During the two and a half years from May, 1953, sixty-one cases of schizophrenia, none of whom had been leucotomized, were studied by me at St. Ann's, a 69-bedded subsidiary hospital of Holloway Sanatorium, Virginia Water, which has been available for the treatment of psychoneuroses since the end of 1946 and where at any one time a large majority of the patients are psychoneurotic. Except that patients are normally expected to be in by 10 p.m. it is as open as any hotel, there is no sex distinction in any of the sitting and games rooms, the dining room, the occupational therapy department and so on and where the ‘male side’ and the ‘female side’ meet the rooms may be occupied by men or women, so that men may have to pass women's rooms on the way to the toilets and vice versa. The hospital is mainly an ‘amenity bed’ one with charges of 2 to 4 guineas a week and although no policy of exclusion exists the bulk of patients are from ‘lower middle’ or ‘upper lower’ backgrounds. Treatment is based on careful history-taking and investigations of various kinds, with explanatory and supportive psychotherapy, but E.C.T. always with pentothal and scoline, modified insulin, modified narcosis and other physical treatments are available although they are strictly limited by the small nursing staff. Remembering that there are only three doctors, one of whom is partly taken up with administrative duties, both for in-patients and for a reasonably active out-patient service which includes the use of all the daytime hospital facilities, an exercise in simple arithmetic will make it clear that the forms of psychotherapy used are also strictly limited.

Lesions of the cerebral cortex are generally accepted as a potential source of psychological change, and the difficulties that may arise in distinguishing between one of the psychiatric illnesses at present regarded as idiopathic and one due to a lesion of the prefrontal cortex, the temporal lobe or the posterior parietal region are well recognized. Since there is normally a continual functional interplay between cortex and subcortical structures, lesions in the latter may also be expected at times to produce changes in psychological function.

With the coming of the National Health Service, there seemed a real chance of establishing fuller psychotherapy in Out Patients. This is not to imply that psychotherapy was not given before; but in most hospitals it was necessarilly limited except in special cases, and there was a tendency to leave it a good deal to junior staff who had the time and wanted the experience.

In psychiatry, generalization is a process which requires careful handling. It must be firmly rooted in everyday experience of the practical empiricism which gets results, and must be free, as far as possible, from the numerous fallacies which have brought “armchair” philosophizing into disrepute. These are formidable requirements, but fortunately one way of meeting them lies ready to hand. There are doubtless many others apparent to more fertile minds, but the one with which this paper deals rests on the fact that a patient who has been successfully treated by a psychiatrist behaves, when well again, in a different manner from that which he displayed when ill. He is cheerful, not depressed, relaxed, instead of being tense; realistic and socially enterprising as opposed to being autistic. If the term “Behaviour” is used in a sufficiently wide sense, it can cover the great majority of psychiatric phenomena without losing its cardinal virtue for the present purpose, namely that behaviour can be observed and its manifestations measured with considerable accuracy. The products of observation can be handled statistically, thereby avoiding armchair theorizing. Admittedly the interpretation of statistically derived findings presents some difficulty, but this is not insuperable. It is usually easier than the process of generalizing from observed data without the benefit of statistical pre-digestion.

A number of studies have shown that the incidence of schizophrenic illness (as measured by first admissions to mental hospitals) is high in the central areas of large cities and diminishes progressively towards the suburbs (Fans and Dunham, 1939; Dunham, 1947; Hare, 1956). Two main hypotheses have been advanced to account for this distribution. The first, the “breeder” hypothesis, is that social factors in the central areas are causal for schizophrenia and the particular factor most likely to be responsible is that loosely called “social isolation”. The second, the “attraction” hypothesis, is that the social disorganization or anonymity characteristic of the central areas attracts unstable and schizoid persons, either because such persons are unable to maintain themselves in better areas or because they wish to avoid the intimate personal relations of family life.

The present paper is a continuation of work previously carried out and is an attempt to define more accurately the conditions under which the rotation effect can be induced in normal subjects.

