The author singles out the new edition of Nonne's Syphilis und Nervensystem, and a new book by Wilhelm Gennerich, Die Syphilis des Zentralnervensystems, which he regards as the most important work on neuro-syphilis published to date.

The present article is chiefly concerned with those thyroid abnormalities which have been found associated with the so-called affective psychoses. The author himself has met with many cases of melancholia, hypomania, and anxiety psychosis, which, at the same time, were goitrous. Thus in a case of agitated melancholia presenting thyroid enlargement with signs of hyperthyroidism, complete mental recovery followed the removal of a thyroid cyst. In another case of melancholia with a large goitre the latter was treated by radio-therapy, with the result that the signs of hyperthyroidism diminished and the melancholia disappeared.

The writer's experience shows the need of co-operation between magistrates and alienists. Representations which led to legal investigations were made by the former confederates of an alcoholic woman who was improving rapidly in the sanatorium of Fort-Jaco. The inquiry was conducted in a spirit of antagonism and suspicion which spread discontent among patients. The removal either home or to the asylum was ordered of certain patients well suited to sanatorium care who had not asked to go. These included chronic psychoses without anti-social conduct, paranoias, simple dementias, transitory and curable psychoses, etc. In particular the removal home as mentally fit and wishing to leave was ordered of a blind paraphrenic who made a stereotyped demand for discharge to go to “X, where she had the freedom of the city,” but who remained, though she carried the writer's signed permit, and who refused to depart with her friends. Other cases, unable to exercise volition (e.g., of stupor) were to be certified.

This plea for greater use of the opportunities which hospital control affords for the diagnosis and treatment of syphilis is based on replies to a questionnaire sent to institutions for the insane and mental defectives in U.S.A. and Canada, and on personal experience as superintendent of Dannemora State Hospital. At Dannemora, of syphilitic cases which received adequate treatment (limited by expense to 25 per cent.), with the exception of paretics, all responded by changes in the Wassermann reaction of blood and spinal fluid and by physical improvement, and nearly all by mental improvement, usually preceded by temporary loss of weight and occasionally by transitory mental exacerbations. Reports of four cases are given as examples. Treatment, the details of which are described, consisted in four courses of neo-arsphenamide given intravenously combined with mercury salicylate intramuscularly and sodium iodide by mouth, and with attention to diet and hygiene. Some paretics showed reductions in Wassermann, blood-count and globulin, but not in gold curve, nor has there, as yet, been a cure. General paralysis, however, is simulated by curable forms of neuro-syphilis. Syphilis may be a factor leading to loss of mental balance even without actual cerebral infection. A routine Wassermann test should be made on all inmates, and all serologically or clinically syphilitic should receive intensive treatment.

Emphasis should be laid on the relation of directed activity to mental adjustment and social rehabilitation. There are three groups to be dealt with: (a) Patients likely to remain permanently in hospital, (b) recoverable hospital cases, (c) pre-hospital work at clinics. The candidate for training should not be too young and should be selected by a committee. Personality and character are of the highest importance, and the work demands consecration and genuine human love. The training is both theoretical and technical. The student is taught a little of general hospital administration, hospital etiquette, and the relation of her work to the organisation as a whole. She starts with the lower grades, and is taught something of the interdependence of the mental and physical, of the nature of habit reactions and methods of overcoming bad and forming good habits, including the habit of attention. Habit training is especially important in the reception service and with the unemployed deteriorating class. The deteriorated patients of many years' standing are the most difficult of all, but the writer looks forward to a lightening of this burden in the future when improved methods of prophylaxis and treatment have been used from the beginning. However, these patients are entitled to a chance, and even now results are encouraging. The next grade is the kindergarten. Here the student learns methods of re-education along lines of sensory stimulation and training: colour, music, simple exercises, games and story-telling are employed along with occupations. In the grades above this patients are given manual occupations chosen to meet individual needs. They are of increasing complexity, increasing interest, and require increasing concentration. Still higher is the occupation centre or “curative workshop,” where really beautiful work is sometimes done. Patients may be sent here for special observation, or before parole, or before passing to the “pre-industrial” or vocational training departments. The student should here make a general survey of the patient from the point of view of his personal needs, interests, inhibitions, emotions and relation to environment and the construction of a balanced programme of work, rest and play.

For thirty years—first at State Hospitals for the Insane, and later as Medical Director of Phipps Psychiatric Clinic—Dr. Meyer has assisted at the progress of occupational treatment for mental illness. He has seen it develop from a purely industrial type of employment with mainly utilitarian aims to the educational methods of occupation and recreation under the direction of specially trained organisers, in establishing which Mrs. Meyer was one of the pioneers.