Through the kindness of Dr. Mercier we have been favoured with an advanced copy of the first instalment of a new work recently completed by him on the subject of Causation, with special reference to causes of death and causes of insanity. Owing to conditions now existing in consequence of the war, with, as a result, an extreme scarcity of suitable literary material for publication, as explained in the October number of the Journal, the Editors have had to face quite unprecedented difficulties; and they wish here to express their acknowledgments to Dr. Mercier for so generously coming to their aid in what may almost be termed a crisis in the history of the Journal. The second (and final) instalment of Dr. Mercier's book will appear in the April number.

Ladies and Gentlemen,—I wish your President, especially as you are condemned to abide under his aegis for a second year, had been a man able to enthrall you with some lofty theme appropriate to this time of stupendous events.

The purpose of this paper is to develop the thought that delusional formations fulfil a definite function; they are the expression of certain underlying trends in the individual, and they satisfy certain needs. At the present time there is a reaction against the tendency to regard classification as the ultimate aim of clinical psychiatry. While the separation of mental disorders into certain broad groups has its obvious uses, it is being recognised that classification in itself is not a very vital point, and it does not take us far in the understanding of our cases. Not only is each case a member of a particular group, but in a certain sense it is an entity in itself; the odd behaviour, the delusions and hallucinations, have an individual significance; they are the outgrowth of personal conflicts and aspirations, and the whole psychosis is no more than one form of reaction to experience.

Hitherto a difficulty in forming a just opinion as to the value of the colony treatment of epileptics has been the inability to keep trace of the patients after they have left the Colony. In connection with the Lingfield Colony (which has nearly 300 epileptic patients), an attempt has now been made to follow up, and obtain a report upon, those patients who have left the Colony during the last 4½ years. To this end a circular was sent to the different local authorities asking for their co-operation in this investigation, and thanks are due to them for their prompt response. The number of cases inquired into totalled 101. The number of reports actually received was 100, but 20 of these were blank, the patients having disappeared without leaving an address.

Within recent years a considerable amount of work has been done upon the bio-chemistry of cholesterol, and valuable information has been acquired which has thrown light upon the important part which this substance plays in numerous physiological and pathological states. It will be of value in connection with the results described in this paper to shortly review some of the more outstanding facts which have been discovered.

The South Yorkshire Asylum, Wadsley, near Sheffield, was offered to the War Office by the West Riding Asylums Board under the scheme prepared by the Board of Control.

The accompanying photograph illustrates an attitude when sitting frequently adopted by many cases of dementia praecox. The point to which special attention is directed is the position of the arms and hands. The arms are held close to the trunk, with, as a rule, the elbow-joint in a condition of stiff extension and the hands in pronation, and resting on the lower part of the thighs, or even on the knees. When the photograph was taken there was no special posing for the purpose of this note, the subjects merely being told to sit down. In the wards I have seen these particular patients as well as others maintain this position for hours at a time. They sit, as a rule, rigidly upright, for example, in the case of the man shown, whose head is erect with the eyes staring forwards. In other cases the body and head may be bent slightly forwards. Most frequently the feet and knees are found to be close together, but, as in the case of the woman on the extreme right, the legs may be kept apart.

As this is a fairly rare condition, the following case is considered worth publishing:

R. P—, æt. 39, married, a private in the R.F.A., was admitted to the Isle of Wight County Asylum on January 2nd, 1915, from a Red Cross Hospital in a condition of status epilepticus. The history obtained from his wife was interesting. He joined the Army when about 18, and spent six years in India. He took part in the South African War for fifteen months. He returned to England in 1903, married, and had several healthy children, and had lived at Dorchester for the last ten years. At the outbreak of war he was called up on the Reserve, and sent to France with the B.E.F., and was in the battle of the Aisne. Early in October he developed “epilepsy,” and was invalided to England. He had always been strong and healthy till then, and never had a fit previously. Under treatment he improved, and was on sick furlough, when in November he had a severe epileptic attack, and was readmitted to a military hospital. He then became sullen, drowsy, and irritable, with occasional slight fits till December 20th, when he had three severe attacks, but came round from them, and was able to write a clear letter to his wife on December 26th. On January 1st, 1915, he started having severe fits, and these continued up to his admission twenty-four hours later.

Among the many duties of life which have had to be thrown overboard in consequence of war strain is that of recording and tabulating facts connected with asylum experiences. It certainly would be undesirable that a process, which at the best of times is but a burden to many, should be continued when the asylum, more than any other class of institution, is heavily stressed by an increase in function accompanied by a notable decrease in the means of performing function. Nevertheless it cannot be denied that a breach in a long continued series of medical observations is in itself somewhat of a misfortune.