Without psychology there can be no psycho-pathology; and any advance that psycho-pathology may have made from time to time has in no small measure depended on corresponding progress previously achieved in the realm of psychology. The reason why psycho-pathology made little headway until comparatively recently may be found in the unfruitfulness—from a medical point of view—of classical psychology.

The shortness of the tour allowed only a limited number of places to be visited, and the salient and most distinctive features of psychiatric and allied activities in each to be seen. These included general and mental hospitals, psychiatric clinics and reception units, observation wards, mental deficiency institutions, mental hygiene centres, child guidance centres, including nursery schools, and child delinquency work associated with juvenile courts, etc.

Dr. Petrie's paper is mainly descriptive of American psychiatric institutions, and deals only briefly in its conclusion with his impressions of American psychiatry in its various fields. My paper, however, deals principally with the latter subject and avoids the former as much as possible. It is also my duty to report on my mission as the representative of the London County Council and of the Royal Medico-Psychological Association at the First International Congress on Mental Hygiene.

Late congenital syphilis, with which this précis is concerned, is not always easy to recognize, as unquestionably the disease has altered in severity during the last few decades, and it is now rather exceptional to find cases which exhibit all the cardinal signs. In the following account, which is based on the examination of nearly 200 cases in the Leavesden Mental Hospital, the clinical manifestations have as far as possible been grouped under the various systems of the body and it has been thought advisable to include, not only the classical and unequivocal stigmata, but also those which, though not exactly specific, are yet of sufficient importance to evoke a suspicion of syphilis. Their relative frequency is shown in the accompanying table.

It is generally admitted that hereditary predisposition plays an important part in the development of dementia præcox (or schizophrenia), and that a family history of mental illness is traceable in about 60% of cases.

Sensori-motor disturbances resulting from gross lesions of the nervous system are, as a rule, easily demonstrated. Slight degrees of inco-ordination, however, associated with disturbances of consciousness and attention, are, by the ordinary clinical methods of examination, sometimes most difficult to discover. In psychic conditions, such as emotional and subnormal states, manic-depressive insanity and schizophrenia, sensori-motor disturbances may manifest themselves in the form of tremors, inhibitions, inco-ordination and accelerated or sluggish action.

In studying the ætiology of any ailment it is profitable to assume that no disease has a single cause. All the manifestations which constitute disease are the result of a disturbance of equilibrium between the human organism and its environment. In the production of this disharmony many factors play a part, each varying in importance from case to case. Nevertheless, since the discoveries of Pasteur we have become accustomed to view diseases mainly from the standpoint of their causative organisms, thereby neglecting many equally important factors in their ætiology. Yet we know of many instances where these selfsame pathogenic agents reside in the human body without producing any symptoms of disease. The meningococcus and diphtheria bacillus are found in the air-passages of many healthy people, while after the disease has run its course, the causative organism in typhoid may continue to occupy the body indefinitely. Moreover it frequently happens that living parasites of malaria, purposely introduced into the human subject, fail to produce any symptoms after many weeks of incubation. In cases of this nature it may transpire that the addition of further noxious influence, such as an injection of milk or even a cold bath, may precipitate the symptoms of malaria, which thereafter runs its normal course. Conversely, there are many individuals, or groups of individuals, who are particularly prone to fall victim to maladies from which others appear to be protected. The mentally disordered are very liable to infection by the Flexner group of organisms, while those who nurse them are seldom attacked. Such illustrations, which might be multiplied indefinitely, serve as a useful reminder of the complex factors at work in the production of diseases of microbic origin. The soil is just as important as the seed, and no study of ætiology would be complete were the question of individual susceptibility to be omitted.

One of the main difficulties encountered in the study of psychology is the lack of exact definition in its terms. In psychopathology this difficulty is intensified and many authorities use the same term with widely varied meanings. This is especially noticeable with the term “perseveration.” Some writers restrict its use to describing a subsidiary symptom of apraxia or agnosia, and limit its application to the repetition of an already executed movement in the presence of desire to make a fresh movement. Others write of agnostic perseveration as being synonymous with ideational inertia, and define it as the persistence of an idea in the process of recognition. Woodworth (1) defines perseveration as recall seeming to occur without a stimulus, and considers that some undetected external stimulus is necessary. Dumville (2) holds that perseveration is much the same as retentiveness, and limits its meaning to spontaneous revival in the case only of intense experiences, tracing a close connection between perseveration and association.