Examinations of the cerebro-spinal fluid, with a view to determining its starch-splitting power, have been carried out with varying success for the past thirty years, but the results which have been recorded are meagre and unsatisfying.

Dr. Hughlings Jackson remarks that in every case of insanity there are negative lesions of the highest centres, which cause some paralysis, sensory or motor, or both (“Journal Mental Science,” October, 1888). Evidence that this is so has been brought forward by him, principally, however, in relation to the insanity of epilepsy and postepileptic states.

[The French alienists, as deeply interested as we have been in this country, in the much-mooted question of the value of the Gheel system, have preceded us in an earnest and praiseworthy effort to solve it with an impartial and educated judgment. At the meeting of the eminent Medico-Psychological Society of Paris, held in July last, the society formed a commission to visit Gheel and to report. The commission consisted of the following eminent alienists:—MM. Michèa, Moreau, Mesnet, and Jules Falret, Trelât and Baillarger. The report has been drawn up by M. Jules Falret. The multiplied writings upon Gheel which have hitherto been put before the general and medical public have dealt, for the most part, only with the surface of the system, and too frequently with its sentimental appearances; this careful consideration, therefore, of its merits and demerits, founded upon a minute investigation made by a commission of eminent psychologists, is of great value. The early pages of the report, in which the details of the Gheel system are described, have been omitted by us, because they do not differ materially from the descriptions given in these pages by the able pens of Dr. Cox and Dr. Sibbald, and even in the present number by Dr. Carmichael McIntosh.—Ed.]

When we examine the purpose and the progress of the animal world from the scientific standpoint, we find that “life is a cycle, beginning in an ovum, and coming round to an ovum again,” and the history of the human race, the failures and triumphs of nations, the loves and hates, the baseness and nobility of individuals, appear to be “the mere by-play of ovum bearing organisms.” Whatever other purpose is served by our existence, we are certainly placed here to reproduce our kind, and to furnish human figures to play their part in the next scene of the perpetual panorama of life. Moreover, we make man in our own image, after our likeness, and endow him with the characteristics we have inherited from our ancestors, and with those which we have created, for good or evil, in our own life. One of the oldest of books teaches us that the sins of the fathers will be visited upon the children to the third and fourth generations, and we might go further and say that physiological sins will penalize the race for many generations, and even lead to its utter extinction, unless counteracted by the strong antidotes of physiological morality, perfect hygienic conditions, and judicious intermarriage with untainted breeds.

The subject which I intend to bring before you to-day mainly relates to the thyroid gland, a part of endocrinology I have been interested in for some time past.

This is the third or fourth time that I have been the occasion of bringing the subject of Punishment before your notice, and my justification for treating of it again is that I am given to understand you are not yet—all of you—of my opinion. On the first occasion I had but one adherent, but that one, Sir William Gairdner, was in himself a host. On the last occasion a good many voices were raised in my favour, and to-day I hope we shall be unanimous. You will remember that the first time I brought the subject forward, it was in connection with the thesis that every lunatic is not necessarily to be considered exempt from punishment; that most lunatics ought properly to be punished for some of their wrongdoings; and that the practice in every asylum is to punish lunatics upon occasion. To this it was objected that although the fact was admitted that we do pursue towards lunatics the same course of conduct that is called punishment when applied to sane people, yet, when applied to lunatics, it is not punishment, because we dare not call it punishment. This led me to a disquisition upon the nature of punishment, in which I arrived at the conclusion that punishment is the painful consequence of conduct; and to this conclusion I still adhere, but subsequent meditation has shown me that although it is the truth, it is not the whole truth, but that there is another aspect of punishment of equal importance. Moreover, I think that the chief reason of the disagreement between my critics and myself was that, while I looked at one side of the shield and maintained that it was black, which it was, they were looking at the other side and maintained that it was white, which it may have been—in parts. In other words, I was looking upon punishment from the point of view of the punishee, which some of you, at any rate Dr. Noott, will consider was the proper point of view for me to take; while others regarded it from the point of view of the punisher.

Within recent years a considerable amount of work has been done upon the bio-chemistry of cholesterol, and valuable information has been acquired which has thrown light upon the important part which this substance plays in numerous physiological and pathological states. It will be of value in connection with the results described in this paper to shortly review some of the more outstanding facts which have been discovered.

The present group contains 20 cases of “Dementia following Epilepsy,” of which 12 are of the male and 8 are of the female sex.

Although some years have passed since the end of the period under consideration, the subject matter is not altogether inappropriate. Neurosyphilis is now rare, though by no means completely abolished in the Western countries, and it is necessary to bear it in mind, for long-forgotten and undiagnosed cases are still liable to confront busy practitioners or specialists. In many parts of the world the situation is different and neurosyphilis is still frequently seen. Its global incidence may be waning but it is not yet a historical curiosity.

An extensive review of recent advances in the aetiology and treatment of neurosyphilis was published in this journal by one of us, E. L. Hutton (1941). While it is mainly the later manifestations with their crippling disabilities that present themselves to the psychiatrist in the mental hospital, it is becoming increasingly obvious that early treatment is imperative to obtain good results, and that neurosyphilis itself must be regarded as a preventable disease.