The development of megaloblastic anaemia as a complication of anticonvulsant therapy is now well recognized, and a total of thirty cases has been recorded.

Badenoch (1) reported the first detailed studies of megaloblastic anaemia developing in epileptic patients treated with phenobarbitone and epanutin, whilst Fuld and Moorhouse (6) reported the association with primidone (Mysoline) alone. In all the cases reported, the anaemia responded to folic acid therapy, whilst anticonvulsant drugs were continued.

The power or process by means of which Time is mentally recognised and estimated independently of, or before, its external and artificial measurement, has not received a clear or comprehensive solution at the hands of those who have dealt with the subject. Certain metaphysicians connect the idea of duration with that of extension, and conceive that the child, or the savage, may have acquired a notion of intervals, or interrupted extension, from seeing and feeling through the muscular sense the alternate extension and flexion of his limbs; all comparison of such events with the successive changes in objective phenomena, as in days and nights, being the result of subsequent experience. Certain others conceive that our notion of Time originates in our consciousness and observation of succession in our thoughts, feelings, and mental states, a succession which necessarily involves a series of changes separated in time, and order, and nature. Sir W. Hamilton, apparently aware of the difficulty of the problem, says that “Time is a form of thought,” and “if we attempt to comprehend Time, either in whole or in part, we find that thought is hedged in between two incomprehensibles.” Other philosophers, belonging to a more practical school, who may be claimed as psychologists, contend that the subjective element of Time is imparted by the communication of impressions upon the external senses to the sensorium, coming as these must always do in succession with intervals of different length, and, as they often do, of regular length and intensity. It will be observed that in all these hypotheses it is taken for granted that the mind is capable of directing attention to its own conditions, and, to a certain extent, of analysing these, of marking their course, their swiftness, or slowness, their regularity, or irregularity. On the other hand, the phrenologists contend that there is a primitive and special faculty connected with a portion of the anterior lobe of the brain, by which Time, or the succession of events and intervals, is perceived or becomes known to us. My own speculations formerly led me to the theory that the perception of rhythm, or regular sequence, in sensorial impressions was conveyed by the pulsations of the cerebral arteries, either to the whole brain, or to such portion of it as may take cognisance of internal movements or changes. Sir H. Holland, that noble veteran, that learned and travelled and philosophic physician, who has just passed from amongst us, dedicated a chapter in his “Medical Notes and Reflections,” p. 499, to the exposition of “Time as an element in Mental Functions,” in which his chief object is to show that ideas or different modes of mentalisation arise and are propagated in different degrees of velocity and intensity in Time in different temperaments, and in the same individual at different periods, in accordance with the predominant physical or mental condition.

When I accepted the great honour of giving the Maudsley Lecture this year, I was instructed that my subject should be one of popular interest. The theme of “Education in Medicine” was chosen with some trepidation, not so much on account of any lack it might have of intrinsic interest, but because its elaboration might lead me to express views not entirely in harmony with popular opinion. “Education in medicine” rather than “medical education”, because I had it in mind to discuss the kind of instruction which, if within his reach, would enable the layman to recognize and appreciate some of the principles on which the practice of medicine is based and pursued. And my choice was determined by the conviction, which must be generally shared, that the practice of medicine is much handicapped by a want of understanding, and therefore of sympathy and co-operation, on the part of the public—a want of understanding, the causes of which might be explored with advantage to both parties concerned in it.

The following two case-records furnish an interesting example of similar mental illness occurring in identical twins, in which, however, in the one case the illness had come on endogenously, whereas in the other there was an apparent precipitating cause. Their age when seen was 25 years.

There is a very general impression among members of the medical profession abroad that it is only by the free use of stupifying drugs that British alienists are able to dispense with the use of mechanical appliances in the management of the insane. It cannot be gainsaid that, by the use of toxic remedies, noisy and violent patients may be as effectually controlled for the time being as by any species of mechanical appliance; nor can it be denied that in many of our asylums narcotics and sedatives are employed in such doses, so continuously, arid for such purposes as to justify the appellation of “chemical restraint.” But there are no facts to bear out the assumption that it is by excessive drugging we are enabled to avoid the use of restraining apparatus in our asylums. On the contrary, there is incontrovertible evidence to show that in foreign asylums where mechanical restraint is extensively practised, chemical restraint is likewise employed to an extent not thought of in this country. Dr. Wilbur∗ has been at pains to collect statistics for purposes of comparing the relative extent to which mechanical and chemical restraint is carried in British and American asylums. The result of his investigation clearly shows that in British asylums and in the few American asylums conducted on non-restraint principles, chemical restraint is not the substitute or alternative for mechanical restraint, but that, on the contrary, the general rule seems to be: the more mechanical restraint, the more chemical restraint.

The following is an account of the cases of schizophrenia admitted to Broadmoor from 1900 till 1931.

The use of the term “schizophrenia” in place of “dementia præcox” has rendered the classification of these cases more accurate than would have been possible with the older name, and also made possible the inclusion of several cases which otherwise would have had to be left out.