A survey of the literature regarding the more obvious variations in the physical characteristics of the skin to be found in the mentally deranged, reveals a considerable divergence of opinion as to their degree and associations. Consequently the following investigation was undertaken with an open mind.

During a symposium on the psychotherapy of the psychoses held under the auspices of this Section,† I took occasion to point out that, owing to the nature of their case material, many psychoanalysts had been forced to undertake this branch of treatment, whether they liked it or not. In the case of psychiatric classification the position is somewhat different. However much the psychoanalyst may choose to procrastinate, he cannot postpone indefinitely the task of correlating psychiatric data with his own systematic formulations on mental development. The more precise and dogmatic these formulations become, the more incumbent it is on the psycho-analyst to test them in the psychiatric field. Already some ventures have been made in this direction, notably in the work of Rickman,† Schilder,§ Stärcke‖ and others. The main justification for a renewal of these attempts lies in the fact that during the past four or five years, appreciable advances have been made in the psycho-analytic understanding of early stages of ego development. A great deal has been achieved by the analysis of small children, largely under the inspired stimulus of Melanie Klein, and already this work has produced reverberations in other directions. I am constrained to make this preliminary explanation in the hope of mitigating an impression which I fear still prevails in some quarters, namely, that in its relations to psychiatry, psycho-analysis displays the dogmatic over-compensation of an ignorant and none-too-welcome parvenu. Indeed, I should like to take this opportunity of stating that psycho-analysis, if even on the barest grounds of economy of effort, looks forward to an increasingly close alliance with pure psychiatry. And I hope to be able to indicate in this paper some problems on which the co-operating energies of the two sciences might well be concentrated.

The object of this paper is to show that certain errors are inevitable when white blood-cells are enumerated, and to demonstrate that results from such enumerations must be interpreted with mathematical considerations. In the past the mathematical applications have, to a large extent, been ignored, and only the actual experimental figures considered. Here an endeavour is made to correlate the two, and to refer to various fallacies that may be present when conclusions from such results are under consideration.

Shortly after the introduction of therapeutic malaria into this country, the Ministry of Health and the Board of Control, in consultation with the London County Council Mental Hospitals Department, established a special centre for this treatment at Horton Mental Hospital. A separate villa in the hospital grounds was set apart for the work, and, through the interest, advice and help of Col. S. P. James, M.D., F.R.S., of the Ministry of Health, a laboratory was equipped and arrangements were made for the supply of malarial infective material to all parts of Great Britain. The work was begun in April, 1925, and during the seven years that have elapsed since then, 200 cases have been treated. These cases are all women, drawn from the various London County Mental Hospitals; recently, however, an annexe has been added to the centre, and facilities are now available for treating men also.

During the last few years at Rainhill Mental Hospital, an investigation has been carried out into the clinical and pathological features of dementia præcox in its so-called acute or malignant form. A description of the characteristic clinical features and of the gross morbid anatomy was presented in a previous article in this Journal (4), but it may be of advantage to re-state the conclusions arrived at in this preliminary inquiry.

The tell-tale facies of the subject of long-standing tabes is familiar to all clinical observers, and is the sum of several components. The pallor and thinness of the face are, in all probability, largely related to the impaired state of the patient's nutrition, and this in turn is often an expression of chronic infection of the urinary tract. The remaining components, namely, the ptosis, the pupillary anomalies and the equally constant changes in the appearance of the iris, are of neurogenic origin.

In the course of this article it is intended to study carefully the after-history of patients treated by malarial inoculation for general paralysis since the introduction of this method of treatment into this country at Whittingham County Mental Hospital in July, 1922.

The treatment of diseased conditions by means of induced pyrexia is now so frequently carried out that it is surprising how little we know of the biological processes involved. It is not an exaggeration to say that the beneficial effects of malaria in general paralysis are as gratifying as those of liver in pernicious anæmia, and of insulin in diabetes, but we still await a satisfactory explanation of its mode of action. An attempt in this direction was made by Eddison (1), who observed a failure of leucopoiesis in untreated cases of paralytic dementia, which he attributed to degeneration in the reticulo-endothelial system. He considered that, in general, pyrexia was associated with leucocytic reactions, and that this resulted indirectly in reticulo-endothelial stimulation. It is not proposed to consider here the arguments put forward by Eddison, but he should be given credit for being the first person in this country to draw attention to a very important aspect of pyretotherapy.

Nembutal (sodium ethyl [1-methyl-butyl] barbiturate) has recently come into use in general hospitals in this country as a preliminary to and partial substitute for general anæsthesia.