Few mental diseases have attracted the attention of medical men working in outlandish parts of the world more than Latah. This is due, not only to its intrinsic interest, showing as it regularly does the unusual symptoms of echolalia, echopraxia, and automatic obedience, but also to its remarkable geographical distribution. This illness was described by travellers to the Malay Archipelago in the latter part of the nineteenth century, but very similar reactions were later found to exist in other lands, known to the native peoples by other names. The term “Latah,” however, is the best known, and as the common features between these various reactions became apparent, it has been used as an inclusive name for them all. It is to-day employed with much the same connotation in the French, Dutch, Italian, and English literature, but the discussion of its nature betrays inadequate understanding, attempts at its nosological classification remain unsatisfactory, and speculations as to its aetology continue to be somewhat fanciful.

Since the demonstration of increased sympathetic activities during insulin hypoglycaemia by Cannon, MacIver and Bliss (1924) the assumption has been current that hypoglycaemia also increases the concentration of circulating adrenaline, and repeated attempts have been made to verify this experimentally. Brandt and Katz (1933), using the perfused rabbit ear, the isolated rabbit ileum and the enucleated frog eye as test objects, found that human blood possessed adrenaline-like activities during hypoglycaemia, while control blood was inactive. Meythaler and Wossidlo (1935) reported that the blood of subjects injected with insulin caused an increased vasoconstriction of the perfused rabbit ear and, more recently, Meythaler, Lobenhofer and Haggenmiller (1951) found that the response varied according to the constitutional type of the subject. Heilbrunn and Liebert (1939), however, observed no uniform effects when they tested the blood of patients undergoing insulin shock therapy with the frog perfusion technique; while there was a rise of adrenaline-like activity in some patients, others showed a fall and some failed to show any definite pattern. The results of Tietz, Dornheggen and Goldman (1940) and of Tietz and Birnbaum (1942) who used Shaw's colorimetric method indicated little change in the first two hours after insulin injection, but in the later stages of hypoglycaemia there was a more consistent tendency towards an increase of concentration. The proportion of adrenaline in the chromogenic material estimated by Shaw's method increases during hypoglycaemia, according to Raab (1943). Kalaja (1942), with a fluorimetric method, also found an increase of the blood adrenaline level after insulin injection. On the other hand, Richter (quoted by Jones, 1939) who used the method of Shaw came to the conclusion that adrenaline was not present in significantly increased concentration in arterial blood during those stages of hypoglycaemia when the clinical picture suggested the possibility of adrenalinaemia.

The word “oecology “was coined by Hacckel in 1869, and the study of the complex interactions between organisms and their environment led to fruitful results first in botany (at the beginning of the twentieth century) and later in zoology. In 1935 Bews formulated the principles of human ecology, but the precise boundaries of this discipline (as Banks (1905a) calls it, since it cannot be called a science) are still not the subject of any general agreement. Its dictionary definition as “that branch of biology which deals with the relations of human beings to their surroundings, their habits and modes of life,” although simple for the purposes of formulation, is probably too diffuse in practice. On the other hand, Miller (1950), in suggesting that the ecological study of disorders should be confined to their distribution in the purely demographic sense, seems unduly to restrict its application. There is a tendency among American ecologists (who have been the pioneers of this subject) to take a middle course. Park (1936) conceives of human ecology as the study of the community in terms of the competitive forces which mould it, as opposed to the cultural forces which make for social co-operation. Similarly, Faris (1944) distinguishes the ecological order, which arises automatically and unintentionally out of the struggle for survival, from the cultural order, which is based on mutual affection and sentiment.

