The aim of this paper is to investigate some para-hallucinatory visual phenomena, to classify them into certain groups, to describe their phenomenology, and to try to explain their psychodynamics and their significance in everyday life.

The Müller-Lyer illusion is one of the best-known geometrical optical illusions. It was described by Müller-Lyer in 1889 (7) and first studied quantitatively by Heymans in 1896 (5).

“Stelazine” is the trademark name for Trifluoperazine. It is a derivative of phenothiazine with the following chemical formula: 10-3-(1-methyl-4-piperazinyl)-propyl-2-trifluoromethylphenothiazine dihydrochloride, or structurally:

An outstanding problem with neurotics in the psychiatric out-patient clinic is that of coping with the pressure of numbers whilst continuing to afford an adequate degree of therapy. Views do evidently vary enormously as to what constitutes adequate therapy. Within the same clinic it is possible to find one psychiatrist habitually seeing neurotic patients at weekly returns, and another seeing comparable patients once or twice only. The higher frequency of interviews gravely limits the case load and is only slightly preferable to the other extreme in which the service provided is discouraging both the patients and home doctor. It might be agreed that if the symptoms which the patient first presents are thought capable of abatement, then therapy should be afforded through the clinic until some reasonable moderation of the disability is established and progressive. It is presumably also justifiable to continue clinic attention where such work may be expected to prevent or much to limit an otherwise certain deterioration.

The beneficial effect of monoamine oxidase blockers on depressive states has been established. Their therapeutic effect has been assessed at ranging between 60 and 80 per cent. of all cases treated. We have tried to improve on this rate by combined treatment with iproniazid and reserpine, a combination which has been used in experimental animals by Chessin et al. (1, 2) and Brodie et al. (3). The results of our treatment will be briefly described in this paper.

In earlier papers we have shown that ataraxic drugs whose main point of attack lies in the hypothalamic area are able to evoke endocrine effects (1, 2, 3). These are obviously the result of depression of the reticular formation and hypothalamic centres responsible for the anterior pituitary's endocrine activity.

There are two stages in the evaluation of a new treatment: the first is to determine if it has any effect at all, and the second is to determine as strictly as possible, the conditions of its applicability. In practice, these two stages overlap considerably, for they are not completely distinct. As soon as some evidence is available that a treatment is effective, attention tends towards ascertaining the precise indications for its use, the evaluation of its effectiveness, its contraindications and complications.

A review such as this is not the place, nor has it the space in which to discuss the nature of intelligence. Some conclusion, however, must be reached as to the factors to be considered in estimating any correlation, positive or negative, between level of intelligence and degree of epilepsy.

Problem

Elsewhere (3) it has been argued that, when reporting a subject's results on the WISC (5), it is preferable to give them in the form of scores or intelligence quotients on orthogonal factors than as Verbal and Performance I.Q.s since the latter overlap in a rather arbitrary fashion. In this study a similar recommendation is implied when dealing with a subject's results on the WAIS (6) and the problem is to indicate how factor scores on this test can be obtained.

Although the syndrome of internal carotid artery occlusion was first described by Ramsey Hunt in 1915, the neurological complications were not fully appreciated until recent years. Internal carotid occlusion has now been intensively studied, and the criteria for its diagnosis well defined (Webster et al., 1956; Shapiro and Peyton, 1954; McGuire and Jaeger, 1955; Smyth, 1954; Moniz, Lima and de Lacerda, 1937; Hultquist, 1942). Among its clinical manifestations psychiatric features have been mentioned: they range from so-called mental aberrations (Eisenberg, 1955), personality changes, emotional instability and memory loss (McGuire, 1955), to frank dementia (Fisher, 1941). Little attention, however, has been given to the problem of the relationship of bilateral internal carotid occlusion to dementia, and few attempts have been made to document by psychometric testing the degree of intellectual impairment. It is for this reason that a case of bilateral internal carotid occlusion is now reported.

There is evidence of unduly high frequencies of alcoholism, psychopathy and criminality among the relatives of alcoholics. Åmark (1951) found a frequency of alcoholism among the brothers and fathers of 645 Swedish alcoholics to be about 25 per cent. (Fremming's estimate of alcoholism among 1,730 males from the Danish population being 3·4 per cent.). In a more recent study of family data on 1,000 patients admitted to a Canadian mental hospital that included 56 patients with alcoholism, the present author (Gregory, 1959) found a recorded history of excessive drinking among 23·2 per cent. of the fathers of the alcoholics, among 1·8 per cent. of the mothers, and among 4·2 per cent. of their siblings. Allowing for the age and sex of these siblings, it would appear that there was a lifetime expectancy of excessive drinking of at least 14 per cent. among the brothers of these alcoholic patients. These figures compare with a minimal estimated lifetime expectancy of alcoholism amounting to 1·6 per cent. of the total population, or at least 2·7 per cent of the corresponding male population of Ontario.

