108 PRESIDENTIAL ADDRESS — SECTION F. 



quently than formerly in bringing about far-reaching remissions, 

 which, as iong as they last can be equivalent to a cure; unfortu- 

 nately, these remissions are not of long duration and are nearly 

 always followed by a relapse. Cases of paresis in which an 

 actual cure has been effected have only been published as 

 extremely rare exceptions. This jDsychosis only becomes manifest 

 many years (up to twenty) after the primary infection. It is, 

 therefore, a very difficult matter to get a reliable estimate of 

 the number of primarily infected persons who ultimately become 

 paretic. With regard to this most important point, Mattauschek 

 and Pilez have compiled very valuable and accurate statistics of 

 over 4,000 officers of the Austrian Army, v/hose subsequent 

 histories could be followed for a sufficiently long number of 

 years. For this material they found an incidence of paresis of 

 4'7 per cent., or nearly one in twenty. In other places figures 

 have been found which are either somewhat lower or consider- 

 ably higher. At any rate, the fact that this dreadful and fatal 

 condition awaits a certain number of infected persons, and that 

 it could not possibly occur unless infection had taken place, is 

 one of the very strong arguments in favour of effective general 

 measures to combat venereal disease. It is gratifying to note 

 that measures have been taken in the Union of late to establish 

 venereal clinics in some of the bigger centres. 



There is one other infection which is inclined to run a pro- 

 tracted course, and which is of practical importance in many 

 parts of our country, namely, malaria. Its relation to mental 

 disturbances is less clear than in the case of syphilis, neither 

 has it been studied as extensively. At any rate, there is no 

 specific group of " malarial psychoses." But in the history of 

 some mental patients malaria in repeated attacks figures as an 

 apparently important factor. And often one cannot help thinking 

 that without the malaria, the patient would not have become 

 insane. According to Dr. Leipoldt, malarial infection is also an 

 important factor in the causation of intellectual retardation and 

 enfeeblement. There can be no doubt that eradication of 

 malaria, apart from all other benefits, would also improve the 

 general mental health and vigour of the population. 



The psychoses which I have mentioned so far, clearly belong 

 to the intoxication class. Another kind of insanity which also 

 comes under this heading, is the group which was foiTnerly 

 known as dementia prfecox, but for which Bloulers' name of 

 schizophrenia is undoubtedly less inaccurate. This disease is 

 extremely important, if only because of the very great incidence. 

 The figures vary according to locality and investigators, but we 

 are not going far wrong in assessing them at roughly one-fifth to 

 one-third of all the admissions to hospitals for the insane. The 

 percentage in the Union for 1919 and 1920, as published in the 

 Commissioner's Report, was 21. In some institutions it has been 

 found to be as high as 50. An appallingly large number, surely, 

 more particularly if we realise that the major portion gradually 

 deteriorates and forms the demented residue of the mental 

 hospitals. Of the minority which get well enough to be dis- 



