The pharmacology of chlorpromazine (Anton-Stephens, 1954; Hopkin, 1955) and its use in psychiatric practice (Garmany et al., 1954; Elkes et al., 1954; Charatan, 1954; Labhardt, 1954) have been described in several recent papers. The present paper briefly describes a controlled experiment on the use of the drug in a group of chronic disturbed schizophrenic patients, the object being to introduce as few variables as possible into the experimental situation, with a view to making the results as objective as is ever possible in a psychiatric investigation.

It is often said that the Disorders of Affect are the most commonly encountered psychoses and it is, of course, depressive illness which accounts for the large majority of such disorders; nevertheless Mania and Hypomania present as great a problem. As great because from the medical point of view treatment is less certain and less satisfactory, and socially because the manic, and even more the hypomanic, patient seems capable of doing more harm to his family and home by his ill-judged actions and schemes than almost any other person. He seems, too, to have a singular affinity and attraction for wasters, ne'er-do-wells and psychopaths who assist all too readily in the disposal of goods and money and encourage him in his grandiose and extravagant schemes.

For depressive illness we have, in Electro-Convulsant Therapy, a ready, useful and comparatively reliable, safe and effective therapeutic measure. The majority of patients accept such treatment quite readily and respond well to it. Where there is a history of chronic or recurrent illness, leucotomy (often in one of its modified forms) seems to offer a good hope with an excellent prognosis. Depressed patients, moreover, from the very nature of their illness, tend to accept treatment, even if they dislike it, often maybe from poorly concealed masochistic urges and as punishment for what they believe to be their guilt and unworthiness.

Manic and hypomanic patients, on the other hand, present a totally different problem. Firstly they rarely, if ever, complain themselves and consequently they resent being referred to the doctor. When they do come it is often unwillingly or merely to demonstrate their well-being; or maybe to show some invention, gadget or discovery they believe they have made. Secondly, such patients, even when they have been seen, are notoriously unreliable over treatment and will rarely accept it. In the majority of patients it is only when under some form of control (which for all practical purposes means certification) that treatment can be carried out satisfactorily.

In Mania (and Hypomania) as in depression, convulsion therapy—usually E.C.T.—proves satisfactory in many instances, but the problem of long-term prognosis is not affected and in the case of recurrent manic attacks leucotomy seems to have no benefits to offer and is in fact often liable to make things worse. Any effective method of treatment is therefore to be welcomed, and more especially so if there is any suggestion that it can be continued after the patient leaves hospital, on a maintenance or prophylactic basis.

The Wechsler Adult Intelligence Scale is now rapidly replacing the Wechsler-Bellevue as the major battery used by British clinical psychologists to test intelligence or intellectual deterioration. The following investigation was conducted to ascertain divergences in British mental patients from the American order of difficulty of items in the Information, Vocabulary and Picture Completion Tests, where both obvious and subtle cultural factors are present. The equivalence of certain possible substitute items was also explored.

Many current textbooks fail to place sufficient emphasis on the occurrence of psychological symptoms in cysticercosis. The case reported gives point to the contention of Bickerstaff (1955) that clinical manifestations other than epileptic convulsions are not widely recognized.

Cortisone therapy has been claimed to produce favourable results in clinical schizophrenics (Cohn and Karnosh, 1951; Cohn et al., 1953). Rees and King (1952) carried out a controlled investigation on the effects of Cortisone given in moderate doses over a four-day period to a group of schizophrenic patients and found no significant changes in symptomatology, behaviour or in a series of psychological and physiological tests.

In a personal communication Dr. Cohn suggested that Cortisone given in higher doses over a longer period would probably be therapeutically more effective in chronic schizophrenia.

The present paper describes a controlled investigation into the therapeutic effects of Cortisone given in high dosage over a relatively prolonged period.

It is generally conceded that the majority of effectual therapeutic remedies carry potential hazards, some of them incalculable.

Photic stimulation, the exposure of the human eye to repetitive flashes of light, has been employed in recent years in three ways; as a diagnostic, as a therapeutic, and as a research method. In each case, its use has opened new frontiers of inquiry into the borderlands of neurology and psychology.

