It is usual to open a paper with a historical survey of the subject under review. In a sense that is an academic approach. This paper, however, deals with the purely utilitarian aspect of psychiatric out-patient clinics; and a historical survey would only be in place if it were to give us practical suggestions, likely to prove of value in present circumstances. Up to the present time most of the literature of this subject has been in the shape of formal annual reports. A notable exception to this general statement was the paper on “The Oxford Clinic,” communicated by Dr. Good at the Annual Meeting of this Association in 1921. That paper was not only an account of the general method of working a clinic, but was a concise description of how psychiatric out-patients should be handled. It was followed in 1922 by a paper by Dr. Ninian Bruce, dealing more particularly with Ministry of Pensions Clinics, and expressing the view that the methods employed there could be satisfactorily adapted for civilian patients. It is interesting to note that Dr. Ninian Bruce used the future tense in describing the utility of these clinics, and that practically all of his forecasts either have come, or are coming, true. The methods described by these writers have been widely used in many clinics in the ten years which have since passed; various practical points have cropped up; legislation has been changed; and a review of the utility of the psychiatric out-patient clinic in the light of these things is the aim of the present paper.

The recent recrudescence of interest in the Boltz test, as evidenced by Dr. C. J. Thomas's paper on the subject, prompts us to publish further results obtained with this test, together with a few conclusions as to its value.

In a previous investigation (1) it was ascertained that the amount of cholesterol present in the serum of psychotic patients shows certain variations from the normal, and that it is influenced by the acuteness of the mental condition. Hypercholesterinæmia is usual in all forms of mental disorder except imbecility, and a fall in blood cholesterol content occurs during attacks of excitement, agitation or confusion. These results suggested an association between the blood cholesterol and the nervous system, probably by way of the sympathetic and endocrine gland systems.

When the relations between self and environment are considered, a duality is found; the attention of the observer can either be consciously directed to objects, or objects can attract conscious attention. Thus, a gun fired unexpectedly in one's immediate neighbourhood would probably attract one's attention, whereas a row of runners lined up for the race are all “attention” in readiness for the sound of the gun. This duality I shall attempt to put in terms of my fundamental equation H + L = T.

The object of the present paper is to point out that two different working parts of muscle have hitherto been generally confounded together, whereas their analogues in the psychic mechanism have always been deemed separable. Scientific explanations of the phenomena of mind, however, seem ultimately to wait on knowledge of what happens in excitable tissues, such as muscle, so that the result of finding two working parts in the psychic mechanism, where it was believed there was only one analogue muscle, has been the introduction into physiological psychology of a number of what I have to suggest are superfluous terms. In addition, the present paper deals with the possible nature of the connection between cerebral excitation processes and the psychic response.

In a previous communication the subject of training was considered, and the deduction made that a trained act differed from an untrained act in respect of the composition of the excitation processes mediating the act (1). That is to say, though the formula H + L = T can be applied to both the trained and the untrained act, the trained act contains more L and less H than the untrained act. In other words, training adds L and diminishes H (1).

In previous communications made to this Journal I have pointed out that the cerebral excitation processes mediating an idea, or judgment, are produced by the interaction of two factors which I term H and L respectively, and that, in the case of judgment, the factor L constitutes the material to be judged and the factor H judging capacity. When the judge has interacted with the material brought for judging, there results a judgment (1, 2, 3, 4, 5). So long also as we avoid some form of fit (2) or spasm (4), the sum of the two factors H and L must fall within the limits of another factor, T, the capacity of the responding organ (1).

Medical men are often called upon to give evidence as to the mental condition of an individual, charged with crime, at the time of committing the crime. They are also expected to give an opinion as to whether by reason of insanity the accused was incapable of knowing the nature and consequences of his act, or did not know that what he was doing was either wrong or contrary to law. The question is frequently one of life and death for the accused, and therefore it is very necessary that medical men should understand the inner working of a criminal's mind before they venture an opinion regarding his mental condition. In India we have hitherto depended for our guidance on books written by learned authors who base their conclusions on conditions prevailing in their own countries, and cannot be expected to know the conditions of Indian life. I feel the time has come when we should begin to collect first-hand information regarding our criminals from our own observations. I am afraid very little work has been done in this field in India, and it is time that we compare our results with those obtained in the West. It is with this object that I venture to submit this paper, so that it may stimulate others in India also to work on these lines.

The title of this thesis is, to some extent, self-explanatory. It is not an attempt to establish a new set of concepts, but rather an endeavour to combine in a grouping, which has not been sufficiently recognized, a set of existent formulations.