Schizophrenia is disputed territory. Thus, the numerous theories put forth to explain it are of all sorts: biochemical, genetic, religious, psychoanalytic, sociological, crosscultural, interactional, legal, moral, and so forth. These theories resemble, in a curious way, the productions of the schizophrenic patients on whose behalf they are constructed; they tend to be self-involved, and while they often display much internal consistency, they lack any comprehensible relation to each other.

Since Kraepelin's classical description of cryptogenic or functional psychoses—manic-depressive, schizophrenia and paranoia—the possible influence of culture on the frequency of these clinical reactions has been considered. Although it is recognized that there are other types of mental disorders peculiar to certain cultural groups (8, 12), it is acknowledged that the kinds of psychoses mentioned above are repeated in the various cultures (5).

El-Zar is one of the most popular traditional healing cults in Egypt, and it seems to have been introduced into the country from Sudan through Ethiopia. The word “Zar” means, in Amharic, the “devil” or “spirit”. Literally, the word is a derivative of the verb “to visit” and implies the intermittent visit of some wicked spirit. In practice, it generally connotes the gathering of some women, headed by a woman called “kodia”, with the purpose of exorcizing evil spirits.

Although the main value of hospital statistics is administrative, in connection with planning future needs of the mentally ill, they have been used by Shepherd (1957a), Brown et al. (1961), Barr et al. (1962), and Ratcliff (1964) to study trends in the characteristics and fate of patients admitted to mental hospitals. Since the factors that govern the admission of patients to psychiatric hospitals are both complex and varied, as has been shown by Svendsen (quoted by Reid, 1960), it would be more correct to say that the studies referred to describe the end-results of a number of factors interacting with each other and changing from time to time, such as hospital policy, demands of the mentally ill, available resources, therapeutic advances, attitudes of the community to admission, the state of the law, and so on. All these factors could be expected to influence the number and characteristics of patients admitted, especially for the first time.

This report was stimulated by the fact that two middle-aged depressive male patients killed themselves in the same ward under identical circumstances within a fortnight. It was thought that it would possibly be instructive to examine the hospital records since its opening in 1866 to look at the available information about patients who had committed suicide whilst under inpatient care here. The total number of suicides to date has been 24 and in the years 1901, 1911, 1955, 1957 and 1965 there have been two suicides in each year. There was sufficient information available to suggest that there were certain similarities between those occurring in the years 1901, 1957 and 1965, so these cases are considered in greater detail in the following reports.

Psychiatric consultation in many general hospitals is regarded in much the same light as the French Revolution; it has its hazards and its critics, but tends finally to be accepted as “a Good Thing”. Various aspects of consultation have been discussed, (1) (2) (3) (4) (5) (6) (7) (9), but the findings of Mendelson and Meyer are of particular interest, for they point out the high degree of social and family disruption in the patients seen. Elsewhere, the same authors indicate that the impetus for consultation comes, not from the patient, but from the physician, and that disturbed behaviour leads to the psychiatrist being called in (8).

There is no doubt that electro-convulsive treatment is a safe treatment, perhaps very safe, yet from time to time reports of a fatality appear in the literature. When death occurs, most authorities agree that it is the cardiovascular system that fails. When there has been no suggestion of respiratory mismanagement, and death has been unrelated to the actual fit, vagal over-activity has received attention as a cause of death. It has been said that almost the only physical contraindication to treatment is a recent coronary thrombosis. Whatever the truth of this may be, uncertainty exists as to the “buffetings” an ischaemic myocardium or a diseased arterial system will tolerate.

This investigation began as an attempt to measure the anxiety shown by patients while awaiting electro-convulsive therapy. One measure used was an assessment of the degree of palmar digital sweating, using the plastic paint technique described by MacKinnon (1963). This is a method by which the number of active sweat glands in a given area at a given time can be counted. In a preliminary trial, the effect on sweating of waiting for E.C.T. was equivocal, but there seemed to be an increase in sweating in depressed patients as their clinical condition improved. In the main trial, therefore, the emphasis was placed on differences in sweating of depressed patients when ill and recovered, though the reading in the E.C.T. waiting-room was retained.

Endogenous depression appears to be frequently associated with autonomic disturbances, and it has been suggested that in this condition there may be some abnormality of the hypothalamus (Elithorn, 1962; Pollitt, 1965), investigation into which might throw light on its aetiology.

Sleep disturbance is commonly found in depression. Plasma cortisol levels in non-hospitalized normal subjects show a rise prior to waking, with peak values at between 5 and 8 a.m. (9, 10). In a group of eight normal subjects, Perkoff (10) changed the sleep rhythm to sleeping during the day, using darkened rooms, and found that the plasma cortisol level followed suit, rising sharply in the two-hour period before waking. He stated: “A fundamental characteristic of the diurnal variation of plasma 17 OHCS concentration is the abrupt rise which occurs during the sleep period.”

In the study of mental diseases and their treatment physical activity seems to be an important variable. In order to get an objective recording of physical activity, we have applied two methods. In this study we wish to show how a normal group behaves under different circumstances concerning these two measures of activity, and we also report a pilot study in which the two methods were applied to a group of patients with mental diseases.

The impressive successes of early Behaviour Therapy are now being subjected to critical revaluation, whilst current work in the field employs more sophisticated methodology (Marks et al., 1965; Eysenck, 1964; Lazarus, 1961; Lang et al., 1963). The treatment is entirely symptom-centred and so its effects should be more easily assessable than those of other forms of psychotherapy. Yet results are still controversial, in spite of efforts to apply all the normal control measures.

As cases of fatal non-responsive anaemia have been observed in schizophrenia over a period of years, with few corresponding cases in other mental diseases, it was decided to collect and tabulate the findings in cases in which full histological examinations had been carried out. This was done covering a period of 11·5 years (1951–1963).

The present work is a psychiatric cytogenetic study of a patient with “pure gonadal dysgenesis”. This term was first used by Harnden and Stewart (1959), but Swyer (1955) had already drawn attention to the clinical condition of a tall female with hypogonadal signs, amenorrhoea and poorly developed secondary sex characteristics, and Hoffenberg et al. (1957) had described two tall patients with gonadal dysgenesis and recognized this as a variant of Turner's Syndrome because of the normal stature and lack of congenital malformations; they termed it gonadal dysgenesis in the normal-looking female.

For a series of 972 first admissions of functional psychoses admitted to Gaustad Hospital between 1938 and 1950 a long-term clinical follow-up has been carried out. The prognostic importance of clinical, social and genetic factors was analysed in great detail (1).