There cannot be many hospitals and medical schools owing their origins to the visual hallucinations and grim forebodings of a depressed monk. Yet that is precisely the story of how the venerable institution of St. Bartholomew's Hospital was founded. The monk Rahere, on a journey to Rome to obtain forgiveness for his sins, “fell ill and thought his last hour was drawing nigh. He burst into tears and vowed a vow that if he should be allowed to return to his own country he would there build a hospital for the recovering of the poor” (Moore, 1918). On his way home, he had a vision of St. Bartholomew who instructed him, among other things, to build a church in Smithfield. Was it, asks Moore, a fantastic illusion, such as men have in their sleep, or was it a heavenly oracle? Was the illness, he might have added, a depressive illness given the melancholic mood, tearfulness, feelings of impending doom, and gradual recovery? And why a vision of St. Bartholomew? The saint is associated with medicine, or more accurately with surgery. The fact that he was flayed alive and thereafter has tended to be protrayed pictorially with his skin draped in folds about his bones has suggested to some a distinctly ‘barber-surgeon’ flavour, and he is indeed the patron saint of butchers. Less well-known is the fact that he exorcised a devil from King Polimius's daughter—a therapeutic action which entitles him to be regarded as the patron saint of nervous diseases, (Dawson, 1957).

A survey of patients with drug-related problems seen in London casualty departments during the course of one month revealed 1,706 separate incidents. In 477 cases the patients were dependent on drugs, and more than 40 per cent were dealt with by only five hospitals, all in the West End of London. The remaining 1,229 incidents involved non-dependent patients who had taken a drug overdose, and these cases were distributed more evenly between hospitals all over the Greater London area. The implications of this study for service planning and for further monitoring of the patterns of drug misuse are discussed.

A 27-year-old neuroleptic-stabilised schizophrenic patient presented with a three-day history of psychomotor retardation, disturbed sleep, and social and emotional withdrawal following reduction of his anticholinergic dosage; his symptoms had intensified after an increase in neuroleptic dosage, based on a diagnosis of psychotic decompensation. Recognition of a cholinergic syndrome and institution of appropriate anticholinergic treatment resulted in rapid improvement. The clinical distinction between a cholinergic overdrive state and schizophrenic exacerbation, while sometimes difficult, can be critical in selecting appropriate management.