The influence of slight variations in the inorganic constituents of the tissue fluids on the function of the nervous system has long been the subject of physiological investigation. Thus a disturbance of the ratio Ca/Na is known to be related to the irritability of muscular tissue (1). Ca and K are antagonistic in their action on the vegetative nervous system: Ca increases the excitability of the sympathetic system, whilst K excites the parasympathetic system (2). The influence of Ca on the excitability of the central nervous system finds a clinical illustration in tetany; and, from a pathological point of view, diminution of the serum Ca is well established in certain types of this disorder.

Commencing with Lankes's well-known study, “Perseveration”, in 1914, a number of commendable experimental investigations (cf. Jones, Bernstein, Pinard, etc.) have contributed to the demonstration of the existence of a general functional “factor”, common to all cognitive activity at least, to which the name “perseveration” has been applied. The main reason for thus designating the factor seems to have been that it manifests itself under conditions where the influence of one mental operation persists and interferes with efficiency in a totally different task. In several studies an attempt has been made to relate this factor as a function making for individual differences to differences in personality features as judged by the observation of behaviour.

According to the accepted description, a tic is a psychogenic symptom, an expressive movement derived from a mental fixation. This concept was rejected by some of those authors who observed tic-like movements as sequelæ of acute encephalitis. Other cases, quoted by Steck (I), in which the onset of a hyperkinetic encephalitis was associated with tics, suggested still more definitely that there might be an organic cause for such movements. An extreme concept localized the lesion responsible for these symptoms in the corpus striatum. This wholesale assumption was in turn objected to from the neurological standpoint, particularly by Kinnier Wilson (2), who, in his well-known paper, pointed out how complicated the possible connections were. In particular he mentioned that even tics following encephalitis might be conditioned not only by the brain disease itself, but also by constitutional and psychic factors. The network of different ætiological factors becomes less complicated when a disease like chorea is studied, rather than cases of encephalitis where widespread permanent lesions remain. We have, therefore, studied the occurrence of tics in connection with chorea, though we do not claim that any conclusions can be drawn from these observations for tic neuroses generally.

The incidence of achlorhydria and its association with certain forms of anæmia has recently been the subject of much interest, largely owing to the work of Witts (1, 2) on idiopathic hypochromic anaemia, and of Hurst (3) on pernicious anæmia.

The research described in the following monograph is the result of seven years' work. In 1926 I attempted to introduce psychological methods of treatment into the out-patient department of the First Medical Clinic of the Charité, Berlin. It soon became evident that there was a widespread demand for the application of such methods within the field of the medical clinic. In the course of years, hundreds of patients with psychoneuroses linked to organs passed through our hands. A selection of specially instructive cases is given below. Our researches were performed on patients and collaborators who readily placed themselves at our disposal for our experiments. In grateful remembrance I wish to thank my esteemed former chief, the late Geh. Med.-Rat Prof. Dr. W. His, for the interest he took in my line of work and for the support he extended to it. My work in Germany came to a sudden end in March, 1933, but thanks to the kindness of Dr. F. L. Golla I was able to continue my studies at the Central Pathological Laboratory, London. Furthermore, I owe special thanks to the Professional Committee which, by the grant of a scholarship, enabled me to continue and complete this work.

So far the attempts to relate measurements of perseveration empirically to types of personality, whether in the normal or the psycho-pathological field, have not given rise to such coherent results as might lead to any comprehensive general hypothesis.

For many years past, much research has been undertaken into the structure and functions of the blood-cell elements with a view to ascertaining whether there are any regular quantitative and qualitative changes in the cells, which would prove of diagnostic and prognostic value in the psychoses.

In a recent short paper an attempt was made to indicate what happens to the love-object in the manic phase of manic-depressive psychosis. Reference was made to the view that the depressed phase represents failure of adaptation, with introjection of the reproaches which are concerned with being cut off from loved ones and which were originally directed against the mother. The manic phase, it was suggested, represents an attempt at adjustment to reality, with externalization of the mother, not on to definite people, for the manic is incapable of transference, but on to others in general. This attempt at adjustment being unsuccessful, regression to the oral phase occurs again and the depressed phase returns.

