I am going to give sketches of the lives of three notable nineteenth-century psychiatrists who were associated with and lived in my own county of Warwickshire.

This thesis gives an account of the use of cortisone and adrenocorticotrophic hormone (ACTH) in the treatment of prolonged comas occurring in the course of deep insulin coma treatment. Cases in which neither hormone was used are also included. The pathology and aetiology of this type of prolonged coma are discussed and a classification of the cases seen is made.

The discovery that iproniazid benefits certain subjects with depression, linked with the demonstration that it inhibits the enzyme monoamine oxidase (MAO), led to the hypothesis that inhibition of MAO was the essential mechanism by which iproniazid caused relief of symptoms (Pletscher, 1959). Iproniazid, unfortunately, can produce serious toxic effects, particularly on the liver (Pare and Sandler, 1959), and this has limited its clinical application. For this reason a search has been made for MAO inhibitors with an effective anti-depressant action yet without the serious toxic effects of iproniazid. Among the newer compounds for which such claims have been made is N-isonicotinoyl (-N-N-benzylcarboxamidoethyl) hydrazine or Nialamide.

In order to test whether a drug is an inhibitor of monoamine oxidase in the human subject, three main measures are available:

1. We can measure an increased excretion of the normal substrates of the enzyme, e.g. tryptamine (Sjoerdsma, et al., 1959b).

2. We can measure a decreased excretion of the metabolites resulting from the enzyme's action, e.g. 5-hydroxyindoleacetic acid (5-HIAA).

3. We can administer a loading dose of an enzyme substrate and observe how the subject deals with it before and after the drug, e.g. 5-hydroxytryptamine (Sjoerdsma et al., 1958), and epinephrine (N-methyl-C14) (Resnick et al., 1958).

So many new compounds are now being introduced for the treatment of psychiatric disorders that it is difficult for the clinician to assess the accuracy of the claims made for them. If a form of therapy is one hundred per cent. effective in a disease which was previously one hundred per cent. fatal, for example vitamin B12 in pernicious anaemia, the question of a controlled trial does not arise. But even the manufacturers do not claim such a degree of effectiveness for drugs advocated for the treatment of mental illnesses, and in addition the natural course of such illnesses is very variable, so that it is essential that clinical trials of these drugs should be controlled. Foulds (1958) has reviewed British and American clinical trials of drugs in psychiatry during the years 1951 to 1956, and has shown that the less controlled a trial, the more likely it is to result in a favourable report on the drug being tested, presumably because of bias on the part of the clinician. Forrester (1958), however, on the basis of a completely uncontrolled trial of Stelazine on only twenty-five patients, concluded that “the amount of improvement in a few cases was not sufficient to encourage the further use of the drug”.

There are many reports referring to incidence of agranulocytosis in patients receiving phenothiazines. This and the potential hepatotoxic effect of this group of drugs have been the greatest drawback in their usage.

As a result of new methods of biochemical investigation an increasing although yet small number of cases of mental deficiency can be shown to be caused by congenital metabolic abnormalities. In 1958 Wright et al., reviewed and classified anomalies of this nature and since than a new syndrome has been described by Allan et al. (1958) and a syndrome closely related to, if not identical with, Maple Syrup Urine Disease by Smith and Strang (1958).

A unit for adolescent psychiatric patients was opened at St. Ebba's Hospital in 1949 by the late Dr. D. E. Sands. At that time, there were few in-patient facilities for this group of patients and the unit therefore received many of the most disabled cases from all parts of the country. Sands (1953)∗ wrote of the need for such a unit. “In the juvenile period there is psychiatric breakdown to a degree which from medical and social standpoints is as much of a problem as such illness in later life. There are some who have stated that all children's and juvenile psychoses should be treated at home. Experience with these patients has shown that, however desirable this may be in theory, it is no more practical or safe for some types of juveniles than for adults. The truth of this view might have been inferred in any case from the frequency with which such cases have found their way for years into all kinds of makeshift in-patient accommodation because home for one reason or another proved impossible or practically nonexistent”. He then gave an account of the classification, aetiology and treatment of patients on the unit and the results on discharge. The present article discusses the presentation of psychiatric illness in adolescence, reviews the follow-up on patients admitted between 1949 and 1953 and compares these follow-up results with those of Sands on discharge.

