Undoubtedly in the past, the prominence of the major seizures in epilepsy led to a focussing of attention on the fit itself, while the accompanying phenomena were ignored or received scant attention. More recently the study of the phenomena associated with the seizures has increased our knowledge, and we realise that by epilepsy we refer to a “symptom-complex” (1). With regard to metabolic processes which occur, and which appear to be of importance, very little has been elucidated, although much work has been done on examination of body fluids, etc. With the hope that it may induce others to join in an endeavour to throw some light on these processes, this is presented, as a preliminary contribution from work done here on the study of epileptic metabolism. The paper is devoted mainly to the consideration of the indoxyl voided in the urine. The clinical examination of the urine of epileptics has been carried on since December, 1905. In the paper attention is drawn to brief summaries which show some of the variations in the output of indoxyl, and a modification of Jaffe's test submitted, which, it is considered, makes for greater clinical accuracy.

The subject of heredity in relation to the mental evolution of the race and to mental disease is of such supreme importance that I plead no excuse for making it the subject of my paper. It is a subject which has not in the past received that amount of attention from us as alienists which its momentous-ness demands. But the work of Galton, the revivified monumental experiments of Mendel, and the investigations of the school of biometricians, headed by Karl Pearson, have latterly given a great impetus to this line of study.

Mental symptoms almost constantly accompany choreiform movements whatever the origin of the latter, and cases exhibiting such movements are fairly common in asylums.

With the exception of cretinism, mongolism and amaurotic idiocy, and juvenile general paralysis, it may be said that the only classification of congenital mental deficiency is one based on the degree of mental defect.

Gentlemen,—The subject which I purpose bringing up for discussion to-day appears to be one which is well suited to debate by such a meeting as this. The various proposals are comparatively new in literature, and more so in open debate by learned societies. It is a matter which you, as mental experts, are eminently fitted to give valuable opinions upon, few other associations having any knowledge of, or interest in, the conditions of mental life and growth which are alone responsible for the origination of these proposals.

When Dr. Goodall suggested to me that I might bring before this Association some details of gynæcological work we have been doing in this Institution, I felt it to be a compliment and opportunity I could not fail to take advantage of. Let me, however, premise that I am a gynæcologist, and do not possess more than a general knowledge of the problems in medical psychology which present themselves to you daily, and that whatever, therefore, I may put before you is more from a gynæcological than a mental standpoint.

A case of puerperal insanity, although distressing in its symptoms, is always welcomed by the asylum physician, for the reason that he knows in all probability the patient will make a good recovery.

With the ever-increasing number of processes proved to be due to the action of micro-organisms, bacterial and protozoal, it is natural that a similar line of research should be suggested in the study of the psychoses. It has long been realised that the classification and differentiation of the various conditions by mental signs alone is confusing and unscientific. Gradually more importance has come to be placed on general clinical observations as indicating broadly the primary disturbances in the economy of the body, secondary consideration being given to mental symptoms as showing the change effected in the individual nervous system by the general disturbance.

Clinical psychiatry is at present passing through a period of transition; to this two influences have largely contributed:

1. (1) The adoption of the biochemical theory of the origin of disease as a working hypothesis in our speculation and investigation.

2. (2) The recognition by the clinician that he must study each case as a whole, and suspend judgment until he has all the facts of the alienation, onset, course and termination before him.

The examination of the mental condition of children in elementary schools presents many difficulties, the foremost being lack of time, owing to the large number of routine physical inspections which have to be completed within the limit of school hours, rarely allowing so much as ten minutes for each child; however, in the smaller rural schools, when it is impossible to get to another school within the same session, owing to distance, there often is sufficient time to enable one to make a detailed examination of some of the mentally defective, and dull and backward children.

The investigation of the problems of metabolism has now become almost exclusively the domain of the chemical physiologist. Much valuable information regarding the method of utilisation of the food-stuffs which enter the body has been ascertained by a study of the excretions. The physiological chemist has, however, passed beyond the boundaries connecting the income and output of these substances. He now seeks to trace the different transformations and combinations which take place in the body, and to connect up all the links of the chain. These changes are intimately bound up with the individual cells, and their metabolism. Unfortunately our knowledge of the cell is at present very limited, but it will be seen how important even this scanty information is to the subject under discussion. It becomes more and more evident every day that pathological changes in the tissues and cells of the body must be considered not only from a morphological point of view, but also from the purely metabolic standpoint. A disturbance in the metabolism of the cell may in time make itself evident, but it is quite conceivable that such changes are taking place without any definite anatomical signs. On the other hand, a morphological change may produce only a very slight derangement of cell metabolism, so slight as to escape recognition. The study, therefore, of pathology with physiological chemistry for its foundation, offers a wide field for further investigation. The object of the present communication is twofold, namely, to correlate the known facts with regard to metabolism in the insane, and to emphasise the importance of studying cellular metabolism in its relation to pathological disturbances.

The word “epilepsy” is used to describe a group of signs and symptoms which are associated with a disease that primarily affects the nervous system. We find grouped together under this name several diseased conditions which, so far as their clinical manifestations are concerned, bear a common relationship, but differ in regard to their exciting causes.

A relationship between malignant growths and mental disturbance has been established in a variety of ways. Some writers have approached the subject from a purely general standpoint. Thus Knapp has noted an increased liability to cancer in individuals who show signs of mental instability and has suggested a possible correlation between the two disorders which are both associated with grave metabolic changes. (1) Proceeding on similar lines, Snow instituted an inquiry which revealed a considerable difference of opinion as to the incidence of cancer in the insane, and concluded that its occurrence is relatively rare. (2)

Some psychiatrists attribute great importance to the neuro-insane diathesis as a factor in the causation of insanity, whilst others belittle its influence. The term is misleading, for it suggests that this diathesis is confined solely to the mentally afflicted, and, further, its precise meaning is vague. A person is generally accused of possessing the neuro-insane diathesis if he presents a temperament which appreciably diverges from the mean of the sanguine and of the phlegmatic; if his actions are unduly strenuous or torpid, his expressions unwarrantably enthusiastic or lukewarm, his moods very variable or religiously constant; in brief, the neuro-insane diathesis may be resolved into a tendency to psychic or motor reaction disproportionate to the exciting stimulus. In common speech the person is emotional. But every person who is emotional is not an incipient lunatic. The faculty of conceiving undue enthusiasm, of persevering unfalteringly in ambition, in order to attain the acme of success in any sphere of life, demands an emotional power in excess of the normal. It is ridiculous thus to brand the best men of all nations as possessors of the neuro-insane diathesis. The term, with its plausible air of scientific accusation, is misleading and vague, and should be wholly discarded. All that psychiatrists wish to convey by it may be more accurately and more descriptively called the emotional diathesis.

The object of this paper is to set out briefly some of the chief clinical points observed during an epidemic of dysentery at the Devon County Asylum, as the treatment of this disease still leaves much to be desired with a mortality of nearly 1 in 5 for all asylums in England. The epidemic started two years ago, and although the number of cases has much diminished during the past few months, there are as yet no certain indications that the epidemic is drawing to an end. Personally I have only seen those cases which have occurred since October, 1909, i.e., 142 in a period of twelve months.