[It was a great honour for me to receive an invitation from the Senate of the University of London to speak on a psychological subject. I had, however, some diffidence about accepting it, since I have to speak in a foreign language. I feel greatly relieved by the assurance that there is to be no discussion after the lecture. Furthermore, I have brought some lantern-slides with me, to render my lecture more intelligible.]

As his oldest surviving friend, and one of 52 years standing, it devolves upon me to write the obituary for the Journal of Mental Science of Dr. T. Outterson Wood, President of the Royal Medico-Psychological Association, 1905–6, who died on July 19 last at his residence, Lodore, Chelston, Torquay, in his 88th year.

In the Sixty-fifth Report (1909) of the Commissioners in Lunacy for England and Wales, the following observations were made in respect of the incidence of cancer in mental hospitals and in the general population:

“There remains one morbid condition which is responsible for an increasing number of deaths in the general community, from which it would almost appear as if the insane enjoyed some immunity. According to these figures, the proportion of deaths from “cancer,” i.e., from all forms of malignant disease, was in asylums 36.4 per 1,000, which may be compared with the ratio of 99.4 per 1,000 in the rest of the community, the disparity being more marked in the female than in the male sex. Although the mortality-rates per 1,000 living show a rate of 2.98 amongst the insane, and of 1.39 in the others, yet having regard to the great divergence between the general death-rates in the two series, the general cancer mortality in relation to that of the insane is not 1.39, but 8.11. Upon what can this difference depend? Is it because, as suggested in the analogous case of bronchitis, the asylum patient is protected from some unknown factor in the development of this disease; or has it to do with mode of living as well as of environment; or can it be that there is any antagonism between the conditions favourable to the development of cancer and those which conduce to insanity? At any rate, in view of these statistics, which seem valid and are confirmatory of those we published two years ago, a thorough investigation of the subject might not be without profit.”

Man is distinguished from all other living creatures by the quality and range of his intellect, and on the physical side by the nature of the brain which confers upon him this mental pre-eminence. Moreover, as its exceptional powers were acquired by a process of evolution, the true significance of the human attributes can only be appreciated by examining the history of their development.

Without psychology there can be no psycho-pathology; and any advance that psycho-pathology may have made from time to time has in no small measure depended on corresponding progress previously achieved in the realm of psychology. The reason why psycho-pathology made little headway until comparatively recently may be found in the unfruitfulness—from a medical point of view—of classical psychology.

When I was asked to either open a discussion or read a paper, I felt a great difficulty in choosing a subject, and I think my choice has been influenced considerably by the interest shown by the public in mental defect. Probably all of us are conversant with some of the various methods that are in use for testing the intelligence. These appear to resolve themselves into either valuing or “marking” by plus or minus or using numbers. It has always appeared to me that in marking by plus or minus signs it is very difficult to form an opinion as to whether it should be + ! or + ?, whereas it is easier to use figures. For instance, you say to a child, “What is the difference between an orange and a banana?” and you desire two comparisons to be given. If you give one mark for a definite comparison and no marks for an indefinite comparison it appears fairly simple, whereas if you are marking by the plus signs and one comparison is correct and the other wrong, it appears to me to be difficult to tell which of the plus signs one should use in marking the whole result. I therefore use the point scale test of Yerkes and Bridges. This method, with some slight modifications of my own, I and my colleagues have used in all the cases. I do not believe that a child cannot be tested until it has reached the age of five years. In this I have some support from recent American workers, and a method of testing the young child may yet be devised. Therefore in marking I do not, as Yerkes and Bridges do, start from five years of age, but as though the child could think from birth. The two tests which I hope to discuss at this meeting are those of association and suggestion. These two units appear to offer some interesting theories which might be worthy of further investigation. In a sense these two tests are dependent on each other psychologically and throw some light on the elucidation of some of our problems, and may perhaps enable us to form deductions of some diagnostic and prognostic value.

The shortness of the tour allowed only a limited number of places to be visited, and the salient and most distinctive features of psychiatric and allied activities in each to be seen. These included general and mental hospitals, psychiatric clinics and reception units, observation wards, mental deficiency institutions, mental hygiene centres, child guidance centres, including nursery schools, and child delinquency work associated with juvenile courts, etc.

It is exactly forty years ago since Dr. Guye, of Amsterdam, drew the attention of the Section of Otology, at the annual meeting of the British Medical Association held in Leeds in 1889, to the presence of certain mental disabilities, designated aprosexia, which may appear, both after as well as before puberty, in the subjects of chronic nasal disease. I submit that mental symptoms additional to those described by Guye are due to diseased conditions of the nose which produce a persistent catarrh.

Although the subject of my short address is named on the agenda “After Care,” I am privileged by your chairman to touch upon the activities of social workers generally in regard to the welfare of the mentally afflicted.

This paper attempts to show how cysts of the pineal body may attain clinical importance, and it consists of what I believe to be descriptive facts rather than conclusions drawn from them or theoretical arguments about such findings.