The phenomenon to which Lasègue and Falret in 1873 applied the term “folie à deux”, had many times previously been recognized and described. William Harvey (1651) noted a case, and his contemporary, Sir Kenelm Digby (1658) not only recorded an excellent clinical description but suggested a psychopathology (Greenberg et al., 1956). For Lasègue and Falret, folie à deux was a social rather than a psychiatric phenomenon: the second “passive” subject, they believed, was not truly psychotic but simply “absurdly credulous”. As they saw it, the more authoritative and intelligent “active” partner created the delusions and imposed them on the “passive” subject. This was more likely to occur in a setting of prolonged and isolated intimacy. The delusions were more likely to be accepted if they were plausible and played on the hopes and fears of the second subject. Heredity, they pointed out, offered no overall explanation, for this process frequently involved unrelated individuals. The second subject often accepted the first's delusions only after a fruitless and exhausting struggle to restore his sanity: “the indifferent escape both this useless travail and its consequences.” They held the prognosis for the “passive” subject to be invariably good, providing that the pair were separated. As early as 1563 Wier, writing on the cure of nuns afflicted en masse by demoniacal possession, had advised this course.

The problem of long-stay patients in mental hospitals is assuming increasing importance. At present, in most large mental hospitals the long-stay patients occupy 80 to 90 per cent. of the beds. The investigation by Freyhan (1955) suggested that although the new methods of treatment of the last 30 years have greatly increased the speed of recovery in the case with the good prognosis, they have not altered the outlook for the deteriorating case. This is in general confirmed by May (1956). Now these patients may have a yet longer stay because of the increased life span.

A number of new tranquillizing drugs have recently become available. We report a method of assessment for one of these—“Pacatal”. In this experiment the new drug was compared with (i) no treatment at all, (ii) treatment using dummy tablets of the same size and appearance as the Pacatal tablets, and (iii) Largactil. A group of patients suffering from schizophrenia were selected, all being deteriorated. These patients can be found in considerable numbers with a reasonably similar clinical picture which is relatively stationary without treatment.

Electroplexy is now a widely accepted and used treatment in psychiatric practice. Primarily it is by far the most reliable means of terminating or resolving depressive attacks, months or indeed years before the anticipated remission of these illnesses on their own accord. Less commonly it is also regarded as an effective treatment in some schizophrenic states, particularly the acute type, or schizophreniform illness, “but actually most schizophrenics are treated at some stage of their illness with electrically induced convulsions” (Kalinowsky and Hoch, 1952). Neither depressive nor schizophrenic syndromes are infrequent in pregnancy and the question must therefore be posed in some of these complications whether electroplexy is justified; whether it can be used safely either alone or with relaxants; and what, if any, deleterious effects may be imposed on the mother and/or foetus.

Meratran (alpha-2-piperidyl benzhydrol hydrochloride) is a cerebral stimulant with an action not unlike the amphetamine series but differing in other respects in that it does not interfere with sleep, nor appetite, nor is its use followed by depression. It is not apparently a sympathomimetic drug, since it does not cause any marked cardiovascular pressor effects. Recent reports from America (1) have suggested that the drug is of use in treating patients suffering from depression and psychomotor retardation either due to mental illness, fatigue or a side-effect of other drugs, e.g. chlorpromazine or reserpine.

The new clan of treated phenylketonurics (1) cannot be assumed to be a happy one, or one with a high proportion of well adjusted individuals. Conceding for the moment that the Phenylketonuric, if he sticks to his diet, will retain much of his intelligence, it is safe to predict that he will be miserable. One of his life's basic processes for satisfaction, his food, has been seriously tampered with, and replaced by a conflict. Eggs, milk, cheese, meat, fish, poultry, most fruit, even ordinary bread, are taboo for his table. He will consume a diet which will be cunningly prepared and flavoured, but he can hardly say that he “eats food”. His fate is that the satisfaction—and the surcease—of incorporating various articles of food does not exist for him, or only in an attenuated form.

The significance of the electro-encephalographic variations found in old age is not well defined and hence the value of this form of investigation as a prognostic measure is doubtful. Apart from a few papers such as Mengoli (1952), Mundy-Castle et al. (1954) and Obrist (1954), most of the published work contains no reference to findings obtained from a control series of persons of similar age and not suffering from a definite disability. This absence of definite criteria in respect of the EEG findings in records taken from apparently healthy elderly persons is important both as regards clear-cut abnormalities and also in reference to minor variations of doubtful significance.

