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1. The cerebro-spinal fluids of 2,000 cases of mental deficiency of both sexes, all grades and ages, were examined. 2. In 1,500 of these cases, observations were made on the after-effects of lumbar puncture. 17% developed post-lumbar puncture symptoms; 142% vomited, 6.8% had headache and 0.73% pyrexia up to 101° F. The incidence of vomiting was nearly twice as high in females as in males, being 20.1% and 10.5% respectively. It was also higher in the feeble-minded group than in the imbecile or idiot group. 3. There was a direct relationship between the rate of flow of the cerebro-spinal fluid and the incidence of post-lumbar puncture symptoms. Where the former was rapid, the incidence tended to be high, and where it was slow, the incidence was relatively low. 4. The tests used on the cerebro-spinal fluid were the Wassermann reaction, cell estimation, Pandy, Lange's colloidal gold, and the acetic anhydride test of Boltz. Many pseudo-positive Pandy and Boltz reactions were given by the fresh cerebro-spinal fluid. 5. Of the 2,000 cerebro-spinal fluids examined, 55, or 2.7% were abnormal. The Wassermann reaction was positive in 19 cases, excess of cells existed in 32, excess of globulin in 44, and the colloidal gold reaction was positive in 30. 6. 23.9% of congenital syphilitics had abnormal cerebro-spinal fluids. 7. The incidence of abnormal cerebro-spinal fluids was higher in those cases of mental deficiency complicated by epilepsy or paralysis than in those free from such complications. 8. The cerebro-spinal fluid of only 1 out of 54 mongolian defectives gave a positive Lange's colloidal gold test. In the remaining 53, the cerebro-spinal fluid was normal in every respect.

1. A positive Wassermann reaction was present (with the spinal fluid) in twenty-eight out of thirty cases of general paralysis; the spinal fluids of thirty cases of epilepsy and dementia praecox gave a negative reaction. 2. A quantitative estimation of the intensity of the reaction, in terms of haemolytic doses of complement, showed that great variation exists from case to case; speaking generally, the more advanced the case the greater the amount of complement absorbed. 3. Fresh cerebro-spinal fluid possesses no activating properties for cobra venom; certain fluids rich in cellular content were found to inhibit the activating power of alcoholic extract of liver; this inhibitory action disappeared when the cellular elements were centrifugalised. 4. Mixtures of cerebro-spinal fluid and alcohol present varying degrees of turbidity; as a rule the greatest degree of turbidity is seen in cases of general paralysis, but equally turbid mixtures were observed with fluids from cases of epilepsy and dementia praecox in their acute phases. 5. There is no relationship between the degree of turbidity and the amount of complement absorbed in the Wassermann reaction; a fluid which, with an equal volume of alcohol, gives rise to an opalescent mixture may deviate more haemolytic complement in the Wassermann test than a fluid which, with alcohol, gives rise to a markedly cloudy precipitate. 6. An alcoholic extract of cerebro-spinal fluid when heated and filtered is found to contain substances which produce lysis of ox-corpuscles sensitised with cobra venom. The precipitate does not possess inhibiting properties in a dilution equal to that in which the precipitable substances are present in the spinal fluid. 7. The strength of this lytic property bears no relation to the density of the precipitate in the mixture of alcohol and spinal fluid or to the amount of complement deviated by the fluid in a Wassermann test. 8. No difference between general paralytics and other cases of mental disease could be determined in respect of the content of the extract of spinal fluid in substances which activated cobra venom; it is thus questionable whether the Wassermann reaction is due to substances of a lipoid character in the fluid. 9. Examination of the protein content of the spinal fluid by precipitation with ammonia sulphate, and also by the Noguchi method, showed that there is a close correspondence between these methods of precipitation and the precipitation by alcohol. A few cases of dementia praecox were found with a high protein content, just as they sometimes show a considerable precipitate with alcohol. 10. There is, however, no relationship between the protein content of the spinal fluid and the intensity of the Wassermann reaction. Most cases of general paralysis show a high protein content in the spinal fluid, but a fluid with a low protein content may give a strong Wassermann reaction, and a fluid with a high protein may give a weak reaction. Cases of dementia praecox with a high protein content do not give a Wassermann reaction. 11. In filtering alcoholic or ethereal extracts allowance must be made for the fact that certain lytic substances in the filter-paper may be extracted.

Encephalitis lethargica, or epidemic encephalitis as it is now usually called, is becoming more generally recognized throughout the world, and while diagnosis is usually easy in those cases with a clear history, and who show the “encephalitic syndrome” to a marked degree, much confusion has arisen in the case of some patients who have shown clinical features which have led observers to arrive at a diagnosis of this disease when later investigations have shown that this conclusion has not been a correct one.

The presence of cholesterol in the cerebro-spinal fluid has been the subject of investigation by various observers. The following communication is based on a series of observations conducted at the Pathological Laboratory of the Maudsley Hospital, on specimens of cerebro-spinal fluid obtained from patients in the mental hospitals of the London County Council.

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.

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 brief summary of the results stated in this paper is based upon an examination of thirty-five cases of general paralysis and seventy-seven cases of psychoses other than general paralysis.

