In the examination of a psychiatric patient it is usual to distinguish between objective and subjective symptoms. Objective symptoms in clude all concrete events that can be perceived by the senses, e.g. reflexes, registrable move ments, an individual's physiognomy, his motor activity, verbal expression, written productions, actions and general conduct, etc.; all measur able performances, such as the patient's capacity to work, his ability to learn, the extent of his memory, and so forth, also belong here. It is also usual to include under objective symp toms such features as delusional ideas, falsifica tions of memory, etc., in other words the rational contents of what the patient tells us. These, it is true, are not perceived by the senses, but only understood; nevertheless, this “under standing“ is achieved through rational thought, without the help of any empathy into the patient's psyche.

It is common knowledge that women often get depressed after childbirth. Yet there has been little evaluation of what this depression amounts to. Transitory tearfulness in the early puerperium, as observed in maternity wards, is commonplace; has been designated “the Blues”—3rd, 4th or 10th day, Maternity or Mother's—and is generally regarded as a normal phenomenon. It has been variously attributed to psychological difficulties and physical discomfort at the onset of lactation, “narcissistic loss before rediscovery of the child” (Sclare, 1955), perineal soreness and hormonal changes.

Relatively little is known about female homosexuality, and there are very few published studies which are based on a representative sample of the lesbian population. Many ideas on the subject are mere extrapolations from studies of male homosexuality. The majority of reports are psychoanalytically orientated and in most instances are concerned with very few highlyselected and atypical cases.

The clinical examination of nominal aphasia has hitherto involved relatively unstandardized procedures. Random objects are presented to patients and account taken of their success or failure in finding the correct name (Allison, 1962). Recent work by Newcombe, Oldfield and Wingfield (1965) and Rochford and Williams (1962–1965) has drawn attention to a number of important variables affecting the likelihood of a correct response occurring. Oldfield (1966) in particular has presented a model of the psychological processes involved in object naming which raises a number of important theoretical questions concerning the nature of the deficit in nominal aphasia.

Very few cases of thyrotoxic psychoses have been reported during the last twenty years. Recent authoritative reviews on the management of thyrotoxicosis and its complications (Ingbar, 1966; Trotter, 1967) scarcely mention psychotic reactions. It seems that such conditions have become increasingly rare since the advent of modern anti-thyroid treatment. The present report attempts to summarize what is known about these disorders, and describes the clinical features, treatment and subsequent course of a schizophrenia-like psychosis which developed during thyroid crisis.

Most reports on the treatment of drug addiction describe only some form of aversion therapy, either by electrical (Lesser, 1967) or chemical means (Raymond, 1964). There seem few reports in which any attempt has been made to correct the underlying disorder which was responsible for the patient's addiction (Seelye, 1967). The argument is put forward that the basic disturbance in drug addiction is frequently one of social anxiety, and that when this has been corrected the patient no longer requires drugs for his support.

The practice of psychiatry overlaps appreciably that of the other branches of Medicine. A high incidence of psychiatric illness has been found in out-patients attending medical and surgical clinics (Shepherd, Davies and Culpan, 1960; and Davies, 1964), and among in-patients in general medical and surgical wards (Meyer and Mendelson, 1960; Fleminger and Mallett, 1962; Eilenberg, 1965; Granville-Grossman, 1967). Other studies have shown an appreciable incidence of physical illness in out-patients attending psychiatric clinics (Davies, 1965), in psychiatric in-patients in a teaching hospital (Marshall, 1949; and Herridge, 1960), and in patients with mental disturbance attending general practitioners (Shepherd, Cooper, Brown and Kalton, 1964, 1966). The extent to which ordinary psychiatric in-patient practice involves dealing with non-psychiatric problems does not appear to have been extensively studied, although Davies, D. W. (1964) has indicated the presence of considerable physical morbidity within a psychiatric hospital population. We here describe an investigation into the incidence of physical morbidity among in-patients admitted to a general hospital psychiatric unit with a total responsibility to a catchment area population of 90,000, and into some of the factors affecting this incidence.

The measurement of muscle blood flow using occlusive plethysmography has recently been proposed as an objective index of anxiety (Harper et al., 1965; Kelly, 1966, 1967). Although the method has been used by physiologists for many years, and its sensitivity to psychological stress has often been mentioned as an incidental finding in physiological studies, its application in psychiatric or psychological research has been slow to develop, perhaps because rather cumbersome apparatus is required. However, promising results were reported by Kelly (1966), who differentiated patients suffering from anxiety states from mixed neurotic patients and normal controls, and who showed changes after leucotomy in anxious patients.

Toxaemia of pregnancy remains the “disease of theories” both in respect of its causation and treatment. Among the many treatments suggested, although not generally accepted, is the administration of progesterone from the middle trimester for the relief of toxaemic symptoms (1, 2 and 3). An unexpected finding has been the clinical observation that children of progesterone-treated mothers appear to reach their milestones earlier and to make excellent progress at school.

