I have ventured to suggest that we should now consider what we are going to do about the classification of mental disorders. Lately, the Royal College of Physicians of London decided to revise the Nomenclature of Diseases, and publish another edition. The President of this College is on the Committee; as is also Dr. Savage, our colleague in London, who has taken much interest in this question. I was somewhat surprised the other day when I asked for a copy of the Nomenclature of Diseases in the Royal Medical Society of London, to find that they did not have a copy in their library—a book which is supposed to guide the profession in the statistical registration of diseases. In 1896, for the third edition, an attempt was made to reform the nomenclature of mental diseases, under the direction of Dr. Hack Tuke and Dr. Savage. In its present state it is still unsatisfactory. The classification with which we have to deal is as follows:—First, there is “idiocy (cretinism), and then mania (acute or chronic), delirious, hysterical, puerperal, epileptic, traumatic, syphilitic, gouty, from either acute or chronic disease, alcoholic, plumbic, or other poisons.” Acute is an absurd word, because we specially want to mark the duration. Acute should be rendered Recent. Then there is “melancholia (acute or chronic), delirious, hypochondriac, climacteric, puerperal, epileptic, syphilitic, acute, other diseases.” Then there is “dementia (primary or secondary), senile, climacteric, puerperal, epileptic, traumatic, syphilitic, acute, other diseases.” Then there is “mental stupor, anergic, delusional.” Then there is “general paralysis.” That is not a mental disease. Lastly, there is “delusional insanity.”

So much has been written on the nervous and mental troubles induced by the conditionsof servicein the Great War that the subject seems almost threadbare at this time of day. But as no special account has appeared, so far as I am aware, of the measures taken in Ireland for the treatment of those whose reason had become impaired in the course of war service, I venture to think that a short contribution to the subject, dealing more particularly with what was done locally, will not be inappropriate either to the place or the occasion.

My object in this paper is to give a brief note of a trial which has recently been made in the Fife Asylum, in the way of introducing female nursing in the male sick-room. Nursing is peculiarly woman's province; and it has, I believe, often been felt that it would be a great advantage if female care could be more freely utilised in the management of male insane patients, or at least of those of them who are suffering from special bodily disease in addition to the mental symptoms. The main objections to the step have hitherto been: (1) that some of the habits and peculiarities of the male insane may make it unfit or undesirable to have them under female care; and (2) that in many asylums the structural arrangement makes it difficult or impossible to bring the male sick-room under systematic supervision by the female staff. Lately it was necessary to build a large addition to the Fife Asylum; and advantage was taken of this opportunity to get rid of the second objection mentioned. The new building is a hospital block, and is intended to receive recent admissions, cases requiring special observation on account of their mental state, and cases of bodily illness. Each side (male and female) is divided into three sections: 1st, sickroom proper (for cases of bodily illness); 2nd, special observation ward (intended for new cases, and cases needing continuous supervision on account of suicidal or other dangerous tendency); and 3rd, general observation ward. There are the usual dining-hall, kitchen, and administrative rooms in the centre of the building. The male and female sick-rooms are placed next to the administrative portion, one on each side; and as the doors here are unlocked during the day, with free communication by the corridor, the male sick-room is easily reached from the female side, and is administered by the matron, the head nurse (who has charge of both sick-rooms), and two junior nurses. Each sick-room communicates with a special observation dormitory, beyond which again is the special observation day-room. This dormitory is empty during the day, but receives at night the cases which require continuous supervision on account of suicidal tendency, and which come to it direct from the special observation day-room. On the male side the door between the sick-room and the observation dormitory is kept locked during the day; and there is thus no direct communication between the sick-room and those parts of the male side which are under the charge of attendants, except by the general corridor. When the Medical Officer makes the evening visit, this door is unlocked, and the sick-room and observation dormitory are thrown into one and come under the charge of a male attendant, who is on duty during the whole night, while the nurses return to the female side of the building. This plan was followed because our numbers are too small to require separate attendance in the two rooms; and in this way the sick-room is under female care during the day, but is supervised at night by the male staff.∗

I wish here to give as briefly as possible an account of the pathology of the nervous symptoms which result from syphilis. Of necessity there is considerable recapitulation from former papers I have written. For syphilis produces very different affections of the nervous system, and I have therefore had to speak of syphilis when considering Amaurosis, Epileptiform seizures, Hemiplegia, &c. It is, however, justifiable to bring together the conclusions one has arrived at about syphilitic nervous affections from the study of nervous affections in general.

The value of visiting by relatives and others to the well-being of elderly in-patients is widely recognized, but there appear to have been few attempts to collect systematic information about it from visitors. A preliminary study was therefore made of visiting in a psycho-geriatric admission ward.

During 1931, 1932 and 1933 at least 20 female cases of mania were admitted to the Warwick County Mental Hospital, and I propose to review the treatment of these cases, omitting melancholia because of the difficulty of excluding involutional illnesses, because mania is more difficult to treat (1), and finally because the results of treatment are easier to follow.

An old teacher of mine, in days gone by, used frequently to remark in his lectures on Logic that the test of accurate knowledge is the ability to give an exact and comprehensive definition. Now, if this criterion were applied to us, alienists, in regard to the subject we are supposed to know most about, the result would, I fear, be somewhat disastrous, and not at all likely to shed lustre on our speciality.

The three establishments which will most repay the trouble of a visit, a e the Bicêtre, the Salpêtriére, and Charenton; The Bicêtre is for male, the Salpêtriére for female paupers, and Charenton is a large private asylum for both sexes.