Gentlemen,—In the first place I desire to express my thanks to the council of the medical school for the honour they have done me in asking me to give the introductory address which is customary at the opening of each of our winter sessions. That I particularly esteem the privilege will be readily appreciated when I remind you of where we are gathered, and that this is the first function which has taken place in the Bland-Sutton Institute of Pathology, which, with its laboratory, lecture theatre, and museum, will always be a monument to Sir John Bland-Sutton's princely munificence, to his affection for the hospital and medical school, to his devotion to science, and to his belief in her power to relieve suffering humanity. and who will dare attempt to gauge the direct and indirect influence of this institute? Sir John's catholicity is well known, and I feel assured of his sympathy when I venture to hope that psychiatry, which is the branch of medicine in which my interests are specially centred, will have its fair share of the blessings that doubtless will be showered from this institute.

Gentlemen,—It is customary for the President of a Section to open the proceedings by an address, but I feel that it would serve a more useful purpose if I opened the discussion on the diagnosis and treatment of parenchymatous syphilis by giving an account of the observations which I have been making regarding the microscopic and bio-chemical pathology of tabes and general paralysis; for it is by an understanding of the pathological processes underlying these diseases that we are able to make a correct diagnosis, and prevent their occurrence or arrest their progress. My personal experience of the effect of treatment is somewhat limited as compared with that of many of those who are to take part in the discussion, and therefore I shall especially devote my attention to the observations which have been made in the Pathological Laboratory of the London County Asylums.

The medical profession, through its leading journals, has paid respectful tributes to the memory of Sir Thomas Clouston—tributes which indicate, among other things, that he was regarded as more than a mere specialist, and as deserving of a place among those whom the profession considers worthy of honour. This distinction is eminently fitting, for his life's work was devoted to the purpose of identifying his specialty with the general scope of medical science and practice.

For a long time attempts have been made to discover definite relations between external and internal stimuli occurring during sleep and coincident dreams, as also between dreams and the more or less momentous happenings preceding them during waking hours. Such attempts as have been made to prove obvious connections have mostly failed, and for reasons which for the first time are set forth by Freud. At the same time, he has demonstrated the subtile evasions and tortuous routes which pertain to the operations of stimuli on the way to dream-consciousness, whether they be sensory or purely physical, as well as the indefinite period of time over which reminiscences, which are concerned in the evolution of the dream, may extend.

Nearly twenty years have elapsed since Mr. Shand published in Mind an article entitled “Character and Emotions”; in this he formulated the hypothesis that the sentiments are complex derivatives of the primitive emotions. Thus, in the analysis of love and hatred he showed that “the same four emotional dispositions of fear, anger, joy, and sorrow, which are essential to the system of love, are present also in the system of hate.” Many eminent psychologists have adopted, or partially adopted, his views, among whom may be mentioned Professors Stout, McDougall, Westermarck, Sully, Caldecott, and Boyce Gibson. A great feature of this interesting work is its literary merit, and the infinite care and skill displayed by the author in his study of the emotions and tempers by an analysis of the characters portrayed by the great dramatists, poets, and novelists. Mr. Shand recognises the fact that the success of the dramatist and novelist depends upon the study of individual characters, and he gives numerous examples which we shall refer to later, but we will first call attention to two quotations which appear opposite the title page. “And this subject of the different characters of dispositions is one of those things wherein the common discourse of man is wiser than books, a thing which seldom happens. Wherefore, out of these materials (which are surely rich and abundant) let a full and careful treatise be constructed, so that an artificial and accurate dissection may be made of men's minds and natures, and the secret disposition of each particular man laid open, that from a knowledge of the whole the precepts concerning the cures of the mind may be more rightly formed. and not only the characters of dispositions impressed by nature should be received into this treatise, but age, country, state of health, make of body, etc. And, again, those which proceed from fortune, as in princes, nobles, common people, the rich, the poor, magistrates, the ignorant, the happy, the miserable,” etc. —Francis Bacon, De Augmentis Scientiarum, B. vii, Ch. iii.

The association between the artistic temperament and eccentricity has frequently been noted, and in the lives of Turner, Vandyck, Michael Angelo, Benvenuto Cellini, Morland, Romney, Maclise, Landseer, Haydon, Cosway, and many others there is much to support Nisbet's contention that “nerve-disorder is a fundamental element of genius in relation to colour and form.” To the list already given, the name of William Blake may fittingly be added, for, just as some of those named at times passed the boundary which separates sanity from insanity, so most certainly did Blake also cross the borderland.

During the spring of this year, my friend Lieutenant Crocket, R.A.M.C., obtained, through the kindness of Dr. Noguchi, a small supply of luetin, and with this he carried out a series of tests, to which he was anxious to add some observations on its use in mental cases. By permission of Dr. G. M. Robertson he was able to examine a series of cases in Morningside Asylum, and I was fortunate in being asked to co-operate with him. Owing to our small supply of luetin, the number of tests done was necessarily limited, and we intended carrying our observations further when Crocket was called away to duty. Only a short time ago the sad news of his death in action was received, and it is largely on this account that I venture to place on record so small a number of observations.

Although modern research has placed the treatment of syphilis on a scientific basis, the Treponema pallidum continues to exact a heavy toll among all classes of society. The seriousness of the disease is largely due to the ever-present risk of a return of symptoms, perhaps many years after the acquirement of infection, and to the frequency with which the central nervous system is attacked.

