Supplementary assessment procedures may be used to complement the psychiatric diagnostic interview. These include procedures for the comprehensive evaluation of the mental and physical state of the patient (psychosocial procedures are considered in part 6 (IGDA Workgroup, WPA 2003, this suppl.)). Psychopathological assessment instruments, biological tests and procedures and neuropsychological tests are among those used to enrich or refine data collected in a clinical interview in order to arrive at the standardised multi-axial diagnostic formulation.

This research was undertaken to establish, as far as possible, Drs. Ford Robertson's and McRae's ætiological hypothesis for general paralysis of the insane. It is hardly necessary to emphasise the importance of giving the fullest consideration to this theory, being, as it is, the first serious attempt of its kind to bring mental disturbance into the category of physical disease, to establish the wealth of histological observation in its place as an effect, and to break from the bugbear of metaphysics and perversion of psychic function. I should like to make it clear that though this research may controvert the ætiological significance of the bacilli of Ford Robertson, it in no wise attacks the fundamental theory of a toxic cause acting through the very definite channels of infection established by Drs. Orr and Rows.

Since the publication of Bender's (3) “Visual-Motor Gestalt Test and its Clinical Use” many attempts have been undertaken to validate the clinical findings which she outlined in her Monograph.

In his “Tentative Guide to the Administration of the Bender-Gestalt Test” Hutt (7) did more than anyone else to put into practice the clinical use of the Bender-Gestalt, but his finding on Psychoneurotics have not been confirmed by empirical studies. However, it is of interest and encouraging to find many of the subsequent empirical studies substantiating most of the original clinical uses outlined by Bender and Hutt.

Little has been written, and comparatively little is known with precision, concerning the insane of Greece—whether we speak of the little kingdom alone, with its present population of nearly 2,500,000, or of the Greeks in general, who live in Macedonia, in Asia Minor, in Egypt, or elsewhere outside of the present limits of Greece. This whole community, diverse in origin and residence, but united by a common language and a common religion, considers itself as one, and sends to the two asylums in Greece—the old Phrenokomeion of Corfu (founded in 1838), and the comparatively new Dromokäiteion in Athens—insane persons from all the countries in which Greeks reside. Thus, during the year 1892 the Athenian Asylum (which takes its special name from a Greek family named Dromokäites, whose wealth has endowed it) received 70 admissions; and of these 13, or nearly one-fifth, came from places outside of Greece. A smaller proportion among the 175 (more or less) who now reside in the Corfu Asylum are from outside of Greece, and it is probable that this proportion is constantly diminishing there. But Athens, from its central position, its rank as a capital, and the affection with which most Greeks regard it, is likely to draw to itself more and more the persons attacked with insanity outside of Greece. This fact will increase a little the visible insanity of the kingdom; but so many are the causes tending to conceal the extent of this malady there that the circumstance of these outside accessions need hardly be taken into account. There is no census of the Greek insane, even professing to be exact, and I have been forced to rely, in my tours and inquiry during two visits to Greece (in 1890 and 1893), on the estimates of careful persons and my own observation.

Bickford has underlined the need for devoting more attention to the chronic psychotic patient and stressed the possibility of accelerating what he believes to be the inevitable remission of the psychosis. There may be a current tendency to think in terms of the physical or pharmacological treatments in handling psychotic patients and to overlook the value of more conservative measures. Myerson attempted to revive interest in the latter by coining the term “total push” and providing a theoretical basis for the activities organized. Galioni et al. presented the results of a similar programme which showed 18 · 5 per cent. of the experimental group “separated” from the hospital as compared with 5 per cent. of the controls. Kamman et al. show that while the initial improvement certainly takes place, unless careful placement is achieved relapse occurs.

