In their fourth Annual Report, published in 1918, the Board of Control drew attention—not for the first time, but in more extended form than hitherto—to deficiencies in the arrangements, as at present organised, for the treatment of persons suffering from mental disorder, especially in its incipient and early stages; to the insufficiency of attention paid at medical schools to this important branch of medical science with its consequent ill-effects both to patients and to the medical profession; and to the absence of any special qualification in psychiatry, as a requirement for the higher medical posts in public institutions for the insane, such as is demanded in public health of medical officers of health of areas of above a stated size.

It is well known that with the grosser lesions of many of the ductless glands there are profound alterations in the subject's mental powers. There are doubtless many less pronounced mental alterations due to slighter lesions of these glands which are for the most part unrecognised—in fact difference in character and disposition in different individuals and in the same individual at different times may be due to the variation in the balance of the internal secretions.

When Noguchi found spirochaetes in the brain of general paralytics some years ago it seemed as if we were entering into a new era, not only in the pathological conception of the so-called “parasyphilitic” or “metasyphilitic” affections, but also in their treatment. In this latter respect most of us have hitherto been somewhat disappointed, and it may therefore be advisable to take up the rationale of the treatment for revision.