Primitive brains and intelligences, whether in earliest man, utter savages, young children or the feeble-minded, find it difficult or impossible to handle abstractions fast and rationally; on the other hand, interest and skill in cerebrizing the abstract, pro tanto is an index of high intelligence. On this “perfectly good” psychological basis psychiatrists as a class are persons intelligent above the average, and properly may be so considered. Thus it may be assumed that if they do not continuously bring into use every available aid and contribution to their science (and probably most of them do not), it must be mostly due to lack of opportunity and of habituated interest. And that, of course, is the still obvious fact.

When a patient is admitted to a mental hospital his condition is investigated from a number of angles. His physical state is ascertained, including the condition of his blood and his cerebro spinal fluid; he may be found to exhibit such and such a neuro logical symptom. His mental state is probed into, his intelligence estimated, his emotional reactions noted, his complexes even may be progressively dug up. As a crowning summit to this edifice of knowledge a label is at last attached to the case, and a diagnosis arrived at.

In order to obtain a complete account of these facts and factors from every available source, and to get the co-operation on behalf of the patient, it is necessary that the relatives, the physician and the nurse of the patient be presented with the data in a comprehensive form.

There are many references in neurological literature to pathological changes in the globus pallidus in diseases accompanied by muscular tremor and rigidity, such as paralysis agitans and post encephalitic Parkinsonianism.

I do not propose to attempt any critical review of what has already been written on the subject which forms the title of this paper, but merely to lay before you my own experience. At the same time I may remind you that there is distinguished support for the view that a close association exists between insanity and disturbances of the cerebral circulation caused by cardiac defects.

Volvulus is not a very common condition. In large general hospitals the incidence is about one case or two cases a year. It has occurred here at Prestwich eleven times from 1923 to 1927, and comparing the huge population served by a general hospital with the number resident in a mental hospital the frequency of the condition is out of all proportion. This fact is the reason for the present paper, giving some account of the condition and stating the factors that were present in the cases. Whether certain types of mental cases are liable to develop this pathological state is a matter which will be discussed, and about which the experience of others will be welcome.

It is now nearly sixty years since Langdon-Down first distin guished the mongol, and it must be admitted that to-day the ætiology of this type of idiot is as obscure as ever.

In a previous communication it has been shown that among intestinal bacteria of the coliform group Bacillus paracoli and Bacterium coli mutabile are at least four times more common in the insane than in the general community, and that they are to be found in great number in at least one-half of the former during acute phases of illness. It was suggested that both the illness and the increase of these bacteria might be due to a third factor, namely, to the action of some other intestinal organism, since certain workers had found that colon bacilli when grown on phenol varied to the mutabile type, and it is well known that phenol is formed in the intestine by certain bacteria.