The association of abnormal low frequency rhythms in the EEG with intellectual deterioration in old age has now often been described, but there has been no clear indication of a quantitative correlation between the degree of abnormality of the EEG and the severity of the deterioration. The present paper describes an attempt to explore the possibility of the existence of such a quantitative correlation.

There have been some indications in recent literature (Naidoo, 1956) that reserpine influences the kind of fit that patients have with E.C.T. The first time this came to our notice was a few months ago when we noticed that a patient who was receiving 9 mg. of reserpine daily took an unduly long time to resume breathing after her fit. However, she also had Parkinsonism, and we were using succinyl choline and intravenous anaesthetic, so we thought that perhaps this was a Parkinsonian idiosyncratic response to reserpine and succinyl choline (Ferguson, 1956). Since then, in chronic psychotics who have been having quite large doses of the drug over a long period, we have been struck by the apparent delay in resuming respiration after E.C.T. given “straight”, i.e. without relaxants. There have been alarming reports of collapse, even death in one instance from America (Foster and Gayle, 1955).

It is generally conceded that the majority of effectual therapeutic remedies carry potential hazards, some of them incalculable.

“Dementia Praecox” was discarded when it became apparent that a true dementing process was not present in schizophrenia. Most writers agree with the view put forward by French authors that the deterioration in schizophrenia is not the same as that seen in the organic psychoses (Lehrmann, 1940). Experimental work has indicated that intellectual deterioration in schizophrenia is more apparent than real, and that as it appears most when sustained effort and co-operation are required, any changes in co-operativeness and ability to maintain sustained effort invariably affect intelligence test scores (Kendig and Richmond, 1940; Sheldon Rappaport, 1951). The concept of schizophrenic deterioration employed in this article refers to a deterioration of behaviour in general, and to a deterioration of a patient's ability to look after himself in particular. With increasing interest in methods of treating deteriorated schizophrenic patients, we need reliable measures of deterioration in order to compare the effects of treatment in different groups. At present discrepancies in results are frequently due to some groups of schizophrenics being more deteriorated than others. For example Layman (1940) demonstrated that sodium amytal speeded up the psychomotor performances of schizophrenic patients, but subsequent work by Ogilvie (1953) did not confirm this finding. This discrepancy may have been due to the fact that Layman's schizophrenic group contained patients who were more deteriorated than the patients in Ogilvie's study. If a scale indicating the degree of schizophrenic deterioration could be devised, future researches into the treatment of deterioration in schizophrenia would benefit. There are a number of rating scales already available of which the best is probably the Fergus-Falls (Lucero et al., 1951). All of these scales have several common defects. They contain a number of items which are very subjective in nature and dependent more on the rater than the patient. Many are also of such length that they are too time-consuming to complete, particularly in the case of patients on long-stay wards where the nursing staff are invariably overworked already.

In 1950 López-Ibor adapted Fiamberti's use of acetyl choline in schizophrenia for the treatment of psychoneurotic disorders (Fiamberti 1940, 1950a, b; López-Ibor, 1950, 1952). Very few reports of the efficacy of this treatment have been published and they vary from the enthusiastic (Sargant, 1952; Phillips and Hutchinson, 1954) and the doubtful (Maclay, 1953), to the unequivocally rejecting (Hawkings and Tibbetts, 1956). The latter authors stressed the beneficial psychotherapeutic atmosphere of the clinic, and showed that injections of sterile water produced equally as good results as acetyl choline. This paper is a further attempt to evaluate the specific effect of acetyl choline in the treatment of mild psychiatric disorders.

The object of this work has been to examine the lipid constituents of human brains at different ages in order to follow the course of increasing myelination.

The first Act of Parliament which authorized the detention of persons “who, by Lunacy, or otherwise, are furiously Mad, and dangerous to go Abroad” was passed in the twelfth year of the reign of Queen Anne (1714):