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ROYAL MEDICO-PSYCHOLOGICALASSOCIATION.

ANNUAL MEETING.

THE annual meeting of this Association took placein London on July 10th, llth, and 12th, under thepresidency of Dr. NATHAN RAw, C.M.G., who delivereda presidential address on

Fear.He began by saying that fear was of immenseimportance to the community and of particularconcern to a large number of individuals. A highauthority had stated that fear was the driving forceof life, without which there would be quiescence andno bodily reactions. Certainly if we had no fear ourinstinct of self-preservation would be useless. Butan aspect which had an enormous bearing on lifewas a needless and morbid apprehension. The lateDr. Mercier entitled his book " Disorders of Conduct,"averring that of mind he knew nothing. Dr. Rawquoted in full Mosso’s classical description of his ownfeelings when called upon to make a speech, andadded his own observations on men afflicted withstage fright when required to address their fellows.A former master of his own, who was a professor ofrhetoric, at the beginning of a nervous affection couldonly speak sitting, owing to excessive trembling ofthe legs, and at last he had to renounce the triumphsof his great eloquence as he was afflicted with atemporary paralysis. The President thought theonly way to find a solution of this distressing statewas to analyse, without prejudice, all that wasknown about cerebral activity, and to see whatphysiologists had discovered in studying the emotionsand the physical phenomena of thought.He acknowledged that it was normal to fear ; it

was one of the emotional manifestations of a primalinstinct and ordinarily expressed itself in efforts atflight or concealment. The Langue-James theorycontended that an emotion was the sensation of thevisceral changes accompanying it. There was noneed of proof that visceral changes accompanied fear,pallor of skin, trembling of limbs, dilatation of pupils,protrusion of the eyes, which were said to be due toexcitation of the adrenals. Reflex action played animportant part in the exhibition of fear. The Langue-James theory was rejected by many great psycho-logists. The real solution was that fear was indicativeof a defensive mechanism, that this was excited bythe perception and realisation of danger, which setin motion a physical mechanism to defend life.Sherrington, by his brilliant work, showed that inanimals the basal ganglia were the seat of the primaryinstincts and emotions. Hughlings Jackson taughtthat the emotion of fear arose in the cerebral cortex.Cowardice was uncontrolled fear; it was abnormaland antisocial to be a coward. The really brave mandid not run away, but not because he had no fear ;he overcame it and faced the danger. There was,however, a limit to human endurance, and thediabolical methods used in the late war had playedhavoc with the nervous systems of thousands ofbrave men, so that they would never recover.Fear associated with disease was well known.

Delirium tremens was not now nearly as frequentas it was 20 years ago. Edgar Allan Poe, who diedof it at 37, had left a ruthless analysis of the experi-ence. Many people lived in constant dread of suchdiseases as cancer, tuberculosis, blindness, or insanity.

National fear was of immense importance ; wholecommunities might be seized with a subdued fear ofattack from more powerful neighbours. The questionwas often asked : Is religion based on fear ? It hasbeen said that fear formed the stock-in-trade of manyirrational forms of ecclesiastical propaganda. Whenreligion, which should appeal to the highest instinctsin man, debased itself to the point of appealing tothe lowest and meanest instincts, it undermined thevery foundations of character, poisoning the fountainof life at its source. - Any religion which appealed

primarily to fear was doomed to decay with the dawnof more universal intelligence. The fear of deathhad long been recognised as an instinct, and Rousseausaid that he who pretended to face death withoutfear was a liar. This fear was a natural impulse, andwas not merely an accident. Schopenhauer, however,said that from the point of view of intelligence therewas no ground for fearing death ; only those withblind faith could subdue this fear of death. Thefinest examples in history of the calm resignation tothe inevitable were furnished by the aristocrats ofFrance when perishing by the guillotine in the FrenchRevolution.The description of the human emotions given by

Charles Darwin 57 years ago had never been excelled.Worry was a comparatively recent product, thoughfear dated from the dawn of human intelligence. Nochildren should be brought up to fear their parentsor anything else. And too many teachers seemed tothink that their secondary, if not their chief, functionwas the creation in their pupils of inferiority com-plexes ; certainly worry over examinations was aprolific cause of academic failure. We could neverhope to conquer fear, but we should learn to control it.

