found in at least fifty per cent of all cases, forming presumably a predisposition; it is also stated that a predisposition may be acquired through various debilitating causes. Exciting factors are claimed to be present, such as mental shock, grief, worry and the like. The disease would then seem to occur when we have a combination of exciting factors and predisposition. Careful consideration will show, however, that no such mental disturbance occurs at this age in many people who show evidences of such predisposition and of exciting factors, therefore it would seem that still other causes were necessary; if we consider the suggestion above mentioned that there are atrophic processes taking place in the sexual glands leading to a loss of the internal secretions and if we further consider that this may take place unevenly and in an unbalanced way, thus aiding in giving rise to the symptoms, we will find a definite point of contact for the osteopathic conception. Osteopathically considered, we may say that the spinal lesions lead to a disturbance of innervation and nutrition to the ductless glands, and therefore produce disordered secretions in those patients developing the disease, whereas such a condition may not be present in others who at the same age period do not develop the psychosis. Symptomatology The emotional tone of depression dominates the picture. Associated symptoms are anxiety, fears, particularly of impending danger, the loss of interest in the external world, with a concentration of attention upon self; psychic distress is usually present, often to an extreme degree, leading apparently to real mental pain, so-called psychalgia. Delusions are usually present and manifold in variety; they mainly refer to the patient himself and are of a self-accusatory nature; they frequently refer to notions of sins having been committed, also unworthiness of the patient, of poverty, nihilistic ideas, either about his own body or external things. He may claim for example that he has no stomach or kidney, or heart, that the external world is unreal and the like. His motor reactions become retarded, or even in the more extreme cases inhibited, producing a form of stupor. The inefficiency which results along with the psychic pain and distress may determine suicidal tendencies which are very frequent. Orientation is usually good, the patient remaining aware of his own identity and that of his surroundings; the judgment of course is impaired so that the patient is unable to appreciate the unreality of his delusions; as a result he sees no hope in the future and on account of present sufferings prefers death to life. The patient may remain in a perfectly passive mood, giving the appearance of extreme depression, paying no attention to the surroundings, possibly mute, giving no regard to the necessity of the toilet, paying no attention to his clothing and the like. This may continue for hours or days. Food often has to be forced on