Before proceeding with the subject of this paper, it is my very great privilege to extend to the distinguished members of the Royal Medico-Psychological Association the cordial greetings of my own Chief of Service, Dr. W. Parsons, the Commissioner of the New York State Department of Mental Hygiene, who has long held in high respect his European acquaintances in the field of psychiatry; in particular, those residing in the British Isles. For purpose of clarity it should be explained that the Department of Mental Hygiene is a branch of the State Government, and the Commissioner is charged with the execution of the laws relating to the custody, care and treatment of the insane, mental defectives and epileptics in all public and private licensed institutions.

In the care and treatment of mental patients there has been great progress. In our fight against the disease, the psychosis, which disorganizes the higher mental functions, we have achieved numerous therapeutic successes. I need only mention malarial therapy in dementia paralytica, salvarsan and trypar-samide for cerebral syphilis, the treatment of the digestive organs in cases of toxæmic psychoses, the removal of focal infections in numerous cases of schizophrenic derangement, the somnifaine prolonged narcosis treatment in manic-depressive psychosis, non-specific stimulation in various other psychotic conditions. The great importance of underlying somatic causes and of a rational somatic therapy are fully recognized, and it remains the principal task of the psychiatrist to search for the causes of the psychoses and for the means of combating and preventing them.

The value of prolonged narcosis as a form of treatment in mental disorder has been well recognized in Switzerland, Germany, Holland and the U.S.A., but, so far, there has been little tendency to adopt the method in this country. It is true that there has been considerable diversity of opinion about its efficacy, but it must be remembered that much of the literature published reveals that there has been a general lack of uniformity as to technique, duration and drug used, apart from discrepancies in the interpretation of results. Furthermore, one of the most potent arguments against the treatment has been its dangers— a fact which has deterred many psychiatrists from giving it a trial. These dangers, however, instead of stimulating research into possible methods which might eliminate toxicity of narcosis, gave rise to a search for a Utopian narcotic, which would serve therapeutically whilst being free from toxic effects. No less than forty substances (according to Palmer and Paine (1)) have been tried, with but little result except to increase the confusion. In a previous communication by one of us (2) toxic symptoms of narcosis were discussed, and a method was described whereby these could largely be eliminated with doses of narcotic sufficient to produce prolonged, continuous sleep. In the present paper it is proposed to summarize and comment on therapeutic results in 107 mixed cases of mental disorder, in which a total number of 128 treatments were carried out. In 117 of these treatments somnifaine was used, in 9 veronal, and in 2 dial.

Serological tests on the blood of mental defectives have been, both here and in other countries, the subject of numerous investigations, but the cerebrospinal fluids of the entire population of a large mental defective institution have never, as far as I am aware, been systematically examined. This paper deals with the results of such an investigation in 2,000 cases of mental deficiency of both sexes, all ages and grades, patients at Caterham Mental Hospital during the last four years, and with the complications following lumbar puncture.

Examinations of the cerebro-spinal fluid, with a view to determining its starch-splitting power, have been carried out with varying success for the past thirty years, but the results which have been recorded are meagre and unsatisfying.

Within the past few years a series of papers emanating from this laboratory has dealt with the respiration of normal subjects and psychotic patients from psychological and physiological points of view. Linking up the chain of these investigations, we have tried in this study to get some information about the respiratory type and the ventilation in different groups of mental patients, especially of schizophrenics.

If anxiety be regarded as it is in this paper, as an energic problem, then the treatment of psychoneurotic, and to some extent of psychotic reactions, can be summarized under the following four headings: