The care of the mentally subnormal in Britain has quite suddenly become a live and prominent issue, but public indignation fades quickly and political interest is soon transferred to other issues that are constantly arising. The time seems ripe to re-think the overall philosophy of provision for the mentally subnormal in a developed industrial society, and in particular, the place of the large institution (Craft, 1970; and McKeown, 1970). These institutions resulted from conditions which no longer exist, and they now attempt to carry out a variety of functions, which many think ought to be separated. However, the subject remains a very controversial one (Shapiro, 1969, 1970; Freeman, 1969a).

This investigation is an extension of a study carried out recently (Lowe, 1966) with educationally subnormal school children.

The ingestion of a pint of milk by a normal fasting individual is followed by certain blood changes, the most important of which are an increase in the leucocyte count and a slight rise of blood pressure. In the condition known as anaphylaxis, or protein shock, the general symptoms are accompanied by a fall in the number of blood leucocytes, a reversal of the differential count, and a lowering of the blood-pressure.

Gentlemen,—My first and most pleasing duty in taking this chair is to thank you very warmly for the honour you have done me in placing me here. Recalling the names of those who have occupied this position before me, I am abashed by my sense of my own unworthiness to fill it. When the question of my nomination as President of this Association was mooted, I would fain have stood aside, but the kindly representations of those members who said that it was Ireland's turn for an Annual Meeting made me feel that I could not evade the honourable task which was put upon me, even though I feel that I am very far from being the fittest of my contemporaries to undertake it. I have also been moved to accept your kindness and the distinguished honour you have conferred upon me in the hope that a meeting might be arranged in Dublin in such a way as to further the objects of the Association and to be of advantage to the members, particularly to those who live in Ireland. How far this hope may be fulfilled remains to be seen. I trust, in any case, that our present meeting may be so far successful that all our future Annual Meetings may be working meetings, and that under successors, I hope more competent than myself, the Association may be thereby materially aided in its forward path. For this meeting we have, I am happy to say, a very large and comprehensive programme, the members having heartily seconded the efforts of the General Secretary and myself to bring in good material. I desire no credit for this. I may say, with Montaigne, “I have brought you here a nosegay of sweet flowers; nothing is mine but the string that ties them together.” It is, perhaps, the function of the Chairman of such a meeting as this rather to aid and to suggest discussion than himself to take a very prominent part therein; rather to offer opportunities for others than to make them for himself; rather to be the whetstone than the chisel—

The estimation of vitamin C in the urine has recently been undertaken on a fairly large scale on patients suffering from physical disturbances. Harris (1) and his co-workers investigated 74 hospital patients at Cambridge, and found that 62 (84%) excreted less than the minimum standard, or 13 mgrm. per day. Excluding 19 on special diets, 43 excreted less than 13 mgrm. per day, and the average excretion of 55 was 10 mgrm. per day.

Before the invasion of established general paralysis there is a prodromal stage, which ranges within wide limits as to its scope and duration. The clinical manifestations are many and various, and are symptomatic of either a rapid, or of a slow and insidious disintegration of the intellectual, moral, and affective life. Of all the prodromata, failure and decay of the moral sense are the most important, and are exemplified by acts of omission and commission against law, order, and propriety. The disease attacks all classes, and as the friends cannot nicely discriminate the changes in character, and are apt to look upon them as temporary aberrations, the disturbance to the social fabric caused by these sporadic displays of moral perversion is not inconsiderable. The nature and extent of the disharmony and distress occasioned by these moral lapses depend largely on the social standing, occupation, and opportunities of the diseased individual, and desolate homes, widespread ruin, and unenviable publicity often follow in the train of the predominant imaginative conceptions. The larger ambition may lead to wild speculation, the bolder schemes to fraud. Sobriety is turned into drunkenness, and sexual excitement may result in rape and acts of indecency. If thwarted or opposed, destructiveness or violence may ensue, but in this direction serious consequences are comparatively seldom associated with the expansive prodromata. The budding paralytic of this type is rarely vindictive; although easily roused to anger, he is easily calmed. Being, in his own estimation, so superior mentally and physically to his fellow-men, he can afford to pity and forgive.

I wish to make it clear at once that for the purpose of this paper I am taking the definition of psychiatry as being synonymous with the term psychological medicine—in other words, the study of the subject as a whole.

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.

That medico-mental science is often at variance with the doctrines and decisions of the courts of law is a fact too well known and too generally admitted to need formal proof. It is almost as generally assumed that the scandalous failures of justice, which too often result, must be attributed to the defective education and knowledge of the profession. It is alleged that, as a body, we are for the most part ignorant and theoretical in matters relating to insanity, and if not ignorant, then presuming, and often using the little knowledge we possess, rather with the intent to rescue thieves and murderers from the legal consequences of their crimes than to help the administration of justice. It is certainly a fact which many of us lament that the corporate bodies of the profession generally, including the general medical council, ignore the subject as a distinct department of medical education; and consequently medical practitioners, not being duly trained, do sometimes appear to great disadvantage in courts of law. Medical shortcomings are not, however, the subject of my paper, but certain fundamental defects in the principles and procedures of the law which render medico-mental science sometimes even worse than useless, and always less useful to the commonweal than it might be, if rightly adapted to the needs of modern society. Nor would it be difficult to show that some of the crime and folly which occupies our courts and fills our reformatories, prisons, workhouses, and lunatic asylums, is capable of prevention by a well-devised use of medico-mental science. As these matters are wholly beyond the powers of the profession, I shall ask leave to move at the close of the discussion that a committee be appointed, with power to take such steps as may be thought necessary to secure a thorough inquiry by the Government into the relations of medical science to the administration of the law in regard to all persons mentally disordered or defective, with a view to such improvements as may be practicable.