When I accepted the great honour of giving the Maudsley Lecture this year, I was instructed that my subject should be one of popular interest. The theme of “Education in Medicine” was chosen with some trepidation, not so much on account of any lack it might have of intrinsic interest, but because its elaboration might lead me to express views not entirely in harmony with popular opinion. “Education in medicine” rather than “medical education”, because I had it in mind to discuss the kind of instruction which, if within his reach, would enable the layman to recognize and appreciate some of the principles on which the practice of medicine is based and pursued. And my choice was determined by the conviction, which must be generally shared, that the practice of medicine is much handicapped by a want of understanding, and therefore of sympathy and co-operation, on the part of the public—a want of understanding, the causes of which might be explored with advantage to both parties concerned in it.

In a recent lecture on “Individual Psychology and the Bases of Science,” Dr. Crookshank declares that Adler “like Socrates … condemns … the pursuit of knowledge for its own sake, as a futile attempt to transcend the limits of human intelligence” (p. 54). Again (p. 48): “… the real problem is that of right living—the pursuit of knowledge for its own sake is a delusion and a snare, a delusion inasmuch as absolute knowledge is unattainable, and a snare inasmuch as it draws us away from the study of conduct”.

When a defence of insanity is put forward in answer to a criminal charge amnesia for the crime is not infrequently affirmed, in fact East (2) states that it is more often alleged than any other mental anomaly. The defence of amnesia is at times raised when there are no grounds for supposing that the prisoner is suffering from loss of memory, but there are undoubted cases where the crime, generally homicidal in character, has been committed during a disorder of consciousness or the memory of it subsequently has been lost. It is therefore of the greatest importance from a medico-legal point of view to distinguish between real and simulated amnesia. While amnesia may be simulated in cases where there is no mental disorder present, there are also instances where loss of memory is feigned by individuals in whom there are other reasons for regarding them as mentally abnormal. In this connection it must be realized that memory also is sometimes malingered; a prisoner who by reason of insanity accompanied by amnesia has escaped the responsibility for his crime may presently arrive at the conclusion that a persistence of his loss of memory will tend to keep him confined in an asylum, and therefore he asserts a remembrance of his crime, the story of which he is likely to have become familiar with at his trial or elsewhere. Not all such false memories, however, are definitely malingered. A patient may have heard the story of his crime so often that in the end he becomes convinced that he actually remembers it.

In 1923, under the title, “The Illusion of Doubles in a Case of Systematized Delusional Insanity” (1), J. Capgras and J. Reboul-Lachaux described for the first time an interesting syndrome of non-recognition. The case was that of a persecuted and megalomanic woman in whom there existed a condition of agnostic identification without disturbance of sensory or memory images. The patient postulated a series of “doubles” replacing the various persons of her environment, even her husband and daughter being included. During the course of a few months she complained that she had been shown one thousand doubles of her daughter. The person confronted was appreciated to resemble exactly the known individual, but on account of some subjective disorder, the ability to identify her was lost and the belief in “doubles” brought forward in order to explain this state of non-recognition.

During the last nine months of 1931 a series of 175 cases were tested for syphilis by means of several reactions, and the results were reported in this journal in January, 1932. During the next nine months the work was continued and considerably extended, and we shall here give the further results thus obtained, together with a statistical expression of the findings of both periods combined.

Acting on the theory that hyperpyrexia is the effective agent in the treatment of general paralysis by malaria, Neymann and Osborne (1) experimented on dogs to see whether, by means of diathermy, sufficient heat could be generated to raise the temperature of the experimental animals to a high degree without injurious results.

This being found practicable, they devised a method of applying diathermy to the human subject, with the same purpose in view.

They found that they were able, by using a suitable set of electrodes, and by thorough insulation of the individual, to raise the body temperature to any height, and, moreover, to keep the temperature under definite control.

During the last few years, in which pyretotherapy has figured so largely in the treatment of general paralysis of the insane, the question must have arisen in many minds whether general paralysis occurs in communities where malaria is indigenous, and if so, whether satisfactory results would be obtained from further malarialization on artificial lines.

The Central Mental Hospital of the Federated Malay States has over 2,500 patients in residence, and draws its cases from the whole of the Malay Peninsula. Many races are represented besides the native Malay and associated races—Chinese, Japanese, Siamese, Indian, etc.—and malaria is indigenous over the whole territory.

The following paper is the result of experience gained during two and a half years' work at The Retreat, York.

It was prepared at the time that public attention was being focused upon the Mental Treatment Act, 1930. One of the most striking features of that Act was the provision that any person—pauper or otherwise—could be received into any mental hospital by applying for admission voluntarily. The removal of the bar of certification was widely welcomed; this welcome was believed by the writer to be partly a sentimental one. So little was known of any of the legal and medical difficulties which the voluntary boarder system had produced during the forty years it had been in fairly constant use in the registered mental hospitals, that these problems were seldom referred to when the Mental Treatment Act was under consideration.

It is now universally recognized that there is nothing specific in the form of psychoses associated with childbearing. There is, however, still a tendency to attribute to the puerperium itself or to pregnancy or lactation a significance quite out of proportion to that of other precipitating factors; thus such terms as “puerperal depression”, or “puerperal schizophrenia” are still in use, as if the precipitating factor were something special as opposed to the innumerable other causes assigned to the appearance of an attack of mental disorder. Nor is this surprising when one reflects on the enormous significance of the sexual life. One is quite willing on a priori grounds to grant to the puerperium this all-important rôle.

On the evening of Monday, April 25, 1932, the members of the fourth Study-tour of Mental Hospitals met at Cleves, seven miles east of the Dutch-German frontier. Two of our party used a private car and the others a motor coach, into which we had detrained at Nymwegen. We were joined there by Dr. Kraus of Santpoort and Herr Rou, an able and zealous guide, whom the Hamburg-Amerika Linie had sent to ease our way, and facilitate our intercourse with the German colleagues receiving us.