Until a few years ago there existed a sharp dichotomy of opinion between the pharmacologists, who, on the basis of their experiments, assigned to acetylcholine the role of universal synaptic transmitter, and the electrophysiologists, who denied that this substance could effect the transfer of excitation from one conducting element to another. It is, however, now generally agreed that, certainly at the neuromuscular junction, and probably also at ganglionic and some—but not all—central synapses, acetylcholine does indeed exert a primary transmitter action. It must be added that recognition of this fundamental action has been hastened as a result of recent experiments by those very electrophysiologists (such as Eccles and his colleagues) who previously supported exclusively electrical hypotheses of nervous transmission. For this reason the assumption which is implicit throughout this paper that the acetylcholine in brain is concerned in maintaining central synaptic transmission is likely to go unchallenged and requires no detailed justification here.

The previous paper of this series (Roth and Hopkins, 1953) described test performance in senile and affective psychosis. The same tests have been administered to patients in three other diagnostic groups: paraphrenia, arteriosclerotic psychosis, and acute confusional states. These five clinical categories account for the majority of mental hospital admissions in patients over the age of 60.

Hurler's disease is characterized by chondro-dystrophic skeletal changes, corneal opacities, hepatosplenomegaly and mental defect. The skeletal changes are such that the patient presents a large head, grotesque facies, deformed limbs and kyphosis.

The association of an abnormal electroencephalogram with obsessive-compulsive states has been investigated by Pacella et al. (1944), who found in these states a higher incidence of “convulsive-type” patterns, consisting of occasional or frequent runs of serial 2–4 c/s potentials of high amplitude than in a random control group. In most of the cases this type of activity was only noted after a period of hyperventilation not exceeding two minutes.

Tics are involuntary, repetitive or stereotyped movements which apparently lack purpose and which, with adults, tend to be permanent or long-term abnormal aspects of the individual's motor behaviour. The question arises whether certain basic psycho-motor and personality traits characterize persons who develop tics. No previous experimental work on this problem has been reported. In the present research, therefore, a preliminary attempt was made to describe precisely, by the use of psychological tests, certain aspects of the motor behaviour and some of the personality characteristics of tic patients and to compare the results with a similar examination carried out on matched, but non-tic, control patients.

The drug which is now known officially as Mephenesin (“Myanesin,” “Tolserol”) was introduced by Berger and Bradley (1946), who showed that it antagonizes strychnine convulsions, counteracts pre-narcotic excitement, and increases the duration of barbiturate anaesthesia. Small doses depress the reflex excitability of the spinal cord, and larger doses have an ascending depressant action on the central nervous system. When Berger (1947) found that doses with little effect on voluntary power restored deranged reciprocal innervation to normal, he suggested that mephenesin might be useful in spastic and hypertonic conditions.

There is a considerable body of literature concerning the diagnostic value of differences in pattern and scatter found in response to intelligence tests.

The relations between Psychiatry and Occupation are considerable and complex. This is the case whether we consider psychiatry as limited (Curran, 1952) and thus approach the problem through the individual patient and his work, past, present and future, or less limited and thus concerned with industry and group adjustment. In reality both approaches deal with essentially the same basic problem which is the biological adaptation of man to his occupation, or to earning a living. Such work phases form an integral part of man's very existence, whether he works to live, or lives to work. Interest in the maintenance of health through prevention of occupational hazards has developed rapidly in this century, stimulated by war stresses, defence programmes and economic cataclysms. The struggle for our industrial survival has focused more than our interest, as psychiatrists; but extravagant offers of industrial consultancy, of trying to teach where little knowledge is yet available are patently dangerous. Industry, like society, has often been led to expect too much, and too soon, from our as yet embryonic facts, experiments and principles in this field.

Cook, Dax and Maclay (1952), studying the population over age 65 in the public mental hospitals in England and Wales, showed that, for the ten-year period 1938 to 1948, the percentage of patients over age 65 to the total mental hospital population rose by approximately three times as much as the per cent. increase in the general population of those over age 65 to the total population. However, in addition to the magnitude of the problem of mental ill-health in the aged, its many aspects involve extensive fields where knowledge is still lacking. In consequence, it is extremely desirable to investigate more fully the psychiatric disorders occurring in old people, and the increasing importance of these maladies—especially their social significance—has prompted the present study.

In recent years there has been renewed interest in correlating cerebral function with mental phenomena. For a time, with the advent of prefrontal leucotomy, interest in the frontal lobe reigned supreme. However, in recent years the temporal lobe has been coming to the fore, and is now beginning to rank with the frontal lobe in importance.

When we pass under review the theoretical concepts of aggression three main types stand out clearly, which are fairly representative of prevalent opinions.

Perhaps most clinicians experienced in mental hospital work suspect, at least, that left-handedness and stuttering occur relatively frequently among hospitalized epileptics. However prevalent this impression may be, it remains to be tested systematically. There has been little study of dextrality among the different diagnostic groups. Defects of speech among some groups have been studied considerably, among other groups very little.