Many chemical substances have been used to assist psychotherapeutic treatment. Abreactive procedures, using either depressant substances like sodium amytal, or excitatory substances like methedrine, or sometimes a combination of these substances, are standard procedures though, in everyday psychiatric practice, their use is limited.

The possibilities of therapy in cases of male transvestism are very limited. There are a few references in the literature to the use of synthetic oestrogens and in these papers the aim has been to feminize the patient by hormonal castration. Benjamin (1) recommends the use of oestrogens for milder cases and Hamburger (2) has used them prior to surgical castration.

Although some years have passed since the end of the period under consideration, the subject matter is not altogether inappropriate. Neurosyphilis is now rare, though by no means completely abolished in the Western countries, and it is necessary to bear it in mind, for long-forgotten and undiagnosed cases are still liable to confront busy practitioners or specialists. In many parts of the world the situation is different and neurosyphilis is still frequently seen. Its global incidence may be waning but it is not yet a historical curiosity.

In the six years that have elapsed since the tranquillizing drugs have been introduced for the treatment of mental illness, psychiatrists have been overwhelmed by the multiplicity of drugs, each claimed by its manufacturer to be more effective and less toxic than all the others. Contemporaneously, there has been a demand for the better assessment of the value of therapy in psychiatry with less reliance on clinical impression and more on the controlled trial (Eysenck, 1957; Foulds, 1958). It is quite impossible for each clinician to familiarize himself with each new drug, and it is difficult to carry out a fully-controlled double-blind trial on more than a small proportion of them. Moore (1959) has suggested a centrally-controlled trial of the tranquillizing drugs in schizophrenia by a body such as the Medical Research Council (1954) similar to the study on aspirin and cortisone in rheumatoid arthritis. Difficulties concerning diagnosis, and, probably more important, variations in the environment of the treatment situation which are of so much importance in determining the outcome of a mental illness, militate against the successful pursuance of such a scheme, and do not appear to have been overcome so far.

The Anglo-American literature relevant to psychiatry and obstetrics reveals studies of the puerperal psychoses (Tetlow, 1955); papers describing the psychological reactions experienced during pregnancy and labour (Tobin, 1957; Kartchner, 1950) and retrospective studies of patients presenting with obstetric abnormalities of pregnancy and labour (Coppen, 1958; Caldwell, 1958; Cramond, 1954). The present paper describes the psychiatric and obstetric follow-up of a group of neurotic pregnant women, a study of similar material not being previously recorded in the literature.

Many phenothiazine derivatives are no. in use in the treatment of schizophrenia. We, in this hospital have used Largactil extensively and more recently Stemetil in the management of chronic schizophrenia.

Iproniazid, introduced as an anti-tubercular drug, has been widely used in the treatment of depression. It is a monoamine oxidase inhibitor and some of its effect on the central nervous system may therefore depend upon its preventing the breakdown of serotonin. It is hepatotoxic. Dally (2) and many others have commented upon a time lag of at least a week after the start of treatment before observable clinical improvement in depressed patients.

In spite of a thorough search of the medical literature in this country we have been able to discover only two articles (1, 2) that come within the scope of this paper and these were descriptions of single cases in elderly men at the end of the last century. As it is commonly stated in medical text books that not more than 10 per cent. of all cases of intestinal obstruction are due to volvulus and that of these up to 70 per cent. occur in men, we have been impressed by the incidence of four cases of volvulus in just over three years on the female side of this mental hospital (536 females of all ages).

A generally acceptable method of comparing psychotomimetic compounds has apparently not been devised. A method of this type would provide the replicability not now available in the newly developed field of psycho-pharmacology. For example, the method employing the Cold Spring Harbor questionnaire devised by the writer and his co-workers has been criticized as being “too suggestible”, “too structured”, or “insufficiently cognizant of unconscious processing”. It is the purpose of this communication to show that the Cold Spring Harbor questionnaire (1, 2) provides a suitable method of study of the psychotomimetic drugs similar to d-lysergic acid diethylamide (LSD-25). The basis for this statement is the comparison made here of the results of an independent study of a series of congeners of LSD-25 made by Isbell, Miner and Logan (3) in another laboratory, in a different milieu, and on a different population sample. It has been found that the comparative effectiveness of a series of LSD congeners both at Cold Spring Harbor and at Isbell's laboratory in Lexington, Kentucky are the same when the Cold Spring Harbor questionnaire is employed.