It may be regarded as an established fact that the incidence of mental disorder is much higher in the single than in the married. In a previous paper two possible explanations were discussed: 1. There is a selection by marriage, whereby individuals who are personally and socially handicapped tend to remain single. Among such possible marriage handicaps there are certain personality traits which correlate markedly with a predisposition towards certain forms of mental disease, in particular schizophrenia.

In the course of a systematic investigation of the pharmacological properties of a-substituted glycerol ethers it was found that some of these compounds produced muscular relaxation and paralysis. In small doses, administered sub-cutaneously, muscular relaxation and a sleep-like condition were produced in laboratory animals—in larger doses there was ataxia followed by paralysis. Of the various compounds studied, mephenesin was found to be the most potent and to possess the greatest margin of safety, and it is this product which is used, for oral administration, in Myanesin Elixir.

Since the treatment of juveniles as in-patients in a special unit is somewhat unusual in mental hospital practice, a brief introduction may not be out of place. These units might be considered as another development in a trend which has been progressing for the past 25 years. Until 1930 certification of all admissions to mental hospitals and a mainly custodial régime ensured the majority of patients being largely the end-results of psychiatric illness. Since 1930 the steadily increasing use of the voluntary system has brought many patients to hospital at a stage when their illness can be favourably influenced by modern therapeutic methods. An associated development was the increased provision of wards or units separate from the chronically disturbed cases, or even, as at this hospital, a complete villa system of detached and semi-detached wards for mainly voluntary adult patients.

During recent years renewed interest has been taken in the possible importance of adrenocortical function in psychiatric disorders. Psychiatric syndromes and symptoms associated with pathological functioning of the adrenal cortex found in Cushing's and Addison's diseases have been recognized for many years. The classical work of Selye (1949) and his school has elucidated the importance of the adrenal gland in the individual's reaction and adaptation to stress. Qualitative and quantitative abnormalities in adrenocortical responsivity to stresses and stimuli in various psychiatric disorders have been reported in recent years (Freeman et al., 1944; Hoagland et al., 1946; Pincus and Elmadjean, 1946; Pincus et al., 1949).

Since the introduction of curare to modify the contractions in E.C.T., the use of relaxants has become standard psychiatric practice. These substances reduce the risk of fractures and enable treatment to be given to patients who would otherwise be denied it owing to risks arising from concomitant physical disease. During recent years great efforts have been made to simplify the technique of muscle relaxation, in particular to evolve a method which is short in duration, free from undesirable side-effects and easy in use. In this short paper we give a description of our experience with three drugs recently introduced, namely, Suxamethonium Bromide or Brevidil “M” which we used in 111 treatments, Suxethonium Bromide or Brevidil “E” (70 treatments), and Suxamethonium Chloride or Scoline (653 treatments). These choline succinic ester derivatives have similar characteristics which can be considered together.

There is now considerable clinical and experimental evidence that the autonomic nervous system may play an important role in the pathogenesis of gastric and duodenal ulceration. Cushing (1932) reported the development of gastric ulcers after intracranial operations, and concluded from animal experiments that parasympathetic overactivity produced changes in the gastric mucosa conducive to ulcer formation. Experimental lesions in the hypothalamus were found to give rise to gastric ulcers by Watts and Fulton (1935) and Hoff and Shehan (1935). Davey, Kaada and Fulton (1950) found that increased gastric secretion resulted from stimulation of areas of the frontal cortex in monkeys and dogs. Furthermore, clinical reports have shown that lesions in the cerebral cortex, diencephalon and midbrain have been found to be associated with gastric ulcers (Bochus, 1949).

Difficulty occurs at times in the diagnostic differentiation between the manifestations of organic cerebral disease and those of hysteria, particularly in patients who suffer from symptoms which are largely subjective in nature, and which are not accompanied by physical signs. An attempt is made in this paper to discuss behaviour reactions which are characteristic of organic cerebral disease, and which, if present, exclude the possibility of the disease being “hysterical” in nature.

From October, 1947, to October, 1952, we have had the opportunity of performing prefrontal leucotomy on 339 patients at the Neurosurgical Clinic in Belgrade. As this operation is of importance in the treatment of mental disease we consider it necessary to report our experiences and our results.

