This paper embodies an attempt to study paranoid conditions by the use of psychological tests of the “projection” type—here, the Thematic Apperception test (TAT) and the Ink-blot test of Rorschach. In giving a standardized projection test to a homogeneous group there is some hope that factors specific to the group may emerge. When the group has a common “mental disease” or psychiatric syndrome, it is possible that the results may throw light on the nature of its psychological processes—and hence, ultimately, on the nature of the disease.

During the first half of 1049 a battery of cognitive and personality tests was given to a sample of 104 adolescent and adult high-grade male defectives resident in Darenth Park, Dartford. The testing was carried out by N. O'Connor and the writer, in collaboration with Dr. J. M. Crawford, Deputy Superintendent of Darenth Park. The following report presents a summary of the cognitive and motor test findings, and discusses some of their implications.

In adult intelligence testing the Wechsler-Bellevue Intelligence Test is increasingly used and is gradually taking the place of the Terman-Merrill. Not only is its verbal part better adapted to adult life, but it has the added advantage of being at once a verbal and a performance test. A comparison of a subject's achievements in the two parts of the test often shows where his strength and weakness lie, and so sometimes affords a clue to difficulties which he may experience in his work or otherwise without being aware of their cause.

There appears to have been little investigation of the effects of local anaesthetic infiltration of the brain. Occasional reports mention the possibility of such procedures for diagnostic purposes.

One's approach to transorbital leucotomy must be critical for many reasons, chiefly that it is another blind operation with all the deficiencies this signifies. Meyer and McLardy have demonstrated the variety of anatomical sites in which lesions may be found following prefrontal leucotomy, and have stressed the variability in the position of the underlying cortex in its relations to the bony landmarks of the skull. Once more, sweeps are to be made with a blunt instrument, and the differing consistency of the brain, and perhaps its movement, will make it impossible to be certain whether the lesion produced is the size intended and in the position calculated. The dangers of intracerebral haemorrhage exist as before, and, in addition, because of the site of entry, there are chances of introducing infection, of cerebral rhinorrhea resulting from damage to the frontal sinuses, and of raising bone spicules from the orbital plate. More recently McLardy has said that with the addition of the deep frontal cut, were the caudate nuclei to be damaged bilaterally, restlessness, persisting incontinence and “delayed operative death” might occur, as may follow posterior cuts in prefrontal leucotomy.

During the past few years interpretations of drawings for the assessment of intellectual and emotional aspects of personality have been used frequently. Various scales have been designed on the basis of a correlation between the elaboration and complexity of a drawing on one side, and the intellectual capacity, as measured by orthodox intelligence tests, on the other side. The best known of these scales is Goodenough's “Draw-a-Man” test (13), which has been used extensively.

The term “therapeutic factor” will be used to denote any agency which is potentially capable of producing such changes in the personality of a patient that an alleviation or cure of clinical symptoms may result. Such agencies originate either in the environment of the patient or in his organism. In psychotherapy we are primarily concerned with environmental agencies, namely those which are introduced, regulated and controlled by the therapist, and which are therapeutic only if the patient responds to them in a manner that is conducive to producing the desired changes in his personality. We can therefore distinguish three elements in a therapeutic process: environmental factors, responses by the patient, and ultimate personality changes.

The purpose of this paper is to call to the attention of neurologists, psychiatrists and neurosurgeons a group of meningiomas with dementia as the earliest and presenting symptom. The diagnosis in these cases is apt to be missed, especially if the patient is in the arteriosclerotic or presenile age-group. This is equally true of other tumours, but the practical importance of early diagnosis of meningiomas is that with the removal of the tumour the patient usually recovers from the mental illness.

Multiple personality in its true form is a comparatively rare occurrence. Taylor and Martin (19) in a recent survey place the estimate at about 150 cases. In their definition, however, they exclude many cases which seem “too hypnotic, narrowly hysterical, evidently organic, psychotic, likely faked, or insufficiently described to be called multiple personality.” The following case, although it might fall into the “narrowly hysterical” category, appears to be of sufficient interest to justify publication.

Suicidal attempts by coal-gas poisoning are very common. Carbon monoxide is a principal constituent of this gas, and can produce severe and permanent brain damage. It is surprising, therefore, to find so few cases of chronic organic psychosis attributed to this cause in mental hospital practice. Rosseter (1928) found only one example of permanent psychosis in 2,000 cases of carbon monoxide asphyxiation. Shillito, Drinker and Shaughnessy (1936) made a follow-up study of 21,000 cases of acute carbon monoxide poisoning. In only 43 of these were the after-effects sufficiently severe to warrant their admission to a mental hospital. Twenty-three subsequently recovered, 11 died, and 9 suffered permanent nervous and mental sequelae. They found that the ratio of psychosis following carbon monoxide poisoning to other psychoses was 1 in 2,000. Henderson and Gillespie (1944) could find only one such case in 5,000 consecutive admissions.

There is a distinct variety of mutism in children which Tramer (6) and others call “elective,” i.e. partial, occurring vis-à-vis certain persons only. The children are “sensitives” in Kretschmer's sense, i.e. they are timid, shy, susceptible to teasing and irony, and come from an insecure milieu; the abnormality is often familial.

Although psychotic attacks following overdoses of amphetamine are well known, the following case is reported because it appears unusual in that repeated attacks of mental illness, over a period of several years, have occurred following the ingestion of this drug.

Early in 1950 we treated 34 depressed patients with desoxyephedrine, in an attempt to discover whether it is comparable in efficiency to electroshock in the treatment of depression in a substantial proportion of cases. We originally intended to treat approximately 100 consecutive depressed patients admitted to hospital, and to compare the results with those obtained in the previous 200 consecutive depressions treated by electroshock. The results, however, caused us to stop the experiment at a much earlier stage.

During the early winter of 1943 a series of cases was seen that presented syndromes of emotional disturbance, varying from acute excitement and confusion to depressive traits such as hypochondriasis, vague fears and insomnia. Hallucination, delusions, or ideas of reference, appeared in all. The patients concerned, six in number, were Indian males, all between 20 and 40 years of age, and were referred to the psychiatric section of the combined general hospital at Basra between October and December, 1943. They had a common background, inasmuch as they had all been away from India with their units for a year or more, and were members of military units working in S. Persia, closely in contact with petrol, either as can fillers or can stackers in enclosed spaces. The hours of work were long, and the men were kept at this work for extended periods. It was, at the time, essential to maintain heavy deliveries of petrol, and the men concerned were at work in high natural temperatures with only little consideration being given for possible ill effects from the freely evaporating petrol.

The metabolism of nitrogen-containing compounds, and in particular amino-acids, in mental patients, has aroused interest in recent years for the following reasons.

The purpose of this paper is to establish two points: first, the safety and relative simplicity of curare-modified E.C.T., and secondly, the need for such a treatment.

Electric convulsion therapy has been generally accepted as a valuable method of treatment in depressive states. Assessment of the results of this form of treatment has generally been based on a small series of cases, and percentage rates of recovery and relapse have usually been computed on one hospitalization. No report has so far been published of a complete follow-up of patients throughout their frequent hospitalizations and remissions. Nevertheless, it is only on such a long-term basis that treatment of depressive states can be accurately evaluated. It was with this ideal in mind that the present study was undertaken. The clinical cases on which it is based are those of 923 patients treated in the Royal Edinburgh Hospital for Mental and Nervous Disorders between the years 1930-48.