The scientific method of studying the phenomena of the human mind by founding it on a physiological basis, and thereby tracing the cerebral functions through the lower animals and uncultivated man, according to the plans adopted in other physiological investigations, must necessarily tend to modify or even change much that is contained in our received systems of psychology. In the hands of such men as Darwin and Huxley, the comparative method, when worked out in all its truthfulness, must necessarily bear good fruit, and be unaffected by any of the bias which the purely metaphysical method of the schools is apt to give to the investigation. The objection that it is degrading to compare the human being with the lower animals, or to take mankind in the mass, is of no value to the scientific investigator, who is merely seeking after truth, and knows that no researches of his can in any way affect man's history in the past or for the present; although they may afford many explanations of human conduct.

A granular condition of the ventricular ependyma has long been recognised as a pathological condition in various cases of insanity, and is so common in cases of general paralysis that we are surprised when it is not present. It is, however, by no means confined to that specific class of case, but exists in others, and, although not so frequent, is sufficiently common to make one inquire into its cause and as to its bearing, if any, on insanity.

In the numbers of the Journal for January and April, 1896, I described the recent action of the Berlin authorities in placing a considerable number of the insane poor under care in private dwellings, which illustrates one of the latest ways in which this mode of providing for the insane has been organised. Having in the year 1895 revisited for the third time the well-known colony of the insane at Gheel, in Belgium, and having once in 1895 and again in 1896 visited the recently established Belgian colony at Lierneux, I now propose to describe the present position of these two colonies, which exemplify the oldest systematised method of providing for the insane in private dwellings.

Since May, 1915, I have habitually used the Cantani injection in moribund cases of general paralysis, and I have been impressed on many occasions by the remarkable effects produced, in that the life of the patient has been prolonged generally for several days and often for a matter of weeks or months. I had been taught that nearly all forms of mental disease were practically incurable, and that general paralysis in particular was not only incurable, but invariably fatal. In view of my experience, however, I determined to try and improve the method. In taking up the investigation I was largely influenced by the fact that if the method of treatment were successful it would have the strong practical advantage of keeping the patients alive until relatives residing at long distances could reach them and so be present at the death-bed.

The Laurence-Moon-Biedl syndrome shows much variation in its clinical picture from case to case and the limits of this syndrome are indefinite. This clinical entity was first identified by J. Z. Laurence and R. C. Moon in 1866 and was more completely described by A. Biedl in 1922. In 1935, Cockayne, Krestin and Sorsby stated that some 30 isolated cases and 15 affected families were reported during the ten years from 1925 to 1935, and in 1939 Sorsby, Avery and Cockayne made a later review. In October, 1955, J. Todd described a case of Laurence-Moon-Biedl syndrome with paranoid psychosis in the American Journal of Mental Deficiency, and in 1950 R. A. Burn reviewed 82 cases giving the total number of reported cases as 260. Up to 1957 about 320 cases have been described in the world literature but even this number is likely to rise with the increased interest shown in this syndrome.

In an earlier investigation (Holland, 1960) the peripheral visual field was examined under three treatment conditions, namely meprobamate (2-methyl-2-n-propyl-1, 3 propanediol dicarbamate), Doriden (glutethimide), and no drug. Results from 24 subjects, each tested three times, indicated that there were significant differences, attributable to the treatments, in both the inner and outer discrimination thresholds and also in the magnitude of the interval of uncertainty between thresholds. In the present experiment it has been thought worth while to examine the visual field for the effects of two other compounds, a stimulant dexamphetamine sulphate (Dexedrine), and a depressant sodium amylobarbitone (Amytal).

That a uniform statistical method should be generally adopted by all those connected with the insane is greatly to be desired, for though statistical researches have met the fate of all other methods (‘Annales Psychologiques,’ July, 1856), have been received with un-reflecting infatuation, or been the subject of unmerited reproach, according as they have given us useful facts or have led us into error, yet everything leads us to expect that the extension of a statistical programme, would furnish us with useful data, for the examination of some of the most important questions relative to mental alienation.

All the forms of insanity we have hitherto been considering have been more or less connected with the sexual organs or sexual functions and conditions, with the exception of the first and last—the epileptic and phthisical insanity. The forms which follow are mostly connected with disease of the body, affecting the brain sympathetically, or disease of the brain acting on its functions directly.

I have read with interest and appreciation the brief paper on “Focal Infection in Relation to Mental Disease “(vide Journ. Ment. Sci., April, 1929, p. 267) contributed by Drs. Kopeloff and Kirby, whose work, along with that of their colleague, Dr. Cheney, is familiar to English and American psychiatrists.

The proposals for legislation as contained in the Mental Deficiency Bill are here dealt with under the following heads, viz.

A number of recent studies of apparent movement have been designed with Kohler and Wallach's satiation theory or some similar theory of cortical processes as their basis. The work has been reviewed in some detail (4) and we shall concern ourselves here only with those studies that are both less equivocal and directly relevant to the present study.

The widespread use of barbiturates as hypnotics for insomnia has greatly increased the risk of accidental overdosage and the number of suicidal attempts. The size of the problem concerning barbiturates and suicidal attempts is difficult to estimate as only suicidal deaths are recorded by the Registrar General, and his statistics for 1956 (R.G., 1958) reveal that out of a total of 5,282 suicidal deaths, drugs (mainly barbiturates) were second only to domestic coal gas poisoning as the effective agent. Stengel (1958) calculated that six times the number of suicidal deaths gives an approximate estimate of the number of attempted suicides. Locket and Angus (1952) found that of the patients admitted to their Unit, barbiturates were the drug involved in 80 per cent. of the cases and that in 90 per cent. of the cases it had been prescribed for the treatment of insomnia. Locket (1958) also estimated that some 6,000 patients were admitted annually to hospitals in England and Wales for treatment of barbiturate poisoning.

Since the definition of subnormality in the Mental Health Act (1959) specifically adds to its other descriptive statements, “… including subnormality of intelligence,” as part of the criteria for delineating this type of patient, it is clearly of great importance to come to some decision about the exact meaning of this phrase. One can either insist on a purely intellectual interpretation where the major emphasis is placed on the individual's estimated problem-solving ability relative to the community at large (Castell and Mittler, 1965); or one can broaden the concept to include much more than sheer intellectual ability (Shapiro, 1965) and argue that it also involves a person's social behaviour and his empirically demonstrated failure to adapt to the social and economic environment. If the purely psychometric view is taken, then reliance is placed wholly upon the use of standardized tests which are capable of arranging the population in order of intelligence, and which supply statistically defined cut-off points, according to the percentage of the whole population likely to fall beneath such limits. Conversely, if the clinical viewpoint is adopted, then intelligence levels assume a relatively minor role, and more emphasis is placed on social maturity, and behavioural control. In the absence of properly standardized, and widely accepted maturity scales, the clinical diagnosis is based mainly on subjective impression, supported by case history factors, and the knowledgeable experience of the examining medical expert.

In reviewing controlled trials using mono-amine oxidase inhibitors in the treatment of depression it is soon obvious that workers vary as to whether they consider “depression” as a symptomatic mood change in diverse conditions or as a disease entity. Where the latter occurs, a variety of classifications of depressive illnesses appear, and that most widely used is the broad separation between endogenous and reactive depressions. Other points to note are the authors' definition of improvement, and particularly whether this refers to one aspect of the mental state only and whether the patient left hospital before receiving any treatment other than the drug.