The need for applying to cases of mental disorder the biological and bio-chemical methods of the laboratory is, it is to be hoped, apparent to all and sundry who are concerned in the treatment of these cases, whether they are styled psycho-analysts, esoteric-psycho-therapists, or psychiatrists pure and simple.

The story of the founding of the German Institute of Psychiatric Research reveals the astonishing fact that a great enterprise, requiring millions of marks, and serving in the first instance purposes of pure science, has been carried into execution, even amid the tumult of the war, in little over a twelvemonth. The preparatory work dates back, of course, to the pre-war period, but the scheme had to give place to the great task of the day, until, on January 6th, 1916, with the subscription of the first half-million marks, the possibility of its materialising came suddenly within reach. Six months later the future of the new Institute was firmly assured, and on February 13th, 1917, His Majesty King Ludwig was able to grant the charter that gave it being. On June 10th, 1917, was held the first public meeting at which the position of the Institute with regard to the development of our science could be made plain, and in April of this year (2) five of the seven departments originally projected had taken up their work under the leadership of eminent savants. The others will follow as soon as the circumstances of the time permit a satisfactory solution of the problem of personnel.

We are met to fulfil the behest of one of the most distinguished physicians of psychological medicine of recent times. Maudsley was a leader in his lifetime, and he lit a lamp for research which it is our duty and that of the generations which follow after to keep burning. He was a man with a great insight and practical withal, for he has left behind him benefactions which are endowed by his inspiration and which must live with increasing benefit to mankind. The acuteness of Maudsley's vision is demonstrated by the method in which he founded these lectures; he perceived, and perceived rightly, that mental disorder was not purely a medical problem, but that there was a lay side to it which was of vital importance, and in consequence he directed that in alternate years a scientific and a popular lecture should be given. He wrote that “there are not many natures predisposed to insanity but might be saved from it were they placed in their earliest days in exactly those circumstances and subjected to exactly that training most fitted to counteract that innate infirmity.” No doubt this connotes much, and to some it may seem an overwhelming task. For it would appear to include a full appreciation of how mental disorder is brought about; what, if any, are the precursory indications, and what symptoms, when present, should be regarded as potentially dangerous to the future welfare of the mind of an individual. The inquiry is a fascinating one, and the problem can be more quickly unravelled by the working of physician, psychologist and educationalist in close collaboration. Mental disorder unfortunately, as things are at present, only becomes a medical matter when it has advanced a considerable distance, but this must be changed, and it must be our endeavour as physicians to control its very beginnings. Whilst it is right to devote time and energy to examine scientifically every means by which the recovery or the alleviation of mental disorder may be brought about and to use them to the full, in the end the return for these labours must be limited; to control its gateways and to prevent its occurrence far out-rivals any treatment of disorder that has once become established. In fact it is doubtful whether a complete recovery ever does take place in the sense that the patient is free from any scarring from the experience he has passed through. Preventive medicine is the side of medical science which is most attractive, offering as it does benefits of infinite value both to the individual and to the nation. Investigation tends more and more to establish the view that many disorders have their inception in childhood and experience confirms that this is true of the more common types of mental disturbance. It is on this account that I have decided to take as my subject for this lecture “Some Aspects of Education and Training in Relation to Mental Disorder.” The term “education” will be used in its widest sense and will connote the instruction and upbringing of the child both at home and in the school.

The dominating motive which for more than a generation has directed the activities of the asylum authorities in Scotland has been the desire to make the asylum in that country an institution, inspired by the same exalted principles and conducted on the same medical and nursing methods as those existing in our great general hospitals. That ideal has the supreme merit of being simple and tangible as well as high, for the voluntary hospital is the most perfect embodiment of practical humanitarianism and science at present known to us, and the position it occupies is unique among medical institutions. The more nearly this ideal is reached, the more closely will the care of those suffering from mental disorder approximate to a state of perfection, and the more completely will the asylum be transformed into a hospital for the treatment of a special disease. This is what is understood by the phrase, “the hospitalisation of the asylum,” which was first used in 1902.

IN order to understand venous stasis in its several relationships to the functions of the brain, it is advisable to refer to some of the problems which have been the most difficult with which neurologists and psychiatrists have had to deal. The aspects of the problems studied have been so varied, and the interpretations of the phenomena so widely different, that it has hitherto been almost impossible to obtain any degree of unanimity of opinion. In dealing with the aetiology and pathology of disease one of the first considerations ought to be to determine, if possible, the existence of physical or mechanical factors of causation.

