As syphilis is a contagious disease it is a matter for surprise that so few investigations have been made into the conjugal histories of patients suffering film general paralysis of the insane.

Until quite recent years the figures of O. Fischer (1913) have largely been quoted when the incidence of conjugal neurosyphilis has been brought into question. Among the husbands of 86 female paralytics he found 8 cases of conjugal neurosyphilis. More recent inquiries have been made by Moore, the Solomons and Kemp, and their results have been summarized by Moore (1933).

The Rorschach method is valuable in the study of personality and claims have been made for its application to clinical diagnosis. Clinicians would welcome any method which would help to distinguish “psychoneurotic” from “organic” disease. There is a tendency, however, to demand from a new and unfamiliar method a complete diagnosis, rather than that the technique should provide standardized information which can be used towards a diagnosis by the clinician along with other methods. Psychologists using the Rorschach method have played into this expectation to some extent and have sought to present sets of signs and types of Rorschach records which could be considered as suggesting certain definite diagnoses. This paper is concerned with the study in a wide range of patients of some of the signs obtainable by the Rorschach technique in an effort to determine what degree of specificity can be attributed to them, and what likelihood of success and failure is attached to their use.

Fatigue is one of the commonest complaints a physician encounters, so common indeed that it gives little guidance for the diagnostic approach. Besides, fatigue is a normal phenomenon; so why and when does it become a symptom, in other words an indicator of illness ? Fatigue is a conspicuous symptom in effort syndrome cases, and the close association between effort, or rather incapacity for effort, and fatigue suggested an approach to the effort syndrome problem from the angle of fatigue.

Fatigue, as used in psychomatic medicine, has both a subjective and an objective meaning. According to the prevalent interest in the somatic side the objective aspect has been studied more than the subjective in medicine; even the psychologist tends to interest himself in the objective results of fatigue rather than in the psychological phenomenon as such.

The readjustment of the emotional problems of childhood which show themselves in behaviour disorders and nervousness is a most important part of any mental health service. This involves not only the relief of the immediate situation, but also prevention of more serious symptoms which may appear in adult life.

It is now being realized that the war-time evacuation of children is increasing the urgency for dealing with these problems on a broader basis. A recent editorial in the British Medical Journal (1941) stressed the strain that wartime imposes upon children by the break-up of normal family life and the consequent loss of security. It emphasized that these problems are seen mainly in the evacuation areas and stated, “There is in this situation a very real danger that the seeds of neurosis will be sown in an increasing number of children.”

Increased welfare and social work can do much to improve the situation, but many children need further treatment. There is an urgent need for more centres where adequate treatment can be obtained for selected cases. This paper indicates the methods by which children can be treated satisfactorily in an ordinary psychotherapeutic out-patient department when a fully established Child Guidance Clinic is not available in the district.

Each child is given an intelligence test, and mental defectives are not accepted for treatment by these methods. Detailed history from the parents is supplemented by visits of the psychiatric social worker to the home and to the school. In mild cases readjustment of unsuitable environmental conditions will effect improvement, but in more severe cases other measures will also be necessary.

The psychiatrist is brought into contact with the patient who has received a blow on the head some time after the event in the majority of cases. His task is in many instances to be shared with the neurological surgeon. The Army psychiatrist is called upon to see such a large number of such cases that the following somewhat exoteric account is offered as covering some of the major considerations involved.

A blow to the head may result simply in stunning, in which case the patient thereafter remembers, if vaguely, the essentials of his behaviour and experience, or the alteration of consciousness may be more severe and for some recognizable interval he may subsequently possess a true amnesia, in which case we speak of concussion.

The degree of concussion clearly comprehends a wide range of disturbance of function which may almost immediately be fatal.

Thirdly, the patient may be killed outright.

Functionally considered, therefore, there are three degrees of effect from head injury : stunning, concussion, and death. Structurally we have no real parallelism of observed pathology, since it is only cases of severe concussion which characteristically come to autopsy. Consequently nothing is known for certain concerning the pathology of concussion. Cerebral contusion is therefore clearly inadmissible as a synonym, although its existence may be presumed in severe cases.

As regards the after-effects of head injury it is clear that the disturbance of function may be psychogenic or physiogenic, or a mixture of the two, and in discussing the physiogenic results there are two main clinical methods of approach. In the first our interest is focused on syndrome production, and in the second we are more concerned with individual function. Clinical orientation, however, as in all psychiatry, can only be achieved by the former.

This paper is concerned with the occurrence in three cases of a major psychosis of more or less circumscribed and apparently psychogenic episodes similar to those described by Ganser (1897), and which form a characteristic syndrome, since called after him. Two of the cases here described were endogenous depressions, the third was a schizophrenia. All three showed depersonalization.