Dr. REGINALD WORTH proposed a cordial vote ofthanks to the President for his address, and Dr.BEDFORD PIERCE seconded.On July llth Dr. W. M. FORD-ROBERTSON (North-

ampton) read a paper entitledSorne Cases of Mental D’is01’der: A Patho-Clinical

Study.in recent years, he said, research into mental

disorders had tended to become, more and more,the study of the pathology of the living, and to thisthe advances of biochemistry had largely contri-buted. He did not think the study of focal infectionby bacteriological methods would lead very far.More effort should be made to correlate its local andremore effects in disordered hsemopoiesis, disorderedmetabolism, disturbed endocrines in relation to thepatient’s economy as a whole. It seemed that inmental disorders one had to deal with bacteria of aspecial type, which probably could only adapt them-selves as chronic infective agents to a certain groupof the community-i.e., those who had a neurotoxicsusceptibility. This needed that one should searchfor new methods of bacteriological technique, studythe results, and attempt to correlate cause and effect.Knowledge of the somatic disorders underlyinginsanity was, as yet, so limited that attempts tocontinue on these lines would lead only hesitatinglyalong the progressive path. Efforts should be con-centrated more on the individual as a problem inpathology. There had been up to the present alamentable lack of proper collaboration betweenbiochemist and bacteriologist.

Dr. Ford-Robertson’s main thesis consisted of adetailed account of the findings in 120 cases of mentaldisorder which had been thoroughly overhauled, andfour of these were given with minuteness. Theyserved, he said, to emphasise how complex, indeedelusive, were the problems of the physical disordersunderlying insanity. His observations led him tobelieve that the person of psychotic tendencies failedto reveal clearly the underlying pathology of theinternal environment by ordinary signs and symptoms.Surgical removal of foci of infection alone could notbring about recovery. Yet focal infection was of thegreatest importance in mental disease. He hadsatisfied himself that the insane harboured anaerobicbacteria of the diphtheroid and lepto-streptothrixgroup which often infected the major part of thealimentary canal.

Dr. W. F. MENZIES (Cheddleton) discussed thecontribution at some length, and expressed regretthat the association had not provided in its rulesfor the admission of the pure biochemist, as he wouldbe a great acquisition for this kind of research.

Dr. J. R. LORD (Epsom) also spoke, pointing outthat it was not so much a matter of the presence ofseptic foci in these cases,. but that the toxins were

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absorbed. In the latter event a biochemical problem.arose, which, if not adjusted, led to dysfunction ofsome part of the nervous system. Neuro-toxinsseemed to have a degree of selectivity of action,,different toxins selecting different functional zones.

Other Subjects Discussed.Dr. GORDON PETERS (Epsom) read a paper on

’Charcot’s Joints in Tabo-paresis. He related threecases of general paralysis of the insane who werealso afflicted with Charcot’s disease of the spine.,One remarkable case was that of a woman of 29,the subject of congenital tabes who had sufferedfrom Charcot’s spine from an early age.

The morning of July 12th was taken up with aconsideration of the Report of the Mental DeficiencyCommittee (1929), the discussion being introducediby Dr. A. F. TREDGOLD.

In the afternoon Dr. LORD spoke on a ModernApproach to the Problem of the Admission of MentalPatients to In-patient Treatment. The points he.dealt with specifically were : (1) the non-interventionat any point of a judicial authority ; (2) the adminis-trative recognition of the non-volitional case ; (3) thepower of local authorities to deal with (and retain.as necessary) occurring mental disorder on lines.as far as possible parallel with those practisedin regard to infectious and other physical diseases ;(4) notification of all non-volitional and involuntary-cases to the local authority, and the latter also to acentral authority ; (5) certification to be abolished.and replaced by a system of confirmation or con-tinuation of the initial action taken by the localauthority, or by a panel specially nominated by thelocal authority ; (6) all institutions receiving volun-tary cases who are retained voluntarily and non-volitional cases to be registered and subject tovisitation by the local authority ; (7) active prophy-laxis by the psychiatrisation of public assistance work.A discussion followed.On Wednesday the Association dined together,

with the President in the chair, and the guestsincluded Lord Riddell, the Mayor of Westminster,Dr. Pameijer, Sir Arthur Robinson, and severalforeign delegates. On Thursday afternoon a recep-tion and garden party took place at SpringfieldMental Hospital.

Obituary.KENNETH ARTHUR LEES, O.B.E., M.B.,

B.CmR. CAMB., F.R.C.S. ENG.,ASSISTANT SURGEON FOR DISEASES OF THE THROAT, NOSE AND

EAR, ST. bTARY’S HOSPITAL, PADDINGTON.

