A patient, S., voiced the opinion that subnormals, the blind, anyone with physical or mental imperfections should be exterminated. This included the psychiatrically ill and consequently himself. He had attempted suicide, and said that when he thought it appropriate he would attempt suicide again. In projective tests and interviews he expressed the wish to kill his father, and showed much sado-sexual fantasy and racial prejudice. Psychological tests showed that he was of average intelligence, non-retarded and abnormally overinclusive. He was diagnosed initially as “paranoid schizophrenic”. Such bizarre and macabre features are not necessarily dangerous, but S. was married with two young children. He believed his children to be highly intelligent. Another baby was expected shortly. This study attempted to predict whether these attitudes were potentially dangerous should the patient discover some imperfection in his family.

An unusual case of writer's cramp in a 12-year-old deaf girl is reported. Possible aetiological and contributing factors in her environment are discussed, with particular relevance to a hysterical conversion reaction.

We evaluated the dexamethasone suppression test (DST) as a predictor of response to drugs and placebo in 105 patients, in a large double-blind placebo-controlled out-patient trial to determine the efficacy of paroxetine HCI, a selective serotonin reuptake inhibitor, compared with that of imipramine HCI and placebo. The presence of a positive or negative DST did not predict response to either paroxetine or imipramine. However, a positive DST predicted a poorer response to placebo: only 3 out of 18 patients who showed DST non-suppression responded to placebo, as opposed to 11 out of 21 who exhibited DST suppression (P<0.05). A positive DST was associated with a 61% response to drugs and a 16% response to placebo. This finding suggests that the presence of a positive DST implies the need for active somatic treatment.

The three establishments which will most repay the trouble of a visit, a e the Bicêtre, the Salpêtriére, and Charenton; The Bicêtre is for male, the Salpêtriére for female paupers, and Charenton is a large private asylum for both sexes.

Sigmund Freud's family background holds extraordinary fascination, not just because he is an historic figure but because his very ideas centred around the influence of formative family relationships. In addition, Freud used his own experiences as one means of research, from which he concluded that some personal details only may be available in disguised form. This has proved an irresistible challenge to those interested in the evolution of Freud's theories.

I have ventured to suggest that we should now consider what we are going to do about the classification of mental disorders. Lately, the Royal College of Physicians of London decided to revise the Nomenclature of Diseases, and publish another edition. The President of this College is on the Committee; as is also Dr. Savage, our colleague in London, who has taken much interest in this question. I was somewhat surprised the other day when I asked for a copy of the Nomenclature of Diseases in the Royal Medical Society of London, to find that they did not have a copy in their library—a book which is supposed to guide the profession in the statistical registration of diseases. In 1896, for the third edition, an attempt was made to reform the nomenclature of mental diseases, under the direction of Dr. Hack Tuke and Dr. Savage. In its present state it is still unsatisfactory. The classification with which we have to deal is as follows:—First, there is “idiocy (cretinism), and then mania (acute or chronic), delirious, hysterical, puerperal, epileptic, traumatic, syphilitic, gouty, from either acute or chronic disease, alcoholic, plumbic, or other poisons.” Acute is an absurd word, because we specially want to mark the duration. Acute should be rendered Recent. Then there is “melancholia (acute or chronic), delirious, hypochondriac, climacteric, puerperal, epileptic, syphilitic, acute, other diseases.” Then there is “dementia (primary or secondary), senile, climacteric, puerperal, epileptic, traumatic, syphilitic, acute, other diseases.” Then there is “mental stupor, anergic, delusional.” Then there is “general paralysis.” That is not a mental disease. Lastly, there is “delusional insanity.”

The results of treating psychopaths and other mentally abnormal offenders at Balderton Hospital, Nottinghamshire, and in North Wales (Tables I, II and III), have shown that there is a small intractable group who react explosively when in the company of less disturbed patients, and who are best treated in a long-term unit specially designed for their needs. The small group surveyed here are mentally abnormal offenders of dull-normal or average ability whose aggression or inadequacy, sometimes combined with schizophrenia or resulting from brain damage, makes them prone to repeated convictions for violent acts, arson, sexual offences or drunkenness.

Between the clinical features of the following cases are. found differences flowing from two sources—one, the situation of the more marked changes following the injury; the other, the habitudes, tendencies, spread of, and line of action pursued by the morbid intracranial process eventually existing and dependent upon the injury.