The insulin therapy of the psychoses as evolved by Sakel (1) was introduced to Three Counties Hospital 16 months ago. The total number of patients treated and under treatment is 74; 56 have had a full course of the treatment in addition to psychotherapy, and of these, 29 have been discharged and 4 will leave the hospital in the near future. A total number of 3,205 hypoglycæmic comas have been induced up to the present in 4,379 patient insulin days. Serious emergencies arose in only 6 comas. One patient had severe laryngeal spasm, another acute ódema of the lungs, and four delayed return to consciousness. No fatality occurred. Twenty-eight patients had 81 fits in the same number of comas. I shall outline briefly the circumstances which led up to the emergencies met with by myself and some published by other workers in this country, and give the treatment applied.

(1) The “we” means the inner or subjective side of group-experience, expressed grammatically in the first person plural. For instance, the mother giving her child a bath says to it, “We are having a bath now, and then we are going to sleep “, whereas it is only the child who is going through the ceremony.

The popular conception of mental defect is that it is a common abnormality of a kind fairly easy to understand and to study, and for whose ætiology simple rules can be laid down. Textbooks on general medicine usually dismiss the subject in a few paragraphs, and even those devoted to diseases of the mind rarely find room for more than one short chapter on mental defect.

One difficulty which hinders the advance of psychiatry is that the facts of a mental disorder are not easy to describe and to record accurately. Many of the descriptive words used, such as “depression”, “confusion”, are taken from common speech and carry with them vague meanings. Out of sympathy with the sufferer, we tend to read our own emotions into the clinical picture. Moreover, because a disorder of thought and behaviour is a disorder of adaptation to living, the description of a mental disease involves not only the recording of the symptoms, but also a description of the circumstances and life-setting in which they occur. Another difficulty lies in the great variation in the clinical pictures of mental disorder. These vary so much that a diagnostic label such as affective psychosis or schizophrenia does not convey, and indeed is not intended to convey, an idea of a specific disease. These difficulties are somewhat more marked in the investigation of mental disorder in contrast to the investigation of mental defect. The statement that a patient is a Mongol or a cerebral diplegic conveys the idea of a fairly definite clinical syndrome, whereas a statement that a person suffers from schizophrenia calls up a much less clear mental picture. It seems that the only way out of this difficulty is to give a short statement of the clinical facts about each psychotic whom one discusses.

Theories have been put forward concerning children's play which relate it to phylogeny and to an impulse towards preparation for life.

Child psychotherapy must be founded on modern depth-psychology. Exact structure-analysis is the condition for therapy.

Since there are several excellent accounts of the technique of insulin therapy (1, 2, 3, etc.), and since our method is based largely on the recommendations of Sakel, we do not intend to describe this in detail, but to discuss such variations and points of interest as have developed at Hatton during the completion of treatment in 59 cases.

The development of psycho-analysis can be considered as a reaction against an exaggeration of the synthetic point of view in suggestive psychotherapy and moral education. If the result should be that the synthetic point of view is considered unscientific in theory and arbitrary and bad technique in practice, this would mean another exaggeration. Even in psycho-analytic circles the problem of synthesis has arisen in relation with child-analysis and with influencing the super-ego.