The theme of the address I am about to give—if anything so discursive can be said to have a theme—is the medical treatment of the insane during the period of transition and reform at the end of the eighteenth and beginning of the nineteenth centuries.

That there is some relationship between goitre and the psychoses is beyond all question. We have only to recall the mental syndromes of Graves' disease and endemic cretinism—goitre occurs in all but a few exceptional cases of the former, and in about 50 per cent, of the latter. Moreover it is by no means uncommon to find goitre in adult myxcedema.

The fluid obtained by the easy and now frequent procedure of lumbar puncture affords, when subjected to simple tests, valuable aid in the diagnosis of mental disease.

Mr. President and Gentlemen,—You will, I know, agree with me that there is no doctor who has not frequently been at a loss to know what treatment to adopt in a case which, although apparently simple and straightforward, continued to show no signs of improvement, and when we are dealing with mental cases this is, I think, especially noticeable. But, after all, we must admit that the means at our disposal for the treatment of mental diseases are very inadequate—differing widely from many medical and surgical conditions in which the only and proper treatment is invariably followed by recovery. In most mental diseases I am afraid we must acknowledge that there is still no specific treatment guaranteed to cure any given case: recoveries frequently occur when least we expect them, cases which we deem recoverable frequently disappoint us.

Special features of interest in two cases of epilepsy in twin sisters under care in this asylum induced me to publish these short notes, although the cases do not exhibit anything particular from the clinical side.