The purpose of psychotherapy does not differ essentially from that of the treatment of sickness generally. It is to relieve distress and promote efficiency of mind while improving the patient's adaptation to the group in which he lives, to their mutual benefit. Before psychotherapy can be prescribed or undertaken, a diagnostic review is necessary of the relationship between the patient's psychophysical constitution and the stresses to which he has been and is being exposed. This relationship is a complex one which involves the effects of previous stresses and the way in which they have been surmounted or have left their mark. The introduction of a third complex entity, the method and personality of the therapist, renders the total situation too involved for detailed comprehension and logical analysis, especially if the therapy is to be of the causal-anamnestic or comprehensive kind which is not content simply to deal with symptoms and their immediate causes. In the presence of this degree of complexity—well beyond the range of mental encompassment by one mind at one time—the psychotherapist must walk in humility, for he can rarely feel justified in thinking that he knows exactly what is going on.

Control subjects voluntarily overbreathed to produce end-tidal PCO2 levels similar to those found in patients suffering from neurotic or endogenous non-retarded depression. Red cell sodium content was found to decrease during overbreathing in all the subjects. The changes were similar to those usually reported for depressed patients.

The results imply that red cell sodium levels are in part dependent on respiratory behaviour. They suggest a need for considerable caution in interpreting red cell sodium values from psychiatric patients.

This review is based on neuropathological contributions which have either a direct or indirect relation to mental disease or are of major general interest. Notwithstanding these restrictions the field which had to be covered remains vast, and no claim can be made that the survey of the literature is complete, although it is hoped that it is, to some extent, representative. In order to counteract this defect, recent reviews or comprehensive papers on special problems have been recommended, whenever they were available. They will enable the reader to trace references which for lack of space had to be suppressed. For the same reason of economy, a number of quotations have been made from reviews. This does not mean that the original papers have not been consulted.

We have it on the word of Justinian, that “by the law of nature all men were born free.” Yet the Blue Book of the Commissioners in Lunacy, recently published, shows that 36,871 Englishmen are deprived of their liberty, and confined in lunatic asylums. And if we compare these numbers with those in the Report for 1869 it will be found that during the year 1870 the insane of all classes have increased in number by 2,042, or 174 private and 1,868 pauper patients. This increase is not exceptional, but has been going on for many years.

Among not a few less agreeable influences pervading lunatic asylums, there is one under whose effect every person concerned in the general management of those institutions is sure to come, viz., the architectural. No asylum superintendent is to be found, who has not various plans of renovation and improvement for his own institution, who does not see precisely the constructional arrangements which the insane require, and who has not, very generally, floating before his mental vision, asleep or awake, some grand scheme for a model asylum. Nor is this to be wondered at, when it is considered that the asylum building is the machine through and by which the superintendent is to work out and develope his system of moral management; that, in short, it is an instrument of cure, of the adequacy, utility, and perfectness of which he must be the best judge.