During the first two decades of this century important advances were made in our knowledge of syphilis. Wassermann in 1904 introduced the serological reaction which bears his name; Schaudinn and Hoffmann discovered the spirochaete in 1905; Plaut in 1908 extended the application of the Wassermann test to the cerebro-spinal fluid; Ehrlich in 1909 synthesized “606”; Noguchi in 1913 demonstrated spirochaetes in the brains of general paralytics, and Wagner-Jauregg in 1918 inaugurated malaria therapy. During the second two decades no outstanding discoveries have been made, but there has been in these last twenty years a large amount of verification and elaboration; more sensitive serological tests have been devised, new chemo-therapeutic drugs have been manufactured, the histology of parenchymatous neurosyphilis has been more fully studied, and many methods of pyretotherapy have been tried. A review of the vast literature which has been published soon reveals the fact, however, that there are still numerous outstanding problems awaiting solution, many of which were already being discussed 20 and 30 years ago.

The haemorespiratory system is subject to disease like any other tissue of the body. Degenerative changes of large arteries are known to have occurred thousands of years ago, and atherosclerosis is to be found throughout the world irrespective of race or geographical distribution. The first recorded observations of disease of the cerebral vessels appeared in the year 1700 (1). Perivascular softenings were noted in 1814 (2); a book on disease of the brain with clinical associations was published in 1836 (3). Atheroma was studied in 1844 (4), and periarteritis of the cerebral vessels in 1868 (5) and 1887 (6). Changes in the vessel walls and perivascular cells were noted in 1863 (7), and white cells and emboli seen in cerebral vessels in 1882 (8).

The aetiology and pathology, as well as the clinical characteristics of those diseases of the nervous system in which the myelin sheaths and the axis cylinders are unsystematically affected, but the other elements of the nervous tissue spared, are as yet incompletely understood. Of these diseases, the group in which the changes of the nervous system are associated with anaemia and other dyscrasias of the haemopoietic system, generally classified as subacute combined degeneration of the spinal cord, is the most clearly defined. However, even in this group cases occur in which the characteristic degeneration of the spinal cord is not accompanied by gross pathological changes in the blood. There is still, therefore, much research required before these atypical cases can be brought into line with the general pathological conceptions of the subacute combined degeneration. Furthermore, the existence and character of pathological changes in the brain and other parts of the nervous system of cases with subacute combined degeneration, apart from the spinal cord, remain to be investigated more fully. The case which we have to report has various special features, the study of which should contribute in some degree to the elucidation of these complex problems. In this case, which presented the typical picture of a subacute combined degeneration without blood changes, there was an extensive affection of the brain and the peripheral nervous system.

Few patients in British mental hospitals are given a standardized mental test. Such tests may not be indispensable, but properly interpreted they tend to a precision otherwise lacking in clinical observation. Many psychiatrists rely on the answers to haphazard questions on general knowledge, simple arithmetic and so on. These not only have an indefinite significance, but may flatter to deceive.

Sodium amytal (sodium-isoamylethylbarbituric acid) has been used in psychiatry for several purposes; its uses in producing lucid intervals in catatonia are acknowledged (Bleckwenn). Broder employed it for the first time in continuous narcosis; and later, in combination with caffeine, he used it for therapeutic purposes in the treatment of psychoses; Harris, Horowitz and Milch discovered its prognostic value in insulin and cardiazol therapy, and Hermann, its effects in clearing psychogenic amnesias. It gradually lost its interest from the research point of view because sodium amytal (S.A.) appeared to be similar in results to ordinary hypnosis, but in the course of our own observations we found definite differences between the two.

During the routine investigation of the blood of patients at Tooting Bec Hospital it soon became obvious that a considerable number showed either a positive Wassermann reaction and a positive Meinicke or only a positive Meinicke.

The conditions of warfare in the present war have so far differed markedly from those in the 1914-1918 war. Up to date (September, 1940) the incidence of psychoses and neuroses appears to be comparatively small. One cannot however foretell what may occur later, and perhaps the following observations on psychoses in officers in the last war may be of some value. They were the subject of a paper I read to the East Sussex Medico-Chirurgical Society in 1920. I have made practically no alterations in the text.