Mr. President and Fellowsof the College,—Permit me first to thank you for the great honour you have done me by inviting me again to deliver the Morison Lectures in this great seat of medical progress and learning.

Temperament, derived from “tempero,” owed its meaning to the supposed mingling of the “humours,” the sanguineous, the bilious, the phlegmatic and the melancholic, the predominance of any one of these in an individual giving rise to the characters of the corresponding temperament.

It is not without much hesitation and diffidence that I stand here to open your discussion on psycho-analysis, because I am merely one of Freud's disciples, and quite unworthy of assuming the role of an apostle of the psychology for which that great man—in my opinion the greatest psychologist who has ever lived—is entirely responsible.

By the majority of individuals, and even of medical men, homo sexuality has simply been regarded as a disgusting perversion which merits no further interest or investigation. This disgust and revolt of the moral sense is explained by Freud as due in great part to the existence in the ordinary mind of a homosexual component of the sex instinct, which finds indirect expression in condemnation of homosexuality in others, in the same way as the repression of the sexual instinct in the prude expresses itself in the condemnation of normal sexual activity. This idea seems to be confirmed by the great tolerance of homosexuality we see in some countries where sex repression is also much lessened. We must bear in mind that man is not the purely reasoning individual he deludes himself he his, and it is certain that he is largely swayed by unconscious emotional forces which warp his thought and action. The student of science is by no means an exception, and we should do well when new theories come before us, and controversy is apt to be rife, to dip thoughtfully into the chapters on the psychology of belief.

It is now two years since Armistice Day, and I then delivered a short address on vocal therapy and the manner in which it originated at the Maudsley Hospital in small beginnings. It was then energetically supported by Lady Carnarvon, and a society was founded for the purpose of providing teachers for instruction of soldiers and ex-service men in breathing and singing, as well as in the treatment of speech disabilities, under medical direction and supervision. I was fortunate in securing such excellent teachers as Miss Oswald, Miss Bush and Miss Dredge, who, with genuine enthusiasm, successively carried out vocal therapy at the Maudsley Hospital.

Mr. President and Members of the Medico-Psychological Society,—Permit me to thank you for the great honour you have conferred upon me in asking me to give the second Maudsley Lecture; also for permitting me to deliver it in the Hospital which bears his illustrious name and which owes its existence to his generosity.

Mr. President and Gentlemen,—TO make more clear to you the general position in South Africa as it affects the subject of mental disorders and defects, I propose, if you will allow me, to begin my paper by referring briefly to matters outside its scope as indicated by the title.

Sadism is conceived as including anything from an impetuous attitude towards the sexual object to the stage in which sexual gratification is exclusively dependent upon the complete subjection and ill-treatment of the sexual victim.

In the latter part of 1919 a patient who had hitherto proved inaccessible began to speak freely of his hallucinatory experiences. His observations were so interesting that it seemed to be an excellent opportunity to gain some insight into the obscure question of hallucinations, and I have therefore kept a complete record of everything which the patient has told me in the course of our conversations during the last year. The method of study has been purely conversational. The method of free association was not utilised for various reasons, and, in a sense, it was scarcely necessary since the patient really analysed himself naturally, and in his remarks made the origin of his experiences quite apparent. It is only proposed, in the present instance, to describe the hallucinations, and to discuss their origin and significance. There are many other features of interest in this case, such, for instance, as the reactions provoked by hallucinations, but these matters are much beyond the scope of a short paper. A brief history of the case will first be given.

Human activity is always conservative, and the sphere of mental medicine is patently no exception to the rule. Since the reaction took place from the callous and barbarous treatment of the insane we have progressed far, and are rapidly tending to regard the mentally disordered individual from a similar point of view as the physical sufferer. The late war has brought the problem of mental disease vividly to the notice of the laity, the medical fraternity have been stimulated thereby to take greater interest in the subject, while even many psychologists and psychiatrists have through war clinical experience become more humanistic in their outlook upon the psychotic patient. Following upon the special provisions which were made for those who broke down mentally in the service, there is much discussion as to what alterations should be made with regard to the care for the insane, and more especially those who are in an incipient stage. That some adequate provision must be made for early care and treatment hardly requires pointing out, for its absence is perhaps the greatest defect in the existing organization. Any real advance, however, in this direction cannot take place until a fresh generation of psychiatrists have had the opportunity of being thoroughly trained to understand the genesis and pathology of those initial symptoms with which the average asylum physician of to-day would be more or less powerless to cope. We have arrived at the stage in which we have built huge caravanserais in which the insane have an environment which leaves little to be desired for this type of system. Is it not possible that we have lingered so long at this stage in a self-satisfied way that the conclusion is reached that little more can be done to alleviate the lives of those who have become mentally afflicted? Is this extreme measure of segregation away from society the ideal to be aimed at for the treatment or comfort of the patients? Is it also good for the social community? To a large extent at present so-called treatment merely means institutional confinement.

IN February, 1914, there came before the French Senate a project for the revision of the law of 1838 regarding the insane. The law of 1838 states that “each department is to have a public establishment designed specially to admit and care for the insane.” This article was rewritten in the new project as follows. “Persons suffering from mental affections which compromise public order or who are dangerous to themselves or others are to be cared for and detained in special establishments when they cannot be provided for at their own homes.”

In dealing with the subject of psycho-analysis I do not desire to be critical for the mere sake of criticism, but with regard to the work of Freud I might begin with a word of personal explanation.

I cannot commence my paper without first expressing the great pleasure I had in accepting the kind invitation of your President to read a paper at this meeting. Since 1904, when I was elected a Corresponding Member of your Society for Spain by the good offices of Dr. Rayner, I have always endeavoured to be useful to your Association.

In a short paper of this sort it is possible to do no more than touch on a few points emerging from the consideration of the treatment of the psycho-neuroses. There are various methods of treatment based on equally varying theories; owing to this lack of uniformity on the theoretical side it is not surprising that doubt and confusion have arisen, and that, in the minds of some, the whole subject is regarded as chaotic. It therefore behoves one to go slowly, but to be prepared to use such means as experience, in any or all of the methods, has proved to be useful. The greater issues have been much written of and discussed, and in this search many of the lesser issues have been lost sight of.

The question, “What is the efficacy of psycho-analysis in the treatment of the psychoses?” recalls to one's mind the problem of the utility of surgical procedures as a remedy for cancer. For in both we have to deal with an ætiological factor that is still obscure.