Dr. Petrie's paper is mainly descriptive of American psychiatric institutions, and deals only briefly in its conclusion with his impressions of American psychiatry in its various fields. My paper, however, deals principally with the latter subject and avoids the former as much as possible. It is also my duty to report on my mission as the representative of the London County Council and of the Royal Medico-Psychological Association at the First International Congress on Mental Hygiene.

Mental change in cardiac disease, though a rare complication, is a subject that can be properly and usefully discussed at a meeting of psychiatrists at which physicians are asked to take part. For while the physician may be able to assess accurately the physical defect in the circulatory apparatus, he is trained only in a rough-and-ready way to interpret different types of character, and the way in which they react to disease, and is liable to go astray in his interpretation of mental states. There is also this advantage—that in the present state of uncertainty as to the physical basis of mental disease we cannot look at the subject from too many points of view.

The ordinary method of making an emulsion of fæces in saline or broth and plating therefrom is of value in gross pathological infections of the bacillary and coccal variety. As a method of isolating the sum total of aerobic fæcal streptococci, it is, however, peculiarly incomplete. Anyone who cares to incubate a specimen of fæces in 1% neutral glucose broth and plate therefrom on successive days on to blood media will notice some very interesting facts. Whereas, in the majority of cases, coliform bacilli will grow therefrom in the first two or three daily platings, after a few days they cease to be recoverable and are replaced by streptococci of various types, sometimes later by staphylococci or moulds in pathological instances, and finally all that can be grown are Gram-positive bacilli or filaments. These bacilli are the lactic acid or acidophilus bacilli, and they have, by their production of acid and possibly by other lethal products, destroyed all aerobic bacilli except themselves. In time they, too, succumb, not apparently from hyperacidity, but from lack of pabulum. They can easily be kept alive by transplantation, to either human citrated blood-agar or glucose broth. Elsewhere∗ I am publishing a detailed account of this “acidophilus phenomenon,” but a consideration of the annexed Table I will make tolerably clear the mechanism of this curious process. It is, in the main, a question of acidity, inasmuch as any germ which produces a lower hydrogen-ion concentration (that is, a more acid medium) will inevitably destroy any accompanying germ which produces a less acid medium. For instance (see Table I), a mixture of B. coli communis and Staphylococcus aureus will eventually yield from glucose broth a pure culture of the latter organism, since B. coli produces a pH of not less than 4.0 in neutral glucose broth, whereas the staphylococcus can produce a pH of 3.8. Likewise a streptococcus producing a pH of 3.8 will oust a B. colt producing a pH of 4.2–4.0. We should thus expect an alkaline stool to yield a majority of coliform organisms, and a more acid stool to yield a majority of streptococci or staphylococci; this is precisely what happens.

India, like many other countries in the world, for centuries held the “demonologicalconception” of insanity. As late as the eighteenth century the insane were regarded as possessed by evil spirits, and requiring drastic measures to get rid of their afflictions. Under this belief some were mercilessly flogged and others were made to drink or eat nauseating stuff. With the progress of civilization, India, like Europe, began to erect grim, sombre buildings for the treatment of her mentally afflicted, with small openings in the walls, guarded by strong iron bars; narrow corridors, dark cells and desolate compounds, where no tree, shrub or flower ever grew. Moreover, the old asylums were manned by brutal types of attendants,who were always ready to impose manacles and chains and stripes at their own free will. Insanitary conditions and semistarvation of the patients were special features of these institutions. Of recent years, however, India has been making a steady though sather slow progress in psychological medicine. The old asylums in the Provinces are now called mental hospitals, and the old buildings are either given up, or improved as far as practicable to fit in with their new names. A humanitarian hospital system for the insane has been instituted.

Pyretotherapy, or the artificial induction of pyrexia as a means of treatment of the psychoses, has engaged the attention of psychiatrists for many years. The means employed to this end have been numerous, and they may be divided into two classes:

1. Chemical: Hypodermic injections of sodium nucleinate; or of protein in the form of peptone, blood, milk, tuberculin or emulsions of dead bacilli.

2. Infective: The introduction of living organisms, especially Plasmodium vivax malariæ and Spirochete recurrentis duuoni.

If I may be allowed to speak to you about the importance of functional impediments to the circulation, I would like to do so from the point of view of the anatomist. I shall not speak about the clinical and physiological observations in neuropathology and internal medicine; I want rather to begin with the deductions to which the anatomist is led by his own methods, independent of clinical facts and questions.

Late congenital syphilis, with which this précis is concerned, is not always easy to recognize, as unquestionably the disease has altered in severity during the last few decades, and it is now rather exceptional to find cases which exhibit all the cardinal signs. In the following account, which is based on the examination of nearly 200 cases in the Leavesden Mental Hospital, the clinical manifestations have as far as possible been grouped under the various systems of the body and it has been thought advisable to include, not only the classical and unequivocal stigmata, but also those which, though not exactly specific, are yet of sufficient importance to evoke a suspicion of syphilis. Their relative frequency is shown in the accompanying table.

The recent publication of two papers by Patterson and Weingrow (1, 2) on the brain-liver weight ratio in epilepsy suggested to the writer that an investigation of this ratio in non-epileptic psychoses as well as in epilepsy might prove interesting.