It happens not unfrequently that a provisional diagnosis of general paralysis is made in the insane, which the subsequent course of the case fails to confirm. In the three cases on which this paper is based a diagnosis of general paralysis was made, in one of them quite confidently, and in the two others only as a last resort, because the course of the disease presented so many unusual clinical features. These three cases are specially interesting because a post-mortem examination was made on each of them, and so permitted of a confirmation or otherwise of the diagnosis, and also on account of the very interesting pathological findings.

In opening this subject, I wish to give first a few preliminary words of explanation. The object of this paper is to raise the points germane to the organisation of research. Organisation, to my mind, is the most important point in research, and the only foundation upon which successful investigation can rest. Anything which follows will be clearly understood to be merely an opinion expressed in order to open discussion and invite free criticism. The illustrations given of the difficulties attending investigation in our subject are nothing more than examples: they are not meant to be regarded as definite lines along which research should be conducted, but rather to be read in the sense of evidence brought forward in favour of a serious and co-ordinated effort on the part of those who would attempt to discover the pathogenesis of morbid psychology and neurology.

The Inverness Lunacy District, which was formed after the passing of the Lunacy Act of 1857, comprises the four counties of Nairn, Inverness, Ross, and Sutherland, and is of very large extent. Its area is, roughly, one-third of the total area of Scotland, and includes the greater part of the Highlands. Its population, on the other hand, is extremely sparse, and has been steadily decreasing during the last fifty years. It is a district in which there has been much intermarriage of relatives, and which is less open and accessible than most of the rest of Scotland to the factors that have brought about such great changes in the general life of the country during the last fifty years. In recent years, however, the extension of railways, and the wide use of motor cars, have done much to diminish this degree of isolation and remoteness.

Charcot was the first to notice the occurrence of amnesia in some of his patients suffering from alcohol-neuritis. Korsakow studied this peculiar kind of amnesia more elaborately. He regarded this condition as a disease sui generis, which could arise also from other causes besides abuse of alcohol, and used the name “polyneuritic psychosis.” It was later recognised that the same mental picture could exist without accompanying neuritis. Jolly proposed the name “amnestic” or “Korsakow's” syndrome, regarding it as a modus of reaction of the nervous system to various harmful agents, viz., head-trauma, senium, infections, poisons—alcohol being the most frequent cause of this reaction. Most later writers agree with this view. I shall deal in this paper with the cases of thirty patients, who, at some time during their illness, presented this syndrome; I have not included any cases in which alcohol could not be regarded as the principal factor.

The relations between alcohol and criminality have been considered by many students of such subjects, and figures relating thereto have been worked out by more than one observer. But these figures have applied either to some large city, or to England and Wales as a whole. No statistics have been (so far as I know) compiled for such a county as Stafford. In this paper I have endeavoured to supply this omission, having had some opportunity of considering the question while serving as Medical Officer of H.M. Prison at Stafford. The county of Stafford is, in some respects, peculiar, inasmuch as the density of its population varies greatly in different districts, and its industries are very diverse. The extreme south of the county abuts on Birmingham, and considerable parts of the county area are now contained in “Greater Birmingham.” In the south and south-west of the county are the various towns and districts which make up the “Black Country.” Towards the north of the county lies the densely-populated area of the “Potteries.” Mining districts are scattered in various parts, and there are two boroughs with distinctive industries of their own—Stafford (boots and shoes), and Burton-on-Trent (the metropolis of beer). The remainder of the county consists of agricultural and grazing land.

The case I venture to bring under your notice has been a subject of much interest to me for some time past, chiefly because of its obscurity, and now, with a view to obtaining some information rather than throwing light on the subject, I will give you its main features.

There are some pathological conditions which, though of considerable interest to the student of morbid anatomy, appear to have very little importance from the point of view of clinical study. The reason for this, sometimes at least, lies in the fact that it is difficult, if not impossible, to diagnose the onset and follow the progress of the morbid process during the life of the patient. Pachymeningitis interna hemorrhagica is essentially a condition of this kind. It is a morbid state which has been named and described for years, and yet it is a condition the diagnosis of which during life is extremely difficult. As a rule, when it is demonstrated at the post mortem, the clinical records of the case furnish us with no definite information suggestive of its presence. Often when symptoms point to the likelihood of its presence no lesion is found, while it occurs in cases which during life showed nothing special to indicate the possibility of such a condition.

D. C. G—, admitted to Hampstead on April 28th, 1914, æt. 43. Married, first attack.

From the advance that is taking place in so many directions these days a few trends attract attention by their comparative newness. Diagnostic tests such as the Wassermann, the Noguchi, the luetin, the colloidal gold colour reaction of Lange, and the cellular analysis of the cerebrospinal fluid are now being applied far and wide.

The birth of living children to female general paralytics, in whom the symptoms have so far advanced as to bring them under asylum treatment, is of a somewhat rare occurrence.