How wide-spread and how varied the impression was that was created by the late war between the British Empire and the Boers of South Africa, is a matter of common knowledge. There is no means of arriving at an exact idea of the influence it exerted upon one of the belligerent parties, but, so far as the people of the British Isles are concerned, there is abundant evidence to show that it produced an immediate and very profound, though unlasting, modification of national character and conduct.

In taking up the office of President of the Association, I wish first of all to convey my thanks to the members for having appointed me to this honourable position, which is at the same time so full of onerous duties, and to assure them that during my tenure of it no effort will be wanting on my part to maintain the honour and interests of the Association. The first onerous duty which is put upon the shoulders of the President is that of giving a presidential address, a duty which I can assure those who have not yet passed the chair involves no small amount of anxious thought and work throughout the year of probation allowed to the President before taking up his office.

It is a fact in Psychiatry which has by no means been sufficiently recognised, that attacks of mental disease have early symptoms that are often not mental in character; and it is equally true that in Neurology the fact has not attracted sufficient attention, that all sorts of sensory, vasomotor and motor symptoms may be the mere preludes to an attack of insanity and not of themselves the real disease. Such prodromata of so serious an event as an attack of insanity are exceedingly well worthy of careful study for many reasons, most notably because the recognition of their true character and their explanation might enable us in many cases to anticipate and possibly to ward off the mental attack. The neurologist who is called in to see a woman suffering from an unusual form of headache, with anorexia, insomnia, and obscure paræsthetic sensations, often misses the real point of the case because he does not realise that such symptoms are, in this particular patient, higher-cortical in origin, and may mean an attack of acute mania in a week if nothing can be done to arrest their course. The psychiatrist often considers a mental attack as being sudden in origin, and puts it down as an unled-up-to mental explosion, when in reality there had been sensory and motor symptoms, sleeplessness, and other indications which would have pointed to the existence of previous auto-intoxication, nerve exhaustion, or other disturbance.

The following observations are the result of three years' work in examining the leucocytes in the various patients admitted to the Perth District Asylum. During this period the blood of 150 patients has been systematically examined, not on one or two occasions only, but often for weeks and months at a time. We have observed in medical literature observations recorded on the leucocytosis occurring in various forms of insanity in which the observer had made many observations on different patients, but as a rule limited the observations made on each individual patient to one, two, or at most three occasions. Such records are of little or no value, and would be on a par with the observations of, let us say, an astronomer who, having examined the heavens on two nights out of the 365, and having found both nights cloudy, reported that no such things as stars existed. With regard to the technique employed for the estimation of the number of leucocytes per c.mm. of blood, we have throughout employed Coles' system of counting “fields” with the counting slide of a Thoma Zeiss' hæmocytometer. Never less than thirty fields were counted for each enumeration, and frequently sixty and eighty fields were counted when extra accuracy was deemed necessary.

The object of this paper is to draw attention to the nature of the social conditions that lead respectively to drunkenness and to chronic alcoholism, and to point out that these two phenomena are in great measure related to two distinct types of drinking, differing in origin, differing enormously in social gravity, and corresponding to quite different statistical measures.

Although the psychology of hallucination does not enter largely into the literature of this country, it may be gathered from the writings of our English psychologists that most of them recognise in hallucinations, illusions, percepts, and ideas a family resemblance; but the points of dissimilarity among these processes have not, in my opinion, received their due measure of consideration. I propose, therefore, to describe the ordinary psychology of these processes, drawing especial attention to their points of dissimilarity; and I will endeavour to show that, while their resemblance is mainly psychological, their difference is mainly physiological.

The subject of this paper might almost be said to have achieved immortality, and it may be doubted whether any other woman—in London at any rate—ever attracted the attention of the public to such a degree, or was the cause of so many newspaper paragraphs, during the closing years of the reign of the late Queen Victoria, as the demented inebriate whose morbid character we shall attempt to analyse.

My object in reading this paper before this important Association of mental experts is twofold: first, to draw attention to the great frequency of mental symptoms developing in the course of an attack of bodily illness; and secondly, to the unsatisfactory condition of our system in this country in dealing with and treating persons suffering from temporary mental disease.

The type of imbecility with which my paper deals is chiefly met with in the special institutions and in the out-patient clinics of children's hospitals, and is fairly common in this country. The somewhat scanty literature of the subject, however, includes descriptions of the leading features of the class which differ a good deal in detail. This divergence of opinion is due, I think, mainly to the fact that observers are by no means agreed as to the degree of deviation from other types which qualifies an imbecile for inclusion in the Mongol group—a disagreement easy to understand when we realise that there is hardly one single feature which can be regarded as peculiar to Mongolism. Further, many recorded cases have been noted only at an early age, when certain later-developed aids to diagnosis are wanting. I have thought it of interest to record my observations of twenty-one well-marked cases met with among the 2000 inmates of Darenth Asylums, where the minimum age of admission is five, trusting that they may afford some guide to the mental and physical forecast advisable in dealing with the infant.

Reviews, abstracts, and papers concerning this subject having appeared from time to time in the Journal of Mental Science, I shall, with the exception of making a few incidental explanatory quotations, confine myself to an account, more or less brief, of some of my own cases and to the remarks suggested by them.

At the Annual Meeting of this Association held at Liverpool two years ago I had the pleasure of giving an account of the work which I was then doing, on the medullated nerve-fibres of the cortex cerebri, and I endeavoured to demonstrate that a comprehensive study of the form and arrangement of these constituents in the normal adult condition afforded a useful guide to precise localisation of function.

On June 13th, 1750, Dr. Thomas Crow, Mr. William Prouting, and four other gentlemen met in a tavern in Exchange Alley, their object being to promote the establishment by subscription of a hospital as a further provision for poor lunatics. They drew up certain “considerations,” which were printed and distributed to the public.

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 have thought that at the present time, when there is a prospect of systematic school provision being made for epileptic children in accordance with recent legislation, the attention of this Association might usefully be called to the necessities of the case.

For a considerable period before the now practically universal system of caution cards was adopted in our asylums, other methods had to be resorted to in order that special attention should be given to suicidal patients. In the earlier established asylums, when the various duties, clerical and otherwise, of both medical officers and attendants were less mapped out for them, when, in addition, the number of patients was very much less, the then existing verbal caution was in general use, and was considered fairly efficient.

It must be gratifying to us that our Association has in a great measure solved for itself the problem of registration which is now agitating the nursing world and divided it into two hostile camps—those for and those against registration.

Gheel is a well-worn theme on which it is hard to say anything that is very fresh. But circumstances of various kinds have of late contributed to renew general interest in this ancient settlement. The condition of lunacy affairs in our own country is somewhat fluid just now, and the insertion of any foreign object may help to bring about solidification. Finally, I had occasion to revisit Gheel during the past summer. On the whole, when I was asked for a paper for to-day it seemed not unsuitable that I should fall back upon this time-honoured topic.

During the past year we have frequently used antiserums experimentally in cases of acute insanity because we have been led to believe from our observations that many of these cases, either primarily or secondarily, are suffering from bacterial infection. The grounds upon which we base this belief are that we frequently find hyperleucocytosis, and in forty-eight out of seventy-six cases examined we have found bacterial agglutinines in the blood which do not exist in the blood of healthy people.

The criticism that, at the Annual Meeting, I applied to Tables IV and VI, was purely destructive, and while it was, as I think, efficacious, it is open to the retort that the criticised tables must stand, unless I can suggest something better. The object of this present communication is to suggest tables which shall not be open to the objections which I have urged against those proposed by the Statistical Committee.