Suggestions have from time to time been made as to the probable functions of the basal ganglia, but so far none of them appear to have been very satisfactory.

It seems to be generally accepted that the optic thalami are not merely sensory centres for every or any special kind of sensation, but are large association ganglia, and it is the endeavour here to point out from anatomical, pathological, and other reasons the kind of associations with which they are probably concerned, and the very important part they play in the life of all animals possessing them.

Until the specific causes of the various types of colitis are ascertained dysentery may be regarded as a group of symptoms which are presumably the result of microbic action, although it does not follow that the organisms which have been isolated from the intestines are invariably the specific cause of the symptoms, or that their presence will necessarily produce the symptoms; even the Shiga (or Flexner) bacillus, which is looked upon by many as the origin of non-amoebic tropical dysentery, has been found in the fæces of healthy persons (v. Allchin). It is probable that the specific organisms are some of the various bacilli and micrococci which are commonly to be found in the intestines, and which are normally benign in character, but through certain influences within and around the subject, become pathogenic.

The brief summary of the results stated in this paper is based upon an examination of thirty-five cases of general paralysis and seventy-seven cases of psychoses other than general paralysis.

The interesting paper by Dr. Turner published in this Journal upon the blood-pressure in the insane has led me to make these few remarks, which I have based upon a large number of observations obtained by Martin's modified Riva-Rocci sphygmomanometer. I attempted besides taking the systolic pressure to estimate the diastolic also, but my results in the latter case were not satisfactory, for so many likely errors were always present.

It is not surprising that weakmindedness should be common amongst the habitual frequenters of prison, but the proportion of those who become certifiably insane is small. How very few are there of our ordinary asylum patients who come from the slums, or at least the criminal class. Is it that, in these less cultured individuals, crime and alcoholic excess take the place of insanity, each of them being a signpost marking distinct paths of degeneration, or does insanity exist, but is not recognisable as such? The unavoidable importance placed upon conduct in determining insanity amid the ordinary respectable conditions of life may prove misleading in the case of those in whom what is commonly called bad conduct is a normal condition. A distinguished alienist tells how he was once called to see a lady, and on being introduced to her she spat in his face. Without more ado he sat down and certified her. It may be that many amongst the criminal classes suffer from there being no possible obverse to this picture. I have seen men sent into an asylum suffering from delusions of long standing whose condition never caused their friends a serious thought till some Monday morning they refused to go to work, and before next pay-day they were certified. I have seen men sent to prison for habitual failure to support their wives or for neglect of their children where there seemed to be distinct mental enfeeblement, not certifiably obtrusive like a delusion, but in the particular circumstances as potent a factor in the lapse of conduct.

In the mass of conflicting evidence which has accumulated in recent years as to whether organisms are the exciting factor in the production of certain insanities, I have found it difficult to discriminate between cause and effect. Is the organism or group of organisms the specific pathogenesis of certain insanities or merely a bacteræmia secondary to the psychosis?

The presence of delusions, whether arising primarily or following other mental states, is significant of a faulty cerebral action, yet the co-existence of normal ideas suggests that the morbid process is limited to certain groups of nerve-cells. It is thus reasonable to suppose that many of the nerve-cells associated with ideation are in such cases working normally. There would appear to be “wrong thought centres” or “wrong series of associations” giving rise to delusions.

The class of defectives with which I propose to deal briefly in certain of its aspects consists of those persons over school age who are capable of earning a living in favourable circumstances, but are incapable, from mental defect existing from birth or from an early age, (a) of competing on equal terms with their normal fellows, or (b) of managing themselves and their affairs with ordinary prudence—a definition which, though rather rough, may be accepted as of some value in practice. Such persons have been found by the Royal Commission on the Feeble-Minded to constitute about 40 per cent. of all aments in the United Kingdom; and it has been estimated that their numbers in England and Wales amount to between 50,000 and 60,000. In my investigation, in the City of Dublin I found 365, or 30 per cent. of all aments. Thus they deserve separate study from their numbers alone, apart from the fact that, owing to their relatively high intelligence, they at once are more dangerous socially, and repay help better, than any other class of aments.

The object of this paper is to consider whether it is necessary or advisable to introduce ordinances for the discouragement of parenthood on the part of the “unfit,” and the encouragement of large families on the part of the “fit,” in fact the eugenic principle, and to those who believe that the only true cure of insanity is its prevention, the subject must be of vast importance.

In a former paper diet was referred to as a part of the management of the epileptics under care in a mental hospital, and the opinion expressed that, on a diet mainly purin-free, tendencies to serial fits, confused states and dream states appear less marked.

It is only within the last few years that any serious attempt has been made to investigate the viscosity of the blood and to find out what importance, if any, could be attached to the variations in the fluid friction of the blood in health and disease. Prior to this period a few physiologists did pay attention to this subject, but many of their results have been ignored on account of the difficulty encountered by the coagulation of the blood. Defibrinated blood or blood to which an anti-coagulator had been added was used in later investigations.

But why the term communicated? Is insanity catching? Such was the question asked by this Journal some five years ago referring to a case of so-called communicated insanity mentioned in a county asylum report. In this article I shall endeavour to bring evidence to show that in some few cases apparently it may be so.

The Lunacy Commission, it is rumoured, is to be increased to the extent of an additional medical and an additional legal member, but the amalgamation of the Medical Chancery visitors with the Commission is not yet carried out, even if seriously contemplated.

Manifestations of anæsthesia, mental confusion, and moods are frequently met with in general medicine and psychiatry. Their occurrence is not confined to pathological states; in normal people it must be studied in the domains of physiology and psychology. It is by no means always easy to differentiate the physiological from the pathological, or in psychology the normal from the abnormal. This difficulty in demarcation has tended to render investigation arduous and the findings imperfect.

The value of Wassermann's reaction in the diagnosis of syphilitic and the so-called para-syphilitic diseases is now generally conceded, but, apart from the technical difficulties in carrying out the test, which places it beyond the means of all except those working in well-equipped laboratories specially licensed, the fact that it merely enables one to diagnose a previous syphilitic infection in nearly all its stages, detracts somewhat from its value as a means for the special diagnosis of general paralysis or tabes. Wassermann's reaction tells us what nearly every patient is able, if willing, to tell us; whereas the protein reactions, especially that described by Ross and Jones, appear, so far at any rate as my observations go, to be much more specific in the information they yield. The Ross-Jones test in my hands only gave a positive result in general paralysis and cerebral syphilis.