The condition of physiological homeostasis results from the maintenance of a steady state for the functions of organs and the levels of different blood constituents, despite the constant variability of other factors from without and within tending to upset that steady state. Most organs of the body show variability and adjustment of their functions in the presence of stresses, but the brain cannot itself make such adjustments. Yet any change in the external or internal environment of the body affects the brain, and particularly the cortex, most severely. Homeostatic mechanisms function as defensive mechanisms, protecting the cortex of the brain from harmful alterations in the internal environment.

In the nineteenth century considerable attention was devoted to the art products of psychotics. The approach to these interesting phenomena was, however, unsystematized and of little value to psychopathology. Prinzhorn (1922) described the collection of psychotic art at Heidelberg. His monograph on the subject is a classic, but it has been pointed out by Elkisch (1945) that his analysis was not carried far enough to produce significant diagnostic criteria. In five recent articles Anastasi and Foley (1940, 1941) have made a comprehensive survey of work done on the whole field of the artistic behaviour of abnormal people. They have pointed out the inadequacies of research in this sphere: the lack of control groups of normal people, the generalizations made from a few selected data, and the constant danger of reciprocal projection.

Cytochrome, an intracellular enzyme widely distributed in all oxygen-using tissues, consists of a mixture of three haemochromogen-like substances referred to as a, b, and c. Of these cytochrome c has been isolated and is available commercially. In living cells cytochrome can be seen spectroscopically to be undergoing alternate oxidation and reduction. It plays an important part in tissue respiration, the respiratory activity of a cell being indeed proportional to its cytochrome content.

Since the introduction of penicillin into therapeutics the important question of the penetration of the blood-brain barrier by the antibiotic in infections of the nervous system has cropped up. In vital staining experiments Goldman (1913) observed that the acid semi-colloidal dye, trypan blue, which makes its way from the blood into the tissues, is unable to penetrate into the central nervous system. When the dye was injected into the cerebrospinal fluid it passed without difficulty into the brain substance. These observations were later verified by other investigators and have been verified for other substances (dyes, drugs, toxins, etc.).

Ability to learn and retain relatively unfamiliar materials has been shown to be impaired in many clinical syndromes, both organic and functional. The testing of this ability features in some form or other in several clinical tests of intelligence, such as the Wechsler Scale and the Binet, while it is more directly tested in the various memory scales. As is well known, efficiency of learning declines with age, and can be greatly reduced by organic brain damage. There is evidence also, which we shall briefly review, that it can be variably reduced in schizophrenia and in psychoneurosis.

Tridione is established as by far the most powerful drug in the control of petit mal. Many of its clinical aspects, therapeutic as well as toxic, are as yet not clear. In spite of this there is a remarkable absence of reports on the use of it in controlled clinical experiments.

From Dr. Sakel's address there emerge two questions regarding the indications for insulin treatment in the psychoses which are worth discussing on this occasion:

(1) General indications for the treatment: Should every case of schizophrenia undergo insulin therapy, i.e., be admitted to a hospital as soon as the illness has been diagnosed ?

(2) Special indications and procedure: What is the role of convulsions in insulin therapy ? What proof is there of the presumed antagonism between coma and convulsion ? Are there any facts supporting the idea that insulin fixes the results of convulsion therapy ?

In the early literature of mental defect there are allusions to behaviour, shown by defective children, which would now tend to be regarded as psychotic. This is probably one factor which has led psychiatrists into thinking of psychosis in childhood as an exceedingly rare occurrence. It now seems at least possible, if not probable, that many cases of early psychosis have been missed because the end-result has been equated with mental defect. In a sense it could be so classed since psychotic children are very often rendered ineducable by reason of their disorder, which sometimes seems to date “from birth” (Kanner, 1943), and in others certainly arises at an early age. However, the term “arrested development of mind” is less applicable, since the mind of the psychotic child appears to develop in a distorted and unbalanced way, showing some faculties to be absent and others apparently developed in a precocious manner (Bender, 1947).

During recent years there has been a revival of interest in the possible role of the adrenal cortex in the pathophysiology of schizophrenia.

To-day I want to confine most of my remarks on the indications for shock therapy to problems concerned with the proper selection and handling of patients for E.C.T. I intend to make only passing reference to insulin.