Mr. President, Ladies and Gentlemen,—Last year I had the honour of delivering the Maudsley Lecture, and I brought forward a certain amount of evidence in favour of the genetic causation of dementia præcox. I have continued these investigations and published the results in papers entitled “Further Pathological Studies in Dementia Præcox, especially in Relation to the Interstitial Cells of Leydig,” Proc. Roy. Soc. Med., 1922, vol. xv (Section of Psychiatry), pp. 1–30; also “The Reproductive Organs in Relation to Mental Disorders,” Brit. Med. Journ., March 25, 1922. The former investigation included 27 cases of dementia præcox, the onset occurring in adolescence; also the results obtained in 9 cases of psychoses other than dementia præcox occurring in post-adolescence, and 4 cases of primary dementia, in which the demential symptoms came on in post-adolescence. From these investigations, and from others which I have been pursuing, I have come to the conclusion that it is better to speak of primary dementia, which may occur either in the pre-adolescent period, adolescence, or post-adolescence; moreover, I am of opinion that all the psychoses belong to one group and are genetic in origin. In those forms of psychoses in which recovery takes place—for example, confusional insanity or exhaustion psychosis, benign stupor, periodic insanity, or manic-depressive insanity—we may assume there is a suspension of neuronic function in the highest psychic level; but all these conditions I have found may end in a terminal dementia, in which the changes in the reproductive organs and in the brain do not differ from those met with in the primary dementia of adolescence, the dementia indicative of a suppression of function. In the primary dementias, naturally, the symptoms may be partially due to a suspension, and partially to a suppression of function, and I would explain partial remission of symptoms by a partial restoration of function in neurones in which the nuclear change was either not present or not advanced.

The investigation of which the ten cases here dealt with constitute the early stage was undertaken in connection with an inquiry, still in progress, into the gastric digestion of a test-meal in cases of dementia præcox. Incidentally, Sir Arbuthnot Lane includes dementia præcox amongst the conglomeration of diseases which, according to him, are traceable to coprostasis.

The influence of the internal secretions is exerted by means of chemical substances—very few of which have been isolated or satisfactorily examined. Many of these substances closely resemble in their action that of medicaments, especially such drugs as the alkaloids. So far as their physiological action is concerned drugs can be classed in two divisions, viz., those which increase the excitability of irritable tissues, and incidentally induce their activity when quiescent; and those which diminish their excitability, and incidentally produce quiescence if administered during activity. As instances of the action of those two kinds of drugs on the nervous system strychnine and morphine may be mentioned; similar examples may be found in the action of antagonistic drugs upon the secreting glands, upon skeletal, plain, and cardiac muscle, and upon protoplasm in general. The principle is of extensive application, some drugs being definitely excitatory, others definitely inhibitory, the effect, whichever it may be, being produced by a reaction between the chemical substance which forms the active constituent of the drug and a constituent of the living tissue, this being in certain cases represented by a special material, termed by Langley “receptive substance,” which has in all probability been formed under the influence of the nerves which pass to the tissue. The action of the internal secretions is due to specific chemical substances which act upon or react with constituents of the cells. Such reaction, as in the case of drugs, tends either to increase or to diminish the excitability of particular tissues, either stimulating the living substance to activity or increasing its activity, or decreasing or arresting any activity that may be present. The expression “chemical messenger” was employed by Bayliss and Starling in their work on the action of secretin upon the pancreas to denote any material circulating in the blood which tends to excite a tissue to activity. Subsequently the word “hormone” was invented by Starling as a short equivalent—not, as he is careful to insist, to be confined to the chemical principles of the internal secretions, but to be used also for any chemical substance, of whatever nature or origin, which acts as an excitant; e.g., Starling gives as an example of a hormone the CO2 of the blood, which, when conveyed to the medulla oblongata, excites the activity of the nerve-cells composing the respiratory centre. Subsequent writers, e.g., Biedl, have displayed a tendency to restrict Starling's term to the active principles of the internal secretions, in place of using it, as he himself proposed, for all chemical substances exciting activity—a proposition in strict accordance with its derivation, which is from the Greek word μαω, I excite. This restriction of the term is the more unfortunate because it has become customary by most authors to include under the term of hormones or excitants substances which have exactly the opposite effect—that, namely, of restraining or inhibiting activity, the custom having arisen probably from the fact that at first the existence of such substances was not sufficiently recognised. Since it is obviously improper to apply the term “hormone” (or “excitant”) to inhibitory substances, I have ventured to propose that an analogous term, “chalone,” derived from the Greek word χαλω, I restrain, should be employed to designate such substances, and that a general expression denoting their drug-like character should be used to describe all the specific principles contained in the internal secretions which promote changes in other organs, whether in the way of excitation or inhibition. Such an expression is appropriately found in the term “autacoid,” which is derived from the Greek words oA, self, and kP, drug or remedy, i.e., a drug-like substance produced within the body itself: the latter part of the expression being already in general use in the form “panacea” or universal remedy. A striking example of a chalone or restraining principle is furnished by the ovary, which produces in its internal secretion a chemical substance—not as yet isolated—which restrains the development of the male characteristics in the female. When this restraint is lacking, as occurs after removal of the ovaries, a tendency to development of male characters makes its appearance. A hen, for example, deprived of its ovary develops the bodily form, the tail, comb and wattles of a cock, crows like the male bird, and even attempts to “tread” other hens. And if the ovary of another individual is successfully transplanted into such a bird, the chalone which is contained in its internal secretion inhibits the tendency to develop male characters, and these presently disappear, so that the animal again assumes all the characters of a hen. Nor is this occurrence of a chalone in the generative glands confined to the hen. There is one variety of Sebright fowls in which the cocks are hen-feathered. In this breed, as has been shown by T. H. Morgan, the testis contains cells, similar to certain cells in the ovary, which apparently yield a chalone, similar to that of the ovaries of ordinary breeds of fowl. And when the testes are removed from the hen-feathered Sebright cock, the castrated animal assumes the plumage characteristic of the ordinary cock-feathered variety of Sebright. Since, therefore, there are two principles of opposite character yielded by the internal secretions, I shall in speaking of their action upon the nervous system employ the expression “autacoid” as a general term to denote the active chemical agent of any secretion, and the special terms “hormone” and “chalone”—with their adjectives “hormonic” and “chalonic”—to express the mode of action of particular autacoids according to whether this is excitatory or inhibitory. These preliminary remarks are introduced to enable those members of my present audience who are not familiar with the history of the subject, and especially with its nomenclature, to understand exactly what is meant by the expressions I propose to use, in order to avoid the confusion which would otherwise result from the employment, as is so frequently done, of the same term—hormone—in opposite senses.

