Early in our clinical studies with the phrenotropic drugs, reserpine and chlorpromazine, we observed that psychotic patients receiving them were more resistant to treat for infectious processes that occurred during their hospitalization (Saunders, 1961). We also observed that in experimental animals, the LD50 of a standardized dose of bacteria was significantly increased if the rats had been previously treated with a phenothiazine. Preliminary observations led us to consider the role of these drugs in protein synthesis, with specific interest in the gamma globulin, since antibodies are associated almost exclusively with this fraction. Further interest in the problem of protein synthesis was stimulated by the reduced albumin and increased globulin levels found in most chronic psychoses, as the phrenotropic drugs are capable of significantly shifting this ratio toward normal. The question of phrenotropic drug action on antibody synthesis was asked at the Second International Congress of Psychiatry in September, 1957, and no specific information was known to the participants (Saunders, 1958). With this background, the question warranted further study in man. We designed our experiment to measure antibody response to oral poliovirus vaccine, Cox strains types 1 and 3, during phenothiazine therapy.

How useful to the psychiatrist are subjective complaints by a patient?

The question of objective appraisal was reviewed by Harris (1938, 1954) in connection with follow-up studies, initially of in-patients, and latterly of day-patients, at the Maudsley Hospital.

The clinical manifestations that may result from abuse of alcohol are numerous. Profound, sometimes fatal, hypoglycaemia, first described a little over 20 years ago (Brown and Harvey, 1941), is among them although as far as we are aware, not previously described in this country. This may be due partly to differences in drinking habits here and abroad where “bootleg” liquor is more readily available, and partly to failure to recognize this complication of alcohol. Many cases of alcohol induced hypoglycaemia may well go undiagnosed, alcoholaemia alone being held responsible for bizarre behaviour or alteration in consciousness following the drinking of alcohol-containing beverages. In some cases, a patient brought into the casualty department with a provisional diagnosis of “drunkenness” is found to have a low blood sugar and the diagnosis hastily altered to the more socially acceptable one of “hypoglycaemia”, but without the cause of the hypoglycaemia ever being determined.

The most pressing problem in general practice today is the provision of adequate psychotherapy for psychogenic illness, which is responsible for 30 per cent. of all consultations (College of General Practitioners, 1958) and only a small proportion of which can be treated by trained psychiatrists. This paper describes a form of brief psychotherapy directed towards modifying neurotic character traits and securing freer expression of personality assets in the passive compliant type of personality which was found in 71 per cent. of all patients specially interviewed in late 1959 and 1960 in a working-class Belfast practice.

Hamilton and Salmon (1962) and Hamilton (1964) have investigated the effect upon male chronic schizophrenics, inter alios, of the following regimes: (a) working in a hospital industrial workshop, (b) occupational therapy and (c) no specific activity (the first study only). Hamilton (1964), considering both studies, concludes that the results “may be said to weight the available evidence in favour of the superiority of Workshop Therapy”. Certain points should be raised in connection with this conclusion.

In our unit open heart surgery has provided sufficient stress to precipitate post-operative psychological disturbances in a high proportion of patients. In the year before this investigation was begun, 21 of 108 patients developed obvious mental abnormalities post-operatively. Blickenstorfer (1) reported post-operative psychosis in 3 per cent, of 300 patients subjected to open heart surgery, and the same incidence, 3 per cent., was reported by Bolton and Bailey (3) following closed and open heart surgery on 1,500 adult patients. The incidence of mental disturbance in our unit was so much higher that a detailed study of all patients (141) operated on in the unit during a 10-month period appeared to be indicated.

Many authors have observed a decrease in glucose-tolerance (G.T.) in melancholia (sec reviews by McFarland and Goldstein, 1939; Altschule, 1953). Using an intravenous test, the present author confirmed that G.T., and also body weight, were significantly lower in a group of depressions than in a matched control group (Pryce, 1958a), but that within the depressions G.T. was not related to body weight. In a subsequent study also (Pryce, 1958b) change in G.T. after treatment was not related to change in body weight nor to three measures of change in emotional state. These studies, therefore, failed to support the views that the decreased G.T. in depressions is related either to nutritional or to emotional factors.

To Wordsworth, the source of these “intimations” seemed clear; it will be remembered that in the Ode bearing this title he says:

In 1957 Professor Buscaino and the author reported the effect of intraperitoneal injection in mice of material from schizophrenic patients (1). The material was obtained from urine by treatment with activated charcoal and elution (2). These results have recently been confirmed by Fujita and Ging (3) who also found a characteristic toxic action of material from schizophrenic patients. Further work (4) showed that direct application to the cerebral cortex of the unanaesthetized rabbit of urinary material from schizophrenics caused the appearance of regular high voltage waves. The material obtained from the urine of controls, when applied to the cortex in the same concentration, did not have the same effect (5).

The present study on the acquisition of Staphylococcus aureus by patients during their stay in a mental hospital, and the nasal carrier rate in the institutionalized patients, was prompted by the fact that in 1959 and 1960 193 out of a total of 407 deaths in Napsbury Hospital were due to lung infection, and that a bacteriological study of 45 unselected cases at necropsy in 1960 had suggested that the fatal lung infections were predominantly staphylococcal (Table I). The incidence of staphylococcal skin lesions, however, remained low, and only 147 cases of this kind were reported during 1959 and 1960 (4 per cent. per annum of the population) (Table II).

Interest in the acid base metabolism in mental disease has existed almost as long as the relevant estimations have been available to clinicians. In the period from 1920 to 1938 many careful and accurate determinations of the factors involved were carried out, both in Europe and the United States of America. The results, while being sometimes equivocal, for the most part showed that there was no demonstrable change between those suffering from schizophrenia or depression and a normal hospital population. Since 1938 little interest appears to have been taken in the hydrogen ion concentration of the blood and the pCO2 in mental disease. During recent years great progress has been made in the apparatus for the determination of blood pH and pCO2 and fairly recently it became possible to estimate the first of these three places of decimals with a reproducibility of 0·005 of a pH unit and an equivalent accuracy for pCO2. In view of this great improvement in the apparatus available, it seemed worth while to estimate the blood pH and pCO2 in a large number of chronic mentally ill patients. The facilities and the patients were available in Hollymoor Hospital, so we decided to see whether with the much more delicate instruments now available it was possible to demonstrate any significant difference in the blood pH and pCO2 between schizophrenics and other mentally ill patients.

Kishimoto (1958) reported quantitative and qualitative peculiarities in the absorption spectra of body fluids in schizophrenia, and considered that there were abnormalities in the oxidation of adenine through hypoxanthine and xanthine to uric acid.

The genetic evidence concerning affective illness of later life is still conflicting and the relationship of such conditions to the manic-depressive psychosis unclear. Kallman (1955) believed that, genetically, involutional melancholia bore a closer relationship to schizophrenia than to the manic-depressive psychosis. An increased risk for schizophrenia amongst the relatives of such patients was not observed by Kay (1959) and Stenstedt (1952). Both these writers do however describe a lower loading for manic-depressive psychosis than would be found amongst the relations of manic-depressive patients, though a much higher incidence than in the general population. Both Stenstedt and Kay assumed that they were dealing with a heterogeneous group of patients containing both psychotic and neurotic depressions.

Several investigators have attempted to relate cerebral activity to extraversion and neuroticism. These include Berger (1933), Jasper (1937), Gottlober (1938), Henry and Knott (1941), Knott (1941), Darrow (1947), Lindsley (1950), McAdam and Orme (1954), Gastaut (1957) and Brazier (1960). The results, however, have been inconclusive.