The use of fibrous wool protein as a model of the structural surface of receptors, possibly involved in the mechanism producing a model psychosis by drugs, was suggested by three lines of evidence.

First, the strong affinity (sorption) of certain basic compounds to keratins of low sulphur content as exemplified by the Gram-positiveness of epidermal (Fischer, 1953c) and nervous (Bailey, 1950) tissue.

Second, the accumulating evidence indicating the similarity in behaviour between keratins of high sulphur content (e.g. wool) and the protein component of certain cell membranes (Fischer, 1951; Fischer and Larose, l952a; idem, 1952b; Larose and Fischer, 1952; idem, l953a and 1953b).

Third, some preliminary experiments confirming the role of wool protein as a useful model to simulate some of those receptors for which certain drugs appear to compete.

Though electro-convulsive therapy (E.C.T.) is one of our most useful treatments, its mode of action is still largely unknown, and this ignorance is preventing us from making it more successful and more widely applicable. Among its possible modes of action is the possibility of its having some “activating” action on the basal, and more particularly on the hypothalamic, structures. Such activation might be expected to show in the psycho-galvanic response (P.G.R.), and we have therefore investigated something of the relationship between them. Many of the facts that would justify this investigation need not be given here as they have been reviewed in previous publications (Ashby and Bassett, 1950; Ashby, 1952(b)).

The “Controlled Projection” Test of Raven is a method of collecting and studying the projection responses of children to a standard series of situations (Raven, 1951). In reports so far published, the technique has provided information on differences in the organizations of thought and conduct characteristic of different national, social and clinical groups, and on individual differences within these groups.

The impulse to attempt this study arose from difficulties encountered in the process of trying to demonstrate the efficacy or inadequacy of various methods of psychiatric treatment (Monro, 1950; and Monro and Conitzer, 1950). The problem which arose was that of matching groups, whose composition necessitated a struggle with diagnostic and prognostic criteria difficult to define and still more difficult to secure agreement about. The chief trouble derived from the fact that the systems of classification in normal psychiatric use had their roots in the past, when the cases were dealt with at a more advanced stage, or were of a more serious nature, than many which are today seen in out-patient clinics and mental hospitals. In the search for a more adequate system of classifying recent and therapeutically promising cases, the work of Cattell (1946) suggested a possible method of advance. It seemed sound to hope that the application of modern psychological techniques to psychiatric problems would be as useful as past applications of the principles of physiology and pathology to clinical medicine.

In view of the importance of prenatal pathology at the present time, a useful purpose may be served by attempting to review the peculiar weaknesses and strengths of the developing nervous system. As a result of personal inclinations, this presentation of the various problems involved will have a structural bias; the subject would, no doubt, be approached very differently by a physiologist, for instance, or by a biochemist. Nevertheless we should all be describing different aspects of the same series of phenomena, aiming at an understanding of the events which must occur before the central nervous system can function.

We have at present no reliable method for indicating the correct sequence of treatment in neurotic cases showing a manifold symptomatology. In such cases much time may be lost through attacking superficial rather than basic conflicts. It would therefore be an undoubted advantage to possess a means of indicating objectively and by experiment which problems are fundamental, and to the resolution of which treatment should be first directed.

Many endocrine disturbances have been described as accompanying disturbances in mentation. Single investigations giving a static picture at a certain stage of the disease contribute comparatively little to the understanding of the pathognomonic significance of the biochemical change, even if they are found to be statistically significant.

Investigations carried out in the past into the steroid hormone excretion rate of mental patients have been limited to the quantitative determination of the total compounds. Assay of neutral 17-ketosteroids in particular, has revealed no significant difference in the excretion rates of schizophrenics from that of normal controls (Leth Pedersen, 1947; Lingjaerde and Lierasylet, 1949 et al). Pincus (1943) has studied the diurnal excretion pattern of 17-ketosteroids in normal persons; a different pattern was shown to occur in some schizophrenics (Reiss, Hemphill, Gordon and Cook, 1949). Some schizophrenic patients also show considerably greater fluctuations in the 24-hour excretion rate than normal persons (Reiss et al., 1949), these fluctuations disappearing after successful treatment of the patients (Reiss, 1952). An increased percentage of excreted 3 β-hydroxy-17-ketosteroids has recently been reported (Mittelman, Romanoff, Pincus and Hoagland, 1952) in schizophrenics compared with normal people, the total ketosteroid excretion rate being found similar in both groups. Increased β-ketosteroid excretion rate was also seen by Reiss, Hemphill, Gordon and Cook (1949), during depressive phases in a state of manic depressive psychosis.

Epiloia occupies an intermediate position between the neoplasms on the one hand and other diseases, such as Huntington's chorea and Tay-Sachs disease, which are system disturbances, presumably based on a metabolic disorder. The lesions in the disease-complex of epiloia might at first sight appear mainly neoplastic in form. Thus the brain nodules have the form of gliomata. Polycystic kidneys may be classed as neoplastic (Jeanbrau, 1928; Vines, 1949). In some cases a frank hypernephroma may develop (Kirpicznik, 1910; Berg, 1913; Ferraro and Doolittle, 1937). The rarely encountered heart lesions may take the form of rhabdomyomata, whereas the skin lesions of the face which are pathognomonic of the disease are described as sebaceous adenomata (Figs. 1 and 2), i.e. benign neoplasms of the sebaceous glands of the face in the area to either side of the nose. In fact the facial eruption is seldom simply adenomatous but is complicated by elements of an angiomatous or warty nature. The heart lesion may likewise involve a variety of elements.

