Nearly everyone here, I imagine, has either been present at or has read the splendid Maudsley Lecture delivered in 1958 by Professor Leo Kanner (1). In this Lecture Kanner reviewed the various interests, or, as he called them, the loosely scattered segments which by their eventual convergence and fusion resulted in the emergence, between thirty and forty years ago, of child psychiatry. He caused them to pass before our eyes in a vivid and colourful procession—psychiatry, mental deficiency, education, criminology, psychology, psycho-analysis, the child guidance clinics, with paediatrics given a place of its own, though not allowed to march in the procession itself. Now, I have been asked to take up one or two of these segments for closer examination, and give some account of their contents and development during the pre-historic period before they began to converge towards their final synthesis. In so far as I am able to do this, my account will be merely factual; I must leave it to you who are engaged in this field of work to assess the relevance of the material which I am presenting.

The passage of small direct currents through nerve cells gives rise to changes in their excitability. For example an outward current flow through the membrane of the soma gives rise to depolarization and a consequent fall in the threshold for excitation of the neurone. When a cell lies in an applied external electrical field a potential gradient exists between the cell body and its distant processes. If this gradient is such that the cell body is negative relative to its processes, the cell becomes more excitable; it becomes less excitable when the cell body is relatively positive.

A previous paper (Lippold and Redfearn, 1964) described the mental changes that can be produced by the passage of small polarizing currents through the brain in human subjects. It became apparent during the course of these experiments that some of the effects persisted for hours or days after the current had been turned off. A persistent excitatory after-effect of surface-positive cortical polarization has recently been demonstrated in the rat (Bindman, Lippold and Redfearn, 1962). It is possible that a similar phenomenon, at the cellular level, is responsible for the long-lasting psychological effects of polarization.

A previous paper (Lippold and Redfearn, 1964) described various mental changes which occur when small direct currents are passed through the brain in human subjects. Some beneficial effects often followed this procedure and it appeared worthwhile to carry out a controlled double-blind clinical trial.

The problem of treating the “back ward” chronic schizophrenic is likely to remain for some years to come, and with it the problem of establishing the genuine effectiveness of particular treatments. Disentangling effective from non-effective therapeutic techniques in “total-push” programmes is particularly complicated. What precisely is responsible for the minimal improvements observed: some subtle change in “ward climate”, the altered medication or the new music therapist? Writers who view mental illness primarily as a breakdown in normal interactional relationships with other persons have stressed the therapeutic importance of certain types of social milieu (e.g. Martin, 1962). Others (e.g. Greenblatt et al., 1955) have suggested that the success of even the physical treatments can be explained in terms of the optimism and enthusiasm with which they are carried out. However, there are few systematic research attempts to disentangle the physiological from the psychological variables.

My purpose in this article is to draw attention to certain statistical features of manic depressive psychosis and to inquire into their possible aetiological significance.

I shall show that some of these statistical characteristics are very similar to comparable aspects of diseases that are widely considered to be autoimmune. Although it does not follow than manic depressive psychosis is an auto immune disorder, the parallels and coincidences are perhaps sufficiently striking to warrant further investigation.

In the previous paper (Burch, 1964), I discussed the possible significance of certain statistical features of manic depressive psychosis; in this one I shall consider corresponding statistics relating to schizophrenia.

In this paper age- and sex-specific first admission rates to hospital for involutional psychoses (Malzberg, 1955), are submitted to the same type of mathematical analysis as that used in the two preceding papers. To judge from the nature of the fit between the observed rates (for both sexes) and a highly restrictive mathematical function it seems probable that this diagnostic category—as used in New York State, 1949 to 1951, and by Kallmann (1953)—corresponds to a definite organic disease. Its relationship to the so-called involutional phase of life would appear to be coincidental. The disease is confined to a genetically specific sub-population and the phenotypic expression apparently requires the accumulation of 12 random events. Certain statistical properties of the system affected by these random events are closely similar to those of the “lymphoid system” in autoimmunity. The hypothesis can therefore be entertained that involutional psychosis—together with manic depressive psychosis and schizophrenia—is fundamentally an autoimmune disorder. However the primary pathogenic agent and its “target” organ have not yet been identified and the disease could equally well arise from stochastic disturbances in some other, hitherto unidentified, system, certain statistical characteristics of which are similar to those of the lymphoid system.

The entire population of Tristan da Cunha (264 islanders and 29 temporary inhabitants) was evacuated in October, 1961, after a volcanic eruption which, although it occurred in close proximity to the settlement, only damaged one out of the 70 buildings and caused no casualties. The evacuees were taken first of all to Capetown and thence by sea to England, where they arrived in November, 1961. Temporary hutted accommodation was found for them at Pendell Camp, an army establishment near Redhill, Surrey, where they spent the first eight weeks of their first English winter in conditions of some discomfort. In January, 1961 they were transferred to more permanent homes in R.A.F. married quarters at Calshot, a small place situated on the western bank of Southampton Water near its junction with the Solent.

Imipramine and amitriptyline have each been tested by controlled trials and have been shown to be effective (Garry et al., 1963; Skarbek et al., 1962; Ball et al., 1959; Leyberg et al., 1959, and many others). Their uses have been discussed in articles in the “Today's Drugs” series in the British Medical Journal for 1959 and 1961 respectively. The literature has been summarized by Burt et al. (1962).

Though there have been many studies on the pharmacological approach to depressive illness, opinions as to the indications for anti-depressant medication and the most appropriate substance to prescribe remain far from any state of general agreement.

It became apparent soon after the introduction of chlorpromazine and reserpine that these drugs were capable both of influencing psychoses and of producing neurological disturbances closely resembling those seen in post-encephalitic Parkinsonism. In classifying drugs with these effects as “neuroleptics” Delay et al. (2) indicated that they considered the two actions to be inseparable thus implying that both resulted from common or closely related neurophysiological changes. On this basis it seemed likely that drugs which more readily produced these neurological disturbances would prove more effective in psychotic illness. It also seemed possible that there might be therapeutic value in the deliberate provocation of such disturbances, as was first advocated by Fleugel (6). The theoretical issues involved were referred to in a previous paper (MacLeod and Moffat (8)).

A preliminary study (Robin et al., 1961) of twenty out-patients showed nealbarbitone to be a therapeutically useful drug. The following study was undertaken to validate this trial.

To Wordsworth, the source of these “intimations” seemed clear; it will be remembered that in the Ode bearing this title he says: