The influence of slight variations in the inorganic constituents of the tissue fluids on the function of the nervous system has long been the subject of physiological investigation. Thus a disturbance of the ratio Ca/Na is known to be related to the irritability of muscular tissue (1). Ca and K are antagonistic in their action on the vegetative nervous system: Ca increases the excitability of the sympathetic system, whilst K excites the parasympathetic system (2). The influence of Ca on the excitability of the central nervous system finds a clinical illustration in tetany; and, from a pathological point of view, diminution of the serum Ca is well established in certain types of this disorder.

At the last annual meeting of the Medico-Psychological Association, held at the College of Physicians, London, in July, 1870, I brought forward a resolution which, after full discussion, was amended and agreed to, in these terms:— “That it is desirable to facilitate the early admission of all acute cases of pauper insanity into county (and borough) asylums, by providing for the proper care and treatment of chronic and harmless cases elsewhere.” The object of the resolution being to ensure for acute cases that prompt treatment which is so essential, and to prevent the overcrowding and overgrowth of asylums, by providing for the transfer of incurable and harmless cases to workhouses, or to lodgings, or to reside with relatives, under proper care, treatment, and supervision. In the absence of any such provision, the enlargement of asylums progresses—this will be shown by the returns of the increase of pauper insanity in England and Wales. Several institutions have attained such dimensions that the difficulty of proper management has become great. In such overgrown establishments the individuality of the curable patient is liable to become lost amongst the crowd of idiots and incurables. The delay in obtaining the forms required by the Lunacy Acts, prior to the admission of insane patients to pauper asylums, is a great hindrance to early treatment. As regards chronic cases, this delay is of little consequence, and from the comforts being greater in the asylum than in the workhouse infirmary, and it being to the interest of workhouse officials to send insane paupers to the asylum, the accumulation of chronic and incurable cases therein can easily be accounted for.

Reviews, abstracts, and papers concerning this subject having appeared from time to time in the Journal of Mental Science, I shall, with the exception of making a few incidental explanatory quotations, confine myself to an account, more or less brief, of some of my own cases and to the remarks suggested by them.

One can arrange the determinants of Rorschach responses in the following groups, according to the sense impression which they convey:

An optic sense impression only is given by the form-, colour- and vista-responses (F, C’, FC, CF, C, FK, K, k responses).

A kinaesthetic impression is conveyed in addition to the optic one by the movement responses (M, FM, m responses).

A tactile and optic impression is conveyed by the texture responses (c, CF, FC responses).

It is perhaps of some small interest that the President of the Section of Neurology delivered last week in this building an address on “The Borders of Neurology,” and that for to-night I had chosen to speak on what is obviously a related topic, the “Tasks of Psychiatry.” It is, of course, possible that behind this choice of our titles there may simply be a geriatric problem, for the President of the Section of Neurology and I worked together as members of the same Field Ambulance in the Battle of the Somme, just over 32 years ago. On the other hand, there may be more than this in it, and perhaps we really do need to define our fields rather more clearly and to make sure what our tasks are, and how we are best to meet them. In fact, I think that the question of the actual borders of psychiatry, as apart from its tasks, was dealt with quite convincingly in the Joint Report of the Royal College of Physicians, the B. M. A. Psychological Medicine Group and the Royal Medico-Psychological Association.

Earlier investigations (3, 4) have shown an abnormal glutamic acid metabolism in schizophrenic patients.

These changes are, briefly, low glutamic acid level (and high glutamine level) especially in acute cases. Glutamic acid concentrations below 1.2 milli grams per 100 ml. venous blood were ascertained in most of these patients.

The Oxford Clinic for Nervous Disorders first came into official being in the beginning of 1918, when the Committee of the Radcliffe Infirmary did Dr. W. McDougall and myself the honour of appointing us as Physicians-in-Charge of this department, and asked us to organise and run it. It was started with an outpatient department one afternoon a week and was entitled the Department for Nervous Disorders. This term was chosen as it was hoped that it would induce all classes of nervous cases to apply for treatment. Particularly for those cases which show mental symptoms was this title chosen, in the hope that such patients would come to the clinic without feeling they were being specially branded as “mental.” Opportunity would be given for treatment, and possibly improvement or even cure might be effected, and thus certification, which every one of these cases most dreads, could be avoided.

“The wicked flea,”—Everybody knows the “wicked flea,” for it is no respecter of persons. It makes its home in the palace of the prince, the hovel of the savage, and the tent of the Arab. The devotions of many a worshipper are destroyed by the Pulex tabernaculi, or church flea, which makes up by its voracity on Sundays for enforced abstinence on other days of the week; and one of the wonders narrated by travellers is that on camping in the desert they have found this wicked little creature waiting for them, ready to bite, although apparently its progenitors from time immemorial could hardly have had an opportunity of gratifying their taste for blood. When in Rome one summer, fleas were abundant in the hotel where I was staying. I used to walk barefooted about my room every morning, and soon a prick on the instep would warn me that a flea was there. I looked down, saw a little black speck, put a wet finger upon it, and after a little rub would transfer it to a basin of water. The sensation of something solid between the finger and thumb and the transference of the black speck from my instep to the water convinced me of the presence of the flea, for I had the threefold evidence (1) of common sensation, (2) of sight, and (3) of muscular sense all combining to prove the actual existence of the flea. At other times during the day I had the evidence of sensation to indicate to me that fleas were again biting, and I felt quite convinced by sensation alone that such was the case, for although I could not corroborate the evidence of sensation either by sight or by muscular sense, yet it was not contradicted by these senses. But sometimes I have felt upon my hand a sensation exactly similar to the bite of a flea, and yet, as the hand has been on my writing-table within full vision, and no object whatever was to be seen on the hand, I have discarded the evidence of sensation in favour of that afforded by sight, and come to the conclusion that no flea either was or had been upon my hand. Had it not been for the sensation of sight, however, and had the hand been hidden from my view, I should have confidently believed that it had been bitten, trusting to the evidence of sensation, which, though unconfirmed by sight or muscular sense, was not contradicted by these senses.

It is likely to be contended that climatic conditions, jungle warfare, distance from home, long separation from wife and family, difficulties in obtaining leave in the United Kingdom, delay in the receipt of mail, close association with members of different races and problems in regard to evacuation contributed to the incidence of psychiatric illness in Burma. It will be interesting to note in due course, when the total figures of psychiatric casualties from all theatres of war are available, whether or not conditions in Burma were in fact relatively more productive of psychiatric illness than they were, say, in North Africa or Italy. Then only will it be possible to conjecture on the relative effects of one type of climate as compared with another, or jungle warfare as compared with desert fighting, and so on.

In a former paper diet was referred to as a part of the management of the epileptics under care in a mental hospital, and the opinion expressed that, on a diet mainly purin-free, tendencies to serial fits, confused states and dream states appear less marked.

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.

The discovery of the nervous impulse established that the nervous system was fundamentally mechanistic, and that it was highly dynamic; and all subsequent work has confirmed these earlier views. The stabilities of inanimate dynamic systems are frequently of high importance and rich in applications. It would seem likely that an investigation of the stabilities of the nervous system would yield interesting results, but it is only recently that the importance of stability in the nervous system has been unequivocally recognized. But it has now been established that such properties are of central importance in the processes of integration and co-ordination. Advance has probably been hampered by the difficulties of the subject.

Considerable attention has recently been directed by several observers to adolescent insanity and dementia præcox, and an increase in the numbers of these varieties, especially of dementia præcox, has been stated to occur, which means an increase in the more hopeless and demented cases. Dr. Wood, for instance, at the Annual Meeting of the Medico-Psychological Association, remarked on the increase in the number of cases of mental breakdown during the age of puberty and adolescence among persons of the upper and middle classes— the ages of which on admission he placed at from eighteen to twenty-eight years—and he suggested as a cause the greater strain of education and the worries of life during the present time. Again, at a meeting of the Section of Psychological Medicine of the British Medical Association, Dr. Robert Jones mentioned an increase of dementia præcox and a general increase of the less curable forms of insanity.