By the death of Dr. Henry Rayner our Association has lost one of its oldest and most esteemed members, who had done great service to it and to the cause of the insane.

Of all the physical phenomena which interest philosophers and psychiatrists there are none more interesting than hallucinations. Psycho-sensory disorder is a complex aggregate in which the psyche in its entirety is mingled with organic disorders, an association which is still a mystery to us. The study of the affective states in the hallucinated is, therefore, of the highest importance, since it allows us to bring psychic and physiological disorders together in their reciprocal relations. “The hallucination,” says Hesnard, “which has always for the patient a personal affective significance more or less distinct, is only the symbolical translation, in comparison with a normal perception, of an interior positive psychic fact, of an affective productivity.”

Many French psychiatrists have described a particular variety of visual hallucination to which M. Leroy has given the name “Lilliputian.“ They are found in many types of insanity and also have been known to occur in normal people. Their character does not vary in that the patient sees everything in miniature. Little men, little horses indeed little animals of all kinds, sometimes not any larger than one's finger, disport themselves under his gaze, all relatively proportioned, perfectly made little people who seem to him to belong to a world of their own, and to have stepped out of it into this big one of ours. There is a condition known as micropsia, in which the patient sees objects around him several sizes smaller than they are in reality, but this must not be confused—as easily it might—with true Lilliputian hallucinations. It might be put into the category of illusion, for there is a perception of an actual object, seen very much reduced in size, like the reflection in a convex mirror.

Wagner-Jauregg was led to adopt the treatment of general paralysis by malaria, following the preliminary observations he had made in 1887. He and many other investigators had noticed the tendency of paretics to improve after intercurrent affections, and he finally decided to use benign tertian malaria because he had satisfied himself that it could be controlled whenever desired. The publication of his results and those of Gerstmann, Weygandt, Kirschbaum, Delgado and others attracted considerable attention, and an increasing amount of literature on the subject is accumulating. Observations on this subject are being made in most European countries, in America and in this country. So far the treatment has been empirical; no one has been able to prove why infection with malaria should produce such striking results. Jahnel and Weichbrodt have shown the destructive influence of high temperature as such on the spirochætes, and it may be the case that the intermittent waves of high temperature may be more destructive to the spirochætes than a continuous temperature to which the organisms might have a better chance to adjust. Again it may be that spirochætes under these conditions would be more readily killed when arsenic is given. Muelilens and Kirschbaum hold the view that there is a great impoverishment of the blood following inoculation, and that the subsequent regeneration leads to a reactivation of the immunity process. In this connection it may be noted that some authorities, e.g., Brown and Pearce, believe that success in the treatment of neuro-syphilis by chemical preparations, e.g., tryparsamide, is due, not to the germicidal properties of the chemicals in question, but to the fact that these chemicals confer some form of protective reaction on the tissue cells which enables them to exercise a destructive effect on the spirochætes. Moore has pointed out that the relative infrequency of clinical neuro-syphilis in women as compared with men may be due to the incidence of pregnancy. It is known that pregnancy modifies the reaction to syphilitic infection, and it may be that the physiological process in pregnancy tends to prevent the disease.

Through the kind recommendation of the late Dr. W. H. R. Rivers I was appointed by the Medical Research Council to undertake a study of the psychoneurotic aspects of miners' nystagmus for six months in 1920–21, and subsequently given permission to publish my results.