My address to you to-day consists of observations on a number of subjects connected with the care of the insane, which may be of interest to you either because they are specially associated with Scottish administration, or because of their topicality at the present time.

Prof. Golla, in introducing the discussion, said: I do not think there is any subject that is of greater importance at the present moment than the physiology and the pathology of the circulation of the central nervous system. I am dealing now with the physiology, with a view to putting a few facts before you which are fairly well authenticated, and pointing out how very little we know at present. I do not intend to speak of the pathological aspect, but I may remind you, in passing, of such things as the therapeutic effects of amytal and of CO2. Again, in the case of epilepsy, whatever one's ultimate view of epilepsy is, we are all agreed that circulatory disturbance plays a very large part.

Vascular lesions, identical in appearance with the sequelae of organic diseases of the blood-vessels, have been found in a great variety of conditions (for instance in epilepsy, hypertension and cardiac disease, psychoses associated with infectious and toxic conditions, head injuries, certain groups of mental deficiency) in which no organic lesion of the blood-vessels themselves could be demonstrated. The theory has been put forward (Ricker, Spielmeyer and others) that these lesions owe their origin to functional disorder of the vascular system, and that this common factor accounts for the identity in histological appearance in spite of the profound ætiological differences.

Though many of the earlier workers made statements based on general impressions from injected preparations about the relative vascularity of different parts of the brain, only comparatively recently has an attempt been made to measure and express numerically the capillary development in different areas, by methods similar to those used by Krogh in studying the vascularity of muscle. Craigie has made an extensive study of the rat brain by such methods, Cobb, and Cobb and Talbot have investigated certain areas of the rabbit brain, and Dunning and Wolf certain parts of the nervous system of the cat. In the present paper a personal investigation (undertaken at the suggestion of Dr. Cobb) is reported, comparing the basal ganglia, cerebral and cerebellar cortex of the cat as regards capillary vascularity. The capillaries were demonstrated by Indian ink injection, and results expressed in millimetres of capillary per cubic millimetre of tissue. Substantiating observations were made on similar areas of monkey and human brains, but without attempting accurate measurement as in the cat material.

It has been calculated that over one-third of the total number of cases receiving sickness benefit have some form of nervous disorder (1), and 1 of 22 persons has to be placed in a mental hospital at one time or another (Carrel, 2). Social prejudice, however, still bars adequate support of psychiatric research, and much scientific work is hampered through lack of financial help.

The circulatory factor in the pathogenesis of mental disorder can be dealt with in at least two different ways. The exposition can be narrowed down to a mere description of what we know for certain about the psychiatric significance of circulatory disturbances. On the other hand, I think it not less legitimate to look at the question as a highly fascinating problem, the full bearing of which upon psychiatry we are only just beginning to discern as a dim shape on the scientific horizon.

I have been asked to speak to you about the psychological implications of functional circulatory disorder. Unfortunately there is no generally recognized system of the functional disturbances of the circulation. For this reason, and also for want of time, I shall be able to deal only with a few sections of the problem.

The clinician's share in a discussion on psychoses of circulatory origin must be to provide, in the first place, a description of the characteristic clinical pictures. This would mean the enumeration of a rather puzzling variety of observations, among which it has until lately been rather difficult to find any systematic order. One could scarcely add very much to the classical chapter on arteriosclerotic psychoses in Kraepelin's text-book. Since, however, Dr. Krapf has singled out the hypertensive psychoses as a special group, the task is no longer one of pure description. The application of the achievements of general medicine to the field of hyperpiesis should have opened new aspects in cerebral vascular disease. Supplementing the fundamental ideas given in Dr. Krapf's own paper, I propose to give you a more detailed survey, with some illustrations.

Miss H. R. N—. Date of birth, November 11, 1889.