Medical Societies

1915 The Lancet  
the President, being in the chair. The PRESIDENT took for the subject of his address the Application of Physiology to the Study of Mind in Health and Disease, and his theme was the importance of the ductless glands in the human economy, especially their influence upon growth and, later in life, upon reproductive activity and integrity. He quoted with approval Maudsley's contention as to the necessity of attempting the objective method in the study of mind, for, as Maudsley said, that which a
more » ... t reflection taught incontestably the present state of physiological knowledge illustrated practically ; and Maudsley contended 40 years ago that no psychology could endure which was not based upon physiological investigations, though physiology could not expect for many years to furnish the complete data of a ' , positive mental science. Physiology, however, had now I made great advances, and in no sphere was this more notable than in the biochemistry of the ductless glands and the influence of their internal secretions on the bodily functions, an addition due, in great measure, to English physiologists. It was very desirable to apply this knowledge to the study of psychiatry. In Maudsley's work on the "Physiology of the Mind" the hormone theory was anticipated, for he said that the overmastering feelings during pregnancy and those arising from puberty could not be explained in consciousness, and that there was reason to believe that each internal organ of the body had its representative control in the supreme cerebral centre. The functional development of the reproductive organs occurring at puberty effected a complete revolution in the mentality of the youth; and he now became susceptible to impressions which were previously a matter of indifference to him ; he was now the subject of aimless longings and obscure impulses, and altruistic feelings began to germinate, and he appreciated what others had done for him in the matter of care and nurture. These feelings were not present in cases in which the reproductive organs were removed before puberty. The evolution of the sex glands was also important in regard to disease. Nature was not mindful of the individual, only of the species, and the sexual was the strongest of all the impulses. The desires had their source in the unconscious life. It was a -common saving that love was blind, yet it also added a precious seeing power to the eye, which was necessary to materialise the biochemical stimulus and effect the continuation of the species. The language of love was universal; it could not be concealed when it existed, nor feigned where it did not exist. Yet in the present condition of civilisation this was the impulse subjected to the greatest amount of repression. Insanity was especially common at two periods of life : in adolescence and at the involutionary period. He asked whether it should be assumed that the mental disorder of the true insanities or psychoses, even those which terminated in dementia, could be explained by any structural changes in the brain ; or should it not rather be believed that they were due to disturbance of the physiological equilibrium and of the internal secretions of the ductless glands, in many instances acting on a weak inheritance ? '! The interstitial gland structure of the sexual organs functioned independently of the genetic gland structure ; and functionally correlated with the sexual glands were the thyroid, the parathyroid, the hypophysis, the pineal gland, the cortical portion of the suprarenal gland, the thymus, and probably also the islands of the pancreas. For a proper study of this subject there should be a systematic examination of all these glands in health and disease, at all age periods, and in persons with and without mental disorder. He had obtained objective grounds for the association of aberrant mental conditions with disease of ductless glands in three cases of myxoedema. In the thyroid gland there was marked increase of lymphoid and fibrous tissue, and a complete absence of colloid material in one, and a great reduction in the others. There was an increase of colloid material in the pars intermedia of the pituitary gland ; and the central nervous system showed marked chromolytic changes in the nerve cells, affecting in a grave manner the autonomic bulbar system. There was an association of the myxoedematous syndrome with acute psychosis. During pregnancy the thyroid gland increased in size, and there was a marked colloid increase in the follicles ; a similar increase took place during menstruation and at the climacterium. In pregnancy, too, there was an increase in the parathyroids. There was also a large increase in the lipoid cholesterin content of the adrenal gland, and these cells were, structurally and chemically, closely allied to the cells of the Graafian follicles. The thyroid gland might be of ordinary size yet contain very little gland substance, hence it was necessary to examine microscopically. An interesting case was that of a married woman, aged 57, whose speech was said to have been slow, and who had indistinct tremors of face, hands, and tongue ; her memory was impaired, and she had no idea of time or space ; she had attempted suicide prior to admission. She became so demented that she was considered to be a case of general paralysis. Post-mortem examination, however, showed that she had not had general paralysis. The sella turcica was very large, the glenoid processes absorbed, the pituitary was twice the normal weight, and the thyroid gland very atrophied and fibrotic. There was an infantile uterus, and the left ovary was destroyed by old salpingitis ; the right one was atrophied and damaged. Probably the patient had had gonorrhoea early in life. An increase in the size of the pituitary gland might have an important bearing on the production of mental symptoms ; if the cerebro-spinal fluid served as the lymph of the brain, as he believed, excess of the colloid which irrigated the neural spaces might have an important influence on the functions of the organ of mind, but more work was required to remove this from the sphere of imagination. The ovaries of women suffering at an early age from insanity, and dying in early or late adolescence, had been found at the necropsy to be fibrotic. Dr. Laura Forster had made a series of examinations of ovaries in cases of dementia praecox. Those of subjects who had reached the age of 30 showed signs of early involution, and great scarcity of Graafian follicles ; also in cases of manie dépressive there was a diminution in those follicles. But the value of these findings was greatly lessened by the fact that in a woman who died from heart disease without any mental trouble there was a like reduction. Still, Dr. Forster's work was highly suggestive. With regard to the pineal gland, it had been shown that tumours of the pineal gland occurring in very young people had been associated with precocious development of the sexual functions and the secondary sex characters. It had been thought that the pineal gland might exert some inhibitory function on the development of secondary sex characters. As to the suprarenals, it had been known since the time of Addison that this gland was essential to life. It had been found that the emotion of fear exercised such an effect as to liberate adrenalin in excess into the blood. Elliott had dealt in an illuminating manner with this subject in the Sydney Ringer lectures. The cortical cells of the suprarenal gland were of great importance in the development of the body during its early existence, especially in regard to the brain. And it was of great importance in relation to the development of spermatozoa, and was increased in the pregnant woman; probably the material was necessary for the growing embryo. Adenoma of the cortex of the suprarenal gland had been found associated with precocious sexual development in both males and females. There was also, in the animal series, a correlation between the size of the brain and the amount of adrenal cortex ; the cells in its cortex were the source of supply of the lecithin and cholesterin required for the enormous growth of the cerebral hemispheres in early life. In conclusion, Dr. Mott said that though the subject of biochemistry was still in its infancy, it promised most hopeful results. Dr. J. G. SoUTAR (Gloucester), in proposing a vote of thanks to the President for his address, pointed out how much the clinical alienist was indebted to those who, like
doi:10.1016/s0140-6736(00)80665-0 fatcat:qls72hawqfgf5jojaqs5geete4