For many years psychiatrists have appreciated the clinical value of the Wassermann reaction, not only in diseases of the central nervous system, but in somatic infection in the psychotic and the mentally defective. As a diagnostic test for syphilis, reliance has been placed on this reaction out of proportion, perhaps, to its relative efficiency; sometimes without a full appreciation of the difficulties which the pathologist has to face in rendering the test as accurate as possible, and also of the fact that the results must be interpreted both on clinical and serological grounds. Adding to the difficulties of co-operation between the two groups of observers, there has been the fact that, owing to increased efficiency in anti-syphilitic treatment during the past twenty years, the strength of the reactions to be found serologically has become progressively less marked. Thus, it is inevitable that many of the methods employed hitherto, although at one time satisfactory and reliable, cannot now completely fulfil all the criteria of a reliable test so essential to accurate diagnosis and the control of modern methods of treatment. Further, and of even more importance from the point of view of research and of the necessity of making strict comparison of the results of one laboratory with another, it has been ascertained that very little uniformity of method exists. This lack of cohesion not only reflects upon the efficiency of the routine work and research in mental hospitals, but isolates them as a whole from the Ministry of Health venereal disease centres, in that in very many instances the methods employed could not be strictly compared. From these facts alone it will be seen that sooner or later the time was bound to come when all the requirements of a standard method should be investigated and, from among many excellent techniques, the difficult task be faced of choosing one or a combination of tests that would serve the needs of the clinician and serologist working in the domain of psychiatry. At the time of the inception of the Pathological, Bacteriological and Bio-Chemical Sub-Committee there was current amongst its members a desire that one of the aims of this section of the Research and Clinical Committee should be to investigate this difficult and highly technical problem of standardization. Thus, after the preliminary work of the Sub-Committee on various schemes of research had been initiated, I was asked at the meeting on February 13, 1929, to prepare a memorandum on a standard method of performing the Wassermann test. This report was entirely of a preliminary nature, and intended only to form a basis of discussion. While this was in course of preparation a questionnaire was sent to those mental hospitals undertaking serological work, with a view to ascertaining and contrasting in some detail the methods employed by each. In order that all interests in the various branches of psychiatry should be fully represented, it was unanimously decided that all members of the General Paralysis, Mental Deficiency, and Encephalitis Sub-Committees should be invited to co-operate. Thus, on May 3, 1929, a conjoint meeting was held at Horton Mental Hospital, Epsom, under the chairmanship of Dr. J. R. Lord. In the memorandum I dealt mainly with the work of the three laboratory conferences held under the auspices of the League of Nations in November, 1922, November, 1923, and May, 1928, the latter, held at Copenhagen, being by far the most important in its results and influence upon the researches into the serology of syphilis.

This investigation was undertaken at the instance of the Mental Deficiency Sub-committee of the Research and Clinical Committee of the Association. It is an attempt to answer the question whether or not the order in which a mentally defective child is born into a family can have any influence as a cause of the mental defect.

Some explanation may seem to be necessary to account for further research into the question of sugar tolerance in psychotic subjects, as it may be thought that this line of research has been exhausted by the numerous workers in this field. A study of their work, however, shows that no critical attempt has been made to correlate the result of the sugar tolerance test with the mental and physical state of the subject at the actual time of the test. Instead, groups of patients suffering from certain psychoses have been investigated, and the results reported as percentages of abnormal curves in such psychoses. Thus, when it has been reported that a certain percentage of melancholics or schizophrenics show sustained hyperglycæmia after glucose ingestion, no attempt has been made to find out in what way these differed from the remainder in whom normal sugar tolerance was found.

Since the introduction of the liver treatment for pernicious anæmia some four years ago that disease has received considerable publicity. It has been generally recognized as having three main clinical manifestations. Thus it may show itself as a blood disease, as a gastro-intestinal disease, or as a nervous lesion (subacute combined degeneration of the cord). It is, however, by no means generally recognized that pernicious anæmia has yet another way of manifesting itself, viz., by the occurrence of mental disorder. The object of this paper is to emphasize this fourth aspect of pernicious anæmia. In this country the subject has not hitherto received the consideration which is due to it. Nevertheless, a number of observers in other countries have shown, both by their own personal observations and from statistics, that mental disorders are frequently met with in the course of pernicious anæmia. The degree of mental affection varies in different cases. There may be merely a modification of character, with irritability and changing mood. W. Richardson would include in this mild group many patients described as uncooperative.

The subject of anti-malarial work in the tropics is one of paramount importance, but I am somewhat diffident in bringing such a subject before the Royal Medico-Psychological Association. However, if not of value, the paper may be of interest.

In dealing with anti-malarial work one can more or less confine one's attention to the anopheline mosquito. It is, however, advisable to deal with other varieties as well, since, though they do not carry malaria, they carry other diseases, for instance Culex fatigans carries filaria, and Stegomyia carries yellow fever. Fortunately, there is very little filaria in Malaya, and no yellow fever; but it has been found that Stegomyia fasciata carries dengue. Also with the opening up of fast new air routes, one has no guarantee that yellow fever will not be introduced into the country, and, seeing the large number of stegomyia there is in Malaya, the result would be disastrous.

In the following investigation an attempt is made to regard the subjects of mental disorder from a synthetic rather than from an analytic standpoint, in other words to envisage the patient as an entity, a complete individual who reacts as a whole to his environment, rather than to look on him as a mere collection of systems, and, in doing so, to pay no heed to his total response. Our present knowledge of mental disease results from skilled work in histological, physiological, biochemical and psychological spheres, and there is thus, of necessity, a tendency among individual workers in the various fields to concentrate their attention almost exclusively on their particular line of work, and so to lose sight of the patient as an individual.

The high incidence of chronic interstitial nephritis at post-mortem examinations at the East Sussex County Mental Hospital prompted an investigation into the urea content of the cerebro-spinal fluid. In the years 1926-29, some 68% of all deaths have had post-mortem examinations performed, totalling over 200 autopsies, and a series of 60 successive results are tabulated below (Table I), giving the following details:

1. (1) The sex of the patient.

2. (2) The age.

3. (3) The interval between death and the estimation of the urea content of the cerebro-spinal fluid.

4. (4) The result of the estimation.

5. (5) The mental diagnosis.

6. (6) Macroscopic evidence of gross renal disease (+ or −).

7. (7) Other gross macroscopical abnormalities.

It is my intention in the present communication to attempt to bring part of the philosophy of Freud into line with the psychic machinery outlined by me in previous papers, and I start by briefly re-describing that machinery.

Janet, like Freud, met the problem of explaining why certain people have not conscious memory of past, for them, tremendous experiences, and yet those experiences exert a marked influence on conduct. To account for these facts he assumed the existence of a force inherent in consciousness, enabling this to hold to itself memories of events. A loss of conscious memory of some past tremendous event would thus be due to consciousness being too weak to hold that event to itself—an hypothesis which also explains why great joy can be as disturbing as great sorrow.