The body is a vital union and communion of an infinite multitude of differentiated cells which constitute its different tissues and organs, their several functions intimately co-ordinated to serve the functions of a bodily whole; so many diversities in unity, unity in so many diversities, which is just what all nature is, what all science, when perfect, must needs be, what every well-fashioned mental organisation ought to be.

Gentlemen,—I have to congratulate you on again forming an independent Section of Psychiatry, and that the term “Neurology” is allied with it. In the second Congress in Melbourne there was a Section of Psychology under the presidency of the late Dr. Manning, but in the succeeding Congresses our subject has been merged with that of State Medicine. I trust that you will be able to demonstrate that the placing of it on an independent footing is justified both in the number of papers and in the quality of the work undertaken. The programme before us, fortunately, promises well, thanks in the main to our energetic secretary, and I trust that it will afford us opportunities for instruction and interest.

One cannot but be struck with the fact that in many (if not in most) attacks of acute insanity the patient, on recovery, has no recollection of the incidents of the illness. She may have answered our questions in a way showing that at the time there was not only a consciousness of a certain kind present, but also the capacity for understanding and replying in accordance with her ideas (however unfounded they may, in fact, be), and yet on recovery, or even in a temporary lucid interval, all remembrance of the disordered state has passed away, and that, too, beyond the capacity of recall—nothing but a misty, hazy remembrance of some condition which has been passed through remains, just as one finds it impossible to re-instate the details of a dream, the reality of which was at the time vivid in consciousness. We have here to deal with a dual consciousness, a knowledge of states apparently incompatible with, and distinct from, each other. We are all familiar with states of acute mental disturbance where there is difficulty in making the patient understand what we are saying—not necessarily difficult or involved questions, but simple queries relating to what we think are matters in the patient‘s consciousness, such as it is. Here it is doubtful if the patients really understand what we are saying, though there is no doubt about their hearing the question, e.g., they may hear the question but the reply will be merely the reiteration of some particular delusion which has no connection with the question, or there need not be any reply at all, as if we were addressing them in a foreign language which they did not understand, or as if what is said to them has a different meaning from what is intended.

There can, perhaps, be no more pleasing conviction than that which assures a man he has won the approval of his fellows; and in gratefully acknowledging the great honour conferred upon me to-day in my election to the Presidential Chair this conviction is mine, and I take the award as an earnest of your good will and confidence. But, as in the richer harmonies of human life the minor chord will ever assert itself, so the knowledge of one's personal limitations introduces a note of sadness, for one is forced to recall how very little, even of one's best, one can give in return for so invaluable a pledge of the esteem of one's fellow-men.

Few subjects of late years have so much engaged public attention as the care and treatment of the mentally infirm, and the pen of almost every writer and critic has been busy over this topic.

The object of this paper is an endeavour to suggest for the consideration of the medical profession certain aspects of their legal duties and responsibilities in matters of lunacy.

In youth, divided into its pubescent and adolescent periods, and, in relation to our subject, taking only the forms of mental disease that may come into question or relevance, besides idiocy's minor degrees, the chief to mention are simple dementia, hallucinatory, and confusional cases; melancholic, maniacal, and “transitory” attacks; periodical and circular psychoses; katatonia, hebephrenia, the paranoias; hereditary forms marked chiefly by impulse or moral perversion; cases on “mental besetment” (obsessive) basis. Many other forms of insanity, of course, exist in youth.

