“The terms manic-depressive insanity and dementia præcox were used by Kraepelin to designate two disease entities, which he considered were between them responsible for most of the states of mental disorder usually gathered together under the title, the psychoses.” The psychoses are something more than states of mental disorder, and something less than disease entities; they lie between them. Excitement, depression, delirium, and stupor are states of mental disorder which may arise during the course of many diseases, general paralysis, hysteria, epilepsy, the cerebropathies, constitutional and infectious diseases; but acute mania, acute melancholia, anergic stupor, delirious mania, are psychoses. They differ from a state of mental disorder in so far as they are self-sufficient, and are not the expression of an underlying disease; moreover, they run a fairly definite course, ending either in recovery or in dementia. The classifications of the psychoses have been unsatisfactory, and none of them has met with general acceptance. The most satisfactory method is that formulated by Kraepelin: and, in the opinion of Dr. Marshall, he “has done for the psychoses what Erb did for the amyotrophies.” He emphasised the importance of dementia as a termination of the psychoses, and gathered those which ended in dementia into one disease category, dementia præcox, and those which did not so end into another category, manic-depressive insanity. The fact that dementia occurred predicated an organic change in the brain, so that dementia præcox was an organic and manic-depressive a functional disease of the brain. Certain states of mental disorder are common to both conditions: yet there are symptoms which render it possible to distinguish between them. In dementia præcox there is “inco-ordination of the individual psychical processes”: manic-depressive insanity depends on “a change in the mutability of the individual psychical processes.” Normal mentality results from the co-ordinated action of the emotional, intellectual, and volitional processes, and is characterised by a certain congruity of thought and conduct. If there is inco-ordination of these fundamental processes, incongruity of thought and conduct results. The nature of the incongruity depends on the mental process mainly responsible for the incoordination. The symptoms may be for a time emotional, intellectual, or volitional.

The author maintains the thesis that acute and borderland cases of mental disease can be received and temporarily cared for in general hospitals. He admits that mental patients are not looked upon with favour by the nursing staff or by the other patients, on account of—in many cases—their restless, noisy conduct. Yet almost all general hospitals must include at times among their inmates some patients who, in the course of treatment for such conditions as acute infections, accidents, etc., become turbulent and violent.

This article has for its object the more clearly defining one of the theses sustained by the author in his work, Formes élémentaires de la Vie Religieuse, namely, the possibility of explaining scientifically the constitutional dualism of man. Religions have always recognised this quality, regarding man as formed of two beings radically different—the soul on the one side, the body on the other. Psychological analysis, in a sense, confirms this belief. There are sensations and sensual tendencies on the one side, thought and moral activity on the other.

The production of this report, without any decrease in particulars and details, is in itself a matter for some congratulation to Mr. Keene and those who help him. His office has been much depleted by the war, perhaps not more so than others relatively, but the huge bulk of returns and figures, for all of which his office is responsible, cannot be matched elsewhere.