It seems a long time ago since I spent days, even nights, observing and examining cases of epilepsy in the epileptic wards of Hanwell Mental Hospital. I had always felt drawn to the epileptic, and epilepsy was ever a fascinating subject to me.

The problem of the treatment of defectives is somewhat different from that met with in regard to the patients in mental hospitals. In the case of mental hospital patients most of them have filled useful positions in the world, and also the percentage of possible recoveries is hopeful, and many of them are able to resume their former occupations. But mental defectives are social misfits, many with anti-social traits, others neglected and ill-treated, and again others of a much lower grade, many of whom are helpless and even cot-cases.

Last summer we had admitted to our hospital a case of the involution period in the female, which presented such notable features from the clinical aspect that I was stimulated to the discovery of the “whys” and “wherefores” it presented. An involution case, I found myself confronted with certain problems of an endocrinological nature, which are the experience of all psychiatrists.

The time for a discussion of occupation as a means of cure or betterment in cases of mental disorder has long been overdue, and needs no apology. The papers which have been read deal with its practical aspect, and relate in a convincing way what has actually been accomplished. My aim is twofold. In the first place, I wish to give a short historical résumé of occupation as it has affected Gartnavel, and in the second place, to discuss its importance and value.

Any paper on the “boarding-out system” in Scotland would be entirely incomplete without a reference to the recent death of its distinguished advocate and supporter, Dr. John Fraser. For seventeen years as a Deputy Commissioner Dr. Fraser visited patients throughout the length and breadth of Scotland, and his interest and enthusiasm in the method lasted to the end of a long life. His devotion to duty and the high standard he always set are fully appreciated by one who, as a Deputy Commissioner, is privileged to come after him, and finds a daily difficulty in adequately following in his footsteps. It is matter of real regret that he is not with us here to-day.

The complement-fixation test, or, as it is known more popularly, the Wassermann reaction, was at one time considered the only reliable laboratory test for the diagnosis of neuro-syphilis. It is a complicated biological reaction, and requires expert knowledge, theoretical and practical, before any deductions can be made as to whether a patient suffers from neuro-syphilis or not. In the majority of cases the cerebro-spinal fluid has to be sent to a special pathologist attached to some general hospital, and in many cases it means sending the fluid to other towns.

America has lately been the scene of a murder, and a consequent trial, both of which were remarkable even for that land of sensations. The circumstances of the crime were quite out of the ordinary. The questions discussed at the trial were of the utmost psychological and medico-legal importance. The local newspaper reports, together with many other details, were sent to us through the kindness of Mr. Stephen M. Reynolds, of Chicago. We thus have information which few, if any, in this country possess. The actual trial lasted thirty-two days. The mere reading of the reports was a heavy task. We then had to separate from the mass of journalism those points in the evidence which might be taken as established. And we think that a summary thereof may be of general interest.

At the Annual Meeting of this Association held at Belfast last July, Sir Frederick Mott gave you an address on the thyroid gland and promised a further contribution with regard to the iodine content. This paper is an attempt to correlate the iodine content with histological structure and with the mental and bodily condition of the patient. I must apologize for the work being far from complete, as most of the time since then has been taken up with the examination of the published methods for the estimation of iodine in the gland, and owing to certain objections to these methods it has been necessary to invent a process without these objections, and which, at the same time, is carried out with a minimum expenditure of time and material.

It is a common experience in the investigation of mental disorders that glycosuria is frequently found, thus indicating a tendency in such cases to a faulty carbohydrate metabolism. With the exception of epilepsy, this occurrence of glycosuria has been noted in most mental conditions. Intermittent glycosuria is met with in general paralysis (Kraepelin) (1); Bond (2) and Strauss (3) note it in about 10 per cent. of their cases. In dementia prócox Schultze and Knauer (4) did not observe glycosuria in the apathetic form of hebephrenia, but often found it to occur with catatonic excitement. With other observers (see Allers (5)) they record the marked association of glycosuria with depressed states, while its occurrence in mania was infrequent except in markedly excited and resistive cases.

The great improvement in the staining of spirochætes devised by Jahnel and others so simplified their photography that ordinary flat-print microphotographs of these organisms became familiar to most of us years ago.

The term “moral imbecile” used in the Mental Deficiency Act is generally recognized as an unhappy one. It is responsible for much difference of opinion as to the class of case which can be properly so described. There is a view widely held and often ex pressed that the number of such cases is very small; that to certify them is an unsafe procedure, and that consequently, their inclusion within the Act is of little or no practical value.

The following paper presents the results obtained from the investigation of enteric fever at Cane Hill Mental Hospital. For some time past there has been a persistent incidence of enteric fever on the female side of this institution. The cases have been sporadic, and as ail circumstances pointed to the existence of “carriers” as the cause, it was deemed advisable to conduct an extensive bacteriological examination on all possible sources of infection.

In the preceding communication the results are given of the investigation of a series of cases of early mental disorder for defects in carbohydratemetabolismby the study of blood-sugarcurves, following glucose ingestion. The investigation revealed the occurrence of an abnormally sustained hyperglyc@mia in a large proportion of these cases; the results are interpreted as a defect of the carbohydrate storage mechanism. As the liver is largely concerned with glycogenesis, it appeared that the hevulose test applied to these cases might afford some explanation of the abnormal findings.

For many years the treatment of epilepsy has been a grave problem, and it may truthfully be said that, until the pathology of the so-called idiopathic cases has been worked out, we area long way from treating this condition in anything like a satisfactory manner.

The word “unconscious” is used in Freud's sense; the word “suggestion” is used more in the general sense of the presentation of an idea to the mind than perhaps in the more technical sense of McDougall.

According to the late Sir William Bayliss, a leading physiologist, the vitamins, which the plant alone knows how to manufacture, are a kind of chemical messengers (hormones). “They are obtained from the plant, and are particularly abundant in fresh green vegetables and fruit.” … “Their precise mode of action is still unknown, but in their absence normal growth and function is impossible and certain diseases make their appearance.” Hence the normal growth of the animals depends upon stimulations and influences directly derived from the plant kingdom. The evolution of the animal is in large part directed by the plant, which is also saying that it is cosmically directed, in virtue of those terrestrial and solar influences which the plant purveys. But it is also saying, in a most important sense, that all organic evolution is directed by the amount of mutuality existing between the kingdoms and what this involves in bio-sociality. If the vitamins are, in Sir William's words, “obviously a kind of chemical messengers,” then we must consider them as the hormones of symbiosis, as “messengers” of health—the diametric opposites of the alkaloids, the vegetable poisons which are of appalling efficacy in the physiological economy of the animal. By symbiosis I mean not parasitism, not commensalism, but definite, almost deliberate, mutual adaptation for the purpose of mutual service, on the part of living things, nearly always of different orders of creation, broadly, that is, between the plant and the animal (“Norm-symbiosis”).

Post-mortem examination of brain.—The dura and leptomeninges are normal and there is no excess of fluid. The right hemi-cranium is health. Section of the left shows a large area of rather recent hæmorrage into the substance of the white matter of the left occipital lobe. This area is confined to the white matter of the lobe, and does not communicate with either the posterior horn or the descending horn of the lateral ventricle, or the exterior.