In the present paper I do not intend to deal with those graver affections, such as apoplexy or paralysis, which frequently occur in the aged, and which depend on gross lesions of tissue. Nor shall I mention the severe and intractable neuralgias of advanced life. I desire to direct attention to a class of neuroses, which more or less inevitably attend the decline of life, and which, though they do not involve any serious catastrophe, are the cause of so much suffering that it is surprising that they should have received little or no systematic notice from medical writers. The neglect of these complaints is not merely a negative evil; for, owing to the fact that their neurotic nature is ignored, certain superficial symptoms which they present are treated as if they depended on functional disturbance of the liver, or ordinary stomach catarrh, &c., and very often with depressing remedies, which greatly aggravate the existing evil.

In psychiatry, generalization is a process which requires careful handling. It must be firmly rooted in everyday experience of the practical empiricism which gets results, and must be free, as far as possible, from the numerous fallacies which have brought “armchair” philosophizing into disrepute. These are formidable requirements, but fortunately one way of meeting them lies ready to hand. There are doubtless many others apparent to more fertile minds, but the one with which this paper deals rests on the fact that a patient who has been successfully treated by a psychiatrist behaves, when well again, in a different manner from that which he displayed when ill. He is cheerful, not depressed, relaxed, instead of being tense; realistic and socially enterprising as opposed to being autistic. If the term “Behaviour” is used in a sufficiently wide sense, it can cover the great majority of psychiatric phenomena without losing its cardinal virtue for the present purpose, namely that behaviour can be observed and its manifestations measured with considerable accuracy. The products of observation can be handled statistically, thereby avoiding armchair theorizing. Admittedly the interpretation of statistically derived findings presents some difficulty, but this is not insuperable. It is usually easier than the process of generalizing from observed data without the benefit of statistical pre-digestion.

The after-care of the male insane, to which I venture to draw your attention, with a view to discussion, is so closely allied to the objects of this Association that I trust its consideration may be not only of interest, but even of some practical usefulness. Although at present lying beyond the limits of our sphere of action, the time may arrive when our resources shall have so far developed that the annexation of this adjacent province may be both practicable and desirable.

The opportunity I have of speaking to you is for me both a pleasure and a privilege, but it is also, I fully appreciate, a responsibility.

The field of psychiatry to-day is not unfruitful and not a few discoveries of lasting worth appear to have been made, while certainly claims to progress of more doubtful value, both as regards letiology and even more with regard to treatment, are so numerous as to be rather bewildering, particularly when they become the subject of articles in the popular press, whereby relatives are enabled to make a diagnosis and decide on a line of treatment without any reference to the medical man.

In the past head injuries have been of comparatively little concern to the psychiatrist. As judged from statistics of admission to mental hospitals they are a small problem. Mapother (1937), for example, who took a very broad view of the causal connection found in L.C.C. mental hospitials—3 per thousand in observation wards, 4 per thousand in psychiatric O.P. depts. in general hospitals, 7 per thousand of the admissions attributable to head injuries. The increasing interest that psychiatrists take in head injuries at present is mainly due to the increasing amount of extramural work that they are being called on to do. In general hospital and outpatient practice they are bound to encounter a considerable number of problems connected with head injuries, both in the acute and in the later stages. The psychiatrists and neuro-psychiatrists in the Services have probably had this experience first, but when adequate provision of psychiatric service becomes available in the general hospitals, many cases will come into the orbit of psychiatrists which hitherto have been “disposed of” without much regard for their mental aspect.

When any belief tends to reappear in various races from age to age and under various conditions of civilisation and education, it acquires a special interest because it probably depends on some general trait in the mental organisation of our species.

Generalized xanthoma is a cholesterol disturbance of the cells, coincident with a normal lipoid content of the blood serum.

The case described involves the skull, dura mater, brain, pleura and gallbladder.

F. M., a domestic servant, aged 20 years, was received into the Inverness Asylum on 13th June, 1894, suffering from acute mania of about a fortnight's duration. There was no assigned cause for the attack, nor was a hereditary tendency to mental or nervous disease admitted.