Our conceptions of how the organs of the body work are primarily derived from experiments done on muscle, the organ from which experimenters have been accustomed over many decades to ascertain the fundamental properties of living tissues; the principles there learnt have then been directly applied to the problems presented by other organs. Such having been, and still being, scientific practice, it follows that, if we find out about the working of muscle something fundamentally different from that hitherto suspected, we not only obtain therefrom new ideas of the working of muscle, but also new principles to apply to our ideas of the working of other organs. It could happen, however, that new knowledge concerning the fundamental working of the organs of the body should actually come from some other organ than muscle. In that case the newly discovered phenomena would not be directly explicable in terms of the fundamental principles derived from muscle. Two courses would then be possible. The discoverer could re-consider his fundamental principles, and thereby be led to reexamine the workings of muscle in the light of the information supplied by the other organ, or he could frame an ad hoc hypothesis concerning the supposed peculiar behaviour of the other organ. The latter has been the usual course followed, though it would not appear that the framing of such hypotheses has been made with full awareness that they really resolve conflict between principles derived from muscle and principles derived from the other organ.

The subject of anti-malarial work in the tropics is one of paramount importance, but I am somewhat diffident in bringing such a subject before the Royal Medico-Psychological Association. However, if not of value, the paper may be of interest.

In dealing with anti-malarial work one can more or less confine one's attention to the anopheline mosquito. It is, however, advisable to deal with other varieties as well, since, though they do not carry malaria, they carry other diseases, for instance Culex fatigans carries filaria, and Stegomyia carries yellow fever. Fortunately, there is very little filaria in Malaya, and no yellow fever; but it has been found that Stegomyia fasciata carries dengue. Also with the opening up of fast new air routes, one has no guarantee that yellow fever will not be introduced into the country, and, seeing the large number of stegomyia there is in Malaya, the result would be disastrous.

Certain findings in the course of routine biochemical investigations at this Hospital suggested to us that the glucose tolerance test in epilepsy might show interesting results, and accordingly a series of 66 cases was submitted to this examination.

The object of the present paper is to point out that two different working parts of muscle have hitherto been generally confounded together, whereas their analogues in the psychic mechanism have always been deemed separable. Scientific explanations of the phenomena of mind, however, seem ultimately to wait on knowledge of what happens in excitable tissues, such as muscle, so that the result of finding two working parts in the psychic mechanism, where it was believed there was only one analogue muscle, has been the introduction into physiological psychology of a number of what I have to suggest are superfluous terms. In addition, the present paper deals with the possible nature of the connection between cerebral excitation processes and the psychic response.

In the following investigation an attempt is made to regard the subjects of mental disorder from a synthetic rather than from an analytic standpoint, in other words to envisage the patient as an entity, a complete individual who reacts as a whole to his environment, rather than to look on him as a mere collection of systems, and, in doing so, to pay no heed to his total response. Our present knowledge of mental disease results from skilled work in histological, physiological, biochemical and psychological spheres, and there is thus, of necessity, a tendency among individual workers in the various fields to concentrate their attention almost exclusively on their particular line of work, and so to lose sight of the patient as an individual.

The cases of general paralysis here submitted, fifty in number, have all been treated by tryparsamide either alone or combined with a non-specific form of treatment. Some of them have been undergoing treatment since 1923, and consequently the method adopted has varied as the result of observation and experimentation. All of them have been under observation for at least two years.

The present paper is a forerunner of what is hoped may be many devoted to psychiatrical material by experimental psychologists of the Spearman School of Factors.

The electrometric titration method for the investigation of “organic acids,” as developed by Perlzweig and Delrue (1) and applied to the examination of sera, indicated a method of investigation of the organic acids of the cerebro-spinal fluid, and an attempt has been made in this paper to investigate the significance of the organic acid titration in mental disorders. Owing to the difficulty of obtaining normal cerebro-spinal fluid, the research had to be confined to the investigation of paretic and non-paretic cerebro-spinal fluids obtained from mental cases. In the former case adequate specimens were obtainable during the process of collection of fluid for diagnostic purposes, and the results obtained in some cases were confirmed by independent collection.

The high incidence of chronic interstitial nephritis at post-mortem examinations at the East Sussex County Mental Hospital prompted an investigation into the urea content of the cerebro-spinal fluid. In the years 1926-29, some 68% of all deaths have had post-mortem examinations performed, totalling over 200 autopsies, and a series of 60 successive results are tabulated below (Table I), giving the following details:

1. (1) The sex of the patient.

2. (2) The age.

3. (3) The interval between death and the estimation of the urea content of the cerebro-spinal fluid.

4. (4) The result of the estimation.

5. (5) The mental diagnosis.

6. (6) Macroscopic evidence of gross renal disease (+ or −).

7. (7) Other gross macroscopical abnormalities.

