Gentlemen,—It is customary for the President of a Section to open the proceedings by an address, but I feel that it would serve a more useful purpose if I opened the discussion on the diagnosis and treatment of parenchymatous syphilis by giving an account of the observations which I have been making regarding the microscopic and bio-chemical pathology of tabes and general paralysis; for it is by an understanding of the pathological processes underlying these diseases that we are able to make a correct diagnosis, and prevent their occurrence or arrest their progress. My personal experience of the effect of treatment is somewhat limited as compared with that of many of those who are to take part in the discussion, and therefore I shall especially devote my attention to the observations which have been made in the Pathological Laboratory of the London County Asylums.

The association between the artistic temperament and eccentricity has frequently been noted, and in the lives of Turner, Vandyck, Michael Angelo, Benvenuto Cellini, Morland, Romney, Maclise, Landseer, Haydon, Cosway, and many others there is much to support Nisbet's contention that “nerve-disorder is a fundamental element of genius in relation to colour and form.” To the list already given, the name of William Blake may fittingly be added, for, just as some of those named at times passed the boundary which separates sanity from insanity, so most certainly did Blake also cross the borderland.

During the spring of this year, my friend Lieutenant Crocket, R.A.M.C., obtained, through the kindness of Dr. Noguchi, a small supply of luetin, and with this he carried out a series of tests, to which he was anxious to add some observations on its use in mental cases. By permission of Dr. G. M. Robertson he was able to examine a series of cases in Morningside Asylum, and I was fortunate in being asked to co-operate with him. Owing to our small supply of luetin, the number of tests done was necessarily limited, and we intended carrying our observations further when Crocket was called away to duty. Only a short time ago the sad news of his death in action was received, and it is largely on this account that I venture to place on record so small a number of observations.

In the Lancet, July 4th, 1914, I have briefly described the method of what I called “subdural injection.”

Juvenile general paralysis is of interest as illustrating one of the many ways in which syphilis may produce its detrimental effect on the human race. The disease may commence at a very early age; according to Thomson, progressive symptoms may be evident in children as young as three years. Males and females are victims in practically equal proportions. The symptoms are very similar to those of the adult form, progressive dementia being very marked; such variations as are present are due to the more undeveloped mental state of youth, and on the whole it corresponds to the demented or confused type of the adult. Periods of acute excitement, or of mental depression, are met with, and epileptiform seizures, which may be present at any stage, are often observed. Delusions of persecution are not uncommon, and grandiose delusions occur; hallucinations are also evident occasionally at some time during the course. In the younger patients a type of advancing spastic diplegia is most common, and even in older cases spastic symptoms are more prominent than in the adult form. The pathological appearances in the nervous system have the same characteristics as those seen in cases of mature age. The duration is usually from two to four years, although sometimes it may be more protracted.

It happens not unfrequently that a provisional diagnosis of general paralysis is made in the insane, which the subsequent course of the case fails to confirm. In the three cases on which this paper is based a diagnosis of general paralysis was made, in one of them quite confidently, and in the two others only as a last resort, because the course of the disease presented so many unusual clinical features. These three cases are specially interesting because a post-mortem examination was made on each of them, and so permitted of a confirmation or otherwise of the diagnosis, and also on account of the very interesting pathological findings.

From the advance that is taking place in so many directions these days a few trends attract attention by their comparative newness. Diagnostic tests such as the Wassermann, the Noguchi, the luetin, the colloidal gold colour reaction of Lange, and the cellular analysis of the cerebrospinal fluid are now being applied far and wide.

During the last year, scientific activity seemed to be suspended by the war; the societies devoted to the study of mental diseases could not meet for want of members, and the publication of specialist journals was temporarily postponed. It is not yet the proper time for examining the psychiatrical consequences of the present events, and such a study will be more pertinently carried on subsequently to the conclusion of hostilities. So an epitome of French psychiatry only covers a period of seven months, from the beginning of January to the end of July.

This is the nineteenth annual report of the parent asylum at Abbassia, and the second of the new asylum at Khanka.