The use of muscle relaxants in E.C.T. constitutes an important advance in psychiatric practice. The merits of the method are not only due to the beneficial effects of the relaxant itself; the anaesthetic, that is invariably administered at the same time, plays an essential part in the procedure. Every phase of the treatment is greatly improved. Anxiety, which so often develops during unmodified E.C.T., is greatly reduced if not abolished altogether. There is no cry or other noise that might disturb other patients awaiting treatment; the convulsion is attenuated to a reaction that may be varied at will from a mild modified convulsion to a mere flicker of facial muscles or complete absence of muscular activity. Cyanosis is absent and the colour remains good throughout, and—perhaps most important of all from the therapeutic point of view—there is no restlessness or confusion after the treatment, the patient sleeping quietly after the treatment until he wakes up without any unpleasant sensations or memories.

The pictorial work of art bears witness, above all else, to the process of creation. Whatever it is that differentiates a work of art from mere skilled productivity—(and aesthetic theories rage about this issue)—it would appear that only in the case of the former is the spectator made conscious of that heightened scale of perception, at once purposive, integrated, and whole, which is the distinguishing feature of creative activity. And if we admit the principle of creativity in artistic expression, then we must seek in paintings something more than a reproduction of external appearance. The visible world indeed is the raw material of art, but it is moulded and fashioned by the artist according to his own purposes and, it is now suggested, by certain qualities of reminiscence. As a consequence of the relation which exists between his own emotional life and these qualities he creates in pictures a world of reality which has for him a compelling intensity—an irradiance in which he finds meaning and justification for his work. It is the embodiment of some new state of comprehension, bringing order, coherence and purpose to what otherwise would be formless and lacking in meaning. This world re-born, founded in experience, is invested with conviction and validity. The making of such an extra-sensory world is at the heart of creativity, for only so can the artist create the conditions for a communicable experience. A purely private world is mysterious and incommunicable, and does not provide the conditions in which schools of art can develop.

When one finds a legend associated with a disease it may be accepted as a general rule that little is known about its true cause. This is exemplified by Huntington's chorea, of which it is said that the original case was a man who imitated Christ's agony on the Cross. A great deal of work has been done on this complaint, but much of it has been to do no more than to confirm the findings of Abel Huntington, who recognized its hereditary nature in 1797.

Because of the widespread incidence of neurosis and the comparative lack of psychiatrists, much thought and activity is being directed into the treatment of a number of patients simultaneously. Apart from economy in time, group therapy has virtues of its own and would have a place in treatment even if there were a sufficiency of trained psychiatric staff.

The amnestic-confabulatory symptom-complex to which the eponymous title of Korsakov's syndrome is usually given was probably first described by the Swedish physician Magnus Huss (1807–90), who spent the greater part of his lifetime in the study of alcoholism. There is, however, no doubt that Korsakov's (1890) paper on the subject gave an excellent description of the syndrome, and stressed the fact that whereas it often developed in patients with alcoholism and polyneuritis, numerous other metabolic and neurological disorders could be complicated by the characteristic mental changes. Indeed, in Korsakov's (1890) own series of cases alcoholics were in the minority. One of the neurological conditions in which the syndrome has been described significantly often is spontaneous subarachnoid haemorrhage. The first reports of the association were probably those of Flatau (1918 and 1921), and it was discussed in some detail by Goldflam (1923) and Herman (1925 and 1926). Each of these authors described the mental symptoms exhaustively but gave no actual case-histories; the first fully documented cases in the literature were the two reported by Hall (1929). Single cases have since been described by Cubitt (1930), Popow (1930) and Kulkow (1935), and in 1939 Tarachow gave an extensive review of the literature and reported an additional 3 cases. It is remarkable that since 1939 the association has received little attention, although it has been mentioned by Sands (1941) and Meadows (1951).

Acute porphyria is a rare disease in this country. Although a typical case was described in the Journal of Mental Science over 50 years ago (Campbell, 1898), Petrie (1948) could find only three cases reported in Britain between 1940 and 1948; since then at least six more cases have been reported. The disease is relatively common in Scandinavia and, to a less extent, in North America—a distribution for which Discombe (1948) has suggested an explanation in terms of relative emigration rates.

