Mongolism was one of the earliest syndromes to be recognized as a specific type of mental deficiency and was first described as such by Langdon Down in 1866. The term “mongol” was applied to this type of defect by Langdon Down on account of the superficial facial resemblance he observed in its subjects to individuals of the Mongolian race.

Until a few years ago there existed a sharp dichotomy of opinion between the pharmacologists, who, on the basis of their experiments, assigned to acetylcholine the role of universal synaptic transmitter, and the electrophysiologists, who denied that this substance could effect the transfer of excitation from one conducting element to another. It is, however, now generally agreed that, certainly at the neuromuscular junction, and probably also at ganglionic and some—but not all—central synapses, acetylcholine does indeed exert a primary transmitter action. It must be added that recognition of this fundamental action has been hastened as a result of recent experiments by those very electrophysiologists (such as Eccles and his colleagues) who previously supported exclusively electrical hypotheses of nervous transmission. For this reason the assumption which is implicit throughout this paper that the acetylcholine in brain is concerned in maintaining central synaptic transmission is likely to go unchallenged and requires no detailed justification here.

The previous paper of this series (Roth and Hopkins, 1953) described test performance in senile and affective psychosis. The same tests have been administered to patients in three other diagnostic groups: paraphrenia, arteriosclerotic psychosis, and acute confusional states. These five clinical categories account for the majority of mental hospital admissions in patients over the age of 60.

Hurler's disease is characterized by chondro-dystrophic skeletal changes, corneal opacities, hepatosplenomegaly and mental defect. The skeletal changes are such that the patient presents a large head, grotesque facies, deformed limbs and kyphosis.

The association of an abnormal electroencephalogram with obsessive-compulsive states has been investigated by Pacella et al. (1944), who found in these states a higher incidence of “convulsive-type” patterns, consisting of occasional or frequent runs of serial 2–4 c/s potentials of high amplitude than in a random control group. In most of the cases this type of activity was only noted after a period of hyperventilation not exceeding two minutes.

Tics are involuntary, repetitive or stereotyped movements which apparently lack purpose and which, with adults, tend to be permanent or long-term abnormal aspects of the individual's motor behaviour. The question arises whether certain basic psycho-motor and personality traits characterize persons who develop tics. No previous experimental work on this problem has been reported. In the present research, therefore, a preliminary attempt was made to describe precisely, by the use of psychological tests, certain aspects of the motor behaviour and some of the personality characteristics of tic patients and to compare the results with a similar examination carried out on matched, but non-tic, control patients.

The drug which is now known officially as Mephenesin (“Myanesin,” “Tolserol”) was introduced by Berger and Bradley (1946), who showed that it antagonizes strychnine convulsions, counteracts pre-narcotic excitement, and increases the duration of barbiturate anaesthesia. Small doses depress the reflex excitability of the spinal cord, and larger doses have an ascending depressant action on the central nervous system. When Berger (1947) found that doses with little effect on voluntary power restored deranged reciprocal innervation to normal, he suggested that mephenesin might be useful in spastic and hypertonic conditions.

There is a considerable body of literature concerning the diagnostic value of differences in pattern and scatter found in response to intelligence tests.

The relations between Psychiatry and Occupation are considerable and complex. This is the case whether we consider psychiatry as limited (Curran, 1952) and thus approach the problem through the individual patient and his work, past, present and future, or less limited and thus concerned with industry and group adjustment. In reality both approaches deal with essentially the same basic problem which is the biological adaptation of man to his occupation, or to earning a living. Such work phases form an integral part of man's very existence, whether he works to live, or lives to work. Interest in the maintenance of health through prevention of occupational hazards has developed rapidly in this century, stimulated by war stresses, defence programmes and economic cataclysms. The struggle for our industrial survival has focused more than our interest, as psychiatrists; but extravagant offers of industrial consultancy, of trying to teach where little knowledge is yet available are patently dangerous. Industry, like society, has often been led to expect too much, and too soon, from our as yet embryonic facts, experiments and principles in this field.

Cook, Dax and Maclay (1952), studying the population over age 65 in the public mental hospitals in England and Wales, showed that, for the ten-year period 1938 to 1948, the percentage of patients over age 65 to the total mental hospital population rose by approximately three times as much as the per cent. increase in the general population of those over age 65 to the total population. However, in addition to the magnitude of the problem of mental ill-health in the aged, its many aspects involve extensive fields where knowledge is still lacking. In consequence, it is extremely desirable to investigate more fully the psychiatric disorders occurring in old people, and the increasing importance of these maladies—especially their social significance—has prompted the present study.

In recent years there has been renewed interest in correlating cerebral function with mental phenomena. For a time, with the advent of prefrontal leucotomy, interest in the frontal lobe reigned supreme. However, in recent years the temporal lobe has been coming to the fore, and is now beginning to rank with the frontal lobe in importance.

When we pass under review the theoretical concepts of aggression three main types stand out clearly, which are fairly representative of prevalent opinions.

Perhaps most clinicians experienced in mental hospital work suspect, at least, that left-handedness and stuttering occur relatively frequently among hospitalized epileptics. However prevalent this impression may be, it remains to be tested systematically. There has been little study of dextrality among the different diagnostic groups. Defects of speech among some groups have been studied considerably, among other groups very little.

