In view of the impending meetings of the Fourth International Congress on the Care of the Insane, to be held in Berlin from October 3rd to 7th, 1910, it seems desirable that the members of the Medico-Psychological Association and other readers of the Journal of Mental Science should be able to have in print a record to the present date of the proceedings of the International Committee, which was originally appointed at the Congress held at Milan in 1906 with the object of studying the causes and prophylaxis of mental disease.

It is with considerable diffidence that I bring this subject before such an Association as this. I should have the same feeling were I to argue before the Mathematical Society for the merits of the Multiplication Table, or before the Astronomical Society in favour of the Law of Gravitation. It is a matter that I have regarded as an axiom for the last five and twenty years, and that I fondly thought was established as a fundamental doctrine of alienism. My astonishment was great therefore, when, at a recent meeting of the Education Committee of this Association, my proposal, that the doctrine should find expression in the syllabus of subjects for the diploma in Psychiatry did not find a single supporter. The experience carried me back to the early years of my membership of this Association, when I constantly found myself in a minority of one in advocating views which are now become commonplaces. It seems, therefore, necessary to bring the matter formally before you, and to argue it out; and here I am in the difficulty felt by everyone who tries to prove formally what seems to him self-evident. I believe that things that are equal to the same thing are equal to one another. I do not know whether any of the members present share this belief. If they believe that conduct is of no importance in insanity, the same cast of mind may very well cause them to believe that things that are equal to the same thing are greater than one another, or that two straight lines can enclose a space, or that things that are unsupported fly upwards. But if they do believe that things that are equal to the same thing are equal to one another, they would have considerable difficulty in giving a reason for the faith that is in them. If I question the truth of it, and ask what are the grounds of their belief, I think I should place them in a quandary. I am in a similar quandary in demonstrating that disorder of Conduct is the prime element in Insanity.

Mr. President and Gentlemen,—I have had a little difficulty with my title, because the disease to which I want to refer is known under so many names. “Exhaustion psychosis” is one, and the same disease is also described as “post-febrile insanity,” “acute confusional insanity” and “acute hallucinatory insanity”; while on the Continent, I think, psychiatrists are unanimous in applying to it the name “amentia.” But “amentia” in this country has a different meaning, so that we cannot adopt that term here. Having, however, given you the list of names by which the condition is known, you will recognise the disease to which I refer.

Melancholia, with its attendant constipation and faulty alimentation, lends itself at once to a dietetic form of treatment.

Whether the constipation is dependent on defective innervation and is a direct symptom of melancholia or is the initial cause of this mental disturbance, it matters not so far as our endeavours in treatment are concerned.

The present paper endeavours to describe, in a short and summary form, the principal tenets of the school of psychology founded by Professor Freud, of Vienna.

Suggestions have from time to time been made as to the probable functions of the basal ganglia, but so far none of them appear to have been very satisfactory.

It seems to be generally accepted that the optic thalami are not merely sensory centres for every or any special kind of sensation, but are large association ganglia, and it is the endeavour here to point out from anatomical, pathological, and other reasons the kind of associations with which they are probably concerned, and the very important part they play in the life of all animals possessing them.

The class of defectives with which I propose to deal briefly in certain of its aspects consists of those persons over school age who are capable of earning a living in favourable circumstances, but are incapable, from mental defect existing from birth or from an early age, (a) of competing on equal terms with their normal fellows, or (b) of managing themselves and their affairs with ordinary prudence—a definition which, though rather rough, may be accepted as of some value in practice. Such persons have been found by the Royal Commission on the Feeble-Minded to constitute about 40 per cent. of all aments in the United Kingdom; and it has been estimated that their numbers in England and Wales amount to between 50,000 and 60,000. In my investigation, in the City of Dublin I found 365, or 30 per cent. of all aments. Thus they deserve separate study from their numbers alone, apart from the fact that, owing to their relatively high intelligence, they at once are more dangerous socially, and repay help better, than any other class of aments.

In a former paper diet was referred to as a part of the management of the epileptics under care in a mental hospital, and the opinion expressed that, on a diet mainly purin-free, tendencies to serial fits, confused states and dream states appear less marked.

But why the term communicated? Is insanity catching? Such was the question asked by this Journal some five years ago referring to a case of so-called communicated insanity mentioned in a county asylum report. In this article I shall endeavour to bring evidence to show that in some few cases apparently it may be so.

The value of Wassermann's reaction in the diagnosis of syphilitic and the so-called para-syphilitic diseases is now generally conceded, but, apart from the technical difficulties in carrying out the test, which places it beyond the means of all except those working in well-equipped laboratories specially licensed, the fact that it merely enables one to diagnose a previous syphilitic infection in nearly all its stages, detracts somewhat from its value as a means for the special diagnosis of general paralysis or tabes. Wassermann's reaction tells us what nearly every patient is able, if willing, to tell us; whereas the protein reactions, especially that described by Ross and Jones, appear, so far at any rate as my observations go, to be much more specific in the information they yield. The Ross-Jones test in my hands only gave a positive result in general paralysis and cerebral syphilis.