The use of pronouns and causal attributions in personal accounts has been analysed to distinguish between schizophrenia and mood disorders. The implications for both cognitive processing and the underlying pathology of symptoms are explored. Context is identified as a key variable in the analysis and interpretation of text.

Skin sensitivity had been mentioned and demonstrated in isolated instances over a long period of years before Schloss in 1912 extended and described its usage and established it as a definite means of detecting hypersensitiveness. Since then it has been universally recognized as a most useful adjunct to the study of the aetiological problems of allergy. At first it seemed that a miraculous means had been found of explaining both the cause of and the reason for the recurrence of certain common disorders of obscure aetiology in widely separated organs. It promised to show how totally different symptoms could be attributed to a common agent. The fact that the skin was sensitive but that the only clinical evidence of disease appeared, say, in the lungs gave the impression that all organs of the body must be in a like state of sensitivity. This has since been widely disputed and denied and on this subject Alexander (1936) states that such an assumption, at least from the clinical standpoint, is a fallacy. Man, he believes, may exhibit general hypersensitivity if a sufficiently large dose of protein be experimentally introduced.

If, then, hypersensitiveness is localized in certain tissues, it follows that the skin may or may not be sensitive in any given case and at any given time. In other words, because the ingestion of a specific food leads to colic or urticaria, it does not necessarily follow that the skin will give a positive reaction to an extract of that food in all cases or at all times. Indeed, a positive reaction may not occur at any time. This limitation of skin testing is now accepted; but nevertheless, allowing for the fact that only 50-60 per cent. of allergics (and that is not an over-generous estimate) give positive results, it still remains a very valuable diagnostic aid.

I am indebted to Dr. Rogers for permission to publish the notes of the following case:—

Five cases of fatal lead poisoning occurred between 1884-6 among the employés of a certain white lead factory in the East of London. The cases presented the following common characters. They were all adult women, aged from 18 to 33. They had all worked at the factory for short periods from three to twelve months. They all exhibited mild symptoms of plumbism, such as a blue line round the gums and more or less ill-defined indisposition; paralyses were absent. They were all in their usual state of health within a few days or hours preceding death. Death was unexpected—mostly sudden. In four cases it was preceded by epileptic fits and coma, but in the fifth case no convulsions were noted, although they may have occurred during the night.

Cholesterol metabolism in epilepsy has been investigated by a number of observers during recent years, but the results have been contradictory and confusing, as the following summary shows: 1920, De Crinis (1): Cholesterol increased before seizures. 1923, Pezzali (2): Cholesterol decreased before seizures; low average levels in epileptics. 1927, Robinson, Brain and Kay (3): Cholesterol decreased before seizures. 1927, Osnato and Killian (4): Results negative. 1929, Goodall (5): Results negative. 1929, Fox Gosden and Brain (6): Cholesterol decreased before seizures; general low values in epileptics and increased variability in individual patients. 1930, Duncan (7): That there is no definite evidence to show that the occurrence of an epileptic fit is associated with a fall in the level of cholesterol in the blood.

Most of us are in the active discharge of the duties of medical attendance on the insane, many of us are at the head of large public institutions. We are by the public expected both to be learned, ready and exact. Serious calls are daily made on our knowledge of medicine and surgery, but by many of us I am certain these are much more readily responded to than the calls on our powers of administration and on our judicial functions as guardians and care-takers, as well as the physician and friend of our patient. Now to my mind no one portion of duty is more unpleasant than having to listen to complaints of illtreatment, or even negligence and carelessness made by patients, to investigate them, to weigh, balance and decide on the best course of action.

There is a type of social psychology which finds the explanation of man's social behaviour in a hypothetical “disposition” of his mind. This motive-complex is conceived as specialized for the function of adapting conduct to social life, and as being in itself relatively closely integrated, developing and functioning as a whole. Of this hypothetical “gregarious instinct” McDougall goes so far as to say: “For it is highly probable that instinctive dispositions are Mendelian units” (Journ of Abn. Psych, and Soc. Psych., vol. xvi, p. 316). This plainly suggests that the unity of the social disposition (its existence as a discrete factor in development) is to be regarded as antedating experience—that it is an ultimate datum for psychology not susceptible to analysis, and is not a derivative of any other known motive such as “love,” “fear,” or “hope of reward.” This “instinct” interpretation of social behaviour has been criticized on many grounds (as unfruitful for psychology and incompatible with biological fact); but of course the demonstration of a Mendelian transmission of the social disposition would compel us to regard it as an element of character. Our conception of mental development and of the “socialization” of the individual, of the relative significance of upbringing as compared with organic endowment and our whole psycho-pathology depend upon our acceptance or rejection of McDougall's view. If he is right in regard to the germinal “unit” determination of the social disposition, criminological studies should offer verification. I propose, therefore, to consider how far we are justified in regarding moral insanity and moral imbecility as true “morbid entities.”

The great progress which medicine in general has made during recent years, must in considerable part be ascribed to the anatomical direction it has assumed. The study of pathological anatomy has entirely changed the character of medical science, which, instead of a chaotic medly of unfounded theories and ingenious hypotheses, the fruits of speculation, is now a philosophic system resting on a firm foundation of facts with mutual and definite relations. To such an extent has the pathological investigation of disease been carried, that, in the ordinary maladies which attack the body, the instances are now exceptional where we cannot demonstrate certain gross, palpable changes of structure having an invariable causal connection with functional disturbance. By bringing diagnostics to our aid, we can also in many cases predict with confidence and precision the nature and extent of the lesion which will be found after death. But the triumph does not cease here. In conjunction with chemistry and the microscope, pathological anatomy has passed from the gross alterations of organs, and succeeded in elucidating the processes and changes which take place in their ultimate elements; and Virchow, bringing to the subject all the zeal and instinct of genius, has given us an insight into the arcana of cell-life, and laid down the comprehensive generalisation as the basis of a new pathology, that the cell is the ultimate agent by which, both in health and disease, structural and functional alterations are effected. All the practical departments of the healing art have participated more or less in this progress. Medicine proper, or that branch which restricts itself to the study of internal diseases, has separated itself more and more from dynamics, and found a natural explanation of its symptomatology in anterior changes of structure; while surgery and mid-wifery, with their outbranching specialities, are daily becoming more anatomical in character.