The need for applying to cases of mental disorder the biological and bio-chemical methods of the laboratory is, it is to be hoped, apparent to all and sundry who are concerned in the treatment of these cases, whether they are styled psycho-analysts, esoteric-psycho-therapists, or psychiatrists pure and simple.

The investigation of which the ten cases here dealt with constitute the early stage was undertaken in connection with an inquiry, still in progress, into the gastric digestion of a test-meal in cases of dementia præcox. Incidentally, Sir Arbuthnot Lane includes dementia præcox amongst the conglomeration of diseases which, according to him, are traceable to coprostasis.

I have to present the results of an inquiry into the possible importance of chronic bacterial infection as a factor in the causation of dementia præcox. My conclusions are based chiefly upon the study of thirty-two early cases in which it has been possible to make a sufficiently complete examination. I have also investigated by the same methods thirty cases of other forms of acquired insanity, and over 300 cases of nervous and other disorders in persons among the general population. I have to describe the chronic infections I have found in the cases of dementia præcox, and to endeavour to estimate their relation to the malady.

The Oxford Clinic for Nervous Disorders first came into official being in the beginning of 1918, when the Committee of the Radcliffe Infirmary did Dr. W. McDougall and myself the honour of appointing us as Physicians-in-Charge of this department, and asked us to organise and run it. It was started with an outpatient department one afternoon a week and was entitled the Department for Nervous Disorders. This term was chosen as it was hoped that it would induce all classes of nervous cases to apply for treatment. Particularly for those cases which show mental symptoms was this title chosen, in the hope that such patients would come to the clinic without feeling they were being specially branded as “mental.” Opportunity would be given for treatment, and possibly improvement or even cure might be effected, and thus certification, which every one of these cases most dreads, could be avoided.

When your President did me the honour of asking me to read a paper before this Association, it occurred to me that a subject not lacking in topical interest at the present day might be such an one as the relation between suggestion and psycho-analysis. But, on second thoughts, I felt that this would be giving undue emphasis to a tendency at the present day that does not need encouragement, and perhaps one may say should not be encouraged.

The subject of the relation of recurring dreams of adult life to that almost inseparable mixture of real experience and fantasy which forms the mental life of the child was dealt with by Rudyard Kipling in The Brushswood Boy, and by George du Maurier in Peter Ibbetson, after a fashion not given to psycho-pathologists. The psycho-analytic school has of late years endeavoured to trace the genesis of the psycho neuroses to aspects of the same period generally considered less attractive. There has, I think, been less effort to establish such a connection in the major psychoses.

Change of phase is a well-recognised feature in the course of certain of the psychoses. In manic-depressive insanity it is on the phasic variation of the affective state that the separation of that type of mental disorder is based. So, also, in many cases of the chronic psychoses phase changes occur as the disorder progresses, and as the patient fits in new experience and builds up fresh mental content on the basis of the already existing delusional state.

General paralysis is often very difficult to diagnose, and the responsibility of coming to a decision is not lessened by the fatal character of the disease. Amongst the protean manifestations of neuro-syphilis, the early and definite recognition of this, its most deadly and intractable form, offers a problem in nice discrimination—a problem which is in the present tense and imperative mood. According to Southard, of 119 cases diagnosed as general paralysis, post-mortem examination revealed a diagnostic error of 26 per cent. If anyone had been able to devise a less intricate test for syphilis, the Wassermann reaction would never have survived to the present day. It is one of the most complicated methods that have been applied to diagnosis in medicine. Any simple test, therefore, which promises increased precision in diagnosis, is worthy of that careful investigation which is the half-way house to knowledge.

In this paper I should like to emphasise the technique of the colloidal gold reaction rather than the results I have obtained, for the cerebro-spinal fluids I have been so far able to examine have been mostly from cases of dementia paralytica, and, though the results are interesting and suggestive, the number of cases is too limited to allow one to dogmatise on the findings.