In a previous communication the subject of training was considered, and the deduction made that a trained act differed from an untrained act in respect of the composition of the excitation processes mediating the act (1). That is to say, though the formula H + L = T can be applied to both the trained and the untrained act, the trained act contains more L and less H than the untrained act. In other words, training adds L and diminishes H (1).

Reactions produced by experience fall into two great groups. The larger group consists of the reactions of those individuals whose mental mechanisms are accurately attuned to the demands of life; the smaller group is composed of the reactions of those unfortunates who are unable to adjust or adapt their mental processes to the ever-increasing complexities of civilization. The individuals forming the former group are called normal. Kræpelin termed the mal-adjustments of those in the latter group the “biogenic psychoses.”

It is my intention in the present communication to attempt to bring part of the philosophy of Freud into line with the psychic machinery outlined by me in previous papers, and I start by briefly re-describing that machinery.

In a recent publication entitled Schizophrenia (1928), issued by the Association for Research in Nervous and Mental Diseases, there are articles by thirty-one authors. The symposium contains 460 pages, of which only 18 are devoted to treatment. Does the ratio of 18 to 460 represent the relative interest existing in the treatment as compared with other aspects of the disease?

Bleuler, in his Text-book of Psychiatry, says that “Reactive mania is unknown.” This statement occurs in the section devoted to the consideration of the reactive states; temporary psychoses, that is to say, where the ætiology is so clear and in such temporal contiguity to the onset of the symptoms that the illness can be definitely laid at the door of some recent alterationin the patient's total life situation.

In previous communications made to this Journal I have pointed out that the cerebral excitation processes mediating an idea, or judgment, are produced by the interaction of two factors which I term H and L respectively, and that, in the case of judgment, the factor L constitutes the material to be judged and the factor H judging capacity. When the judge has interacted with the material brought for judging, there results a judgment (1, 2, 3, 4, 5). So long also as we avoid some form of fit (2) or spasm (4), the sum of the two factors H and L must fall within the limits of another factor, T, the capacity of the responding organ (1).

The rôle of focal sepsis as a causative factor in mental disease has received increasing attention during the past few years since Cotton published his results in this field of inquiry (Journal of Mental Science, October, 1923). In England, prominent workers in this branch of medicine, while unable to report the striking therapeutic results of Cotton, have confirmed his main contention that many acute and subacute psychoses seem to be intimately related to some focus of sepsis. Thus confirmation of this main thesis has come from Graves (Journ. Ment. Sci., October, 1923 and 1925), Chalmers Watson (ibid., October, 1923), Hunter and Moynihan (Brit. Med. Journ., November 5, 1927). On the other hand, equally prominent psychiatrists have called in question the results claimed, and the alleged “proven relationship” of sepsis and mental disorder, chief among whom are Henderson and Menzies (Brit. Med. Journ., November 5, 1927, p. 818).

Janet, like Freud, met the problem of explaining why certain people have not conscious memory of past, for them, tremendous experiences, and yet those experiences exert a marked influence on conduct. To account for these facts he assumed the existence of a force inherent in consciousness, enabling this to hold to itself memories of events. A loss of conscious memory of some past tremendous event would thus be due to consciousness being too weak to hold that event to itself—an hypothesis which also explains why great joy can be as disturbing as great sorrow.

Medical men are often called upon to give evidence as to the mental condition of an individual, charged with crime, at the time of committing the crime. They are also expected to give an opinion as to whether by reason of insanity the accused was incapable of knowing the nature and consequences of his act, or did not know that what he was doing was either wrong or contrary to law. The question is frequently one of life and death for the accused, and therefore it is very necessary that medical men should understand the inner working of a criminal's mind before they venture an opinion regarding his mental condition. In India we have hitherto depended for our guidance on books written by learned authors who base their conclusions on conditions prevailing in their own countries, and cannot be expected to know the conditions of Indian life. I feel the time has come when we should begin to collect first-hand information regarding our criminals from our own observations. I am afraid very little work has been done in this field in India, and it is time that we compare our results with those obtained in the West. It is with this object that I venture to submit this paper, so that it may stimulate others in India also to work on these lines.

Sulfosin was first introduced by Schroeder (1) in the treatment of general paralysis and other syphilitic infections of the nervous system, and later its use was extended to the treatment of schizophrenia. He stated that the results were encouraging, and that this method of treatment was worthy of an extended trial. Loberg (2) treated 100 schizophrenic patients with sulfosin, and of these 49 had remissions in varying degrees. In a later report (3) he stated he had treated 135 patients, of whom 62 improved but only 12 had permanent remissions. Marcuse and Kallmann (4) treated 46 patients, 16 of whom were improved; Salinger (5) treated 16 patients, of whom 2 had remissions and 14 were unchanged.