In this university the study of medical psychology and mental diseases is wholly voluntary. None of the faculties require candidates for degrees to attend the course I deliver, or examine them in the subjects discussed. Doubtless the faculties of arts, theology, and law, might reasonably object to so great an encroachment upon vested interests and established traditions; but it is different with the faculty of medicine, because moral philosophy has only been added to the curriculum of medical studies since I commenced to deliver this course. I have therefore thought it would be expedient (and suggested it, indeed) to permit students of medicine going up for their degrees to choose between medical psychology and moral philosophy; nevertheless the course is still without even this modified recognition. Nor do any of the other medical boards of examiners of the United Kingdom require it. The Senate of the University of London has, however, very lately recommended the practical study of mental diseases to candidates for medical degrees; but valuable and important as this step is, yet, inasmuch as it excludes medical psychology, it falls very far short of what must ultimately be required in the interests of society of all students seeking general culture or to enter any of the learned professions. I entertain a deep-rooted conviction that mental science, in the modern and practical sense of the term, will sooner or later be forced on the attention of political economists and statesmen as one of the needs of the time; and I am equally convinced that no such science is possible except by the observation and study of morbid mental states. I therefore propose on this occasion to plead for the general study of medical psychology or mental science developed according to this method in this classroom, and although I may not hope to be successful in my pleading, I trust I shall at least encourage you who engage in the study voluntarily to pursue it ardently, as offering its own full reward for any labour you may bestow upon it.

If I fix a square peg into an oblong hole, the fact that they do not fit is instantly perceptible; but it is manifest that the. several percepts of the peg and of the hole must precede the perception of the relation of non-adjustment subsisting between them. Furthermore, if I want to determine how much the peg lacks in size, I must measure separately both the peg and the hole before I can calculate the amount of the hiatus between them. What is true of this simple case of adjustment is true of the complex case of the adjustment of the organism to its environment. However rapid and apparently immediate may be the cognition that a patient is insane—is unadjusted to his environment—yet that cognition must be preceded by a previous knowledge both of the organism itself and of the environment with which his adjustment has failed. The truth of this statement, which is involved in the definition of Insanity, may not be at once apparent, but a little consideration will render it clear. It is manifest that before pronouncing a man insane, we must first know something about him, but that we must also take into account his environment is, perhaps, not so self-evident.

The cases dealt with in the present paper came under review during the course of my duties as Medical Officer to the Leeds Committee under the Mental Deficiency Act. They comprise examples of the four varieties of mental defectives defined by that Act, viz., idiots, imbeciles, feeble-minded, and moral imbeciles, and include most of the clinical types described by writers on the subject. The commonly accepted division into primary and secondary groups has been adopted; a third group, containing cases which appear to combine the characteristics of both types, and a fourth group containing “doubtful” cases, in which the data are insufficient to allocate them definitely, being also added. It has seemed useful, too, to give columns showing the number of cases corresponding to the accepted clinical types, those complicated by epilepsy, those exhibiting pronounced stigmata of degeneration, as well as those showing a definite family history of neuropathic affections, tubercle, or alcohol respectively. It is obvious that many of these cases will figure under the several heads. The following analysis then shows the proportion of cases under each of these heads of the total number of cases examined, viz., 200:

There is a very general impression among members of the medical profession abroad that it is only by the free use of stupifying drugs that British alienists are able to dispense with the use of mechanical appliances in the management of the insane. It cannot be gainsaid that, by the use of toxic remedies, noisy and violent patients may be as effectually controlled for the time being as by any species of mechanical appliance; nor can it be denied that in many of our asylums narcotics and sedatives are employed in such doses, so continuously, arid for such purposes as to justify the appellation of “chemical restraint.” But there are no facts to bear out the assumption that it is by excessive drugging we are enabled to avoid the use of restraining apparatus in our asylums. On the contrary, there is incontrovertible evidence to show that in foreign asylums where mechanical restraint is extensively practised, chemical restraint is likewise employed to an extent not thought of in this country. Dr. Wilbur∗ has been at pains to collect statistics for purposes of comparing the relative extent to which mechanical and chemical restraint is carried in British and American asylums. The result of his investigation clearly shows that in British asylums and in the few American asylums conducted on non-restraint principles, chemical restraint is not the substitute or alternative for mechanical restraint, but that, on the contrary, the general rule seems to be: the more mechanical restraint, the more chemical restraint.