Six years ago Dr. Shennan and I recorded the observations that rats which had been fed with cultures of a threading diphtheroid bacillus, isolated from the bronchus of a general paralytic, developed symptoms of paresis, which tended to go on to a fatal termination, and that the tissues of the animals showed changes resembling those that are found in cases of early general paralysis. In all of four animals in which the experiment was fully carried out the brain showed periarteritis, neuroglia proliferation and severe nerve-cell lesions. Two years ago Dr. McRae and I recorded some further experimental observations upon the effects of feeding rats with various strains of diphtheroid bacilli. A diphtheroid bacillus, which formed acid in glucose and saccharose test broths, and which was virulent to mice (Bacillus paralyticans brevis), produced very striking results in twelve animals. They developed acute or chronic forms of general paresis which went on to a fatal termination. The most marked lesions found after death were those affecting the nerve-cells of the spinal cord and brain, but in several of the animals there were also distinct periarteritis and neuroglia hypertrophy. Similar experiments with several other strains of diphtheroid bacilli, which could be classed as one or other of the two forms to which we have attached special importance, gave much less definite results. Some of the animals have not yet, however, been examined microscopically. Control animals fed with other organisms gave quite negative results. These experiments have at least shown that diphtheroid bacilli isolated from cases of general paralysis may occasionally have sufficient virulence to determine in rats, by infection through the alimentary tract, a disease in which the chief symptoms are those affecting the nervous system, and in which the tissue changes have a certain resemblance to those found in general paralysis.

The mere accumulation of facts is useless unless some attempt is made to interpret their significance; therefore in this paper I propose to examine my observations on blood-pressure with the design of seeing whether its routine estimation in the insane is worth while; whether from it any fairly trustworthy conclusions can be drawn as to the condition of the circulatory apparatus during life, or as to the prognosis, not only with reference to the mental disorder, but as to the prospects of the duration of life, or whether the time spent in this direction might not more profitably be otherwise employed; and further, to ascertain whether the results obtained tally with those of previous workers.

In recent years very numerous observers have endeavoured to ascertain if, in cases of general paralysis, micro-organisms can be demonstrated in the cerebro-spinal fluid withdrawn by means of lumbar puncture during life. All, with one or two exceptions, have obtained negative results, both from direct examination of the centrifuge deposit and from cultures, and the very general conclusion has consequently been formed that no micro-organisms are present.

This research was undertaken to establish, as far as possible, Drs. Ford Robertson's and McRae's ætiological hypothesis for general paralysis of the insane. It is hardly necessary to emphasise the importance of giving the fullest consideration to this theory, being, as it is, the first serious attempt of its kind to bring mental disturbance into the category of physical disease, to establish the wealth of histological observation in its place as an effect, and to break from the bugbear of metaphysics and perversion of psychic function. I should like to make it clear that though this research may controvert the ætiological significance of the bacilli of Ford Robertson, it in no wise attacks the fundamental theory of a toxic cause acting through the very definite channels of infection established by Drs. Orr and Rows.

This afternoon we have a wide field to traverse, and it is necessary, therefore, to select certain notable features for discussion, to omit much that might be said. I pray you excuse me if this discourse proves somewhat curt and dogmatic in dealing with the placement of the insane and the present position of psychiatry. Both are really in a state of flux, and we can only arrive at conclusions as provisional findings, to the best of our knowledge and belief, still requiring investigation and confirmation. That, of course, applies to the whole range of medicine as a science and as an art.

In view of the general interest at home and abroad taken in “maniacal-depressive insanity,” and because of the special attention this division of the Medico-Psychological Association gives the subject to-day, the writer ventures to submit some considerations (based on his personal experience) on the value of the term.

