There does not appear in the literature any method of treatment to which the term “prolonged narcosis” can be applied prior to the year 1897, when Macleod (47, 48) published his first article on the bromide sleep treatment. The Hippocratic “Aphorisms” (126) mention that immoderate sleep is bad for the patient, but Celsus (129) quotes Asclepiades as being in favour of procuring sleep, and remarks that some insane patients recover if sleep is obtained, and Paulus Aegineta (128) observes that sleep produces oblivion of mental suffering and rectifies the distracted powers of reason. Aretaeus (127) in discussing satyriasis mentions “very protracted sleep” as the proper cure for the condition”.

On looking through the literature relating to the blood-picture in various types of mental disorders, one finds that most workers have confined themselves to the red and white cells only. Relatively little attention has been given to the study of the third element of the blood, namely, the blood-platelet. It is now almost universally accepted that the blood-platelet is a constant element in normal blood, and it has been shown both clinically and experimentally that in health and in disease the platelets fluctuate independently of the red and white cells. In toxic conditions there is agreement that the platelets fall in the acute stages, and that during convalescence their numbers tend to increase, after which there is a gradual fall to the normal limits. This constant behaviour of the platelets has been observed in certain acute infectious diseases, in pneumonia and in typhoid fever. Certain writers think that the platelets have an important function in eliminating foreign bodies from the blood, or play some part in establishing a state of immunity to infection. This part played by the platelets in the sterility of the blood-stream suggests an explanation for the reduced numbers in acute infections. Diminution would be due to the using-up of the platelets in removing and destroying the infective agents or their products. The present work gives the results of an attempt to show that this same relation between the platelets and toxins also exists during certain phases of mental disorder and, in these particular cases, a toxin from a focus of infection can be assumed to be the causative agent in producing the psychosis.

The treatment of congenital syphilis, in spite of the advances in the general treatment of syphilis in the last thirty years, still leaves much to be desired. Veeder, after treating some 500 cases of congenital syphilis in St. Louis between 1912 and 1920, came to the conclusion that the results of treatment were most unsatisfactory, and that very little was to be gained by the treatment of the syphilitic child. He advocated the treatment of the parents to prevent the birth of syphilitic children. Nabarro is of opinion that the criterion of cure should be the complete cessation of any symptoms of activity and a normal blood and cerebro-spinal fluid. He has not been able to fix any limit of time after which he can regard the patient as cured. He mentions a case of his which relapsed with interstitial keratitis after having had a negative Wasser mann reaction for eight years. Ambrose King doubts whether congenital syphilis is ever really cured; he states that “cases had been seen in which manifestations of congenital syphilis appeared only after the lapse of a number of years, and others in which active lesions occurred, but with a negative Wassermann”.

Vascular lesions, identical in appearance with the sequelae of organic diseases of the blood-vessels, have been found in a great variety of conditions (for instance in epilepsy, hypertension and cardiac disease, psychoses associated with infectious and toxic conditions, head injuries, certain groups of mental deficiency) in which no organic lesion of the blood-vessels themselves could be demonstrated. The theory has been put forward (Ricker, Spielmeyer and others) that these lesions owe their origin to functional disorder of the vascular system, and that this common factor accounts for the identity in histological appearance in spite of the profound ætiological differences.

A considerable diversity of opinion exists on the definition of that part of the personality which is known as temperament, and some authorities go so far as to say that no practical advantage is to be obtained in differentiating it from character. Temperament, nevertheless, is the means in every-day use by which strangers provisionally gauge the extent of their affinity to each other.

Barbital therapy has aroused more interest than any other method of narcotic treatment. The reason is that barbital narcosis offers a new means of establishing contact with hitherto suspicious, seclusive and inaccessible patients. It is the quickest and most effective method of inducing sleep and rest in various maniacal states. Furthermore it is a potent agent in terminating the course of many acute psychoses. Barbital therapy, being empirical, and to some extent experimental, is difficult to define. It denotes more than the mere induction of continuous deep sleep. In fact, it denotes an organized scheme whereby physical and psychic rest, increased suggestibility and alteration of affect are used together to restore normality.

The subject of the fate of sodium barbitone in the body appears still to be a valid subject for discussion; various workers have investigated the excretion of the drug in the urine of normal persons and persons suffering from bodily—not mental—illness.

The subject of this essay has almost the blessings of antiquity. The increase in the knowledge of the aetiology of epilepsy makes the revision of its classification very necessary. It has been well said that complexity of nomenclature implies poverty of knowledge. This is conspicuously true of one branch, in particular, of medicine, where the desire for classification has outrun the accumulation of data. It is not so with epilepsy, where increased knowledge of causation necessitates a revision of the scheme of classification.

Sporadic bacillary dysentery is an accepted concomitant of lunacy, and mental hospitals, on statistical evidence, harbour more than 99% of the disease. When an epidemic of dysentery occurs, the laboratory of the mental hospital is cluttered with fæcal specimens, but when the epidemic is resolved on a solitary “carrier” and a faulty drain the disease ceases to arouse further interest. Little effort is made to assess and control the endemic level. This the author has attempted to do, in a county mental hospital of, roughly, 1,000 beds.

Though many of the earlier workers made statements based on general impressions from injected preparations about the relative vascularity of different parts of the brain, only comparatively recently has an attempt been made to measure and express numerically the capillary development in different areas, by methods similar to those used by Krogh in studying the vascularity of muscle. Craigie has made an extensive study of the rat brain by such methods, Cobb, and Cobb and Talbot have investigated certain areas of the rabbit brain, and Dunning and Wolf certain parts of the nervous system of the cat. In the present paper a personal investigation (undertaken at the suggestion of Dr. Cobb) is reported, comparing the basal ganglia, cerebral and cerebellar cortex of the cat as regards capillary vascularity. The capillaries were demonstrated by Indian ink injection, and results expressed in millimetres of capillary per cubic millimetre of tissue. Substantiating observations were made on similar areas of monkey and human brains, but without attempting accurate measurement as in the cat material.

The condition of spontaneous hyperventilation tetany has received some attention recently, and in many cases it has been impossible to demonstrate adequate biochemical changes to account for the tetanic manifestations, which so closely resemble the more recognized clinical types of tetany. The reason for the apparent spontaneity of the attacks has remained obscure beyond the general trend to recognize it as “functional” in most cases. In view of this recent interest, and of the atypical clinical manifestations in this case, the following observations on a single patient are put on record. A few previous cases treated at the Maudsley Hospital, but differing from the present one in the absence of loss of consciousness during the attacks, are also briefly reported.

When normal human skin is moderately cooled it goes blue, owing to a contraction of the arteries and arterioles, and a relaxation of the capillaries and subpapillary venous plexus of the epidermis. This blueness is light in colour. In certain individuals, however, it is deep, or relatively saturated, in the hands or feet or both; these include cases of acrocyanosis (extremity, = dark blue). This condition, though rare in the general population, is common among the inmates of mental institutions.