In 1929 Berger (1) discovered that changes of electrical potential in the human brain could be detected through the unopened skull. Since that time the study of electro-encephalography has occupied the attention of many workers, and the literature is already too extensive for adequate review in this place. A brief description of the technique for obtaining an electro-encephalogram, or “EEG”, and a summary of its normal and pathological characters may be found in a communication by one of us (2) on the relation between the EEG and the presence of intracranial neoplasms. The cortex in the region of a tumour was found to produce abnormally slow potential waves, which were provisionally called “delta” (δ) waves to distinguish them from the normal “alpha” (α) waves which are the original “Berger rhythm”. In the same paper a case was reported in which a focus of δ waves was found in the left parieto-occipital region associated with an area of degenerating cortex. The history in this case was of occasional minor attacks and one major fit and an indefinite severe illness in infancy, the only sign being a right homonymous hemianopia in accordance with the left-sided focus. Ether and nitrous oxide anæsthesia are also accompanied by the production of slow waves, but in this condition there is no fixed focus, the whole cortex being engaged in abnormal electrical activity. Since the publication of the above-mentioned results, a case of cerebral abscess has been examined, and the EEG was found to indicate a δ focus similar in character to those which have been found in cases of new growth.

The title of this paper will suggest a number of problems which are still the subject of considerable controversy.

Thus, some authorities appear to uphold the general proposition that there is a fundamental and clear-cut distinction between all neuroses (or psychoneuroses) on the one hand, and all psychoses on the other.

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 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.

Within recent years a great deal of attention has been paid to the question of chemical transmission of nervous impulses, and it has been definitely established by Dale and his co-workers (1, 2, 3) that acetyl choline is the transmitter in the case of the parasympathetic nervous system, and also in part of the sympathetic nervous system.

In the routine examination of the urine of patients admitted to this hospital one is struck by the frequency of albuminuria. For example, 27·4% of 667 consecutive female admissions had a trace of albumin in the urine (i.e., a faint cloud appeared when the heat test was applied), while 37·2% had more marked albuminuria (i.e., the urine showed a thick cloud when the heat test was applied); only 35·4% were entirely free from albuminuria. Of 517 consecutive male admissions 20% had a trace of albumin in the urine, 19·5% more marked albuminuria, and 60·5% were free from albuminuria. B. H. Shaw (1) at Stafford found even higher percentages in his 250 admissions in 1935.

IN 1935 V. V. Issahyev reported very favourable results from the treatment of a number of cases of idiopathic epilepsy by diathermy to the head, stating that although the method could not be held to cure the complaint, nevertheless it produced considerable relief in the majority of cases. The object of the present investigation has been to repeat this form of treatment in a further series of cases in order to see how far these results could be confirmed.