This paper presents certain observations which stem from the testing of exploratory hypotheses with regard to an expected relationship between photic stimulation and imagery, alpha rhythm, critical flicker frequency (CFF), personality test data, overt reactions, and after-images in three major diagnostic groups: schizophrenics, organic brain damage (paretics and others), and normal individuals (no history of brain damage or emotional disorder).

Since this is a report of exploratory work, no attempt has been made to apply rigorous statistical tests nor to arrive at final conclusions. The aim is rather to stimulate further research which may employ more adequate instruments, larger groups, or different conceptual schemes.

Familial dysautonomia, first described as a distinct entity in 1949 (Riley et al., 1949), is considered to be a comparatively rare disease, only some 48 cases being so far recorded (Riley et al., 1954). But as its features become more widely known it is likely to be increasingly recognized. It occurs in children of Jewish parentage, the majority of cases being reported from the U.S.A., with one from South America (Tyndel, 1955), and some from Montreal (Riley, 1955).

The constant symptoms comprise: defective lachrymation (“crying without tears”); symmetrical, blotchy erythema following emotional disturbances or eating; excessive sweating; sialorrhoea; emotional lability; poor motor coordination; relative indifference to pain; and hypo- or areflexia. Inconstant symptoms are: intermittent hypertension; periodic vomiting which may threaten life; liability to respiratory diseases; frequent unexplained bouts of pyrexia; attacks of apnoea during the first year of life; corneal ulceration; orthopaedic changes (scoliosis, pes cavus); and epileptiform convulsions (Riley, 1952).

The condition is familial, apparently being inherited as a simple recessive trait (Riley et al., 1954), though an irregular dominant is a possibility (St. Martin, 1953).

Disorientation is not a uniform phenomenon and does not always follow the same pattern. Its pattern varies with its causes. Three varieties may be recognized. (1) The disorientation of toxic delirium. This is the best known variety. (2) The disorientation seen in some cases of schizophrenia. (3) That seen in some cases of brain tumour and other organic brain disease. The three varieties are all different, and the object of this paper is to consider why.

“Dementia Praecox” was discarded when it became apparent that a true dementing process was not present in schizophrenia. Most writers agree with the view put forward by French authors that the deterioration in schizophrenia is not the same as that seen in the organic psychoses (Lehrmann, 1940). Experimental work has indicated that intellectual deterioration in schizophrenia is more apparent than real, and that as it appears most when sustained effort and co-operation are required, any changes in co-operativeness and ability to maintain sustained effort invariably affect intelligence test scores (Kendig and Richmond, 1940; Sheldon Rappaport, 1951). The concept of schizophrenic deterioration employed in this article refers to a deterioration of behaviour in general, and to a deterioration of a patient's ability to look after himself in particular. With increasing interest in methods of treating deteriorated schizophrenic patients, we need reliable measures of deterioration in order to compare the effects of treatment in different groups. At present discrepancies in results are frequently due to some groups of schizophrenics being more deteriorated than others. For example Layman (1940) demonstrated that sodium amytal speeded up the psychomotor performances of schizophrenic patients, but subsequent work by Ogilvie (1953) did not confirm this finding. This discrepancy may have been due to the fact that Layman's schizophrenic group contained patients who were more deteriorated than the patients in Ogilvie's study. If a scale indicating the degree of schizophrenic deterioration could be devised, future researches into the treatment of deterioration in schizophrenia would benefit. There are a number of rating scales already available of which the best is probably the Fergus-Falls (Lucero et al., 1951). All of these scales have several common defects. They contain a number of items which are very subjective in nature and dependent more on the rater than the patient. Many are also of such length that they are too time-consuming to complete, particularly in the case of patients on long-stay wards where the nursing staff are invariably overworked already.

