During the past ten years, largely perhaps as a consequence of the tremendous mental strain to which the nations of Europe have been subjected, myriads of people who previously left the great questions of life and destiny to the priesthood, and contented themselves with their daily round of duties and pleasures, have begun seriously to think. These, seeing their own ignorance in the minds of others, have set to work as raw recruits to cultivate their own little holdings as if the whole world were virgin soil, and they were the first pioneers.

The hæmoclastic crisis is the name given by Widal and his col laborators to the vasculo-sanguinary crisis which occurs following the ingestion of milk by patients with hepatic disease and in certain anaphylactic conditions, and was originally described as a test for liver inefficiency. Its occurrence has also been noted in certain cases of psychoses and epilepsy.

The family physician is occasionally called into consultation when one of his patients, a hitherto respected citizen, becomes arrested for a sexual offence. In such circumstances the relatives, friends or legal advisers of the accused are often prompted to raise a defence of insanity, mental disorder or defect in answer to the charge. On examination the physician may find such evidence. If not he may regard the patient as being psycho-pathological, but unless he has devoted time to the consideration of the subject, and is also well acquainted with insanity, amentia and border-line states in his daily work, he may not feel sufficient confidence in his general knowledge and medical experience to face with equanimity the prospect of a severe cross-examination in the witness-box on an admittedly difficult and controversial subject. I know the family physician may, in such cases, feel embarrassed, and I propose to attempt to bring before you certain matters for consideration which it seems well to bear in mind when inquiring into the mental condition of persons accused of sexual crime, and which I suggest throw some light upon actions that otherwise appear unusually obscure.

When in the year 1917 Dr. Wagner-Jauregg, Chief of the Psychiatric Clinic of Vienna, inoculated nine patients suffering from general paralysis with the blood of a case of benign tertian malaria, he was only testing a theory he had formed many years previously. In the interval he had been treating his cases of general paralysis by injections of tuberculin, typhus vaccine, etc., and with encouraging results. Remissions produced by these efforts were more frequent and more lasting than those which occurred in untreated cases, but a lasting remission only rarely followed.

Last summer we had admitted to our hospital a case of the involution period in the female, which presented such notable features from the clinical aspect that I was stimulated to the discovery of the “whys” and “wherefores” it presented. An involution case, I found myself confronted with certain problems of an endocrinological nature, which are the experience of all psychiatrists.

The complement-fixation test, or, as it is known more popularly, the Wassermann reaction, was at one time considered the only reliable laboratory test for the diagnosis of neuro-syphilis. It is a complicated biological reaction, and requires expert knowledge, theoretical and practical, before any deductions can be made as to whether a patient suffers from neuro-syphilis or not. In the majority of cases the cerebro-spinal fluid has to be sent to a special pathologist attached to some general hospital, and in many cases it means sending the fluid to other towns.

It is a common experience in the investigation of mental disorders that glycosuria is frequently found, thus indicating a tendency in such cases to a faulty carbohydrate metabolism. With the exception of epilepsy, this occurrence of glycosuria has been noted in most mental conditions. Intermittent glycosuria is met with in general paralysis (Kraepelin) (1); Bond (2) and Strauss (3) note it in about 10 per cent. of their cases. In dementia prócox Schultze and Knauer (4) did not observe glycosuria in the apathetic form of hebephrenia, but often found it to occur with catatonic excitement. With other observers (see Allers (5)) they record the marked association of glycosuria with depressed states, while its occurrence in mania was infrequent except in markedly excited and resistive cases.

In the preceding communication the results are given of the investigation of a series of cases of early mental disorder for defects in carbohydratemetabolismby the study of blood-sugarcurves, following glucose ingestion. The investigation revealed the occurrence of an abnormally sustained hyperglyc@mia in a large proportion of these cases; the results are interpreted as a defect of the carbohydrate storage mechanism. As the liver is largely concerned with glycogenesis, it appeared that the hevulose test applied to these cases might afford some explanation of the abnormal findings.