Sporadic bacillary dysentery is an accepted concomitant of lunacy, and mental hospitals, on statistical evidence, harbour more than 99% of the disease. When an epidemic of dysentery occurs, the laboratory of the mental hospital is cluttered with fæcal specimens, but when the epidemic is resolved on a solitary “carrier” and a faulty drain the disease ceases to arouse further interest. Little effort is made to assess and control the endemic level. This the author has attempted to do, in a county mental hospital of, roughly, 1,000 beds.

The condition of spontaneous hyperventilation tetany has received some attention recently, and in many cases it has been impossible to demonstrate adequate biochemical changes to account for the tetanic manifestations, which so closely resemble the more recognized clinical types of tetany. The reason for the apparent spontaneity of the attacks has remained obscure beyond the general trend to recognize it as “functional” in most cases. In view of this recent interest, and of the atypical clinical manifestations in this case, the following observations on a single patient are put on record. A few previous cases treated at the Maudsley Hospital, but differing from the present one in the absence of loss of consciousness during the attacks, are also briefly reported.

Though many of the earlier workers made statements based on general impressions from injected preparations about the relative vascularity of different parts of the brain, only comparatively recently has an attempt been made to measure and express numerically the capillary development in different areas, by methods similar to those used by Krogh in studying the vascularity of muscle. Craigie has made an extensive study of the rat brain by such methods, Cobb, and Cobb and Talbot have investigated certain areas of the rabbit brain, and Dunning and Wolf certain parts of the nervous system of the cat. In the present paper a personal investigation (undertaken at the suggestion of Dr. Cobb) is reported, comparing the basal ganglia, cerebral and cerebellar cortex of the cat as regards capillary vascularity. The capillaries were demonstrated by Indian ink injection, and results expressed in millimetres of capillary per cubic millimetre of tissue. Substantiating observations were made on similar areas of monkey and human brains, but without attempting accurate measurement as in the cat material.

When normal human skin is moderately cooled it goes blue, owing to a contraction of the arteries and arterioles, and a relaxation of the capillaries and subpapillary venous plexus of the epidermis. This blueness is light in colour. In certain individuals, however, it is deep, or relatively saturated, in the hands or feet or both; these include cases of acrocyanosis (extremity, = dark blue). This condition, though rare in the general population, is common among the inmates of mental institutions.

The Mental Treatment Act of 1930 has brought within the purview of the mental hospital that large class of psychoneurotic and “early psychotic” patients who formerly drifted despairingly in the wilderness between orthodox medicine and the quack. The purpose of this paper is to show how an attempt is being made in this hospital to deal with this heterogeneous class of patients by means of psychotherapy, carried out by the ordinary medical staff of the hospital, without interference with their routine duties.

It has been calculated that over one-third of the total number of cases receiving sickness benefit have some form of nervous disorder (1), and 1 of 22 persons has to be placed in a mental hospital at one time or another (Carrel, 2). Social prejudice, however, still bars adequate support of psychiatric research, and much scientific work is hampered through lack of financial help.

Among the metabolic disturbances in schizophrenia there occur in many cases symptoms which are the result of vasomotor instability or upset. The causation of this vasomotor instability is not known, and it may in turn be due to undiscovered metabolic disturbances.

It has long been recognized that disturbances of the thyroid, such as cretinism, myxœdema and some cases of Graves's disease, can give rise to mental symptoms. Of recent years, however, other endocrinopathies have been investigated from the psychological standpoint, and in nearly all cases evidence of some abnormality has been found. For example, Werner (1) examined 53 castrates, 48 cases of involutional melancholia, and 96 women of menopausal age, and found marked similarity between the mental symptoms occurring at the menopause and those in involutional melancholia, and presumed that they were both due to the same cause—ovarian dysfunction.

Within recent years a great deal of attention has been paid to the question of chemical transmission of nervous impulses, and it has been definitely established by Dale and his co-workers (1, 2, 3) that acetyl choline is the transmitter in the case of the parasympathetic nervous system, and also in part of the sympathetic nervous system.

Prominal was first favourably reported on by several German and other continental observers (1, 2, 3, 4) in 1932. More recently (6, 7, 8, 9, 10) there has been evidence of its value from workers in this country, mainly of its use in epileptics with mental defect. In the reported cases results have indicated that only 3 out of 66 cases failed to show diminution in the number of their fits. In the epileptic psychotics treated at Claybury during the past eighteen months the drug has been found useful in a less striking way.

In a previous paper on general and focal symptoms localization in the brain was discussed as to its principles and limitations. In the subsequent investigations a method of examination has been worked out and is here presented. It is meant to serve a threefold purpose, which should be kept in mind when the scheme is applied.

The circulatory factor in the pathogenesis of mental disorder can be dealt with in at least two different ways. The exposition can be narrowed down to a mere description of what we know for certain about the psychiatric significance of circulatory disturbances. On the other hand, I think it not less legitimate to look at the question as a highly fascinating problem, the full bearing of which upon psychiatry we are only just beginning to discern as a dim shape on the scientific horizon.

Irritability is used in this paper in its popular sense as “the quality or state of being easily annoyed or excited to anger”, according to the definition of the Oxford English Dictionary. I leave it an open question how far other meanings of the word—especially “the condition of being excessively or morbidly excitable by or sensitive to the application of an external stimulus”—have anything to do with the definition of irritability as an affective state. A detailed description of the specific emotional quality of irritability would be of little help to someone who had never experienced it. Irritability might be characterized by its accelerated time factor (in contrast, e.g., to sadness, with its slow time factor), by its tension and proneness to release in outward expressions, and by its unrest. But all such characteristics are only descriptions of the same happening looked at from different angles.

One of the most striking characteristics of patients in a mental hospital diagnosed as suffering from schizophrenia, or dementia præcox, is their dissimilarity. It is easy to pick out cases in which the onset, course, symptomatology and outcome of the psychosis are different. There is thus a tendency to regard the schizophrenic group as possibly containing many different clinical entities. One of the current major problems of psychiatry is to clarify what constitutes schizophrenia and to subdivide the clinical material further in a way which will prove useful for study.

In the routine examination of the urine of patients admitted to this hospital one is struck by the frequency of albuminuria. For example, 27·4% of 667 consecutive female admissions had a trace of albumin in the urine (i.e., a faint cloud appeared when the heat test was applied), while 37·2% had more marked albuminuria (i.e., the urine showed a thick cloud when the heat test was applied); only 35·4% were entirely free from albuminuria. Of 517 consecutive male admissions 20% had a trace of albumin in the urine, 19·5% more marked albuminuria, and 60·5% were free from albuminuria. B. H. Shaw (1) at Stafford found even higher percentages in his 250 admissions in 1935.

A brief summary of this patient's condition was given in our article on “Hypnosis in Mental Hospital Practice “(1), where it was cited as Case 2, illustrating “the great value of hypnosis as a quick method of bridging amnesic gaps”. The hope was there expressed that the case would be published separately in full, as it contains numerous features of general interest. Similar cases appear from time to time in the newspapers, and it seemed to us that a detailed account, showing exactly how the amnesias arose and how the case was dealt with, might be welcomed.

The observations recorded in this paper form part of an investigation into the mineral constituents of the central nervous system both in normal and pathological conditions.

I have been asked to speak to you about the psychological implications of functional circulatory disorder. Unfortunately there is no generally recognized system of the functional disturbances of the circulation. For this reason, and also for want of time, I shall be able to deal only with a few sections of the problem.