On November 21, 1822, a young man named A. L. J. Bayle presented a thesis for the Doctorate of Medicine to the Faculty of Paris. It was entitled “Recherches sur les Maladies Mentales,” and it was sustained. In this thesis Bayle recorded the opinion that general and incomplete paralysis and mental disorder, when they developed side by side, were caused by chronic arachnitis. In other words that these two groups of phenomena—a certain form of paralysis and disorder of the mind—were the associated symptoms of a definite disease, having a distinctive pathological anatomy. This was an opinion never expressed before by anyone, and it has since then been proved to be true in its essential features. The disease he referred to is now known as general paralysis of the insane.

The gracious act of the British Medico-Psychological Association in asking me to deliver the Maudsley Lecture for 1923 is thoroughly appreciated, not only by myself, but also by the medical profession of Canada, showing as it does a further development of the relationship steadily increasing between the Mother Country and the Dominions, I shall not say Colonies, as this term has long ago become unpopular with the rising generations beyond the seas. We feel that we occupy a modest place in the list of nations, we yield to none in our devotion to King and Country, and regard a United Empire as absolutely necessary in preserving the ideals essential for the highest development of the human race.

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 material dealt with in this investigation was collected from 110 cases dying in the London County Mental Hospitals and various General Hospitals and Hospitals for consumptives.

The average mortality from tubercular disease in mental hospitals is over nine times that of the outside population, and as regards dysentery, which is rarely met with among the sane community in this country, the Board of Control state that “during the second half of 1921 some 728 persons were attacked by the disease in mental hospitals and of these 126 died.” It is a most serious reflection that consequent on admission to a mental hospital a valuable life may be lost, such as, for instance, that of a young mother suffering from nervous shock after confinement, as a result of infection with one of these pathogenic organisms. It is therefore a matter of most urgent necessity that everything possible shall be done in order to eliminate dysentery from our mental hospitals and to reduce the mortality from tuberculosis; and now that the voluntary boarder principle is likely to be adopted for public mental hospitals it becomes more than ever necessary.

In the course of toxic and febrile processes, such as occur in association with typhoid, erysipelas, malaria, pneumonia, influenza, psychoses may arise. Amongst the infection-psychoses may be counted also the insanity of the puerperium. In association with epidemic encephalitis various psychoses develop—a fact of significance in the problems of the pathogenesis of these states. Of peculiar interest is the occurrence of disorders of motility in the course of, and after, this disease, resembling muscular disorders in katalepsy and katatonia. A recent and valuable addition to the literature of this subject is furnished in an article by Skliar, who has had the unusual experience of seeing mental disturbances in the course of typhus and relapsing fever, prevalent in Russia during the three winters 1918–1920, inclusive. He also describes five cases of Lyssa in which psychotic disturbances occurred.

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.

We cannot avoid this difficult and theoretical discussion of first principles. The distinction between social and individual phenomena must be defined and shown as real, relative, abstract, etc., as the case may be. We cannot, for example, understand the inter-relations of the group and the unit unless we can form a clear idea of their respective natures. Even the literature of social psychology is not helpful or intelligible to us until the meaning and validity of such conceptions as group mind are definitely established. Hugo Munsterburg, for example, writes: “We compare the social mind with the individual mind. Such a comparison is not meant as a metaphor. It is a true, far-reaching analogy, an account of really corresponding processes.” He then works out the most elaborate parallel, even in regard to “physiological basis.” But parallels never meet, and though this one may be suggestive, it is not helpful to the understanding of the interaction of the social and individual minds—i. e. the psychogenesis of the group and the socialisation of the individual or even in forming clear ideas of these two and their relations. Other writers use group mind as a mere figure of speech, for others again it is a transcendent reality.

When approached by the President of the Medico-Psychological Association to give a short address at the Annual Meeting I chose the above title. On reflection, however, I find it is somewhat over- ambitious and cannot be dealt with in the time at our disposal. It would be better, perhaps, if I endeavoured to place before you some broad principles relative to the close association between neuropathology and psychiatry, and indicate the data in support of the view that anatomically, physiologically, and pathologically the entire nervous system must be regarded, along with its endocrinic appendages, as a unit, each of whose component parts reacts upon the others.

Urea is the compound in which the greater part of the nitrogen from protein metabolism is normally excreted, and of which it forms an important index.

It is extremely befitting that this Association should be interested in the relation of chronic sepsis to mental disorders, principally for the reason that this idea had its origin in England. As early as 1875, Savage, the English alienist, reported the recovery of cases of mental disorder following the extraction of infected teeth. The full significance of this report, of course, was not realised at the time, for if it had been recognised, an entirely different history of the care and treatment of mental disorders during the last century would have been written.

We attribute great psychopathic significance to the stresses incident to the adjustment of the individual to his culture. Everyone is supposed to bear the marks of this conflict. In fact, this disharmony is blamed for all human unhappiness and inefficiency not due to famine and disease. If this opinion is justified how is it that culture, the product of the mind, is not better adapted to the needs and natural capacities of its creator?

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.

It is interesting to recall that fifty-five years ago Maudsley wrote as follows:

I greatly appreciate the honour which the Society has done me in asking me to read a paper by way of introducing a general discussion on the treatment of mental disorders. My remarks will deal with the relationship of physical disorder to mental symptoms. The main point to which I will more particularly draw your attention is to the need for a closer study of the extent to which mental symptoms are the result of some auto-intoxication or infection from one or other of the free mucous surfaces of the body, the gastro-intestinal tract being, in virtue of its size and function, the most important channel. If the relationship is a close one our outlook on mental disorders necessitates greater attention being directed to the investigation and treatment of our patients with the aid of modern methods, than has hitherto been done. The literature of the subject contains many references of a general kind to what is called the toxic factor in the ætiology of insanity, but the systematic investigation of mental disorders from this point of view has not yet been carried out with the reasonable degree of completeness which modern medicine demands. In this connection it is right to refer to the valuable and suggestive work carried out by Lewis Bruce many years ago, the probable significance and value of which has, I think, been largely lost sight of. There is little new in the conception of the aetiology and treatment of mental disorders, which I am going to present for your consideration. It is, however, largely new in the sense that it has not yet been adequately tested. Prof. Robertson has lately drawn my attention to the interesting fact that the leading alienists in France more than 100 years ago entertained the view that the primary cause of mental disorders was to be found in visceral changes. Pinal in his classical text-book on mental disorders in 1809 wrote as follows:

Two methods are available to determine the reaction of a fluid. The first is the method of titration for acidity or alkalinity, in which a standard solution of acid or alkali is added until a certain change in the colour of a suitable indicator is detected. The second method is to determine the hydrogen-ion concentration present in the fluid. The latter is the only satisfactory method of measuring the reaction of a fluid. The hydrogen-ion concentration expresses the reaction of neutral, acid and alkaline solutions. The electrical is the standard method, but for clinical purposes is too intricate. The colorimetric method is less complicated. It is based upon the fact that each indicator has a characteristic zone of hydrogen-ion concentrations within which its colour changes occur. For details as to the theory and technique of this method, the reader may be referred to Clarke and Lubs (J. Bacteriol., 1917, ii), and Cole (Practical Physiological Chem., pp. 19–30).