Skin sensitivity had been mentioned and demonstrated in isolated instances over a long period of years before Schloss in 1912 extended and described its usage and established it as a definite means of detecting hypersensitiveness. Since then it has been universally recognized as a most useful adjunct to the study of the aetiological problems of allergy. At first it seemed that a miraculous means had been found of explaining both the cause of and the reason for the recurrence of certain common disorders of obscure aetiology in widely separated organs. It promised to show how totally different symptoms could be attributed to a common agent. The fact that the skin was sensitive but that the only clinical evidence of disease appeared, say, in the lungs gave the impression that all organs of the body must be in a like state of sensitivity. This has since been widely disputed and denied and on this subject Alexander (1936) states that such an assumption, at least from the clinical standpoint, is a fallacy. Man, he believes, may exhibit general hypersensitivity if a sufficiently large dose of protein be experimentally introduced.

If, then, hypersensitiveness is localized in certain tissues, it follows that the skin may or may not be sensitive in any given case and at any given time. In other words, because the ingestion of a specific food leads to colic or urticaria, it does not necessarily follow that the skin will give a positive reaction to an extract of that food in all cases or at all times. Indeed, a positive reaction may not occur at any time. This limitation of skin testing is now accepted; but nevertheless, allowing for the fact that only 50-60 per cent. of allergics (and that is not an over-generous estimate) give positive results, it still remains a very valuable diagnostic aid.

This communication is a summary of convulsion therapy in a series of 40 cases admitted for psychoneuroses occurring in war-time. It comments on similarities and differences observed during treatment as compared with the convulsion treatment of psychotics, and discusses the psycho-dynamics of convulsion therapy. It is assumed that the reader is acquainted with the elements of convulsive treatment and the various phenomena which may result therefrom.

On December 8, 1939, 35 patients, neurotics and psychotics, met in “Sunnyside House” and formed a social club. The chair at the meeting was taken by a patient. We had previously met this patient with a few others, and explained to them the aim we had in view in proposing that they formed a club. Later this aim was expressed in the following paragraph which is taken from an article written for the first magazine of the Club :

“We find there are two main problems common to many who come to a modern mental hospital—the problem of ‘occupation’ and the problem of 'social relationship,’ that is, the relationship between the ‘I’ and the ‘ you.’ It was with the importance of the latter problem in mind that we suggested the establishment of a social club… . The satisfaction of successful co-operation is one of the surest foundations for happiness and inner security. Many of us here are lonely souls who have walled ourselves off to some extent from the society of our fellows. For one reason or another we have avoided the social impact and retreated into solitude and isolation. We have thus deprived ourselves of the possibility of co-operative activity and of the sense of security and fulfilment that this can bring. The Sunny Side Club will enable us to take the first few steps in the direction of fuller social co-operation by giving us the opportunity of working together on its various committees or of joining in its activities.”

Since Sakel's introduction of hypoglycaemia into the therapy of psychoses, discrepancies between the level of the patient's blood sugar and the severity of disturbance of consciousness have frequently been noted. The blood sugar decreases in a relatively steep curve within the first and second hour after the injection of insulin; but only after it has remained on a low level—differing from case to case—for a considerable time does the patient go into coma.

It seems useful to define the clinical signs of coma if it is intended to correlate it with laboratory findings. It is a state of unconsciousness in which the patient cannot be roused by sensory stimuli; in coma such stimuli do not provoke local and purposeful, but global movements only, if any. Once in coma the patient remains so, independently of the blood-sugar level, which can rise and fall within a certain range without visible change in the clinical picture; it may even rise to a level at which the patient was awake or could be easily wakened before he went into coma. Subcutaneous or intravenous injections of adrenalin in coma produce a rise in blood sugar without clinical effect. On the other hand, the flooding of the blood stream with sugar by nasal tube feed of a concentrated sugar solution or by intravenous injection of 33 per cent. glucose solution terminates coma and restores consciousness within a few minutes. The latter's action is so immediate that it is considered a practical rule not to stop injecting glucose until the patient is really awake.

From these observations coma appears to be a kind of trigger mechanism comparable to instinctive reactions, such as thirst, hunger or sexual desire. Once established it can only be reversed by specific means.

Arachnodactyly, or spider digits, was first recognized as a clinical entity by Marfan in 1896, and since then a considerable number of cases have been described; thus in 1938 Futcher and Southworth were able to find two hundred examples in the literature. Reviews of the condition have been made by Marfan (1938) and Clément (1939). Its relationship to oligophrenia has never been stressed, but since skeletal and ocular abnormalities are so frequent in defectives, it is not surprising that cases of arachnodactyly should also be found.