This is a clinical and pathological report on an unusual case of periarteritis nodosa in which the disease was confined chiefly to the brain and spinal cord. The diffuseness, variability and intermittency of the neurological signs and symptoms over a period of two years, in the absence of many of the more usual somatic manifestations of periarteritis nodosa, was responsible for the nature of the disorder not being diagnosed before death. Mental symptoms were prominent throughout the last year of illness. T.A.B. pyrexial therapy coincided with a marked remission in physical and mental symptoms, whilst arsenical therapy appeared to precipitate the terminal exacerbation of symptoms.

Methods employed in convulsion therapy have undergone many changes since the development of this treatment by Meduna in 1933, using oil of camphor as the convulsive agent. More efficient analeptics such as cardiazol and ammonium chloride soon displaced camphor, and they in their turn have gradually, although not entirely, fallen out of favour since the introduction of electrically produced fits by Cerletti and Bini in 1938. Curarization as suggested by Bennett in 1940, has certainly minimized some of the dangers but, on the other hand, often requires more staff than are available if large numbers of patients are being treated in the one session. In addition, the mental confusion, frequently prolonged, following any form of full convulsion therapy, may give rise to difficulties of an administrative nature as, for example, in out-patient E.C.T. It is in order to minimize these disadvantages that an alternative method has been sought.

In a previous paper (Early, 1946) I reported and commented on the preliminary mass radiography survey in the Bristol Mental Hospital in December, 1944. Each year since then the entire patient population has been subjected to mass radiography and in this paper the results of this work will be reported.

It is perhaps not too fanciful an analogy to compare the expanse of psychiatric symptomatology to an expanse of sea scattered with a small and determinate number of islands.

Multiple personality in its true form is a comparatively rare occurrence. Taylor and Martin (19) in a recent survey place the estimate at about 150 cases. In their definition, however, they exclude many cases which seem “too hypnotic, narrowly hysterical, evidently organic, psychotic, likely faked, or insufficiently described to be called multiple personality.” The following case, although it might fall into the “narrowly hysterical” category, appears to be of sufficient interest to justify publication.

Myanesin was first investigated in animal experiments by Berger and Bradley (1946) and found to have a curare-like muscle relaxing effect. This they thought was mainly due to action on the spinal cord, because strychnine convulsions were inhibited by the drug. Smaller doses were more effective for this than for the reduction of Metrazol convulsions. Hunter and Waterfall (1948) reported an immediate disappearance of epileptic seizures in man after intravenous administration of.4-1 gm. of Myanesin. Gammon and Churchill (1948) found that the spike and dome pattern of the E.E.G. in cases of petit mal disappears following Myanesin, whereas E.E.G. alterations associated with grand mal seizures were uninfluenced. Higher doses might, however, abolish these changes. Geer (1949) used the drug (in doses up to 3 1/2 gm.) in conjunction with electric convulsive therapy (E.C.T.) for mental disorders and found it of no demonstrable value because it apparently tended to make convulsions more severe, although it slightly increased the voltage time stimulus necessary to produce a convulsion. Unna and Kaplan (1949) examined the anticonvulsive properties of Myanesin in mice. Metrazol seizures of mice treated with Myanesin were seen to be at least as severe as controls and often prolonged. The tonic extensor phase was, however, eliminated. The death in Myanesin-treated animals was delayed as compared with controls. Electroshock also caused a seizure in 89 per cent. of the Myanesin treated mice, but no deaths occurred, whereas controls without Myanesin had a mortality of 33 per cent. Here, again, Myanesin appeared to abolish the tonic phase of the fit and only more violent clonic convulsions occurred. Schlau and Unna (1949) reported that the pattern and duration of seizures in E.C.T. in man were not changed following 2 gm. of Myanesin four times daily by mouth. They did, however, observe a shortening of the period of apnoea following the convulsion.

The Rorschach personality test is based on the stirrings of imagination. The interpretation of the structureless inkblots by the tested person stimulates his imagination in such a way that he projects his inner thoughts into the responses. Imagination is not merely one of the functions of a personality, but it is an expression of the personality as a whole. Medieval thinkers have described this by calling imagination “the star of man,” by which they meant the essence of his personality. This is the reason why the Rorschach method is a valid test for the assessing of personality.