Most of the classical reviews of narcolepsy were written in the decade from 1925 (Kinnier Wilson, 1928; Redlich, 1931; Thiele and Bernhardt, 1933; Daniels, 1934, and others). The clinical picture was well established by these writers and does not need discussion. In addition to narcoleptic seizures, other symptoms are common, the most frequent being attacks of loss of tone and power, variously called cataplexy, “Lachschlag,” “Tonusverlust.” Night sleep is often disturbed by periods of wakefulness and bad dreams. During the phases of going to sleep or waking up, temporary paralysis of the muscles, without disturbance of consciousness, and hallucinatory episodes of all sense modalities sometimes occur. The generally accepted explanation of these various phenomena is that they represent a dissociation of the motor, sensory and central components of sleep. There are, however, three controversial points: firstly, the relationship of the patho-physiology of the seizures to epilepsy; secondly, the “somatic constitution “of the narcoleptic patient; and thirdly, the nosological status of narcolepsy.

The first paper in this series described a number of experiments on a single subject, carried out to investigate an anomaly observed during performance of the Kohs Blocks test. This anomaly consisted of making the model correctly but rotated. (Illustration 1.)

The first hypothesis adopted to explain this observation was that anomalies of perception are functions of disturbed figure-ground relations (Goldstein and Scheerer, 1941). This hypothesis is not precise enough to permit a deduction which would make possible an exact experimental test, i.e., a deduction defining the conditions which would produce a measurable change in the rotation phenomenon. It was therefore necessary to arrive at more definite ideas about figure-ground relations. Such ideas were found in three hypotheses developed by Goldstein and Scheerer (1941) to account for variations in speed of carrying out the Block Design test. The first of these is that the square orientation (e.g., Cards a and b in Illustration 2) of a figure would tend to diminish the frequency of appearance of the anomaly, while the diamond orientation would increase it (e.g., Cards c and d in Illustration 2).

While the main syndrome of tetany arising from hypoparathyroidism is widely recognized, it is doubtful if a sufficiently comprehensive view has been taken of the extensive range of manifestations which may be presented. The underlying pathological mechanisms may also be complex, and the circumstances under which hypoparathyroidism may develop are not always self-evident. Lyle (1949) attempts to classify hypoparathyroidism on an aetiological basis, and distinguishes postoperative, intrinsic, extrinsic, and idiopathic types. In our paper we are mainly concerned with tetany following thyroidectomy, the incidence of which has been estimated by Bell and Bartels (1951) as 2·9 per cent., based on their observations of 2,000 consecutive operations. The case which we are going to describe is one in which a history of thyroidectomy did not immediately appear significant in relation to the presenting features. Admission to hospital followed the onset of a psychotic illness, which in itself did not indicate any underlying organic disturbance, despite an account of an occasional epileptic attack some time previously. The latter feature, however, led to routine E.E.G. investigations. These are of particular interest in this case, especially as some of the recordings had been made before the diagnosis of hypoparathyroidism was established, and before the significance of the fits in the clinical syndrome was appreciated.

The purpose of this paper is to draw attention to results achieved in selected neurotic cases treated by short-term abreactive techniques in St. Clement's Hospital during recent months. Patients usually stay in for about two months; as yet it is too early to assess long-term results of this form of treatment, but it is felt that some of the initial results are extremely encouraging.

Biological rhythms exist in a rich variety and almost bewildering profusion to attend and equilibrate the physiology of man. Such dynamic phasic activity appears not only to be intimately concerned with the phenomenology of life and biological processes in general, but is also to be found in purely chemical systems (Hedges and Meyers, 1926). Modalities of the periodicities associated with life can be divided into those external to the organism—including diurnal and climatic variation, sun-spot activity, etc., and into those inherent within the individual such as the respiratory and cardiac rhythms, the menstrual cycle, sleep and awakening. Only less well marked are certain psychological periodicities such as “cyclothymic “variations in mood and personality. In the course of the present century much painstaking research has attempted to link external with internal rhythmic activities, significant correlations being adduced between seasonal variation and, for example, the incidence of psychiatric disorder (Huntington, 1915), immunity from disease (Spencer and Melroy, 1943, Webster, 1944), temperament and behaviour (Petersen, 1934-36; Mills, 1942), and an impressive array of biochemical and physiological variables ranging from blood pH, lactic acid and protein to breath-holding time, plethysmography, tests of hand strength and fatigability, dark adaptation time and various tests of urinary function (Petersen, 1947).

