Temperament, derived from “tempero,” owed its meaning to the supposed mingling of the “humours,” the sanguineous, the bilious, the phlegmatic and the melancholic, the predominance of any one of these in an individual giving rise to the characters of the corresponding temperament.

It is now two years since Armistice Day, and I then delivered a short address on vocal therapy and the manner in which it originated at the Maudsley Hospital in small beginnings. It was then energetically supported by Lady Carnarvon, and a society was founded for the purpose of providing teachers for instruction of soldiers and ex-service men in breathing and singing, as well as in the treatment of speech disabilities, under medical direction and supervision. I was fortunate in securing such excellent teachers as Miss Oswald, Miss Bush and Miss Dredge, who, with genuine enthusiasm, successively carried out vocal therapy at the Maudsley Hospital.

In the latter part of 1919 a patient who had hitherto proved inaccessible began to speak freely of his hallucinatory experiences. His observations were so interesting that it seemed to be an excellent opportunity to gain some insight into the obscure question of hallucinations, and I have therefore kept a complete record of everything which the patient has told me in the course of our conversations during the last year. The method of study has been purely conversational. The method of free association was not utilised for various reasons, and, in a sense, it was scarcely necessary since the patient really analysed himself naturally, and in his remarks made the origin of his experiences quite apparent. It is only proposed, in the present instance, to describe the hallucinations, and to discuss their origin and significance. There are many other features of interest in this case, such, for instance, as the reactions provoked by hallucinations, but these matters are much beyond the scope of a short paper. A brief history of the case will first be given.

Human activity is always conservative, and the sphere of mental medicine is patently no exception to the rule. Since the reaction took place from the callous and barbarous treatment of the insane we have progressed far, and are rapidly tending to regard the mentally disordered individual from a similar point of view as the physical sufferer. The late war has brought the problem of mental disease vividly to the notice of the laity, the medical fraternity have been stimulated thereby to take greater interest in the subject, while even many psychologists and psychiatrists have through war clinical experience become more humanistic in their outlook upon the psychotic patient. Following upon the special provisions which were made for those who broke down mentally in the service, there is much discussion as to what alterations should be made with regard to the care for the insane, and more especially those who are in an incipient stage. That some adequate provision must be made for early care and treatment hardly requires pointing out, for its absence is perhaps the greatest defect in the existing organization. Any real advance, however, in this direction cannot take place until a fresh generation of psychiatrists have had the opportunity of being thoroughly trained to understand the genesis and pathology of those initial symptoms with which the average asylum physician of to-day would be more or less powerless to cope. We have arrived at the stage in which we have built huge caravanserais in which the insane have an environment which leaves little to be desired for this type of system. Is it not possible that we have lingered so long at this stage in a self-satisfied way that the conclusion is reached that little more can be done to alleviate the lives of those who have become mentally afflicted? Is this extreme measure of segregation away from society the ideal to be aimed at for the treatment or comfort of the patients? Is it also good for the social community? To a large extent at present so-called treatment merely means institutional confinement.

In a short paper of this sort it is possible to do no more than touch on a few points emerging from the consideration of the treatment of the psycho-neuroses. There are various methods of treatment based on equally varying theories; owing to this lack of uniformity on the theoretical side it is not surprising that doubt and confusion have arisen, and that, in the minds of some, the whole subject is regarded as chaotic. It therefore behoves one to go slowly, but to be prepared to use such means as experience, in any or all of the methods, has proved to be useful. The greater issues have been much written of and discussed, and in this search many of the lesser issues have been lost sight of.

Surveying the enormous material of observations of psycho-neurosis during and following the war, it looks at the first glance as if the old distinction between organic and functional nervous disorders has been more firmly established than ever. To most writers this distinction seems to be a fundamental one, and the majority of those nerve specialists, whom the war has developed in such abundant numbers, seem content to regard the distinction (which before the war was being regarded with increasing suspicion) as a permanent one—the primary distinction in the classification of all nervous disorders. It has even been suggested that the two groups should be studied and treated by two different classes of specialists—to my mind an arrangement that would represent a most effectual barrier to any further development of psycho-neurology.

The essentials of an education are: (1) a knowledge of actual life; (2) a definite impelling interest in some phase of life; (3) the recognition from actual experience of one's own capacity and limitations of adjustment; (4) the acquirement of the emotional attitudes and habits necessary for perceiving and adapting to reality. These ensure against nervous breakdown, but are not synonymous with modern education, which views the problems of man as he was or may become, not his reactions as he is. Life is a process of slow adjustment, and must be accepted as it is. If elemental biological facts are not faced squarely serious personal difficulty arises. Conflict to the point of mental depression can be so met as to preserve sound personal judgment on public questions. Individual conscious processes are not so essential to adjustment as is believed: decision is made from well grounded feeling, often not from reason which can be logically detailed. An outstanding example is Abraham Lincoln, whom science cannot explain by his heredity or early experiences. Successful life implies consciousness of the reality of environment, and avoids the visions of intemperate idealism. The student is not taught to know himself, to estimate the present, and to intelligently adjust to immediate circumstances. Hence the many graduates of highest distinction who are subsequently failures, being finally seen in hospitals, reformatories, prisons or asylums. The numbers in insane institutions are more than those in colleges or universities.

Organ Inferiority and its Psychical Compensation. (Summary of Adler's Monographic Study.) (The State Hosp. Quart., November, 1920.) Haviland, H. C.

The essentials of an education are: (1) a knowledge of actual life; (2) a definite impelling interest in some phase of life; (3) the recognition from actual experience of one's own capacity and limitations of adjustment; (4) the acquirement of the emotional attitudes and habits necessary for perceiving and adapting to reality. These ensure against nervous breakdown, but are not synonymous with modern education, which views the problems of man as he was or may become, not his reactions as he is. Life is a process of slow adjustment, and must be accepted as it is. If elemental biological facts are not faced squarely serious personal difficulty arises. Conflict to the point of mental depression can be so met as to preserve sound personal judgment on public questions. Individual conscious processes are not so essential to adjustment as is believed: decision is made from well grounded feeling, often not from reason which can be logically detailed. An outstanding example is Abraham Lincoln, whom science cannot explain by his heredity or early experiences. Successful life implies consciousness of the reality of environment, and avoids the visions of intemperate idealism. The student is not taught to know himself, to estimate the present, and to intelligently adjust to immediate circumstances. Hence the many graduates of highest distinction who are subsequently failures, being finally seen in hospitals, reformatories, prisons or asylums. The numbers in insane institutions are more than those in colleges or universities.

Organ Inferiority and its Psychical Compensation. (Summary of Adler's Monographic Study.) (The State Hosp. Quart., November, 1920.) Haviland, H. C.

Pupillary and Reflex Disturbances in 275 Cases of Neurosyphilis. (Journ. of Nerv. and Ment. Dis., August, 1920.) Lowrey, L. G., and Benedict, Mary K.

The Static and Kinetic Systems of Motility. (Arch. of Neurol. and Psychiat., October, 1920.) Hunt, J. Ramsay.

On Deep Localisation in the Cerebral Cortex. (Journ. Nerv. and Ment. Dis., April, 1920.) Van't Hoog, E. G.