This is an investigation to ascertain the ultimate fate of certified patients who have been discharged from a mental hospital as “recovered” or “relieved”.

The control of the colonic motor function, and especially of the series of events which lead to defecation, is generally recognized as being a subject of the greatest importance in medicine; and, more particularly, the possibilities of varying that control. There are a large number of diseases that may, in special instances or in general, be due to constipation and inefficient elimination of waste products. Constipation has been claimed as the first step towards the different catastrophes ranging from Menière's disease and otosclerosis, gout, hyperpiesia and certain of the rheumatisms, to cases of hernia and abnormal presentation. It is my endeavour to look upon it as being even more prominently a secondary manifestation, a symptom of an even more widespread condition—mental misapplication and disorders of mental forces. With this in mind and dealing with an argument that is already proved to some degree in its most marked details, it is hoped to present, not masses of data and deduction so much as an illustration of the value, and even a hint at the frequent therapeutic necessity of orientating the various causation circles in this direction. As a cause, and especially of these mental difficulties themselves, constipation is well enough stressed; constipation as a result has not yet been sufficiently realized, nor attacked rationally from its base. The words “habit formation” cover most of the therapeutic efforts from the mental side, and that is conceived very much as a time-conditional reflex of purely physical determination. A more definite idea, then, of the mental aspect of intestinal motor function may be helpful, and especially so when so many of the habitual purgative class of drug are being authoritatively questioned as being disorganizing to this proper function. The treatment of constipation is hardly yet on a successful or rational basis.

My aim in abstracting the material for this article from experiments with upwards of 350 subjects has been to offer a few additions to the deductions it is possible to make from the Rorschach test, and to criticize and evaluate its general aims. The number of subjects studied approached that from which Rorschach derived the conclusions embodied in his monograph Psychodiagnostik. Among these is a group of 100 normals, the investigation of which should afford an interesting combination with the findings obtained by P. E. Vernon from an equal number of similar subjects.

While the best accounts of anxiety appear in the French literature, which contains a number of monographs on anxiety (19, 23, 32, 34, 40), psychoanalysis regards anxiety as the primitive reaction of the pain principle, and deals with it in a fair proportion of its investigations.

Early investigators differed widely in their estimations of the bromine content of normal blood (1, 2), and it was not until the development of a refined technique by Bernhardt and Ucko (3) that it was generally recognized that blood bromine varied around 1 mgrm. %. These authors gave a range of 1.0 to 1.6 mgrm. %. Their studies, however, were not extensive. During 1931–3 Zondek and Bier (4, 5, 6) published the results of a series of investigations into the bromine content of the blood of normal and psychotic patients. From a study of 150 mentally normal patients they considered that blood bromine usually varied between 0.8 and 1.0 mgrm. %, a range later extended to 0.731.10 mgrm. % as a result of further study. In a large number of psychotics examined by them, values lying within these limits were found with the notable exception that 85%-90% of 60 cases of endogenous manic-depressive psychoses gave figures 40% to 60% below their normal levels (Zondek, 1933) (6). These low figures appeared only to be associated with this psychosis, although of the 16 cases of schizophrenia examined by them, 5 gave figures lower than the normal. They stated that in these 5 cases the mental picture was characterized by more or less marked depression, and they considered the possibility of their ultimately turning out to be manic-depressive in character. In a later paper, three examples are cited of low blood bromine associated with organic brain disease, and thought to be due to interference with a bromine-regulating centre in the brain. The low values found in manic-depressive psychoses were shown to be independent of the phase, and it was stated that values in general were not subject to seasonal variations, to menstrual fluctuations, or to alterations due to variable salt intake.

The application of the above test to epileptics is a useful subject for an article, firstly because Rorschach's findings for epileptics were established from a very small number of patients; secondly, there was, in his investigations, no subdivision of epileptics into mental categories other than those of “early” and “late” demented; thirdly, the references in literature to the application of this test to epileptics are so meagre; and fourthly, the results obtained in this particular investigation show a considerable diversity from those of Rorschach.

The authors consider that protein or pyretic therapy should have a more scientific basis, and for several years have carried out experimental work on the behaviour of blood complement in patients undergoing this form of treatment.