This is a summary of the views and findings of Professor Karl Kleist and his co-workers. It is based on a series of papers published by members of the Frankfort-am-Main University Psychiatric Clinic from 1939 to 1951.

These papers are the result of follow-up studies carried out on patients who had been admitted to the Frankfort Clinic between 1920 and 1953. These patients had been diagnosed as suffering from one of Kleist's special forms of schizophrenia.

Reports on the use of Rauwolfia alkaloids in the treatment of the mentally disturbed and on the remarkable central properties of this group of agents have encouraged a trial of the effect of both mixed Rauwolfia alkaloids, and of reserpine in the management and treatment of the chronic psychotic patient.

The first distinctive account of this condition was given by George Huntington, a physician of Long Island, in 1872. Since then our knowledge regarding aetiology has not advanced greatly, though the hereditary nature of the illness and the fact that it is transmitted as a Mendelian dominant by both sexes has been established.

One of the ways in which the psychiatrist differs from others who work with delinquents is in the importance attached to the sexual history of the offender. The contribution of psychiatrists in this respect has been mainly confined to a description of the emotional and dynamic aspects of sexual adjustment. But it is reasonable to suppose that if these emotional differences are as important as they seem to be from a study of individual cases, they would be reflected in differences in objective sexual behaviour, which are sufficiently definite to be used by criminologists in their more systematic studies. In the case of emotional relationships within the family, for example, psychiatric emphasis has induced criminologists to consider “broken homes” or “maternal separation” in a systematic way, but very few attempts have been made to relate the objective aspects of sexual behaviour and development with criminal behaviour. Even in the Gluecks' exhaustive study of five hundred delinquents and controls, which included psychiatric examination, sexual behaviour was not recorded, but only the presence or absence of sexual conflicts.

Some neurotic patients exhibit such a complex symptomatology that it is often difficult to determine, by present methods, which problems or areas of difficulty are fundamental. Much time may therefore be lost through the treatment of superficial rather than basic sources of difficulty.

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.

It has now been established that megaloblastic anaemia may develop in patients receiving the anti-convulsant drugs phenytoin sodium (“Epanutin”) and primidone (“Mysoline”), given alone or in combination with phenobarbitone. Hobson et al. (1956) found 16 such cases described in the literature, and reported a case of their own in which megaloblastic anaemia developed in a patient addicted to a preparation (“Tuinal”) containing equal parts of amylobarbitone sodium (“Sodium amytal”) and quinalbarbitone sodium (“Seconal Sodium”), which are closely related chemically to primidone, sodium phenytoin and phenobarbitone. Characteristically the anaemia is not related to a deficiency of nor does it respond to treatment with vitamin B12, nor is there achlorhydria, thus distinguishing it from true Addisonian pernicious anaemia. The condition however responds promptly to the administration of folic acid by mouth.

Pacatal is one of the newer so-called tranquillizing drugs. It is a synthetic phenothiazine derivative—N-methyl-piperidyl-(3)-methylphenothiazine which was first investigated in Germany in 1954. It has the same basic structure as chlorpromazine but a different side chain.

Reserpine was first used extensively in psychiatric practice in the U.S.A. where many favourable reports on its use were published in 1954 and 1955. Subsequently a series of reports appeared in the U.K. These reports were more critical and sought to establish more precise indications for the use of the drug. It soon became apparent that the drug was of most value in schizophrenia and the organic hyperkinetic states. The value of reserpine in psychoneuroses is limited but that it is going to have a more than temporary place in the treatment of schizophrenia is suggested by the continued appearance of favourable reports. These last authors emphasize that not only is the drug an effective sedative but also that it does appear, in some places, to induce genuine remissions. The present difficulty is to predict which patients will respond in this way.

It is the aim ofthis paper to present some ideas for a new and practical approach to some of the problems of assessment and placing of mental defectives with respect to motor abilities. Attention will be drawn to some theoretical confusion about the relationship between mental and motor abilities in the mentally deficient population and finally some experiments illustrating the possibility of a new approach will be described.

While Visiting Psychiatrist to a convict prison, the author used the M.M.P.I. as an aid to clinical diagnosis. The test did not prove helpful in that respect. Impressive, however, was a profile recurring so often as to appear typical of the recidivist in prison.

The safety of electro-convulsive therapy (E.C.T.) has been greatly increased since muscle relaxants were first introduced for this purpose. Short-acting relaxants such as suxamethonium and suxethonium reduce the usual strong tonic and clonic contractions to faint muscle twitchings, and fractures do not occur. Respiration can be maintained throughout by positive pressure inflation so that cyanosis and stertorous breathing are avoided. This may ensure that material from small pulmonary lesions is not disseminated to other areas. It is disappointing that the cardiovascular commotion is only slightly reduced, and deaths still occur, albeit rarely.

In a previous paper one of us (4) has elaborated a theory relating drug action to personality. According to this theory, depressant drugs increase cortical inhibition (Pavlov) or reactive inhibition (Hull), thus producing an extraverting effect on personality, while stimulant drugs decrease inhibition and produce an introverting effect in behaviour. It was also suggested in this paper that a direct proof of the hypothesis might be obtained by making predictions regard ing the effects of stimulant and depressant drugs on a variety of experimental laboratory situations connected with the general theory of inhibition and excitation.