In 1930, the first report appeared of what was later described as “the first pure case of a man with complete and isolated loss of memory-retention”. At the age of 24, the patient, a skilled tradesman employed in an iron foundry, had been found unconscious at his place of work and was thought to have been overcome by an escape of gas. Some months later he was admitted to Professor M. Reichardt's clinic at Würzburg, where he was diagnosed as a case of severe organic amnesic syndrome consequent upon carbon monoxide intoxication. Over the next few years the patient was exhaustively investigated by Grünthal and Störring, who reported his case in a series of papers (Grünthal and Störring, 1930a, b; Störring, 1931a), later supplemented by a monograph (Störring, 1936). The patient was twice filmed (in 1930 and 1935) and presented at numerous psychiatric meetings and conferences. The sound film was presented by Störring at the International Congress of Neurology in London in July, 1935.

This paper describes an investigation into the reasons for change in diagnosis in a group of 200 mental hospital patients who were admitted to hospital four times in two years. The cohort consists of the 44,047 patients in England and Wales who had their first admission in 1954, and 46,238 similarly admitted in 1955. The first two years of their progress has already been described in detail (Brooke, E. M., 1963), and further reports are in progress.

Multitudinous factors play upon each patient; among them are the patient's relationship with the doctor, with other patients, with nurses, relatives, employers and a host of others. Many of these factors are unknown. This investigation is an attempt to put a numerical value on one facet of one factor and assess its relationship to a patient's recovery. The factor measured is the amount of attention given to each patient by the doctor.

A number of factors are recognized as being of importance in the prognosis of “Myxoedematous Madness” (Asher, 2), and these are discussed in some detail below.

The purpose of this paper is to publicize another factor, namely accidental hypothermia, which, by causing a super-added confusional state, can greatly increase mental disturbance. That this additional psychiatric disorder may be rapidly reversible is demonstrated by the following case report.

Leucotomy has been used to treat many patients with schizophrenia. Although some patients seem to have derived considerable benefit from the operation, a number have shown little or no improvement (Board of Control, 1947, Tooth et al., 1961). An appreciable number of schizophrenic patients who have had a leucotomy remain long-stay patients in mental hospitals. In the last few years there has been an increased emphasis on the rehabilitation of chronically disabled psychiatric patients and the purpose of this paper is to assess the response to rehabilitation of long-stay schizophrenic patients several years after a leucotomy operation.

An appreciable number of chronic schizophrenic patients otherwise destined to remain long-stay patients in mental hospitals, are able to live in the community if they undergo active rehabilitation. In this paper, an attempt is made to correlate the post-rehabilitation progress of long-stay schizophrenic patients with observations made during their rehabilitation.

The nurse's role in caring for the psychologically sick has undergone sweeping changes during the past century. This study investigates some of the new techniques which the nurse needs to acquire if she is to be effective within the therapeutic milieu that is increasingly being adopted in mental hospitals. It is essential that the training of the nurse should fit her properly for the new role and that we should examine the treatment skills which will be required.

In 1961 I decided to start a hostel for discharged male psychiatric patients. There was available a private house in the City of Gloucester near to the Day Hospital. This had been purchased in 1953 and was being used as an overspill annexe for long-stay male patients.

The increasing demand for the institutional care of elderly psychiatric patients has been a growing concern in England and especially in Essex, which has an unusually large number of old people (21 per cent. over 65 compared to a national average of 12 per cent.) (2).

The sub-speciality of geriatric psychiatry is coming to be known as “psycho-geriatrics”, an abbreviation which is not a very happy one, but which seems to be becoming generally accepted.

Individual variations in drug metabolism are important factors affecting both toxicity and clinical effectiveness (Brodie, 1964; Kalow, 1965; Price Evans, 1965). In most cases the best available index of the drug concentration at the site of action is the plasma level. An estimate of this will show whether the optimal concentration is present and in some cases may indicate whether new symptoms can be attributed to toxic side reactions.

This paper describes a “double-blind” trial comparing ‘Triptafen’ tablets—each containing amitriptyline hydrochloride 25 mg. and perphenazine 2 mg.—with a matching placebo in the treatment of depressive illness.

The object of this paper is to assess, in retrospect, the relative effectiveness of amitriptyline (‘Triptizol’) and amitriptyline with perphenazine (‘Triptafen’) in the treatment of depressed patients.

Biochemical studies on the urine of schizophrenic in-patients and out-patients have shown the drug rejection rate to vary from 5 per cent. to 32 per cent. in the U.K., U.S.A., and U.S.S.R. (3, 4, 8, 9, 11, 12). Even higher rejection rates (70 per cent.) were found with depressed out-patients (12), and high rejection rates have been found in antenatal patients prescribed ferrous sulphate, out-patients supposedly taking P.A.S. for their tuberculosis, and patients on drugs for rheumatoid arthritis (1, 2, 5, 6, 7).

Benzhexol hydrochloride (Artane, Pipanol, Trihexyphenidyl) was the first of a range of synthetic antispasmodic drugs to be made available for the symptomatic treatment of Parkinsonism. Selected as the most potent of a series of substituted piperidyl propanols examined pharmacologically by Cunningham et al. (1949), it was shown to have half the activity of atropine sulphate in inhibiting neurogenic spasm in isolated rabbit intestine. This activity was associated with advantageously reduced mydriatic, anti-sialogogic and vagal inhibitory properties in laboratory animals.

Meclofenoxate (Lucidril), a synthetic substance related to plant auxins, is claimed to cause an increase in the glucose uptake of the mouse brain, and to influence the EEG tracings of rats deprived of oxygen (Nickel, et al., 1963). Other animal experiments show Meclofenoxate to protect rabbit brains against experimental anoxia induced with nitrogen (Dereymaeker et al., 1962), and against histoxic anoxia induced by potassium cyanide (Nakajima et al., 1964).

The foundation of the new Department of Psychiatry in the University of Birmingham in January, 1962 was followed by the development of a post-graduate training scheme in psychiatry operating within the area administered by the Birmingham Regional Hospital Board. It was clear at the outset that the Regional psychiatric hospitals were looking to the new Department for positive help in post-graduate training and research and that its creation was accompanied by an air of expectancy. Because, judging from enquiries received, the scheme has excited some attention from outside the Region, it would seem appropriate to give an account of how it operates.

1. The Sub-Committee was formed at the Annual General Meeting of the Mental Deficiency Section, 1962, following discussion of the inadequacy of postgraduate training in the speciality. A draft report was presented to the Section at the meeting held at Basingstoke in July 1964 and referred back to the Sub-Committee for reconsideration of certain items. Latterly there have been rapid developments towards the reorganization of the Association and the formation of a College, and it became necessary to defer discussion of some educational matters until the structure of the proposed new higher qualification was known.

At the inception of the National Health Service, most of the large psychiatric hospitals were constituted independent administrative “Groups”. In some cases a mental and a mental subnormality hospital, or two mental subnormality hospitals were joined to form a Group; and a number of the smaller psychiatric hospitals (either for mental illness or for mental subnormality) were attached to Groups consisting mainly of general and specialist hospitals for bodily diseases.