First let me thank you very heartily for the high honour you have done me by electing me to the Presidential chair. When one looks over the names that have preceded me, from the time of Conolly downwards, one finds that it has been occupied by men of high talent, well known as workers in psychiatry, not only in this country, but abroad. To emulate them will be my endeavour, and I shall certainly do everything in my power to uphold the dignity and welfare of this Association.

We are all prepared to grant that alcohol is a poison in a general sense, and that any use of it for the pleasurable sensations it produces may lead to discomfort, to folly and to disease, and yet the majority of our adults persist in its habitual use, and readily take the risks of future suffering for the sake of present daily enjoyment.

When East Sussex determined a year or two back to build an asylum for its sole use, a Visiting Committee, appointed for the purpose, was fortunate enough to find in the centre of the county a suitable estate which the County Council purchased. It is situated at Hellingly, a village about nine miles north of Eastbourne. The area is four hundred acres, compact, as you will see on the plan, having within 400 yards of its western boundary a railway station which we propose to connect with the main asylum by a full gauge tramway. It slopes gently upwards from the south towards the north, where it attains its highest level of about 130 feet above the sea. The subsoil is most favourable, being, with the exception of two patches of clay, of a sandy or gravelly nature. The water supply is adequate, and the general contour lends itself readily to an efficient system of drainage, which will be bacterial. The views are excellent, extending to the sea and the south downs. It would be difficult to find a more suitable site for an asylum. A sub-committee was authorised to travel about the country to inspect other asylums, I being appointed its chairman. We visited the Hartwood, Lenzie, Gartloch, Hawkhead, Cheddleton, Burntwood, Glamorgan, Dorchester, Isle of Wight, and Chichester Asylums.

At the last February meeting of the Manchester Pathological Society we made a preliminary communication upon this subject, limited to a description of the changes found in the cortical nerve-cells and the descending degenerations in the spinal cord. Since then we have examined a much larger number of cases, and can therefore give a fuller description, with observations upon other points in the morbid anatomy of general paralysis of the insane.

The preparations I am about to exhibit are taken from cases that have occurred during the past three months at Claybury. The first three are, I am afraid, of no neurological interest, but they are somewhat rare. The first is a case of aneurysm of the thoracic aorta. The patient died suddenly from hæmorrhage. Her age was forty, and she had had three attacks of hæmorrhage previously to the fatal one. She was a chronic drunkard and had had fits. The shape of the clot is rather curious. It is more or less cylindrical, and seems to have burrowed down into the chest, pushing the lower lobe of the left lung forward as its sac. The next specimen is one of rupture of the first part of the arch of the aorta. This patient was an old woman of eighty, who had been resident for about a year, and then developed an attack of bronchitis. In the course of two or three days she got rather worse, and one evening told the nurse she thought she was going to die the following morning. She did die, and the interesting point about it is, that the only other case of rupture of the aorta I remember seeing occurred in a man of about forty-five, and he, also, the day before he died, said he thought he was going to die. The blood had ruptured the aorta in a T-shaped manner about an inch above the coronary arteries, and passed down between the pericardium and over the wall of the aorta and ruptured into the former. The next specimen is an exceedingly rare one. The man was about seventy-seven years of age, and he had symptoms of sensory asphasia. He was quite unable to remember even his own name, or any other name, but if a name was mentioned to him he at once recognised it. In the same way, he could not write a single word, but he at once recognised a word which was mentioned to him, and he was able to write it. The aphasia was associated with symmetrical lesions of the angular gyri. The man died quite suddenly one evening while talking to another patient, and the cause of death was heart failure due to aneurysm of the left ventricle. I do not remember ever before seeing, except in a museum, an aneurysm of the left ventricle. The true wall of the ventricle is about two to three millimetres in thickness, the pericardium is generally universally adherent, and the anterior part of the left ventricle is about an inch in thickness, owing to the existence of this aneurysmal clot.

The slides were taken from sections of the cortex of several cases of juvenile general paralysis, mostly stained by Nissl's method or one of its modifications. The work was done at the London County Asylums Laboratory at Claybury.

The pictures I am going to show are taken from photomicrographs of the giant pyramidal nerve-cells of the upper part of the ascending frontal convolution, and the neighbouring paracentral, and my remarks refer entirely to this variety of cell. They have been studied in sections, stained after modifications of Nissl's method, and in film preparations in which the entire cell is seen.

Dr. Clouston in the unavoidable absence of Dr. Ford Robertson made the following remarks:—The first fact that I have to direct the attention of the meeting to is that Dr. Ford Robertson has devised a new method of examining nerve-tissues by depositing platinum in them. By the use of this platinum method he has demonstrated, amongst other things, that what is called the neuroglia is composed of two sets of elements instead of one, as is generally considered. The neuroglia, as exhibited by this and other methods, is attached to the arteries, to the fibres, and to the brain-cells, forming a generally supporting medium. Dr. Robertson has discovered that in addition to this there is another set of cells, which he has called the mesoglia cells, consisting in a typical form of a cell-body, a nucleus and a number of processes. These processes are in no way connected either with the vascular substance or with the nerve-cells or the nerve-fibres. The mesoglia cells are entirely different from neuroglia cells in appearance, and are found in both the white and grey matter, and in such abundance that Dr. Robertson thinks that there are as many mesoglia cells as there are neuroglia cells existing all through the brain. Sometimes they have no processes, sometimes two processes, but the illustrations show a typical mesoglia cell from the dog and from man. The exact function of these mesoglia cells we certainly do not know, but they certainly do not act in any way as a support to the general brain structure. The mesoglia cells seem to have a phagocyte action in certain pathological conditions. They supply, if not all, at least the greater part of the amyloid bodies which are found in some of the chronic brain degenerations. I think you will agree that it is very important that Dr. Ford Robertson should have discovered a new element in the brain, the particular use of which will doubtless be demonstrated by some of the large number of enthusiastic workers on this subject.

During the course of a series of investigations upon the arterial pressures in recently admitted cases of insanity, we were struck by the fact that the arterial pressures in cases of acute melancholia of recent onset followed a more or less definite course.

A complete analysis of the mentally-afflicted Jew is far too vast a subject to bring before this meeting, and any attempt to give you the entire result of my investigation into the subject would occupy far too much of your time.

The subject of alcoholic homicide has been so often and so ably treated in this and kindred societies, so fully discussed in the literature of mental pathology, that some explanation seems due from anyone who again invites your attention to this hackneyed theme.

The rarity of glycosuria among the insane.—When one observes how frequently nervous influences can be regarded as predisposing factors in glycosuria, one naturally expects in communities of the insane to find the condition common. Yet I think the asylum medical officer who follows the routine habit of making a careful examination for sugar in the urine of every case with which he is entrusted, is rarely rewarded for his trouble. The frequency with which it does occur is differently stated by different individuals. But with one exception, the percentages of the insane who suffer from this dystrophy would appear to vary in different asylums from about five to two.

In the perception of a sensation there are the following factors to be taken into consideration:

1. 1. The physical stimulus.

2. 2. The sense-organ receiving this stimulus.

3. 3. The nerves conveying the effects of the stimulus.

4. 4. The centre of memory receiving the whole impression.

5. 5. The perceptive centres conveying to the mind information concerning individual portions of the impression.