During the last nine months of 1931 a series of 175 cases were tested for syphilis by means of several reactions, and the results were reported in this journal in January, 1932. During the next nine months the work was continued and considerably extended, and we shall here give the further results thus obtained, together with a statistical expression of the findings of both periods combined.

During the last ten or twelve years a great deal of study has been devoted to cholesterol, its metabolism and variation in disease, and its rôle in mental disorder. Since 1926, investigations on this line, laboratory and clinical, have been carried out at Severalls Mental Hospital, and the object of the present paper is to summarize this research, especially in the light of other work, and to indicate what conclusions might be formed.

It is now recognized that mongolism results from defects inherent in the germ-plasm. This has been proved by numerous observers, including Bauer, Orel, Halbertsma, Brousseau and others, who have investigated the occurrence of mongolism in uniovular and biovular twins.

During the last decade prolonged narcosis has been accepted as a most valuable form of treatment in mental disorder, but many psychiatrists refuse to use it because of its dangers. The present paper presents clinical and laboratory evidence that a method has been devised whereby most of the toxic symptoms can be obviated. It is claimed that a large proportion of these symptoms are due to upset of carbohydrate metabolism of the liver and heart by the narcotic, and that in the administration of insulin and glucose as an integral part of the treatment a rational method of prevention has been evolved. No attempt is made to record the results of treatment, as it is proposed to publish this separately, the aim of the present paper being to show the elimination of toxic symptoms by the suggested modification of treatment.

Since 1922, when Kläsi's work on prolonged narcosis with somnifen—a mixture of barbitals—appeared, this form of treatment has become an integral part of the armamentarium of psychiatry. Patients suffering from various psychoses were subjected for a longer or shorter period to intoxication by a hypnotic, with or without the production of a prolonged sleep. Successes—sometimes very great successes—were claimed for this treatment. The number of publications on this subject is so large and the successes described therein so numerous, that the clinical worker is in duty bound to form an independent opinion regarding this method. The question is whether there is anything in this therapeutic method which psychiatry should retain, what that something is, and whether or not we can improve its system of procedure. Too great an enthusiasm is equally dangerous here, as is underrating the method because of a single unfortunate experience during or following the treatment.

Acting on the theory that hyperpyrexia is the effective agent in the treatment of general paralysis by malaria, Neymann and Osborne (1) experimented on dogs to see whether, by means of diathermy, sufficient heat could be generated to raise the temperature of the experimental animals to a high degree without injurious results.

This being found practicable, they devised a method of applying diathermy to the human subject, with the same purpose in view.

They found that they were able, by using a suitable set of electrodes, and by thorough insulation of the individual, to raise the body temperature to any height, and, moreover, to keep the temperature under definite control.

In the whole realm of medicine there are few more easily recognizable clinical syndromes than those which have been grouped together under the generic term of “epilepsy” or “epileptiform convulsions”; nevertheless, in spite of a vast amount of research work, the causation of these conditions is still imperfectly understood.

During the last few years, in which pyretotherapy has figured so largely in the treatment of general paralysis of the insane, the question must have arisen in many minds whether general paralysis occurs in communities where malaria is indigenous, and if so, whether satisfactory results would be obtained from further malarialization on artificial lines.

The Central Mental Hospital of the Federated Malay States has over 2,500 patients in residence, and draws its cases from the whole of the Malay Peninsula. Many races are represented besides the native Malay and associated races—Chinese, Japanese, Siamese, Indian, etc.—and malaria is indigenous over the whole territory.

In recent years new avenues of approach to the treatment of epilepsy have been opened up, investigation and experiment have been stimulated, and, especially in young patients, definite hopes of cure have been held out. Experiments in metabolism have shown that a condition of acidosis is antagonistic to epileptic seizures. The ketogenic diet is one designed to produce acidosis artificially, this being achieved by reducing the carbohydrates and greatly increasing the fats.

The following paper is the result of experience gained during two and a half years' work at The Retreat, York.

It was prepared at the time that public attention was being focused upon the Mental Treatment Act, 1930. One of the most striking features of that Act was the provision that any person—pauper or otherwise—could be received into any mental hospital by applying for admission voluntarily. The removal of the bar of certification was widely welcomed; this welcome was believed by the writer to be partly a sentimental one. So little was known of any of the legal and medical difficulties which the voluntary boarder system had produced during the forty years it had been in fairly constant use in the registered mental hospitals, that these problems were seldom referred to when the Mental Treatment Act was under consideration.

It is now universally recognized that there is nothing specific in the form of psychoses associated with childbearing. There is, however, still a tendency to attribute to the puerperium itself or to pregnancy or lactation a significance quite out of proportion to that of other precipitating factors; thus such terms as “puerperal depression”, or “puerperal schizophrenia” are still in use, as if the precipitating factor were something special as opposed to the innumerable other causes assigned to the appearance of an attack of mental disorder. Nor is this surprising when one reflects on the enormous significance of the sexual life. One is quite willing on a priori grounds to grant to the puerperium this all-important rôle.

Hippocrates was the first to regard epilepsy, not as a “sacred disease” but as a disorder due to natural causes. He believed that a causal relationship existed between humidity of the brain and the epileptic crisis—a hypothesis that in recent years has assumed prominence following the work of Temple Fay (27) and McQuarrie (28). According to Fay an abnormal increase in intracranial pressure is brought about by the accumulation of fluid over the cortex, due to impairment of function of the Pacchionian bodies.