For many years it has been the policy of the London Authority to avoid the certification of patients directly from their own homes, by passing them through an observation ward before making a decision as to their disposal. The system originated partly from the fact that the London Mental Hospitals are some distance from town, and partly from the shortage of accommodation, it being necessary to secure the safe custody of the patients pending their admission. The small scattered wards have now been fused together to form larger and more efficient units, which ensure every case having the fullest consideration and investigation before deciding upon any method of disposal. The various points arising in this paper are illustrated by reference to the work of the largest of these units.

Since the passing of the Mental Treatment Act, 1930, 30 patients have been admitted to St. Ebba's Hospital under Section 5, and it is proposed to analyse the type of case admitted, and to mention some of the difficulties encountered in treating patients on a temporary basis.

The treatment of congenital syphilis, in spite of the advances in the general treatment of syphilis in the last thirty years, still leaves much to be desired. Veeder, after treating some 500 cases of congenital syphilis in St. Louis between 1912 and 1920, came to the conclusion that the results of treatment were most unsatisfactory, and that very little was to be gained by the treatment of the syphilitic child. He advocated the treatment of the parents to prevent the birth of syphilitic children. Nabarro is of opinion that the criterion of cure should be the complete cessation of any symptoms of activity and a normal blood and cerebro-spinal fluid. He has not been able to fix any limit of time after which he can regard the patient as cured. He mentions a case of his which relapsed with interstitial keratitis after having had a negative Wasser mann reaction for eight years. Ambrose King doubts whether congenital syphilis is ever really cured; he states that “cases had been seen in which manifestations of congenital syphilis appeared only after the lapse of a number of years, and others in which active lesions occurred, but with a negative Wassermann”.

When normal human skin is moderately cooled it goes blue, owing to a contraction of the arteries and arterioles, and a relaxation of the capillaries and subpapillary venous plexus of the epidermis. This blueness is light in colour. In certain individuals, however, it is deep, or relatively saturated, in the hands or feet or both; these include cases of acrocyanosis (extremity, = dark blue). This condition, though rare in the general population, is common among the inmates of mental institutions.

Among the metabolic disturbances in schizophrenia there occur in many cases symptoms which are the result of vasomotor instability or upset. The causation of this vasomotor instability is not known, and it may in turn be due to undiscovered metabolic disturbances.

In a previous paper on general and focal symptoms localization in the brain was discussed as to its principles and limitations. In the subsequent investigations a method of examination has been worked out and is here presented. It is meant to serve a threefold purpose, which should be kept in mind when the scheme is applied.

The observations recorded in this paper form part of an investigation into the mineral constituents of the central nervous system both in normal and pathological conditions.

The case reported here concerns the suicide of a voluntary patient and a subsequent claim for damages for “negligence, breach of contract and warranty”, which, after many delays, was struck out of the Assize List on account of the non-appearance of the plaintiff.

Dr. Prentice said that syphilis, in its incidence, diagnosis and treatment, presented, in mental hospital practice, problems which differed from those met with in dealing with the disease in general practice and in V.D. clinics. In the former its incidence was higher than in the general population, and that was largely because many of those whose nervous system had become affected by the later stages of the infection ultimately developed a psychosis. Drugs which were efficacious in somatic syphilis showed but little therapeutic effect in the treatment of the nervous system when affected by syphilis. There was a wide variation in the syphilis occurrence-rate among new admissions to mental hospitals, namely, from 5% to 31%; there was no doubt that incidence varied in different parts of the country; for instance, at Whittingham Mental Hospital, Lancashire, the male admissions in one year showed 21–9% with syphilis, and females 8–9%. At Narborough in the past two years—using the same methods of diagnosis—the positive males were only 7–7%, the females 4–6%. It was difficult to estimate reliably what proportion of the general population suffer from syphilis, but comparison of the figures of the Royal Commission on Venereal Diseases with those given by numerous workers in mental hospitals—excluding cases of general paresis and meningo-vascular syphilis—showed that the part played by syphilis in the ætiology of ordinary mental diseases must be a very small one. Bearing in mind the body-mind relationship, any toxic or infective process which could be a factor in the ætiology of mental illness should be dealt with. Even if the disease were predominantly psychogenic, all possible physiogenic factors should be eliminated or dealt with.