In the outpatient department of the Maudsley Hospital, patients are seen in the first instance by members of the medical staff of consultant status at the diagnostic clinics, to which they are referred from a variety of sources, by far the greater number coming from general practitioners. From the diagnostic clinics there are several possible disposals, one of which is referral for outpatient treatment of a more prolonged and elaborate type, as opposed to treatment at a purely supportive level with brief interviews concerned with environmental factors and immediate practical problems. The more prolonged and elaborate outpatient treatment is under the supervision of a physician of consultant status with a Freudian analytical training and strong interest in psychotherapeutic methods. It is carried out by registrars under his guidance and may consist either of individual or group sessions, or of a mixture of the two, as he directs. His general outlook is well known (Foulkes, 1948). It has been a constant source of difficulty that the number of patients referred for this type of outpatient treatment has been greater than the resources of the hospital could manage, with the consequent development of long waiting lists and of the necessity for making awkward decisions with regard to priorities.

Since Meduna published his monograph on carbon dioxide therapy of nervous disorders (Meduna, 1950) the method has been widely employed. This paper discusses the results obtained by the strict application of the methods described by Meduna to 42 psychoneurotic out-patients at the Maudsley Hospital, and the bearing these results have on his claim that it is an effective and safe method of treating psychoneurosis, such as could be applied by practitioners with little psychiatric experience.

In a previous enquiry the prognostic significance of diverse aspects of the functional psychoses was examined (Harris and Lubin, 1952; Harris and Norris, in press). Prognosis was evaluated in terms of total length of stay in a mental hospital over a follow-up period of 18 years. Each patient was assigned to one of three major diagnostic groups (schizophrenia, affective psychosis or atypical psychosis), the diagnosis being based on Kraepelinian and Bleulerian criteria. The diagnosis was made by one of the authors (A.H.) on the evidence of 20-year-old case notes written by a large number of different psychiatrists. In this investigation the same author himself examined all the patients included in the series. We felt it would be interesting to compare the predictive value of diagnoses made by the rough and ready method of the earlier survey with that of those made by a detailed examination of the patients concerned, as in the present survey. For reasons previously stated (Harris and Norris, 1954) we feel that only certified patients admitted in the second period are comparable with the types of cases admitted in 1930. If a diagnosis of schizophrenia is held to connote an unfavourable and the remaining categories a favourable outcome then in the first series 60 per cent. of the patients were correctly classified while in the second series 58 per cent. of the certified patients were assigned to their correct diagnostic group. This difference is not significant. Thus it would appear that a more sophisticated application of Bleulerian methods of diagnosis does not necessarily give rise to more reliable evaluation of prognosis. Accordingly we have attempted to dissect these three diagnostic categories to determine whether any of the components show prognostic significance. For this purpose we took the second series because for these patients there were available detailed clinical descriptions made by one of the authors (A.H.) in the observation ward of a general hospital, prior to the patient's transfer to a mental hospital. Unfortunately 13 of the case notes containing these detailed clinical descriptions had been lost, so that we could only use 187 patients out of the total of 200. They were first admitted to hospital in the period May, 1940 to May, 1942 and were followed-up for the next 10 years. The result of the analysis is set out in the table.

Most spontaneous movements are considered to be motor expressions of the feelings and emotions (Stagner, 1948). Many movements of this kind are referred to as “nervous” habits or mannerisms, a description in which this assumption is also implicit. It is surprising, therefore, that so readily available and objective a guide to the affective organization of the personality has been studied relatively little: the difficulties of definition, description and measurement may account for this. Olson (1929), however, devised a useful time-sampling technique for measuring nervous habits, but I know of no investigations in which it has been used to compare the spontaneous movements made by healthy and “nervous” subjects.

In the course of planning a research into spontaneous movements (expressive movements and disorders of involuntary movement, such as tics), it was essential to devise some means whereby these forms of motor behaviour might be objectively measured. The purpose of this paper is to describe one of our methods of doing this by the use of motion pictures, and to demonstrate experimentally the reliability and validity of a method which, it is believed, may prove to have a wider application.

This note is intended to supplement Professor Zangwill's communication (1953) under this title in the centenary number of this journal, in which “disorientation for age” as described by Weinstein and Kahn (1950 and 1951) is illustrated as persistent and stable in two cases of alcoholic Korsakov psychosis.

Personality characteristics of patients suffering from bronchial asthma have attracted considerable attention. Most clinical observations suggest that asthmatics present a characteristic difficulty in emotional expression. Reporting on the behaviour of 23 children with either asthma or eczema, Rogerson, Duguid and Hardcastle (5) state that these children were more shy than others in play therapy. Harris et al. (3) compared asthmatic children to children with allergic rhinitis. They suggested that half of the asthmatic group showed more difficulties than the rhinitic group in crying and confiding to the mother. These observations were made on children. On the adult side we have the inferences of French and Alexander (2) (based on psychoanalytical situations) that the asthmatic attack is the equivalent of a suppressed cry. However, as Leigh (4) has pointed out in his recent review of the psychiatric aspects of asthma, little valid evidence has in fact been presented that this feature of personality or any other is characteristic of asthmatics. This paper is a report on findings which may be related to this lack of evidence.