Mental after-care, since the establishment of the Association bearing this name more than forty years ago by Mr. Hawkins the then Chaplain of Colney Hatch, has become very generally adopted in most countries.

There is a type of social psychology which finds the explanation of man's social behaviour in a hypothetical “disposition” of his mind. This motive-complex is conceived as specialized for the function of adapting conduct to social life, and as being in itself relatively closely integrated, developing and functioning as a whole. Of this hypothetical “gregarious instinct” McDougall goes so far as to say: “For it is highly probable that instinctive dispositions are Mendelian units” (Journ of Abn. Psych, and Soc. Psych., vol. xvi, p. 316). This plainly suggests that the unity of the social disposition (its existence as a discrete factor in development) is to be regarded as antedating experience—that it is an ultimate datum for psychology not susceptible to analysis, and is not a derivative of any other known motive such as “love,” “fear,” or “hope of reward.” This “instinct” interpretation of social behaviour has been criticized on many grounds (as unfruitful for psychology and incompatible with biological fact); but of course the demonstration of a Mendelian transmission of the social disposition would compel us to regard it as an element of character. Our conception of mental development and of the “socialization” of the individual, of the relative significance of upbringing as compared with organic endowment and our whole psycho-pathology depend upon our acceptance or rejection of McDougall's view. If he is right in regard to the germinal “unit” determination of the social disposition, criminological studies should offer verification. I propose, therefore, to consider how far we are justified in regarding moral insanity and moral imbecility as true “morbid entities.”

The puncture of the cisterna magna was proposed and carried out in 1919 by Wegeforth, Ayer and Essick, who performed a series of experiments on animals before applying the method to man.

This completes a résumé of the chief changes made in twenty-eight years. It was an unsuccessful attempt to manage a high admission-rate, no longer considerably helped by a high death-rate, in establishments not sufficient to deal with even a quarter of the admissions. Persistent overcrowding only palliated the excessive discharge of patients, and produced great difficulties in administration. The occupation of the dining rooms and corridors by beds prevented ordinary convenience. A high accident-rate and a low recovery-rate were inevitable results of the overcrowding. We were often forced to admit over a thousand cases a year, and to discharge as many, less the number of deaths. Meanwhile these discharged cases committed crimes, and we were continually incurring criticism for our actions. Whenever an extension of accommodation was granted, it was so small, and it took so long to provide, that on its completion it was swamped at once, and the overcrowding was but little relieved. Besides managing the Hospital, one had to besiege the authorities for funds for buildings, in season and out of season, and to take every opportunity to interest them in the work, and educate them as toits importance. The lack of beds for the insane in Egypt remains grave, while in England there are 8,663 vacancies (vide Blue Book for 1922). In twenty-eight years the number of beds for the insane in Egypt has risen from 300 to 1,841. Thus there are now 14 beds to every 100,000 of population. Compare 250 in England, and 3 in India to every 100,000. It is still seldom possible in Egypt to treat curable cases until their recovery; thus 527 uncured cases were discharged in 1922, and still only the dangerous and unmanageable can claim hospital treatment.

A preliminary note on the use of collosol bromine in the treatment of the insane epileptic was published in the Journal of Mental Science, July, 1923.

A great amount of literature has been contributed to the medical press in America, the continent of Europe and in this country about the action of luminal and its sodium derivative in preventing epileptic fits.

Actinomycosis is a rare local specific infectious disease, due to the actinomyces, or ray fungus. The actinomyces is a streptothrix, and grows in colonies which are just visible to the naked eye, and these colonies, on microscopical examination, are found to consist of three elements–filaments, cocci, and clubs. In young cultures they stain uniformly, and are Gram-positive. The streptothrix gives rise to a hard, slow-growing tumour, going on to ulceration, with a thin sero-purulent discharge, containing yellow granules in which the ray fungus can be found. The organism is found growing on cereals, especially barley, and commonly infects cattle. Man is infected in the same way, and the disease is generally met with in farmers, corn-eaters, graziers, etc., especially if the patient has the habit of chewing straw, the infection most commonly occurring in the tongue, jaw, and spreading thence to the skin of the face and neck.