It is charactersitic of mental ill-health that the individual's capacity to make continuous co-operative relations with others is impaired. In the psychoses and psychopathic conditions this is unmistakable; in the neuroses it is sometimes less so, and there are even neurotic patients who seem to be especially kind and co-operative. But we know that they only achieve this behaviour at great cost of effort, anxiety and guilt and that, if they break down, they can be very hostile and withdrawn.

The case here described is of interest in that it concerns a young man of good intelligence who presented a disorder limited to visual-gnostic functions; this is noteworthy as the majority of the cases described are elderly patients and there are usually other than visual gnostic functions involved. The case has special circumstances of additional significance. The patient had lost the sight of his right eye in infancy and he was a definite right-handed man; the damage involved the right hemisphere; this exceptional coincidence raises interesting problems of hemispheric dominance.

Clouding of consciousness is a common feature of organic psychoses. It may be of any degree of severity from acute delirium to some diminished capacity for clear thinking and impairment of retention for recent experiences. However, such a diminution in the level of awareness also occurs occasionally in “functional” mental disorders; severe and rapidly evolving attacks of mania or depression may be associated with some degree of clouding of consciousness, and Meduna in some recent papers (Meduna and McCulloch, 1945; Meduna, 1950) has redirected attention to “oneirophrenia,” an acute psychotic disorder originally described by Mayer-Gross (1924) in which clouding of consciousness is the general rule.

Scattered throughout the literature on the psychiatric aspects of asthma are reports of cases where the psychiatric disturbance was severe enough to be described as “psychotic” (Reichmann, 1922; Hansen, 1929; St. Saxl, 1933; Oberndorf, 1935). The term “psychotic” was used in the sense that the psychiatric diagnosis was either that of manic-depressive psychosis, schizophrenia, or paranoid psychosis. It has been postulated, moreover, that the co-existence of a psychosis and attacks of asthma was no chance relationship, and that there was an intimate link between the psychosis and the somatic disturbance. This relationship, it has been said, is of considerable theoretical significance. Appel and Rosen (1950), for example, consider that “there is a reciprocal relationship between the so-called physical manifestations of psychosomatic illness and the psychological manifestations of psychiatric illness.” This concept is also held to apply in disorders other than asthma—in ulcerative colitis, rheumatoid arthritis, and in certain skin disorders. The treatment of such disorders psycho-therapeutically is said to result at times in an alleviation of the physical disorder, but the concomitant development of a psychotic reaction (Appel and Rosen, 1950; Lindemann, 1950). During the past three years an investigation of patients suffering from asthmatic attacks has been in progress, and the opportunity has arisen to examine these points on a fairly large case material. The present paper reports an attempt to investigate scientifically some aspects of the relationship between asthma and psychosis.

In December 1950, Salter's valuable book What is Hypnosis? (1) was published in England, and some months earlier Strauss (2) had pointed out the wide implications for medicine of Salter's observations, were they confirmed, and indicated the more resistant nature of psychogenic pain, compared with organic pain, to amelioration by hypnotic suggestion. The present article reviews three very different cases in which, at some stage in treatment, an autohypnotic approach to pain was used, and a further case in which autohypnosis, as a means of relief of pain, had been discovered accidentally by the patient. An attempt is made to relate the results and information obtained from these cases to Salter's work and views on hypnosis.

Prolonged cerebral electrostimulation of subconvulsive intensity has been employed as an experimental procedure at this hospital during the past year, and the indications for this technique in the treatment of mental disorders are being investigated. Preliminary tests in conjunction with Dr. H. Weil-Malherbe showed that electrostimulation, when applied to normoglycaemic patients under pentothal anaesthesia, caused a pronounced increase in the concentration of adrenaline-like substances in the blood during the passage of the current. The same current was therefore applied to a series of patients in hypoglycaemic coma to determine whether the effects obtained after injection of glutamic acid—and considered by Weil-Malherbe (1949) to be adrenergic in origin—could also be obtained after electrostimulation. The results of these investigations are presented in this report. The stimulating current employed for this purpose was of the “square wave” (interrupted galvanic) type, which was first applied as a cerebral stimulus by Leduc (1902) in his pioneer demonstration of electrical anaesthesia and sleep. More recently Liberson (1945) has investigated this type of current in relation to E.C.T., subsequently utilizing it in his Brief Stimulus Technique (Liberson, 1947, 1948). This latter technique is also under investigation here at the present time, the same stimulator being used for both convulsive and sub-convulsive therapies; the results obtained with the Brief Stimulus convulsive therapy will be presented in a later report.

Paintings and drawings of emotionally and mentally disturbed persons have been the subject of many psychological and psychiatric investigations. The psychological evaluation of graphic art can probably be considered as the oldest “projective” technique. Paintings and drawings have been systematically studied by psychologists and psychiatrists from three different aspects: 1, As indicators of the developmental stage reached in perceptual, motor and intellectual functions (Goodenough, 1926; Graewe, 1932; Bender, 1938; Gesell and Ames, 1946).