In recent years several writers have attempted to bring the known aetiological effect of maternal age in mongolism into direct relationship with its causation. Brousseau (1928) sifted the available data very carefully, but failed to come to any conclusion as to how maternal age could exert its effect. Benda (1947) considers that advanced age is only a subsidiary factor making maternal illness or endocrine disorder more significant, and a similar view seems to be held by Ingalls (1947). The conclusion is drawn by Geyer (1939) that mongolism is due to an abnormal ovum; if so, the older the mother, presumably the more likely are ova to be abnormal. Conversely, Engler (1949) believes that the foetal dysplasia is caused by faulty embedding of a normal ovum in uterine mucosa which has deteriorated in consequence of age, infection or surgical interference. Jenkins (1933) lays stress on the analogy with certain phenomena seen in animal genetics, for Wright (1926) had shown that the manifestation of hereditary Polydactyly in guinea-pigs was influenced by the age of the dam: young mothers produced more polydactylous offspring than older ones. A similar effect has been found by Holt (1947) in polydactylous mice. There is no experimental evidence as to the nature of the mechanism involved, but it may be supposed to be physical or chemical. The search for a process akin to antigenic incompatibility has also been suggested (Penrose, 1946), immunity developing with greater ease in maturer than in younger maternal tissues. It is not necessary to look for a specifically pathological process, however, since the maternal-foetal reaction might be analogous to that in the aetiology of fraternal twins, which especially occurs at late maternal ages, which centre around 38 years.

More than two years have elapsed since the Szondi test material became available on the home market, but it seems that the widespread use of the test has been considerably delayed by the lack of a translation of Dr. Szondi's books (1, 2). Susan Deri's Introduction to the Szondi Test (3), which appeared last year, may, however, have enabled some who felt attracted by the test to acquaint themselves with it. The purpose of Deri's book is to give some guidance for the clinical handling of the test and for its interpretation. For the rationale she refers to Szondi's own books.

In trying to contribute to this symposium one can either comment, in the light of one's own experience, on what the principal speakers say about indications in general, or one can pick out a special problem which requires clarification. I have chosen the latter course. I propose to report on some observations on the effect of “intensive E.C.T.” By this I mean the administration of two to four shocks on successive days over a period of a week or two, which aims at producing a confusional state with deep clouding of consciousness. It is the method that has been advocated in this country by Milligan. Cerletti devotes a section of his report to this method. According to him, it was Bini who first employed it. He noted that it resulted in a temporary and almost complete annihilation of mental life. Cerletti calls it annihilation therapy, l'anéantissement. Nobody who has carried out or witnessed this treatment will deny the aptness of the term. American writers have called it regressive E.C.T. Bini and Milligan have reported very satisfactory and lasting results in chronic neurotics who had failed to respond to other therapies.

The symposium of the 1950 General Meeting of the British Psychological Society on the use of tests in clinical psychology showed that there was considerable difference of opinion on the way in which tests could and should be used in diagnostic work. As testing is one of the main activities of psychologists working in the clinical held, it is of some importance that this discussion be continued in written form. In this way misunderstanding can be clarified and opinions fully expressed.

In an article under the above title (J. Ment. Sci., 1950, 96, 1060-91) S. Karagulla compared the results obtained in six groups of patients. Two groups, male and female, had been treated at the Royal Edinburgh Hospital for Mental and Nervous Disorders in the years 1900-39, before electric convulsion therapy had come into general use. The remaining four groups had been treated in the years 1940-48, two, male and female, by electric convulsion therapy, and two, male and female, by conservative measures only. The author had the advice and encouragement of Professor Sir David Henderson, and the final statistical calculations were scrutinized by Professor A. C. Aitken. This background of authoritative support is mentioned here, because some readers may have felt that it lent to the author's arguments and conclusions an added weight.

This case has been recorded because it seems to be the first in which E.C.T. has been given to a patient with a skull defect repaired by means of a large metal plate. It is also of interest because there was some doubt about the diagnosis, although this was resolved by the response to treatment.

The concept of “orality” as used in this paper indicates a certain constellation of traits or habitual reactions which are, or are assumed to be, derivatives, whether direct or modified, of behaviour patterns characteristic of early childhood. The importance of the mouth as the first erotogenic zone and as the organ generating fundamental attitudes of giving or receiving, waiting or being impatient, and hoping or despairing, has been stressed by psychoanalysis. According to psycho-analytic theory, the oral phase, that is, the first period of libidinal development, plays a most important part for later character development in as far as gratification, or frustration, of the oral impulses is assumed to have a determining influence on character-formation in later life.

It is time the term “shock therapy “was dropped. Its meaning is not clear, we constantly attempt to avoid shock to our patients, it is not always therapy and the term does not do us much good in the eyes of our colleagues or the public.

In this paper I propose to describe three varieties of behaviour of patients under treatment by means of ether abreaction.

The first object of this paper is to describe the clinical and pathological features of two cases of sub-acute sclerosing leuco-encephalitis (first distinguished by van Bogaert in 1945). A second object is to compare these features with those of the Dawson inclusion type of sub-acute encephalitis (Dawson, 1933, 1934; Brain, Greenfield and Russell, 1943, 1948; Greenfield, 1950; Malamud, Haymaker and Pinkerton, 1950), and the final object is to emphasize the importance of mental change, when associated with motor symptoms, in the diagnosis of both these forms of encephalitis.