On December 8, 1939, 35 patients, neurotics and psychotics, met in “Sunnyside House” and formed a social club. The chair at the meeting was taken by a patient. We had previously met this patient with a few others, and explained to them the aim we had in view in proposing that they formed a club. Later this aim was expressed in the following paragraph which is taken from an article written for the first magazine of the Club :

“We find there are two main problems common to many who come to a modern mental hospital—the problem of ‘occupation’ and the problem of 'social relationship,’ that is, the relationship between the ‘I’ and the ‘ you.’ It was with the importance of the latter problem in mind that we suggested the establishment of a social club… . The satisfaction of successful co-operation is one of the surest foundations for happiness and inner security. Many of us here are lonely souls who have walled ourselves off to some extent from the society of our fellows. For one reason or another we have avoided the social impact and retreated into solitude and isolation. We have thus deprived ourselves of the possibility of co-operative activity and of the sense of security and fulfilment that this can bring. The Sunny Side Club will enable us to take the first few steps in the direction of fuller social co-operation by giving us the opportunity of working together on its various committees or of joining in its activities.”

Since Sakel's introduction of hypoglycaemia into the therapy of psychoses, discrepancies between the level of the patient's blood sugar and the severity of disturbance of consciousness have frequently been noted. The blood sugar decreases in a relatively steep curve within the first and second hour after the injection of insulin; but only after it has remained on a low level—differing from case to case—for a considerable time does the patient go into coma.

It seems useful to define the clinical signs of coma if it is intended to correlate it with laboratory findings. It is a state of unconsciousness in which the patient cannot be roused by sensory stimuli; in coma such stimuli do not provoke local and purposeful, but global movements only, if any. Once in coma the patient remains so, independently of the blood-sugar level, which can rise and fall within a certain range without visible change in the clinical picture; it may even rise to a level at which the patient was awake or could be easily wakened before he went into coma. Subcutaneous or intravenous injections of adrenalin in coma produce a rise in blood sugar without clinical effect. On the other hand, the flooding of the blood stream with sugar by nasal tube feed of a concentrated sugar solution or by intravenous injection of 33 per cent. glucose solution terminates coma and restores consciousness within a few minutes. The latter's action is so immediate that it is considered a practical rule not to stop injecting glucose until the patient is really awake.

From these observations coma appears to be a kind of trigger mechanism comparable to instinctive reactions, such as thirst, hunger or sexual desire. Once established it can only be reversed by specific means.

Arachnodactyly, or spider digits, was first recognized as a clinical entity by Marfan in 1896, and since then a considerable number of cases have been described; thus in 1938 Futcher and Southworth were able to find two hundred examples in the literature. Reviews of the condition have been made by Marfan (1938) and Clément (1939). Its relationship to oligophrenia has never been stressed, but since skeletal and ocular abnormalities are so frequent in defectives, it is not surprising that cases of arachnodactyly should also be found.