It is generally admitted that hereditary predisposition plays an important part in the development of dementia præcox (or schizophrenia), and that a family history of mental illness is traceable in about 60% of cases.

The acetic anhydride test was introduced in 1923 by Boltz, who regarded a positive result as diagnostic of syphilis of the central nervous system. The technique of the test is simplicity itself, and is as follows: Place 1 c.c. of spinal fluid in a small test-tube. Add 0.3 c.c. of acetic anhydride drop by drop; shake. Add 0.8 c.c. concentrated sulphuric acid drop by drop; shake. After five minutes examine the colour of the fluid against a white background. A lilac or blue-pink coloration is positive.

For the past three years at Claybury every case of general paralysis treated by malaria has received a course of injections of arsenic (sulfarsenol) concurrently with the routine course of quinine. During twelve months of this period the majority of cases were given, in addition, (a) a course of iodide and mercury by mouth, and (b) a course of intravenous injections of tryparsamide.

In 1906 Alzheimer reported the case of a woman, æt. 51, who, in addition to the expression of ideas of suspicion and jealousy, failed mentally to such an extent that she was unable to find her way about her own home. During her hospital residence she was perplexed, disoriented for time and place, and had difficulty in understanding and in expressing her thoughts. There were delirious phases, during which she was hallucinated. Her power of retention was greatly impaired. She showed paraphasia and perseveration. The illness persisted for a period of four and a half years, and at the time of her death she suffered from contractures. The post-mortem examination showed a striking alteration of the neurofibrils: “In an otherwise normal cell there appear at first one or more fibrils, which on account of increased thickness and increased stainability stand out prominently. In the further course of the alteration many neighbouring fibrils are similarly affected. These then form thick bundles, which gradually come to the surface of the cell. Finally the nucleus and cell disintegrate, and only a tangled bundle of fibrils remains to indicate the site of a former ganglion cell.” In addition, throughout the entire cortex, especially in the outer layers, there were many miliary foci or plaques.

The researches of Golla and his co-workers, Armstrong, Mann, Marsh, Scott and others on the bio-chemistry of dementia præcox suggested that it might be profitable to explore a line of treatment based upon their results.

By the erythrocyte sedimentation phenomenon is meant the rate at which the red blood-corpuscles settle in an anti-coagulative column of blood. Numerous modifications of the method are in use, differing only in the way results are recorded and in minor details of technique.

Since the publication of the last number in the author's present series of papers (Stewart, 1929), four articles have appeared which bear upon the subject. They are by the following writers: Mutch, Schemer, Mann and Shipp, Shera.

Sensori-motor disturbances resulting from gross lesions of the nervous system are, as a rule, easily demonstrated. Slight degrees of inco-ordination, however, associated with disturbances of consciousness and attention, are, by the ordinary clinical methods of examination, sometimes most difficult to discover. In psychic conditions, such as emotional and subnormal states, manic-depressive insanity and schizophrenia, sensori-motor disturbances may manifest themselves in the form of tremors, inhibitions, inco-ordination and accelerated or sluggish action.

In view of the fact that cholesterol is one of the principal constituents of nervous tissue and presumably plays an important part in the functioning of that tissue, it is surprising that comparatively little attention has been given to the study of the variations of the blood cholesterol in disorders of the brain and mind. Such researches as have been published do not appear to have been based, as a rule, on any extensive number of cases, and there is rarely any attempt to analyse the results according to the actual mental state of the patient, apart from the diagnosis. It is therefore not remarkable that the conclusions of different observers have been somewhat contradictory.

The appointment, believed to be the first of its kind in this country, of a whole-time gynæcologist to a mental hospital,∗ marks a big step forward in the care of the mentally afflicted.

The problem of character has long occupied the minds of philosophers, pedagogues, sociologists and psychologists, such as Socrates, Plato, Pascal, J. J. Rousseau, Kant, and later Bahnsen, Wiszniewski, A. Bain, A. Martin, Ribot, Smiles, Mill, Perez, Paulhan, Le Bon, Galton, Fourneaux, Foerster, Klages.

In studying the ætiology of any ailment it is profitable to assume that no disease has a single cause. All the manifestations which constitute disease are the result of a disturbance of equilibrium between the human organism and its environment. In the production of this disharmony many factors play a part, each varying in importance from case to case. Nevertheless, since the discoveries of Pasteur we have become accustomed to view diseases mainly from the standpoint of their causative organisms, thereby neglecting many equally important factors in their ætiology. Yet we know of many instances where these selfsame pathogenic agents reside in the human body without producing any symptoms of disease. The meningococcus and diphtheria bacillus are found in the air-passages of many healthy people, while after the disease has run its course, the causative organism in typhoid may continue to occupy the body indefinitely. Moreover it frequently happens that living parasites of malaria, purposely introduced into the human subject, fail to produce any symptoms after many weeks of incubation. In cases of this nature it may transpire that the addition of further noxious influence, such as an injection of milk or even a cold bath, may precipitate the symptoms of malaria, which thereafter runs its normal course. Conversely, there are many individuals, or groups of individuals, who are particularly prone to fall victim to maladies from which others appear to be protected. The mentally disordered are very liable to infection by the Flexner group of organisms, while those who nurse them are seldom attacked. Such illustrations, which might be multiplied indefinitely, serve as a useful reminder of the complex factors at work in the production of diseases of microbic origin. The soil is just as important as the seed, and no study of ætiology would be complete were the question of individual susceptibility to be omitted.

The following is an outline of laboratory investigations which have been performed at the Warwick County Mental Hospital during the past two years, together with a summary of results and brief deductions as to the value of each investigation considered from the points of view of diagnosis, prognosis and lines of treatment.

In previous communications I have shown that the excitation processes mediating mind are essentially due to an interaction between Ca salts and colloids; also that behind a response or thought of a particular size there can lie an infinite series of excitation processes differing in the proportions of the two interacting factors. This composition next determines the type, or quality, of thought.

The writers of text-books do not give us much aid in gaining a true idea of the cause of “late” rigidity—rather the reverse, for they seem to think it necessary, always, to drag in “decerebrate” rigidity as an essential preliminary towards understanding the factors in the case.

One of the main difficulties encountered in the study of psychology is the lack of exact definition in its terms. In psychopathology this difficulty is intensified and many authorities use the same term with widely varied meanings. This is especially noticeable with the term “perseveration.” Some writers restrict its use to describing a subsidiary symptom of apraxia or agnosia, and limit its application to the repetition of an already executed movement in the presence of desire to make a fresh movement. Others write of agnostic perseveration as being synonymous with ideational inertia, and define it as the persistence of an idea in the process of recognition. Woodworth (1) defines perseveration as recall seeming to occur without a stimulus, and considers that some undetected external stimulus is necessary. Dumville (2) holds that perseveration is much the same as retentiveness, and limits its meaning to spontaneous revival in the case only of intense experiences, tracing a close connection between perseveration and association.

Several fallacies may occur in the recording of the pressure of the cerebro-spinal fluid. These fallacies may be related to (1) the type of apparatus used, (2) movements of the patient, and (3) reading of the pressure.

Application of the previously given formula for mental excitation processes (z), viz., H + L = T, to the problem of pain indicates that L, the thing felt, is judged through H, and the two together produce the response T.

I assume that cutaneous pain is a special sensation with naked nerve-endings as its “receptors.”

Many requests have been received for information concerning the table, and also as to the method for continuous colon irrigation used at this hospital. In the hope that such information may be of general service the following communication is made:

In 1927 Dr. Henry A. Cotton kindly supplied us with a photograph of the table for this purpose which he had installed at the New Jersey State Hospital at Trenton.