It has been shown by a number of workers that in a large proportion of cases the E.E.G.s of schizophrenic patients are abnormal. This paper is an attempt to increase our knowledge of the hereditary background of schizophrenia by recording the E.E.G.s not only of those suffering from the disease but also those of their near relatives.

Flexibility in adjustment on the part of the interviewer is commonly regarded as one of the main qualifications for good interviewing and part of an interviewer's skill. The high estimation of the spontaneity of the interviewing situation, which has been one of the main reasons why the interview as a technique has retained its popularity against more standardized and reliable methods, rests largely on the presupposition that skilled interviewers can adjust their own behaviour and steer the interviewing situation freely so as to obtain optimum rapport and maximum information. Thus Oldfield (5) considers changes of topic, attitute and tempo of great significance for the conduct of the interview. He particularly stresses the importance of changes of tempo; pauses in the conversation, he says, if “badly chosen may easily break the trend of the relationship which is being built up. On the other hand, if well chosen, they may contribute markedly to the success of the interview.” No evidence, however, exists to show to what extent skilled interviewers actually are free to adjust themselves to any particular interviewing task or which aspects of their interviewing behaviour are more subject to adjustment than others.

Research was carried out by a small unit in the York Clinic at Guy's Hospital into the possible connection between migraine attacks and the patient's emotional life. The hypothesis was that migraine was a product of stress and should, therefore, respond to psychotherapy directed towards helping the patient to deal with his emotional problems in a more adequate way. The clinical aspects of the investigation and therapy are described in full elsewhere (2, 3). Evidence was produced to support the view that migraine is a stress disorder. Contact was kept with all the patients for a period ranging from 2 months to 2 ½ years. In a series of 20 patients eight patients were much improved by therapy, ten improved and two remained unchanged. This paper presents the results of some of the psychological tests which were applied to those 20 patients.

In a previous communication (1951) it was shown that the hyperglycaemic factor described by Meduna and Vaichulis (1948) in the urine of psychotics consisted of two fractions, and that the more active and specific of these was of a protein nature. Morgan and Pilgrim (1952) have prepared concentrates of this factor from the urine of male and female schizophrenics, and have produced further evidence that it is a protein or a substance strongly bound to a protein. In normal male urine they did not find a measurable quantity of the factor.

Hurler's disease is a condition characterized essentially by mental defect, chondro-osteodystrophy, hepatosplenomegaly and corneal opacities. The complex was first noted in 1900, by John Thomson of Edinburgh who, recognizing that he was dealing with a new disease, named it after his first patient “Johnny McL—'s Disease.” Subsequent descriptions were those of Hunter (1917) and Gertrud Hurler (1919).

The Rorschach ink-blot test is so well known amongst present-day psychologists that any attempt to describe its composition and the aims and ambitions of its protagonists would be presumptuous. However, the underlying assumptions involved in the use of the test are neither so widely understood nor so universally accepted. It is for this reason that there have been so many and so various attempts to establish the validity of the Rorschach.

In abreaction under any of the methods in use, a phase of cortical excitation is followed by a phase of temporary cortical inhibition with rupture of pre-existing patterns of conditioned reflexes and behaviour, a phase in which new modes of behaviour are easily adopted, the ultra-paradoxical phase (Pavlov, 1934). In this phase the patient is extremely suggestible, and this corresponds to psychological transference always found in post-abreactive states (Shorvon and Sargant, 1947).

This paper describes a preliminary survey, in which an attempt was made to discover if recognizable E.E.G. patterns could be correlated with consistent patterns of behaviour in a group of aged mental hospital patients.