I have to present the results of an inquiry into the possible importance of chronic bacterial infection as a factor in the causation of dementia præcox. My conclusions are based chiefly upon the study of thirty-two early cases in which it has been possible to make a sufficiently complete examination. I have also investigated by the same methods thirty cases of other forms of acquired insanity, and over 300 cases of nervous and other disorders in persons among the general population. I have to describe the chronic infections I have found in the cases of dementia præcox, and to endeavour to estimate their relation to the malady.

In the Journal of Mental Science, vol. xlviii, 1902, p. 53, I described a case of degeneration of the optic thalami in a male patient, and pointed to the fact that the symptoms were chiefly those of very advanced dementia.

The Oxford Clinic for Nervous Disorders first came into official being in the beginning of 1918, when the Committee of the Radcliffe Infirmary did Dr. W. McDougall and myself the honour of appointing us as Physicians-in-Charge of this department, and asked us to organise and run it. It was started with an outpatient department one afternoon a week and was entitled the Department for Nervous Disorders. This term was chosen as it was hoped that it would induce all classes of nervous cases to apply for treatment. Particularly for those cases which show mental symptoms was this title chosen, in the hope that such patients would come to the clinic without feeling they were being specially branded as “mental.” Opportunity would be given for treatment, and possibly improvement or even cure might be effected, and thus certification, which every one of these cases most dreads, could be avoided.

Mr. President, Ladies and Gentlemen,—In view of what has already been said to-day I am afraid that anything which I may be able to contribute to this discussion will be superfluous, but perhaps, by approaching the subject from the point of view of the influence of certain chemical substances on the general function of the animal organism, an additional side-light may be obtained on this subject. It is difficult to separate many of these chemical actions, as the functional activity of the endocrine glands and the nervous system are so intimately connected. In addition the active principles of some of the endocrine secretions are now identified as definite chemical compounds closely allied to other substances which may possibly be produced in the organism under pathological conditions.

The object of this paper is to raise the question whether the endocrinoses are not secondary to psychical disturbance but primarily caused by it.

When your President did me the honour of asking me to read a paper before this Association, it occurred to me that a subject not lacking in topical interest at the present day might be such an one as the relation between suggestion and psycho-analysis. But, on second thoughts, I felt that this would be giving undue emphasis to a tendency at the present day that does not need encouragement, and perhaps one may say should not be encouraged.