Despite the modifications introduced at Cardiff (1, 2, 3), somnifaine prolonged narcosis remains a dangerous procedure (4, 5), and we had hitherto thought that the method could only be made perfectly safe by reducing the dose below a level which is therapeutically valuable. Witt and Cheavens (6), followed by Day (7), have, however, used a medinal-luminal mixture with apparent safety and with good results, and we have followed their technique in 60 cases. A mixture containing medinal 5 gr. and luminal 1 gr. in each drachm is used. The first dose is 2 drm., which is repeated 4-hourly till sleep occurs; thereafter 1 drm. is given as required. The usual methods of nursing are adopted (3, 4), and Day claimed that narcosis could be continued for as long as 78 days with a gain in weight of from 5 to 30 lb.

The immature psyche of the child is at least as easily upset by both organic and psychological factors as is that of the adult. The slightest fever or digestive upset may, in a child, lead to bad temper, lack of appetite and sleeplessness. In spite, however, of the ease with which minor psychological disorders are brought about, the severe mental disturbances constituting the psychoses are very infrequently met with. Those to be described occur in the early years of life. Some of them resemble serious behaviour and personality disorders; some would seem to be of organic ætiology. Common to all are regressive changes leading especially to loss of recent attainments, and to some disorganization of the personality following a hitherto normal development.

When, a few months ago, your Association honoured me with its invitation, I undertook the task of presenting to you the results of the first 100 cases treated in the Clinic in Vienna. I intended to draw from the individual reactions and the effect of the therapy some conclusions as to its justification. I could also have brought forward conclusions drawn from the records of cases whose treatment has been terminated for a long time and who have remained under continuous observation. These results would have been of some value inasmuch as these would have referred to the cases which I myself treated individually, and in which treatment had been individualized by employing various types of shock.

It is now a little over twelve months since the investigation and treatment of chronic infective disease was undertaken at this hospital, made possible by the erection of a treatment centre and the appointment of an ear, nose and throat surgeon. From what I have seen of the results obtained during the period under review I am convinced of its therapeutic value, not only in recent cases of psychosis where other forms of treatment have failed, but also in chronic cases, which my clinical experience would have pointed to as hopeless, has amelioration taken place.

Whilst it is an undisputed fact that under certain clinical and experimental conditions various antibodies (antitoxins, agglutinins, bacterio- and hæmolysins, complement-fixing antibodies) can be demonstrated in the cerebrospinal fluid, there is a divergency of opinion about their origin. Whereas some authors (Dujardin and Dumont, Ramon, Descombey and Bilal, Neufeld and Szyle, Nélis) ascribe their presence in the cerebro-spinal fluid to their passage from the blood through a damaged blood-cerebro-spinal fluid barrier, other investigators (Mutermilch, liiert, Grabow and Plaut, Friedemann and Elkeles) believe that the central nervous system or its membranes are able to produce antibodies on their own upon contact with an antigen. In the case of the Wassermann antibody in the cerebro-spinal fluid the question of its origin is of particular interest, because of the occasional occurrence of cases which show a positive Wassermann reaction in the cerebro-spinal fluid and a negative or weaker reaction in the blood. This divergence between blood and cerebro-spinal fluid is often quoted as an example of the independence of the cerebro-spinal fluid antibody.

Pace Mr. Punch, we know that there are plenty of takers, and anyone who uses convulsion therapy soon becomes convinced that much good is achieved in one way or another. Moreover, it has become evident that the treatment is not applicable to schizophrenia only; some striking results are seen in depressive states and in atypical paranoid and obsessional cases. This matter is dealt with at length in Dr. Cook's paper. These results, together with the comparative ease of application of the treatment, suggest that it will inevitably be tried out on a very large scale indeed.

Agenesis of the corpus callosum is not as rare as might be expected and over a hundred cases are on record. It is, however, remarkable for the diversity of the clinical signs that are associated with it, and no doubt these are dependent on other anomalies of the brain, some of which apparently always accompany this condition.

The term “dysentery” in mental hospitals may be regarded as applicable to a clinical entity characterized by symptoms of abdominal pain, rise of temperature and passage of blood and mucus. The causative organisms are various, but that occurring most frequently and persistently is the Bacillus dysenteriæ of Flexner. This paper deals exclusively with this type of asylum dysentery.

Under the heading of “Injury before Mental Symptoms” it is desirable to consider first the surgical conditions of concussion, cerebral irritability and states of compression with their associated mental symptoms, for these must form a solid background for our consideration of all those cases where there is a head injury and mental disorder supervenes. It is, of course, possible to get an unrecognized fracture of the skull following a slight injury which will cause no further disturbance than, say, a headache. An example of this is supplied in a recent report, where a prospective member of Parliament sustained a fissured fracture of the skull as a result of bumping his head against the roof of a car when going over a hump-backed bridge; but nevertheless went about his business for a month afterwards, ignorant of the fact of the fracture, although experiencing a headache, which eventually sent him to a doctor who, by radiography, was able to make the diagnosis.

The Takata reaction (1) consists in the production of a flocculation or opacity in fluids on the addition of alkaline mercuric chloride solution. It has been modified and applied to the cerebro-spinal fluid (Takata-Ara (2)), and found to be positive mainly in cases of syphilis of the nervous system. Various modifications in the technique have been described, e.g., Jezler (3) and Ginkel (4), but in the following investigations on 177 specimens of cerebrospinal fluid Ucko's (5) modification of the reaction on serum, whereby the reaction time is reduced from 24 hours to 90 minutes, has been further modified by the author to permit of its application to the cerebro-spinal fluid.

The history, pharmacology, physical and chemical properties of cardiazol have been recorded in many publications recently, and our knowledge has been derived from them. Our technique and method of giving the injections have been more or less on the lines laid down by Meduna and described by Kennedy in the Journal of Mental Science of November, 1937. We used a 10% solution and usually commenced with 3.5 c.c. or 4 c.c., giving bi-weekly injections. The dosage necessary to produce a convulsion varied with different individuals. When a convulsion was not induced the dosage of the next injection was increasd by .5 c.c. or 1 c.c., depending on the reaction of the previous injection. The course was terminated by weekly injections. Our highest dose was 9.5 c.c. The injections were given in 10-15 seconds, and occasionally the first stage of the convulsion came on before the needle was withdrawn. Latterly we reduced the time of the injection to 10 seconds. No definite rule can be laid down as to the number of epileptic attacks to be induced.

In the public mental hospitals of England and Wales, over a hundred in number, there is a small proportion of patients who have arrived at a seemingly stationary condition, short of recovery, which, while calling for continued oversight, does not demand a lengthier residence in the hospital, provided some responsible person could undertake that oversight in an ordinary domestic environment.

In a 15-minute contribution it is only possible to deal with a single aspect of cardiazol therapy. I am confining myself to some observations on the diversity of mental reactions influenced by cardiazol convulsions. My remarks are based on approximately 130 complete courses and a number of incomplete courses given at Bexley Hospital during the last 12 months.