I hope it will not be a waste of time to begin by seeing what can be meant by prognosis in this difficult kind of illness. Prognosis is often conceived as the natural history of disease—or the course it will follow if it is not interfered with. Treatment is valued for the good modification it produces in this “natural” course of events; it may hurry up the processes of recovery or it may bring about recovery that would not otherwise occur, or it may lessen the harm the disease does; in other words, the efficacy of treatment is assessed by the changes produced in the time the illness takes and the shape it takes. In the case of such a disease as malaria, this conception of prognosis, and this use of it for assessing treatment, can be demonstrated. In psychiatry, however, one is not as a rule dealing with parasites, bacteria, or other exogenous agents which live and exert their influence in a definite order of time and place. Causes of mental illness have no set sequence or constancy. Those external to the patient are as variable and manifold as the pattern of daily life around us, and those intrinsic in him are seldom capable of forcing their way and becoming manifest as illness, no matter what befalls the patient. They are for the most part dependent on circumstance, and of their particular transmission and manifestation we know little; we infer hereditary and constitutional causes with good grounds, but of the details of heredity in any of the individual forms of mental illness we cannot be sure. Consequently we cannot find now any accuracy of prognosis, in the sense of predictable sequence in an individual, based on comparable experience of many others; the variations will be too many; we may expect such accuracy when we know more of the nature and mode of transmission, and of the influence of external circumstances upon time and form and degree of manifestation of each kind of mental illness. Without accurate knowledge of how the causal and modifying factors act, prognosis must be uncertain to a greater extent than in many other illnesses. In medicine, it is true, prognosis can hardly ever be exact, but here it is more inexact than usual.

Adolf Meyer writes, “In the end our task is the amplification and specification of the complaint, expressed in the most factual objective and potent terms”. Robert Hutchison also emphasizes the importance of the complaint when he stresses the presenting symptom in his treatment of medicine. A patient always comes to his physician with some complaint, which it is the duty of the physician to investigate and treat. In the majority of cases the complaint is a bodily one; the patient goes to his physician complaining of an ache or pain or some other bodily discomfort. This bodily complaint may or may not be due to some physical illness. In Sir Walter Langdon Brown's words, “Some are unhappy through illness, some are ill through unhappiness”. This paper deals with those patients who have bodily complaints for which no adequate physical basis can be found. This condition is now known as hypochondriasis.

Renal dysfunction is so commonly present in cases of mental breakdown that it is of interest to know whether it is especially associated with any definite clinical type or types of mental disorder. In an endeavour to ascertain this, cases have been selected from recent admissions in which the form of disorder from a clinical point of view appeared to be sufficiently marked to warrant placing them in a definite category. Many cases present such a mixture of cycloid, schizoid, confusional or paranoid indications that in an investigation of this nature the selection of sufficiently clear-cut types from a clinical standpoint is not altogether an easy matter. To determine the degree of concentration and polyuria, Rosenberg's modification of the Volhard test has been adopted. It involves little discomfort to the patient and is as follows:—

Psychiatrists will welcome Piney's recent preliminary communication (1) on the possible significance of certain physical characters. A series of measurements of about 500 bodies revealed that a very high number of suicides among the general population occurred in persons showing a body-length-leg ratio of over 50, i. e., the leg-length being more than 50% of the total body-length. Piney believes that persons of this type, among other abnormalities, have such mental characters as may lead to suicide. He raises the question whether body-length-leg ratios of over 50 are commoner among the inmates of mental hospitals than in the general population.

In dealing with the question of visual impairment in cases of so-called constructional apraxia in a previous paper, I had occasion to discuss arguments put forward by Erich Feuchtwanger, who had proposed to abandon the term “apraxia” for this condition and to call the disturbance “agnosia”. My conclusion was in favour of the original concept of Kleist, who had put the ailment among the apractic syndromes. This, however, makes a detailed analysis of the motor activities and their disturbance in constructional apraxia necessary in order to define its place among the known kinds of apraxia.

In view of the increasing use of intravenous sodium evipan as an anaesthetic, any contribution to the knowledge of its pharmacology would seem to be of value. It is known from experimental work and from clinical reports that injection of this drug causes a depression of both respiration and blood-pressure, and that jactitations or twitchings are often present during induction. The report of the Anaesthetics Committee of the Medical Research Council (1) states that there is generally a decrease in the rate of respiration, and that there is a transient fall in systolic blood-pressure of 20–30 mm. Hg. Weese (2) observed a decrease in rate and amplitude of respiration, and a fall of blood-pressure of not more than 20 mm. Hg. Jarman (3) found a fall of 20 mm. or more.

The following paper represents an attempt to determine more precise prognostic criteria in the large group of the depressions of later life, to find if possible some other guiding lines than the relatively rule-of-thumb principles which obtain, freed as far as possible from debatable preconceptions as to the existence of an “involutional melancholia” or other specific diagnostic label. Obviously in such a group the influence of the menopause and involution periods might be expected to be prominent.

A one-sided approach to any question, which is always suspect, becomes a very real danger when it concerns medicine. It is the purpose of this paper to draw attention to certain half-truths which have arisen in this way in connection with fear. Fear, like pain, is a danger-signal, called into existence to draw to the individual's notice the presence of some threat to his welfare. It has, therefore, ultimately a protective purpose with a direct relation to self-preservation.

The improvement of general paralysis by treatment with malaria is known to be accompanied by—and may be said to be due to—the disappearance of the spirochætes from the brain. The problem of the mode of action of this therapy therefore is centred in the question to what factor the antispirochætal effect of malaria is due.

One of the greatest problems facing the psychiatrist of to-day is the ætiology of schizophrenia, particularly that of the catatonic variety. Our ignorance in this respect is reflected by the number of hypotheses which have been put forward by the various schools of thought. It would be a task beyond the scope of this paper to attempt to summarize or criticize these theories, but for the sake of clarity a brief survey may here be made. The ætiological hypotheses fall into three main groups:

Since the passing of the Mental Treatment Act of 1930 the use made of Section 5, dealing with temporary treatment without certification, has varied considerably in different areas, and has, in general, been much less than had been hoped for. In a discussion of this section of the Act held at a quarterly meeting of the Royal Medico-Psychological Association on November 20, 1934, Sir Hubert Bond stated that, while in the opinion of the Board of Control temporary patients should form 15% of the admissions to a mental hospital, in 1933 the proportion of such patients to total admissions was 6·5% in registered hospitals and licensed houses, and only 1·8% in the public mental hospitals.