The discovery by Schaudinn of the Spirochæta pallida was the starting-point of an extensive series of investigations which have thrown much light on the nature of syphilitic infection and its consequences. Reliable authorities are agreed as to the aetiological relationship between this organism and syphilitic disease, and its presence can with ease be demonstrated in chancres, syphilides, and the tissues of cases of congenital syphilis. In tertiary lesions its presence has been noted in gummata and in aortitis, though only in a very few cases. In the so-called para-syphilitic diseases it has not yet been seen. If it be the case that the presence of the organism be indispensable to the production of tertiary and para-syphilitic lesions, the difficulty of demonstrating it may be due to one or both of the following causes: (1) The organisms may be present in another form representing a different stage in their life cycle; or (2) they may be so few in number as to render demonstration extremely difficult, as is the case with the tubercle bacillus in the lesions of chronic fibroid phthisis. The difficulty consequent on a paucity in numbers may be enhanced by difficulty in staining. Two methods of staining the spirochete are in use–Giemsa's stain for film preparations, and a silver impregnation method for the examination of tissues. It is a remarkable fact that tissue which shows enormous numbers of silver impregnated organisms may show very few or none at all in the films stained by Giemsa's method, while on the other hand we have noted an extreme variability in the extent to which impregnation by silver may be obtained; for example, if the tissues of a syphilitic infant be fixed soon after death and while still in a very fresh state, impregnation may be very slight in some parts and distinct in others; thus, in the case of a syphilitic pneumonia, the organisms in the fresh proliferating pneumonic tissue are not seen, or are represented by delicate spirals which are recognised with difficulty, while in the desquamating and degenerating epithelium of the bronchi they may be much more distinct. It is, on the other hand, a striking fact that the spirochaetes in a syphilitic fætus which has been dead for some time are usually impregnated easily with silver, and this is in accord with other observations in the use of the silver impregnation method in demonstrating structures.

I wish to lay before you the results of an examination of the cerebro-spinal fluid in general paralysis and the nervous lues compared with insanities of almost every type, with a few cases of organic disease other than brain disease, and with ten normal fluids. The most serious difficulty met with in obtaining fluid by lumbar puncture with a view to chemical analysis is the admixture of blood. I may mention that in no instance have I seen any ill-effects on a patient from the withdrawal of the fluid; nor have I noticed any abatement in the acute conditions of general paralysis. The investigation has included the detection of albumose, nucleo-protein, and cholin; the reactions, according to Wasserman, Noguchi, Porges-Meier, associated with syphilis; and an estimation of the cell content, specific gravity, and the reduction of Fehling solution.

As mentioned in the careful summary by Dr. Wilcox in this Journal, October, 1908, p. 761, Drs. Clarke and Atwood remark that “not a few English writers fail to diagnosticate general paralysis in the absence of euphoria during some stage of the disease, a view we believe to be largely due to Mickle's teaching two decades ago” (Journal of Mental and Nervous Diseases, September, 1907).

This research was carried on in the laboratory at Horton Asylum, and was directed to that vexed question as to whether the Bacillus paralyticans (which Dr. Ford Robertson has described) was the cause of general paralysis of the insane or not.

The following observations are made on the menstrual history for ten years, from 1897–1907, of all newly admitted and transferred patients, in whom the catamenia were present, in the Holloway Sanatorium Hospital for the Insane. The patients were all drawn from the upper and middle classes, and their ages varied from seventeen to fifty-five years.

Changes in the mental condition of the patient are frequently to be recognised as one of the earliest symptoms of exophthalmic goitre. These mental changes may be present before the cardiac or ocular symptoms have been established and before the changes in the thyroid have been observed. The most common feature is an intense and indefinable agitation leading to a more or less marked motor and mental restlessness, which causes the patient to look for constant change in her surroundings and work. There is an inability to settle long to any one occupation or recreation. Work begun with a feeling of relief at the change involved soon becomes irksome, is then done only with an effort, and with the cumulative feeling of effort and concentration required soon causes distress and the work is laid aside. Any sudden noise, any unexpected news, any of the ordinary disturbing elements of everyday life may be followed by an attack of palpitation lasting some hours, and yet, in spite of this, there is an imperative desire to keep moving; to go where such incidents may be experienced. Dr. Geo. Murray, in the Bradshaw Lecture of 1905, states that he has not noticed this craving for entertainment. It seems to be entirely a question of degree. If the stimulus is moderate there may be pleasure in its fulfilment; if more marked it may pass into an apprehensive dread with inhibition of this desire.

For the purpose of this report the definition of Maniacal-Depressive Insanity as laid down by Kraepelin has been adopted.