It is well known that there is a definite march of events from onset to ending in the epileptic seizure. The sequence of symptoms differs in the different forms. “Idiopathic” epilepsies have a march through aura, tonus, clonus, and recovery, while Jacksonian organic epilepsies show a characteristic march directly related to their brain anatomical location. Electrically induced therapeutic epilepsy likewise has a march of events which is fairly constant though deviations from the normal pattern do occur, and it is our purpose in what follows to establish and quantitate the normal sequence of events.

This paper reviews and reports on the frequencies of qualitative dermatoglyphic characters in schizophrenia. Dermatoglyphics is the name given by Cummins and Midlo (1943) to the study of the ridged skin found on the fingers, palms and soles. The biological value of dermatoglyphic investigation lies in the morphological constancy, from the time of formation until death, of the dermal ridge arrangements. The dermal ridges are fully formed by the fourteenth week of foetal development, therefore only genetic and prenatal environmental factors can influence ridge formation.

The aim of this study was to examine the factors leading to prolonged stay in hospital of patients admitted with mental disorder. It is part of a larger investigation on the interaction between the services provided for the same area by the psychiatric hospital and the psychiatric unit in the general hospital.

A previous paper (Morgan, 1967) demonstrated the extent to which long-stay psychiatric patients are handicapped by ignorance of the names of people whom they see daily. The mean performance of a sample of patients was less than half as good as that of a control group of non-patients. It was postulated that knowledge of another person's name is a useful tool in social intercourse, and that ignorance of a name represents a handicap to communication. It was further suggested that some cause and effect relationship exists between the social withdrawal of long-stay schizophrenic patients and their ignorance of names. The data presented in the previous paper did not serve to show whether this ignorance is treatable at all or whether current methods of treatment are in fact helping to treat it. The present paper aims to present some further evidence on these points, derived from a deliberate attempt to teach patients the names of other people.

The conduct of this survey has brought home to us the great diversity which exists in the amount, content and methods of teaching psychiatry in U.K. medical schools today. No two schools are quite alike in the type of staff facilities, in the allocation of teaching time in the several years of the course, or in the persons available to act as teachers. After two trial runs, we evolved a schedule of inquiry which has enabled us to compare schools in a number of respects in which reasonably reliable and quantifiable data were available. This report necessarily concentrates upon those aspects in which the various schools can be compared with each other: it does not do justice to the full detail of all the teaching given in any one school. In particular, we have deliberately confined our attention to teaching which is given to all students, whether they take advantage of it or not. Except for some observations on organized periods of elective study, we have not dealt with the extra opportunities which arc available in a number of schools for students who go out of their way to seek additional experience in psychiatry. Our schedule of inquiry was discussed by one of us personally with the psychiatrist responsible for teaching in every school except one—a London part-time teacher who remained obdurately “too busy” to comply with this request. It was found necessary, in the majority of cases, to supplement our interview and the schedule return by further inquiries; in a few particulars, and in respect of certain schools, we are still left in some uncertainty as to the accuracy of the information given to us. This report is submitted, however, as the best approximation possible within the limitations of our survey.

Educational objectives in medical school training used to be stated in global terms, seldom possible to implement and still more difficult to test (Objectives of Medical Education, 1953). The student's training hopefully was required to help him “to respect the rights and dignities of patients”, or towards “expecting to be a student all his life”. How to evaluate the presence or absence of these qualities after training was not conveyed either by the form or by the sometimes frankly inspirational language in which the objectives were stated.

In recent years British psychiatric training has received interested scrutiny from the other side of the Atlantic, and there has been appreciation of the broad based approach in dealing with the larger community of psychiatric patients, which as Keir (1964) has pointed out is beginning to occupy the attention of our American colleagues. It has been noted by Cameron (1965), Lesse (1966) and others that there are disadvantages in the predominant approach in American training—which focuses on dynamics, inference and formulation—in that this has produced a neglect of clinical observation and accurate description, giving little knowledge of syndromes or the natural history of psychiatric conditions.

The role of the doctor in society has changed rapidly over the past 20 years consequent upon great developments in the biological sciences and equally great changes in the society in which we live. In particular we would stress the following factors which would influence the medical curriculum.

In 1965 the Education Committee drew up a questionnaire on postgraduate teaching (prepared in a form suitable for I.B.M. punching) which was then circulated to every psychiatric hospital, psychiatric unit and teaching hospital in the United Kingdom and the Republic of Ireland, and to those hospitals abroad recognized by the Conjoint Board as providing training for the D.P.M. The questionnaires were sent out late in 1965, and after two sets of reminders the returned results were processed by the Tabulating Research Centre at Hampstead. Regrettably, the Centre, although providing a great deal of information very quickly, delayed for almost a year completing the processing of the data.