a paper by way of introducing a general discussion on the treatment of mental disorders. My remarks will deal with the relationship of physical disorder to mental symptoms. The main point to which I will more particularly draw your attention is to the need for a closer study of the extent to which mental symptoms are the result of some auto-intoxication or infection from one or other of the free mucous surfaces of the body, the gastro-intestinal tract being, in virtue of its size and function, the most important channel. If the relationship is a close one our outlook on mental disorders necessitates greater attention being directed to the investigation and treatment of our patients with the aid of modern methods, than has hitherto been done. The literature of the subject contains many references of a general kind to what is called the toxic factor in the ætiology of insanity, but the systematic investigation of mental disorders from this point of view has not yet been carried out with the reasonable degree of completeness which modern medicine demands. In this connection it is right to refer to the valuable and suggestive work carried out by Lewis Bruce many years ago, the probable significance and value of which has, I think, been largely lost sight of. There is little new in the conception of the aetiology and treatment of mental disorders, which I am going to present for your consideration. It is, however, largely new in the sense that it has not yet been adequately tested. Prof. Robertson has lately drawn my attention to the interesting fact that the leading alienists in France more than 100 years ago entertained the view that the primary cause of mental disorders was to be found in visceral changes. Pinal in his classical text-book on mental disorders in 1809 wrote as follows:

The history of general paralysis records undoubted cases where the disease has for some reason or other seemed for a time actually cured so that the patients could return to work. Although such cases after a short time showed relapse whereby the disease then followed its usual course, this fact is sufficient to indicate the possi bility of stopping the progressive paralysis in some way.

The case I am about to describe seems of sufficient importance to bring to your notice, as it presents many points of interest.

A. B. C., æt. 62, widow, was admitted to the Sunderland Mental Hospital on October 10, 1922, suffering from confusional insanity.

This case was tried at the Central Criminal Court, before Mr. Justice Roche, on October 13th. The prisoner pleaded guilty to a charge of assaulting a Mrs. Bles, with intent to do grievous bodily harm. The facts were that Mrs. Bles was walking in Hyde Park, on September 18th, when the prisoner, who was a stranger, suddenly attacked her, and wounded her with a knife. A police constable pursued and overtook the prisoner, who turned upon him and inflicted three wounds. Mrs. Bles was carrying a bag containing 4, and this had disappeared, but whether the prisoner had taken it was uncertain. This point is of importance, in view of the plea of epilepsy which was set up. For, apart from robbery, there was no apparent motive for the crime.

The report of the Committee appointed in December, 1921, by the Minister of Health “to investigate and report on the charges made by Dr. Lomax in his book (The Experiences of an Asylum Doctor) and to make recommendations as to any medical or administrative improvements, etc.,” was published in August of this year. It is a document of considerable interest and has been widely read and discussed, especially by governing bodies of the public mental hospitals.

Psychopathology, in extending its studies to crime and the minor psychopathies, comes to deal more with the maladjustments of function than with their disorders and imperfections. Certain mental aberrations are regarded as “faulty reactions,” “regressions,” or “evasions of difficulties,” and much use is made of the conceptions of “attitude” and “psychological type.” From such a standpoint the alleged traumata is to be found in the social environment; it is social stresses and disharmonies that are blamed. The strictly Psycho-analytic School, in the theory of “censorship,” “repression” and “resistance,” assigns no less pathogenic significance to social contacts. It is not between mind and its physical environment that we find most psychopathic disharmonies. Disturbances in this adaptation point to organic disease or abnormality and are correspondingly intractable. It is with the relationships between mind and mind that psychopathology is chiefly concerned.