Concentration changes of blood constituents other than glucose occurring during hypoglycaemia, and particularly during insulin shock therapy, have been studied by several authors (e.g., Harris, Blalock and Horwitz, 1938; Katzenelbogen et al., 1939) though not always with concordant results. One of the most constant features of insulin hypoglycaemia is a decrease in the level of inorganic phosphate during the phase of blood-sugar fall and a gradual return to normal after the blood-sugar curve has reached its lowest value. This fact which was described soon after the discovery of insulin (see Cori (1931) for a review of the older literature) is generally attributed to the increased phosphate esterification consequent upon the enhancement of glucose utilisation and is in harmony with the current concept that the function of insulin is primarily that of a promotor of glucose phosphorylation.

Suicidal attempts by coal-gas poisoning are very common. Carbon monoxide is a principal constituent of this gas, and can produce severe and permanent brain damage. It is surprising, therefore, to find so few cases of chronic organic psychosis attributed to this cause in mental hospital practice. Rosseter (1928) found only one example of permanent psychosis in 2,000 cases of carbon monoxide asphyxiation. Shillito, Drinker and Shaughnessy (1936) made a follow-up study of 21,000 cases of acute carbon monoxide poisoning. In only 43 of these were the after-effects sufficiently severe to warrant their admission to a mental hospital. Twenty-three subsequently recovered, 11 died, and 9 suffered permanent nervous and mental sequelae. They found that the ratio of psychosis following carbon monoxide poisoning to other psychoses was 1 in 2,000. Henderson and Gillespie (1944) could find only one such case in 5,000 consecutive admissions.

The man, B. T—, who is the subject of this short paper, is an ex-service man aged 32. On 4 October, 1949, he was charged at Quarter Sessions on 20 counts of stealing from the offertory boxes of churches. He was put on probation on condition that he entered this hospital. Previously he had committed 68 similar offences, and has been in prison for 8 months. In 1939 he suffered a head injury and since then has had attacks of headache, vomiting and visual disturbance from time to time.

It is widely recognized that judgment of time may be grossly disturbed in amnesic states of organic origin. Korsakoff (1890), in his classic exposition of the syndrome which has come to bear his name, pointed out that memory for time is often more severely affected than memory for events, and that temporal reference may remain markedly defective, even after remission of the psychosis. Thus one of his patients was able to recall recent events with fair accuracy, but was unable to state whether a given event had occurred yesterday or three years before. After recovery, moreover, this patient presented disturbances in the temporal sphere as the most outspoken residual symptom. Korsakoff further observed that defects of temporal localization might appear as the most prominent manifestation in mild cases of the amnesic syndrome. It would seem, then, that disorders of time judgment form an integral part of this syndrome and may well reflect a disturbance of memory at its highest levels of psychological organization.

The term “Group-Therapy” can have two meanings, and it is well to keep the distinctions clearly in mind. It can refer to the treatment of a number of individuals assembled for therapeutic sessions, or it can refer to a planned endeavour to discover (and so make accessible to the understanding, and thus control) the forces which operate in the participating group.

Tredgold (1948) points out that the “importance of studying the mental health of British troops in the Far East … is unlikely to have diminished with the end of the war,” and he emphasizes that “as long as conscription exists, the mental health of the young man doing his military service will be of great importance to the welfare of the community.” For this latter reason the writer has thought it desirable to report some of the experience he gained during 1948. At that time, he was one of the two psychiatrists stationed in Singapore who dealt with the vast majority of the psychiatric casualties that occurred in the Far East.

There is a distinct variety of mutism in children which Tramer (6) and others call “elective,” i.e. partial, occurring vis-à-vis certain persons only. The children are “sensitives” in Kretschmer's sense, i.e. they are timid, shy, susceptible to teasing and irony, and come from an insecure milieu; the abnormality is often familial.

This paper is chiefly concerned with the recent developments in industrial selection techniques at these works. However, below its chocolate covering, I hope you will find that its centre, although still recognisably confectionery, contains ingredients, varied in origin and possible other use, possessing, if properly masticated and adequately digested, fundamental values not specific to chocolate.

Although psychotic attacks following overdoses of amphetamine are well known, the following case is reported because it appears unusual in that repeated attacks of mental illness, over a period of several years, have occurred following the ingestion of this drug.