Kenneth Lees, who died following an operationfor cerebral tumour on July 23rd at the age of 48,was the son of the famous physician David Lees, andearly decided to follow his father in the study ofmedicine. He passed from school to King’s College,Cambridge, gaining a first-class in the Natural ScienceTripos in 1903. In 1905 he elected to join St. Mary’sHospital, where his father, originally a Guy’s man, wasgiving clinical teaching to crowds of appreciativestudents. Though his untiring energy and keenenthusiasm, when he was working under his father’sinspiration, were apparent, Kenneth Lees showeda great inclination towards surgery. He qualifiedM.R.C.S., L.R.C.P. in 1907, took his Cambridgedegree in 1909, and became F.R.C.S. Eng. in 1912.He held a succession of resident posts at St. Mary’sHospital, and in 1914 was promoted to be surgicalregistrar. During the war years this post was astrenuous one. It involved full afternoons in thetheatres and emergency operations, as well as

much of the teaching in wards and out-patientdepartment normally undertaken by members ofthe honorary staff. All those who worked withMr. Lees during those trying times, when the staffwas seriously depleted as the resultof the war, testify

to his unfailing promptness in answering every call,night and day, and to his equanimity and urbanity.The students who passed through the hospital duringthis time were indebted to him for coaching at uncon-ventional hours, and many owe their examinationsuccess to his conscientious efforts and good-humouredragging, His services to the hospital were recognisedby the award of the O.B.E.Though Mr. Lees always retained a great liking

for general surgery, circumstances led him to specialisein diseases of the nose, throat, and ear; he wasappointed to the staff of St. Mary’s in 1919, andlater to other hospitals, including the Queen’sHospital for Children, Hackney. His interest in thisbranch of work increased every year, and his widesurgical experience gave him from the outset a matureoutlook on all aspects of a case which many specialistsonly acquire late in life.

Outside his work Mr. Lees had many interests. Heenjoyed golf, and his car meant more to him than justa means of easy transport. He was a keen Masonand he was Worshipful Master of his hospital Lodgeat the time his fatal illness manifested itself. KennethLees was retiring in disposition, but in congenialcompany he showed a whimsical humour and keenappreciation of wit in others. He married, a fewyears ago, a niece of the late Dr. William Hill.

THOMAS EAGLESON GORDON, M.B., B.CH.,PRESIDENT OF THE ROYAL COLLEGE OF SURGEONS IN IRELAND

PROFESSOR OF SURGERY, TRINITY COLLEGE, DUBLIN.

THE death occurred on July 27th, at his residencein Dublin, of Prof. T. E. Gordon, President of theRoyal College of Surgeons in Ireland, in the sixty-thirdyear of his age. He had been in bad health for severalmontns past, ana. naa.recently resigned hispost as Surgeon to theAdelaide Hospital,Dublin.Thomas Eagleson

Gordon, a North Irish-man by birth, was

educated at TrinityCollege, Dublin, doinghis professional coursesat the Adelaide Hos-pital ; he graduated in1890, and in 1895 tookthe Fellowship of theRoyal College of Sur-geons in Ireland. Afterholding a residentappointment at theAdelaide Hospital, hewas appointed Assist-ant Surgeon ; he hadalready been electedVisiting Surgeon to theCity of Dublin Hospital, but resigned this post to returnto the Adelaide Hospital. His professional career wasbound up with this institution, for he remainedin active work there for 35 years, and was senior sur-geon from 1915, until ill-health forced his retirement afew months ago. In 1916 he was appointed to the chairof surgery in Trinity College in succession to the lateMr. E. H. Taylor, and during the war was attachedto the 83rd (Dublin) Hospital, B.E.F., with the rank oflieutenant-colonel.

Prof. Gordon was an attractive and accom-

plished teacher, both in hospital and in his professorialwork, while he was particularly interested in hisduties as curator of the pathological museum in

Trinity College, and did much to make the splendidcollection of Robert Smith and Edward Bennett morereadily available for teaching purposes. He was aman of wide culture, well read in history and archoeo-logy. He was elected President of the Royal Collegeof Surgeons in Ireland last year, and in June of thisyear was elected for a second year. His death isgreatly regretted by his professional brethren.

PROF. T. E. GORDON.

Photo by Lafayette, ])Ublin