Problem.

The writer undertook to try out a number of mental tests on a group of senile patients and to submit a tentative battery for a further investigation of senescence.

The problem of estimating objectively the value of any new form of treatment is constantly presenting itself in all branches of medical work. In the case of shock therapy applied in the treatment of mental disease, the task is especially difficult. Standards of initial severity and degrees of improvement in mental diseases are subject to very wide interpretations. Disagreement on questions of diagnosis is common even among psychiatrists who employ the same terminologies. Thus, it is not surprising to find that widely divergent claims have been made about the value of shock treatment in mental diseases. In most of the large surveys, patients have been classified as (i) Recovered, (ii) Much improved, (iii) Improved, or (iv) Unimproved after shock treatment, but little unanimity about the results has emerged. In Table I, the figures given by Malzberg (1938) and Pollock (1939) for New York State and those for Ohio, given by Bateman and Michael (1940), are compared with figures obtained in a survey of the Ontario Mental Hospitals in 1941.

Malarial therapy as a subject for a paper may well have lost the sparkle that it once owed to novelty, but it should still be acceptable if only because the passing of time and the accumulation of experience provide an opportunity of confirming some of the tentative conclusions originally advanced, of emphasizing what has often passed almost unnoticed, even of disproving opinions hastily formed on insufficient data.

In the Tomlinson report on rehabilitation the definition of this form of treatment is given in its strictly medical sense as the process of preventing or restoring the loss of muscle tone, restoring the full function of the limbs, and maintaining the patient's general health, strength, etc. This is apart from such rehabilitation treatment as is required for particular diseases such as tuberculosis. The process should begin as soon as possible after injury or operation or, in the case of acute prolonged illness, as soon as the patient's condition permits, and should continue not only throughout the period of hospital treatment, but also during the subsequent stages of convalescence, whether that takes place in hospital or is provided in a separate centre. Continuity of treatment is essential to achieve the aim of restoring the patient's mental and physical capacity at the earliest possible date, and to the fullest extent possible.

Since psychiatry is that branch of medicine which deals with disorders of the psyche, it must inevitably include in its study the nature and activities of that which is thus disordered; it will therefore be granted that advances not only in scientific, but also in metaphysical, aesthetic and religious knowledge, must be of prime importance for the psychiatrist, since these are indubitably concerned with the activities of the psyche.

The group of mental disorders classified at present under the name of “schizophrenia” or “dementia praecox” offers a number of symptoms of not entirely “psychological” nature, and a more organic line of approach to the examination of these signs.