Friedrich Wilhelm Nietzsche was born at Röcken, in Saxony, in 1844. His father was a Lutheran clergyman, and his grandfather held a high official position in the Lutheran Church. His grandmother Nietzsche “came of a family of pastors,” and his mother was the “daughter of a parson”. In view of the strongly antagonistic attitude which Nietzsche afterwards adopted towards the Christian scheme of morality, the marked clerical strain in his ancestry is worthy of note. According to his sister Their ancestors, paternal and maternal, were very long-lived. “Of the four pairs of great-grandparents [one] great-grandfather…reached the age of ninety, five great-grandmothers and great-grandfathers died between seventy-five and eighty-six, two only failed to reach old age. The two grandfathers attained their seventieth year, the maternal grandmother died at eighty-two, and grandmother Nietzsche at seventy-seven.” Nietzsche's mother was also long-lived; she was born in 1826, and was married, in 1843, to Pastor Nietzsche, who was then thirty years old. She died in 1897, “after having suffered ill-health for several years”. Pastor Nietzsche is described by his daughter as being an “extraordinarily sensitive man…any sign of discord, either in the parish or in his own family, was so painful to him that he would withdraw to his study, and refuse to eat or drink, or speak with anybody”. This tendency to seek solitude is worthy of note, as it reappeared in a very marked degree in his son, Friedrich. The father was short-sighted—as was Nietzsche—and, in 1848, this resulted in an accident, the consequences of which were disastrous: he tripped over an obstacle which his defective eyesight had prevented him from observing, and he suffered as a result from concussion of the brain. This shock to the nervous system initiated a train of symptoms—chiefly cerebral—which led to his death eleven months later. The fall may have been the cause of the attack; or, as another biographer says, perhaps “only hastened its approach.” The same writer informs us that Pastor Nietzsche “might have hoped for a fine career had he not suffered from headaches and nerves”. Frau Förster-Nietzsche, however, says that her father had not suffered from headaches prior to the accident. In view of Nietzsche's history, one feels inclined to agree with Halévy, more especially as, where any history of nervous or of mental symptoms of a morbid character are concerned, relatives are usually the last to admit them. Mügge says that Pastor Nietzsche “suffered either from concussion or softening of the brain…doubtless this accident hastened his death”. The youngest of the three children born to Nietzsche's parents, a boy, died just after his second birthday “from teething convulsions”. There was apparently nervous instability in the family; and Ireland says that O. Hansson “learned from a family who knew Friedrich Nietzsche from childhood that a disposition to insanity had been inherited for several generations, both on the father's and the mother's side”. This statement is not in accord with the details of family history as given by Frau Förster-Nietzsche; at the same time, it is, perhaps, no injustice to her to surmise that she was desirous of minimising the pathological aspect of the family heredity, and of laying greater stress upon the more favourable characteristics. When Nietzsche's life-history with its morbid mental vicissitudes is considered, however, it would be surprising if the family annals were found to be clear of all traces of nervous instability.

1. (1) Brief reference is made to some of the earliest writings on the subject of anger, and comparison is made with more recent views.

2. (2) Anger, as traced throughout the scale of evolution of the animal kingdom, has served as a stimulus to aggression for the procuring of food, as an aid to survival, and as a necessity for the acquirement and maintenance of supremacy.

3. (3) Anger, occurring in mankind is (phylogenetically) an expression of an atavistic reversion or retrogression, and (ontogenetically) also an indication of familial or individual devolution.

4. (4) Anger, clinically considered, ranges in varying degrees of severity, from mere temporary defective inhibition to conditions of suicidal and homicidal impulse of medico-legal and even national importance, as individuals, families or communities, become affected.

5. (5) Reference is made to some of the causes, symptoms, and methods of treatment of anger as coming within the experience of the medico-psychologist.

In the Lancet, July 4th, 1914, I have briefly described the method of what I called “subdural injection.”

Mr. President and Gentlemen,—The subject that I propose to bring to your notice to-day—namely, the hereditary transmission of epilepsy—is one of extreme interest and importance at the present time in this country, where, owing to recent legislation, public attention has been strongly focussed on the question of transmitted defect. The results that I have obtained have been a matter of considerable surprise to me, and I am anxious to obtain the experiences of others in this matter.

That there is a history of hereditary defect attached to the great majority of cases of dementia præcox.

Juvenile general paralysis is of interest as illustrating one of the many ways in which syphilis may produce its detrimental effect on the human race. The disease may commence at a very early age; according to Thomson, progressive symptoms may be evident in children as young as three years. Males and females are victims in practically equal proportions. The symptoms are very similar to those of the adult form, progressive dementia being very marked; such variations as are present are due to the more undeveloped mental state of youth, and on the whole it corresponds to the demented or confused type of the adult. Periods of acute excitement, or of mental depression, are met with, and epileptiform seizures, which may be present at any stage, are often observed. Delusions of persecution are not uncommon, and grandiose delusions occur; hallucinations are also evident occasionally at some time during the course. In the younger patients a type of advancing spastic diplegia is most common, and even in older cases spastic symptoms are more prominent than in the adult form. The pathological appearances in the nervous system have the same characteristics as those seen in cases of mature age. The duration is usually from two to four years, although sometimes it may be more protracted.