A study of recent statistics would tend to show that pellagra is not at this time a factor of importance in our institutions. In Massachusetts in 1919 the admission rate for this disease was .33 per cent. In New York state hospitals during a period of eight years it was only .03 per cent. In twenty-one hospitals in fourteen other states it amounted to only 1.28 per cent. This includes a number of institutions in the south. There were 263 cases (.37 per cent) in 70,987 first admissions to forty-eight hospitals in sixteen different states. The admissions reported from the southern institutions indicate that pellagrous psychoses are comparatively infrequent as a rule. During the year 1918 pellagra constituted 10.7 per cent of the admissions to the Columbia State Hospital. During the biennial period of 1917 and 1918 the admission rate at the Arkansas State Hospital for Nervous Diseases was 8.31 per cent. None were admitted to the Spring Grove State Hospital at Catonsville, Maryland. In 1919 the admission rate at the Western State Hospital at Staunton, Virginia, was 1.14 per cent, at the Central State Hospital, Petersburg, Virginia, 1.39 per cent, and at the Georgia State Sanitarium at Milledgeville, 2.49 per cent. One and sixty-one hundredths per cent of the admissions to the Louisiana State Hospital during 1920 were diagnosed as psychoses due to pellagra. Very few cases are reported in the northern institutions. CHAPTER X THE PSYCHOSES WITH OTHER SOMATIC DISEASES Mental disturbances of various types associated with somatic conditions and not sufficiently characteristic or circumscribed in their symptomatology to constitute definite and separate psychoses have long been recognized. That delirium is a complicating factor in certain acute febrile diseases has been known for centuries. Aristotle called attention to the occurrence of hallucinations and illusions during the course of fevers. Hippocrates referred frequently, not only to excitements, but to delirium and phrenitis. The word "delirus" appears in several places in the works of Horace and many of the early authors apparently used this term as synonymous with both mania and melancholia. That was probably true of Sennert. Flemming in 1844 mentioned fever delirium, hallucinatory and delusional clouded states and an encephalitic form in addition to the various alcoholic types. Sydenham referred to the mental symptoms associated with malaria and Bright in his original "Reports" described other delirious conditions at some length. Sir Thomas Watson showed that the brain was uninvolved at autopsy in the acute rheumatic affections with apparent cerebral complications. Mental symptoms have, of course, been associated for hundreds of years with meningitic processes. Diabetic coma was also recognized long since. Griesinger is said by some to have been the first to call attention to the psychoses caused by the acute infections. Post febrile mental disturbances were, however, referred