I am fully aware of the honour and responsibility conferred on anyone who is asked to deliver a Maudsley Lecture. That great physician realized that the knowledge of medicine advances by devious paths. I have availed myself of his broadmindedness to lay before you to-day some of the physical symptoms associated with a group of mental cases labelled “acute confusional insanity I will lay before you facts which support the belief that in all these cases the departure from health affects the functions of the whole body, the heat-regulating centre, the cellular and serum defences, the renal functions, the carbohydrate metabolism, and the effect of the injection of insulin on low blood sugar.

The objects and advantages of ascertaining the actual and relative measurements of various parts of the body are numerous. For example, this method has been largely used by anthropologists for classifying different races of mankind.

In considering the structure of the central nervous system as the vehicle for the mind, due regard must be paid to the vast amount of psychological knowledge which has been accumulated, and any new theories advanced must at least to some extent be able to explain accepted psychological material in neurological terms.

The relationship between mental disorders and diabetes is studied as shown by 30 cases of mental disorder associated with diabetes, 93 cases of uncomplicated diabetes and 400 uncomplicated cases of mental disorder. This study covers, first, the psychological picture in diabetes; second, the types and courses of mental disorder associated with diabetes; and third, the mental symptoms with hypoglycæmia.

The incidence of achlorhydria and its association with certain forms of anæmia has recently been the subject of much interest, largely owing to the work of Witts (1, 2) on idiopathic hypochromic anaemia, and of Hurst (3) on pernicious anæmia.

In a recent short paper an attempt was made to indicate what happens to the love-object in the manic phase of manic-depressive psychosis. Reference was made to the view that the depressed phase represents failure of adaptation, with introjection of the reproaches which are concerned with being cut off from loved ones and which were originally directed against the mother. The manic phase, it was suggested, represents an attempt at adjustment to reality, with externalization of the mother, not on to definite people, for the manic is incapable of transference, but on to others in general. This attempt at adjustment being unsuccessful, regression to the oral phase occurs again and the depressed phase returns.

The control of the colonic motor function, and especially of the series of events which lead to defecation, is generally recognized as being a subject of the greatest importance in medicine; and, more particularly, the possibilities of varying that control. There are a large number of diseases that may, in special instances or in general, be due to constipation and inefficient elimination of waste products. Constipation has been claimed as the first step towards the different catastrophes ranging from Menière's disease and otosclerosis, gout, hyperpiesia and certain of the rheumatisms, to cases of hernia and abnormal presentation. It is my endeavour to look upon it as being even more prominently a secondary manifestation, a symptom of an even more widespread condition—mental misapplication and disorders of mental forces. With this in mind and dealing with an argument that is already proved to some degree in its most marked details, it is hoped to present, not masses of data and deduction so much as an illustration of the value, and even a hint at the frequent therapeutic necessity of orientating the various causation circles in this direction. As a cause, and especially of these mental difficulties themselves, constipation is well enough stressed; constipation as a result has not yet been sufficiently realized, nor attacked rationally from its base. The words “habit formation” cover most of the therapeutic efforts from the mental side, and that is conceived very much as a time-conditional reflex of purely physical determination. A more definite idea, then, of the mental aspect of intestinal motor function may be helpful, and especially so when so many of the habitual purgative class of drug are being authoritatively questioned as being disorganizing to this proper function. The treatment of constipation is hardly yet on a successful or rational basis.

While the best accounts of anxiety appear in the French literature, which contains a number of monographs on anxiety (19, 23, 32, 34, 40), psychoanalysis regards anxiety as the primitive reaction of the pain principle, and deals with it in a fair proportion of its investigations.

The authors consider that protein or pyretic therapy should have a more scientific basis, and for several years have carried out experimental work on the behaviour of blood complement in patients undergoing this form of treatment.

Some apology may at first sight appear to be needed for burdening yet further the literature on blood sugar in the psychoses. The following observations, however, require recording, in that they illustrate certain aspects of the relation of the behaviour of the blood sugar level to changes in mental state which are as yet obscure.

Mrs. X—, a widow, æt. 28, was recently admitted to Graylingwell Hospital as a voluntary patient.

Family history as far as could be made out was negative.

Past history and personality.—She was described as a cheerful, steady girl, who had married at 21, and had unfortunately lost her husband some few months after marriage. More recently she appeared to be somewhat unstable emotionally and, in spite of serious organic disorder, had been energetic and over-active in her pleasures and amusements, and had taken alcohol freely. There was no previous history of “nervous breakdown”, fits or paralysis. Eighteen months ago she had a severe attack of rheumatic fever with endocarditis, and about six weeks before admission had an attack of “influenza”.