A previous communication (Carpenter and MacLeod, 1952) described the application of a maze, together with a simple test of limb co-ordination, to the study of alcoholic intoxication in rats, as modified by acetaldehyde. As part of a scheme of work here, it was desired to observe the effect of drugs and other substances upon the degree of intoxication produced in rats by ethyl alcohol. Such studies, pursued by the methods previously given, soon led to a formidable mass of recorded material, some features of which were not adequately dealt with by the scoring technique employed. It became necessary to adopt a scoring system which would give an overall indication of the various manifestations of alcoholic intoxication, to serve for the purpose of compact tabulation of results and the drawing of conclusions.

As modification of electro-shock is becoming a routine procedure in every patient undergoing this therapy, it is necessary to find a muscle relaxant, or as it has been commonly called a “curarizing agent,” which will be ideal for this purpose. Ideal should mean no toxicity, rapid onset, short duration and rapid termination of neuro-muscular blocking action.

Interest in this problem on the part of parents, sociologists and paediatricians, among others, has grown of recent years. So much is this so that the casual observer might well conclude that there had been a real increase in backwardness, and that anxious parents now have a more genuine cause for anxiety on this score than was the case a generation ago. This view indeed is held by certain well established authorities in the fields of education and psychology, for example Burt and Professor Godfrey Thompson, who have expressed gloomy views about the intelligence of the nation. Moreover, considerable publicity by means of wireless broadcasts or otherwise has been given to these prognostications. It is not therefore surprising that many parents should be concerned as to whether their offspring will after all prove to be something less of a genius than they had anticipated. The smaller size of modern families is also a factor in increasing paternal anxiety. I say paternal advisedly, since it is more often the male parent, especially in middle-class circles, who has set his heart on his child being an infant prodigy. With only one string to his bow, the whole tension of paternal ambition is concentrated in a single object. Moreover in these days of compulsory examinations at the age of eleven, together with widespread coaching for the intelligence tests which form part of the examination, the unfortunate, innocent babe is barely able to lift a mug or a spoon when his rattle is whisked away and replaced by a host of constructional toys designed on similar lines to modern American intelligence tests. The slightest failure in performance or slackening of interest is liable to produce a state akin to panic in the proud parent, who has just been comparing notes about his prodigy with the owner of another (but naturally, somewhat inferior) budding genius next door.

It is probable that the incidence of vertebral fractures during E.C.T. is greater than was formerly thought to be the case. Meschan, Scruggs and Colhoun (1950) found vertebral compression fractures in over 35 per cent. of 212 cases treated with E.C.T. Plattner (1949), in a series of 500 cases (200 men and 300 women), found fractures in 58 (37 men and 21 women). In 20 of his cases E.C.T. had to be abandoned on account of the fracture.

In previous communications (1951, 1952) we have shown that lysergic acid diethylamide (LSD-25), a drug which has a remarkable psychological effect in minute oral doses, also has an effect on carbohydrate metabolism resulting in an increased concentration of hexosemonophosphate in the blood. This observation has been confirmed by Cornforth and Long (1952). What was less clear from the experiments in mentally healthy subjects was the relation in time and severity between the psychological symptoms and biochemical changes.

The Industrial Neurosis Unit of Belmont Hospital has one hundred beds, two-thirds of which are occupied by males. The vast majority of the patients are chronic psycho-neurotics and psychopathic personalities, who show poor social adjustment. The material treated here is what is usually labelled as “hopeless.” Letters from Out-Patient Departments, seeking admission are prefaced, “We know this is a hopeless case …,” or “If you cannot help him then there is no hope for him …,” etc. During the four years of its existence the Industrial Unit has evolved and practised a variety of techniques of group psycho-therapy, in addition to the orthodox psychological and physical treatments available in modern psychiatric hospitals. More and more importance is being attached to the value of group methods here, to the extent that some doctors, after taking a brief history, thereafter employ group-therapy exclusively. This paper is an attempt to discuss the relative values and roles of therapy carried out at individual and group levels in the Industrial Unit.