Progress in general medicine is brought about by clinical observation or carefully controlled experimental research. In psychiatry there is little opportunity for the latter approach. One of the few methods available at the present time is the use of intoxicating drugs. It was Kraepelin who first emphasized the importance of studying psychological changes produced by drugs. Following his lead many observers have tested their action on various psychic faculties. Copious data have been collected about such agents as alcohol, caffeine, hyoscine and cocaine. But the value of these observations in bringing about an understanding of the psycho-pathology of the major psychoses is limited, since it is rarely possible to produce the picture of a true psychosis without giving the drug in amounts sufficient to bring about dangerous or chronic intoxication.

Since the time of Ferrier and Hitzig, the effort to localize functions in the cortex has been elaborated until at one time there was thought to be a veritable mosaic of centres in the brain. This line of development has repeatedly been interrupted by investigators who denied the possibility of localization. In this paper we shall refer more particularly to the work of Goldstein, who in numerous papers, and in his new book, Der Aufbau des Organismus, has launched an attack on localization, which by virtue of its systematic approach outdoes all previous attempts of the kind. The chief objects of his scrutiny are the theoretical and philosophical principles of cerebral localization. Two of the ideas stressed by him may be anticipated here; the need for defining what is meant by “symptoms” in cerebral pathology, and the importance of observing the general behaviour of patients with cerebral lesions. These ideas are well in conformity with the general methods of psychiatry.

Renal dysfunction is so commonly present in cases of mental breakdown that it is of interest to know whether it is especially associated with any definite clinical type or types of mental disorder. In an endeavour to ascertain this, cases have been selected from recent admissions in which the form of disorder from a clinical point of view appeared to be sufficiently marked to warrant placing them in a definite category. Many cases present such a mixture of cycloid, schizoid, confusional or paranoid indications that in an investigation of this nature the selection of sufficiently clear-cut types from a clinical standpoint is not altogether an easy matter. To determine the degree of concentration and polyuria, Rosenberg's modification of the Volhard test has been adopted. It involves little discomfort to the patient and is as follows:—

The improvement of general paralysis by treatment with malaria is known to be accompanied by—and may be said to be due to—the disappearance of the spirochætes from the brain. The problem of the mode of action of this therapy therefore is centred in the question to what factor the antispirochætal effect of malaria is due.

Carriers of the enteric group of organisms are apt to be a source of some administrative difficulty in mental hospitals. The Infectious Diseases Sub-Committee have therefore attempted to estimate the value of cholecystectomy in this condition.