In a pioneer work, Faris and Dunham (1939) studied the distribution of mental disorders in Chicago. Essentially their findings were that the incidence of schizophrenic cases was highest in the central areas of low social and economic status and lowest in the affluent residential districts on the periphery; that the differential distribution of cases of senile and arteriosclerotic dementia was similar to but less marked than that of schizophrenia; but that cases of manic-depressive psychosis were much more evenly distributed throughout the city though with a tendency to higher rates in better-class areas. They concluded that “social isolation”—the fact that in the central area of the city a person tended to be cut off from intimate and lasting emotional relations with other people—was a causal element in schizophrenia and that this accounted for the observed difference of incidence. Their findings have been confirmed in nine other American cities (Clark, 1949) but there have hitherto been no reports of similar studies outside the United States. The aim of the present study was to test, in an English city, the observations of Faris and Dunham on the urban distribution of mental disorders, and, by relating the distribution to various indices of social and economic status, to determine whether any additional evidence could be found for the hypothesis that social isolation is a factor in causing schizophrenia.

In previous investigations of changes observed in the blood levels of acetylmethylcarbinol and butane-2: 3-diol in patients with manic-depressive psychosis (Dawson et al., 1954), the blood levels of a large number of patients in one mood phase were compared with the levels in another group of patients in a different mood phase. This procedure showed that the differences between the various mood phases were statistically significant. A lack of correlation in time between the chemical changes and the alteration in mood might account for the limited degree of correlation obtained. Thus, if the chemical change preceded the mood change, some of the data would not correspond with the observed mood state during which the blood sample was taken.

Another uncontrolled factor in the previous investigation was the diet; whilst all the blood samples were taken after a 12 hour fast, there was a large difference in the previous dietary history of the patients due to their mental state. Again, only blood levels were investigated and these might have been considerably affected by alterations in kidney activity.

For all these reasons, a different approach to the problem was made, and a small number of patients has been studied closely through a series of mood changes so as to enable us to determine the time relationship, if any, between the change in mental state and the chemical change. The patients were segregated into a small ward where their food intake was determined and 24-hour urine collections made; whilst in the unit, patients were maintained without sedation and without electroconvulsant therapy.

On the basis of the previous work, it was concluded that the variations observed in the blood levels of acetylmethylcarbinol and butane-2: 3-diol did not, in themselves, determine a change in mood but were indicators of some other, more fundamental alteration in the metabolic state of the subject. Consequently, changes in extracellular fluid volume as estimated by determinations of the thiocyanate space, were also investigated with these patients. Estimations of urinary constituents were also made to determine the effect of the kidneys in influencing blood levels.

In 1950 López-Ibor adapted Fiamberti's use of acetyl choline in schizophrenia for the treatment of psychoneurotic disorders (Fiamberti 1940, 1950a, b; López-Ibor, 1950, 1952). Very few reports of the efficacy of this treatment have been published and they vary from the enthusiastic (Sargant, 1952; Phillips and Hutchinson, 1954) and the doubtful (Maclay, 1953), to the unequivocally rejecting (Hawkings and Tibbetts, 1956). The latter authors stressed the beneficial psychotherapeutic atmosphere of the clinic, and showed that injections of sterile water produced equally as good results as acetyl choline. This paper is a further attempt to evaluate the specific effect of acetyl choline in the treatment of mild psychiatric disorders.

In earlier articles from 1939, the results of treatment with amphetamine preparations have been discussed. In this paper, a comparison of the results of treatment by means of electric convulsive therapy with those from methyl-amphetamine will be made.

This is a report of the chemical analysis of iron and calcium in the brains of three cases of Sturge-Weber disease. Although the clinical and pathological features of this syndrome have been well described, the chemistry of the characteristic deposits is less well understood, and there is a conflict of opinion as to whether iron is present in increased amount.

Owing to the kind co-operation of Mr. Alexander of the Neurosurgical Unit, Frenchay Hospital, it has been possible to re-investigate this problem using material derived from lobectomy specimens. The material had been stored in formol saline for some months before the analysis was carried out.

Microscopic examination showed the usual picture of meningeal angioma and massive mineral deposits in the outer part of the affected grey matter. There were also a few concretions lying more deeply in the white matter in all the specimens (Dr. R. M. Norman).

The object of this work has been to examine the lipid constituents of human brains at different ages in order to follow the course of increasing myelination.