The Maudsley Hospital was opened on January 31, 1923, by the Minister of Health (the Right Honourable Sir Arthur Griffith-Boscawen, M.A., J.P.). Fifteen years have now elapsed since the late Dr. Henry Maudsley made his generous offer to the London County Council of 30,000 towards the cost of erection of a hospital with three main objects: (1) Early treatment of cases of curable mental disorder; (2) promotion of scientific research into the causes and pathology of mental disorder with a view to prevention and treatment; (3) provision of facilities for clinical instruction in psychiatry. The realisation of Dr. Maudsley's project was delayed in the first instance by difficulty in finding a site complying with his condition that it should be within four miles of Charing Cross, and later by the occurrence of the war.

The Lecturer, after having briefly epitomised the provisions of the Lunacy Act of 1890, continued as follows: It will thus be readily seen that the chief aims of this Act are to secure (1) That no person is received as a patient into a mental hospital or other approved place unless of a certainty he is a lunatic within the meaning of the Lunacy Act, i.e., an idiot or a person of unsound mind, etc. (2) That a person so admitted shall be discharged immediately he is no longer certifiable as a person of unsound mind and a proper person to be detained under care and treatment. (3) That he is not ill-treated or neglected while under detention. (4) That in case of his death in the mental hospital the cause and circumstances thereof are the subject of special report and possibly searching inquiry.

Between the years 1910 and 1913 I carried out a research at the Clinical Laboratory, Glasgow University, on the activating effect of the blood-serum for cobra venom in various diseases. Since then a fairly extensive research has been carried out on various forms of mental disease, more especially on the commoner forms of mental disorder and mental defect in institutions, in order to confirm the view that the auxilytic action of human serum on cobra venom in haemolysis produces characteristic reactions whereby certain diseases can be diagnosed.

There lie before me notes of some two hundred odd cases of the so-called war neuroses, the majority of which come under the heading of anxiety neurosis. Roughly about 80 per cent, are cases of anxiety neurosis, 6 to 8 per cent, anxiety hysterias, about the same number conversion hysterias, the remainder being psychoses. It is with the first I propose to deal almost exclusively.

It has been admitted that there is nothing of culture outside the contents and processes of “individual minds.” It may, therefore, be argued that “individual” psychology, or at any rate a special application or department thereof, can give an adequate account of culture. In the first place the development of culture is a matter of centuries; its progressions are infinitesimal and cannot be traced in the life-history of the individual. A history of culture has, therefore, facts of its own to deal with—if only as a descriptive science folk psychology (or ethnology) is amply justified.

In spite of the great amount of attention that has been devoted to that protean condition termed “dementia præcox,” it is not yet possible to say that any sort of agreement has been attained regarding its aetiology, pathology, or even its distinctiveness as a clinical entity. Opinion has wavered between the two extremes of the psychogenic and the physiogenic views, and extravagant speculation has risen from a limited foundation of fact. It is interesting to note Freud's (1) remarks in his recently published Introductory Lectures on Psycho-analysis, in which he says—“The edifice of psycho-analytic doctrine which we have erected is in reality but a superstructure which will have to be set on its organic foundation at some time or other.” A pronouncement of such a kind and from such a source gives one furiously to think, and invites a thorough scrutiny of our present position with regard to the problem of dementia praecox. The biological conception of mental disorders is capable of wide application, and has the additional advantage of linking psychiatry with other better established sciences. Already the study of reaction types has proved most helpful in explaining much that was hitherto obscure. Also, in the field of pathology, although it is too soon to judge of the exact significance of Sir F. Mott's (2) work on the changes found in the gonads of cases of dementia praecox and other psychoses, it is nevertheless quite clear that the conception of an inborn germinal defect has opened a new vista for research. Endocrinology, that somewhat precocious offspring of medicine, has not been neglected by psychiatrists. Langdon Brown (3) made a most helpful simile when he compared the vital process to a projectile travelling with a constantly diminishing velocity, but supplied with certain regulators capable of exerting a considerable measure of control upon this velocity. These regulators are the endocrine glands and the autonomic nervous system. He supposes that a deficient equipment of endocrines, especially the gonads, may explain the infantile outlook of the dementia praecox patient, as well as such abnormalities in bodily structure as the atavistic, monkey-like hands. He quotes Stragnell as saying, “No endocrine inferiority can be present without a psychological change, a retreat or a compensation.” It will be remembered that Adler considered that the symptoms of dementia praecox were largely the results of a sort of consciousness of organ inferiority, and that they are really methods or attempts at compensation, though ineffective, vain and misdirected. Centuries ago Lucretius (4) pointed out that the “mind is begotten with the body, grows up together with it, and becomes old along with it.” “The psyche,” says Kempf (5), “is not something which has been added in the course of evolution, its history is that of the history of the body.”

This infection, which is mostly met with in those past middle age, the neurotic, and especially in those with intestinal atony, is particularly prevalent in mental hospitals and causes a high mortality. Although many so-called cases of colitis occurring in these institutions were in reality bacillary dysentery of the Flexner, Shiga and allied types, particularly so in former years, when sanitation was more defective, yet the relation of the normal colon bacilli, as causative organisms, to this disease must not be overlooked, and with a view to studying this relationship a short account of the B. coli will here be given.

In the treatment of epilepsy numerous drugs have been acclaimed from time to time by different observers as sovereign remedies, and with few exceptions each in its turn has been discarded as of little or no value. Borax (sodium biborate) has been advocated repeatedly, and results reported by some have been remarkably satisfactory, while others have not found it worth while to persist in its use. Can these wide divergencies of opinion be explained? It would seem that as regards borax an explanation can be found from an analysis of the following results.

Lead poisoning as a factor in the aetiology of insanity has of late years become rare as a result of improved hygienic conditions among workers.

The relinquishing by Sir Frederick Mott of the offices of Pathologist to the London County Mental Hospitals and Director of the Laboratory is happily not the occasion for a funeral oration, nor does it connote a cessation of those wide activities in the world of neurology and psycho-pathology which have distinguished his career, of which his 18 years' mental hospital service forms only a part, howbeit an important one. On the contrary, as we announced in our last issue, he has accepted the appointment of Honorary Director of the Pathological Laboratory of the Birmingham City Mental Hospitals and Lecturer on Morbid Psychology at Birmingham's University. It thus happens that London's loss is Birmingham's gain, but what is more important, Sir Frederick Mott's services to scientific psychiatry are retained, and, we hope, for many years to come. In his case, as with many illustrious men who have adorned the learned professions, age has only served to broaden the outlook, to give insight, and to ripen wisdom, all of which psychological medicine sorely needs if it is to be a fruitful branch of the healing profession. His British Medical Association Lecture on Psychology and Medicine, delivered in November last (1), is illustrative of this fact, and that his pronouncements now are of more value than at any period of his career.

The serious outbreak of fire which occurred at the Manhattan State-Hospital, Ward's Island, New York, on February 18, resulting in the death of twenty-four patients and three nurses, recalls the terrible holocaust of Colney Hatch nearly twenty years ago. Although the Press reports which reached this country contained many inaccuracies, yet it is apparent that there are several features of similarity between the two occurrences.