The late Dr. Vera Norris (5), in a study of London mental hospital admissions, found that a London woman, at birth, has 0 · 8 chances in 1,000 of being admitted at some time in her life with a puerperal psychosis. This figure, based upon hospital admissions, must be compared with Kline's (4) estimate that 5 per cent. of pregnant women have an associated emotional disturbance. Clearly, hospital admissions represent a small proportion of all cases occurring and it is likely that socio-economic and cultural as well as medical factors play a part in determining whether admission takes place. Estimates of the incidence of psychiatric disorders associated with childbearing must vary according to the age structure of the population, the facilities for psychiatric care available in the community and the criteria adopted for attributing illness to the effects of childbearing.

At the present time only two groups of drugs have an established place in the treatment of chronic schizophrenia, the phenothiazine derivatives and the rauwolfia group of alkaloids. Of these two groups the phenothiazines are in more general use, and, although not free from side-effects, are safer drugs for the long-term management of schizophrenic patients. They also have a wider range of effectiveness in the different schizophrenic syndromes. Many observers, however, have been impressed by the dramatic results obtained in a proportion of cases of long-term schizophrenia treated with the rauwolfia alkaloids and these may be effective in cases not responding to the phenothiazines (Kline, 2).

Glucagon, the hyperglycaemic glycogenolytic factor of the pancreas, was discovered by Kimball and Murlin in 1923 (1). It was crystallized by Staub, Sinn and Behrens in 1953 (2, 3). Glucagon is believed to cause a rise in blood sugar by acting at the site of liver Phosphorylase—converting inactive Phosphorylase to active Phosphorylase (4).

There appears to be a feeling at the moment among many psychiatrists that the treatment of early schizophrenia of all types with the recently introduced phenothiazine derivatives is as effective, if not better than, Insulin Coma Treatment (I.C.T.) and that there are many other advantages besides. In some hospitals insulin coma treatment has been discontinued altogether.

In the WISC manual Wechsler (1949) gives correlation matrices for his battery of 12 cognitive tests for three random samples of normal children aged 7½, 10½ and 13½ years respectively. A factor analysis of each of these matrices, excluding the information and mazes tests which are seldom used in Britain, is reported elsewhere (Maxwell, 1959), and it is shown that the pattern of loadings is similar for all three age groups. The question then arose as to how the pattern of loadings for a sample of children attending a psychiatric clinic would compare with that obtained for normal children. The problem is investigated in this article.

The purpose of this paper is to describe the results obtained when the Bene-Anthony Family Relations Test was administered to 69 children in 28 families and to relate these results to the health and social characteristics of this group. These children, 17 American Negroes, 46 Puerto Ricans and 6 Americans of European descent receive out-patient paediatric care from two paediatricians and a public health nurse, in a small family neighbourhood clinic located in a Manhattan slum area. The parents of these children also receive out-patient treatment from the two internists associated with this clinic.

Clinical trials of thioproperazine (7843 R.P.; “Majeptil”) 2-dimethyl-sulphamoyl-10-(3-4′-methy1-1′-piperazinylpropyl) phenothiazine methanesulphonate, carried out in France by Delay, Deniker et al. (1959b); Perrin, Lambert et al. (1958); Coirault et al. (1959); and in America by Denber et al. (1959, 1960), have shown that it is a highly effective agent in the treatment of schizophrenia and acute mania. To examine the claims made for the drug's value in deteriorated or vegetative schizophrenics, and in other cases that have resisted chemotherapy, a trial was undertaken in this country.