There is a constant endeavour in psychiatry, as in other branches of medical science, to distinguish between organic and functional disorder. Year by year, in most of these other branches, the organic group becomes larger, the functional group smaller. But unfortunately the same cannot be said for psychiatry. When all is said and done, the term “functional disease” is largely a cloak for ignorance. Where there is disease there must be something to show for it, but if the changes are so subtle as to escape detection, we at once label the condition “functional.” General paralysis was considered a functional disease until it was proved to have a very solid anatomo-pathological basis; indeed, until this proof was forthcoming it could hardly be said to exist as a definite entity at all. Until this process is extended to other forms of insanity, clear thinking in psychiatry is impossible. We are still far too prone to look only upon the mental side of the cases which come under our care, whereas we ought diligently to search for some physical causal factor that may be at work, and for corresponding physical changes that may give us a clue to such a factor.

This work was carried out mainly with financial assistance from the Medical Research Council, to whom the results have been com municated, and to whom our thanks are due.Having regard to the paucity of information on the subject of the phosphorus and calcium-content of blood and cerebro-spinal fluid in the psychoses, and to the consideration that at this mental hospital a research laboratory in chemistry is available, it seemed desirable to investigate these matters.

In this paper I should like to emphasise the technique of the colloidal gold reaction rather than the results I have obtained, for the cerebro-spinal fluids I have been so far able to examine have been mostly from cases of dementia paralytica, and, though the results are interesting and suggestive, the number of cases is too limited to allow one to dogmatise on the findings.

The fluid obtained by the easy and now frequent procedure of lumbar puncture affords, when subjected to simple tests, valuable aid in the diagnosis of mental disease.

The pressure of the cerebro-spinal fluid in 12 adult cases of hydrocephalus tended to be higher than in 12 adult cases of microcephalus. Although some cases in the hydrocephalic series gave readings higher than normal, others gave readings lower than normal. No ease of microcephalus gave readings higher than normal, although some cases gave readings lower than normal. The highest readings occurred amongst the male hydrocephalic cases, whilst the lowest readings occurred amongst the female microcephalic cases. In both groups female cases tended to give lower readings than male.

The electrometric titration method for the investigation of “organic acids,” as developed by Perlzweig and Delrue (1) and applied to the examination of sera, indicated a method of investigation of the organic acids of the cerebro-spinal fluid, and an attempt has been made in this paper to investigate the significance of the organic acid titration in mental disorders. Owing to the difficulty of obtaining normal cerebro-spinal fluid, the research had to be confined to the investigation of paretic and non-paretic cerebro-spinal fluids obtained from mental cases. In the former case adequate specimens were obtainable during the process of collection of fluid for diagnostic purposes, and the results obtained in some cases were confirmed by independent collection.

When a patient is admitted to a mental hospital his condition is investigated from a number of angles. His physical state is ascertained, including the condition of his blood and his cerebro spinal fluid; he may be found to exhibit such and such a neuro logical symptom. His mental state is probed into, his intelligence estimated, his emotional reactions noted, his complexes even may be progressively dug up. As a crowning summit to this edifice of knowledge a label is at last attached to the case, and a diagnosis arrived at.

The main points of practical interest in the examination of the cerebro-spinal fluid are the protein reactions and the cell-count. Both are of great value for the early diagnosis of general paralysis, tabes, or cerebral syphilis. The simplicity of the Ross and Jones test brings it within the reach of any qualified man, and it would appear to be the most delicate of all the protein reactions. So far as I know this series is the largest in which the reaction has been tested. Ross and Jones only tested 27, and Amsden 36 cases. At the present time the other characters noted, the acidity or alkalinity and the presence of copper-reducing substance, are mainly of academic interest. It is probable, however, that the degree of acidity to phenolphthaleine may coincide with the development of lactic acid in the fluid during life, and this with the disappearance or lessening of the copper reducing substance; so that inasmuch as lactic acid is rapidly formed in dying nervous tissue, we may have here the means of establishing a test as to the extent of the organic nervous changes in any given case. Writings on the subject of the spinal fluid are now so numerous that some apology is almost needed for adding to their number, especially when, as in my case, nothing new is recorded. Still, I felt it was worth while further testing the trustworthiness of such a simple reaction as that described by Ross and Jones, by its application to a larger number of cases than has hitherto been done, and from my results it appears to come successfully out of the ordeal.

In the mass of conflicting evidence which has accumulated in recent years as to whether organisms are the exciting factor in the production of certain insanities, I have found it difficult to discriminate between cause and effect. Is the organism or group of organisms the specific pathogenesis of certain insanities or merely a bacteræmia secondary to the psychosis?

The investigations recorded in the following paper were undertaken to determine the reason for the discrepancy in the results when applying the Wassermann reaction to the cerebro-spinal fluid and blood-serum of general paralytics. The experiments have yielded results significant in other directions which are of some interest.

The following short paper is based upon observations made during the examination of the cerebro-spinal fluid from a series of cases of various forms of mental disorder. A good deal of attention has recently been paid to the examination of this fluid in conditions of disease; there have been numerous observers, and several important tests have been devised. In this series of cases a routine examination was followed in every case, which embraced the tests described by Noguchi, and by Ross and Jones, an examination of the cells present, and an estimation of the amount of albumen in the fluid. It is to the last of these methods of examination only that attention is directed in this paper.

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.