The fact that intellectual effort is accompanied by an increase of muscular tonus was demonstrated by one of us in 1921 (1), the method employed being the registration, by means of a highly magnifying optical lever system, of slight displacement of a relaxed limb. It was found that those muscles which were in a state of postural tension increased in tonus during intellectual work, whilst the fully relaxed antagonists remained unaffected.

In a disease with so widespread a seat as general paresis, in which the cerebral syphilitic changes are local manifestations of a generalized infection, it is only reasonable that an attempt should be made to correlate the cerebral changes with those found in other organs in the same body.

During the five years prior to the war I carried out a series of investigations on the treatment of general paralysis. The proportion of general paralytics resident at this hospital was then very high—some 40 out of our usual 350 males. The only treatment given by us up to that time had been mercury and potassium iodide.

The use of malaria as a therapeutic agent in epilepsy was suggested by the known beneficial effects of other specific infections in this disorder. The earliest observation was probably that of Plato, who found that lepers were free from convulsions. A “tendency to respite which is sometimes temporarily induced in the course of the confirmed disease” (by febrile infections) is noted by Aldren Turner (1). Hamilton (2) found that of 11 cases who contracted typhoid 9 showed distinct temporary improvement, and 1 of these was free from seizures for four years. Maisonneuve and Gerard (3) reported cases of epilepsy whose seizures ceased altogether during 2 attacks of intermittent fever.

My view that mongolism is caused by fœtal hyperthyroidism ceasing at birth, is based on the theory that if the known actions of hyperthyroidism on the embryos of animals, as proved by feeding experiments and otherwise, were at work on the human fœtus, the characteristic features of the mongol would be produced. Fœtal hyperthyroidism could not fail to cause abnormal endocrine inter-reaction, and it has been said that in every mongol some endocrine disturbance can be demonstrated. The action hyperthyroidism has on frog embryos, including the cutting out of the later stages of normal development and growth, and the action thyroxin has in retarding cell division and embryonic development, would explain the general arrest of growth and development of the mongol, including that of the skull and the brain. The same actions would also account for the coincident congenital anomalies, e.g., congenital heart lesions, cleft palate, hypospadias, undescended and undeveloped testicles, primitive hands and feet, syndactyly of fingers and toes, atresia of anus, spina bifida, etc.; these are also manifestations of arrested development, and in favour of a common cause for the local and the general defects, are the facts that both are symmetrical, and that there is a parallelism between the amount of general physical defect, the number of anomalies, and the degree of amentia.

In the domain of literature there is no author who has probed so deeply into the human soul as Dostoevsky. Possessed of great powers of introspection, and having experienced a most varied career, he was well fitted for the task of analysing the human mind and its motives. His intimate contact with criminals of all kinds during his exile in Siberia, together with the fact that he himself suffered from epilepsy, made him especially qualified to describe subnormal, criminal and epileptic types. Such a type is portrayed in his masterpiece, The Brothers Karamazov, in the character of Smerdyakov; and as an example of amorality, this character is well worth study.

The recent contributions of Hunter (1) and Moynihan (2) are significant of the importance of focal infection or “sepsis” in mental disease. Cotton's (3) view that toxæmia resulting from focal infection is the specific cause of the “functional” psychoses is well known on both sides of the Atlantic. Further, his therapeutic claims for surgical detoxication are only too familiar.

This discussion, which stood adjourned at the Quarterly Meeting held on November 23, 1928, was resumed at the Quarterly Meeting, February 14, 1929, under the Presidency of Prof. J. Shaw Bolton, D.Sc., M.D., F.R.C.P. (vide p. 1).