Research workers are commonly regarded as geese who occasionally lay golden eggs. The three main ways of encouraging them to do so reflect different views of the extent to which this odd process can be either stimulated or directed.

The importance of diagnosis, both in rendering available the knowledge accumulated in the past and in providing a guide to future developments, has long been emphasized in British psychiatry. Thirteen years ago, Mayer Gross, Slater and Roth (5) observed in the first edition of their textbook that diagnosis “has never been only naming and labelling. Ideally it implies judgment of causation, and even if this is impossible for lack of knowledge it always includes a plan of action, i.e. of treatment. …” The authors contrasted this approach with a derogation of the value of diagnosis which they felt had become extant in certain schools of psychiatry, and they deplored this tendency, stating unequivocally “the contemptuous attitude to diagnosis which is so prominent a feature of many contemporary schools runs counter to the entire spirit of medicine”. The pendulum now appears to be swinging back and, whilst several centres have remained preoccupied with socio-cultural and psychodynamic approaches to psychiatric illness, interest in psychiatric diagnosis has redeveloped both in Great Britain and in the United States (Kreitman, 1961; Kreitman et al., 1961; Ward et al., 1962; Sandifer et al., 1964, 1966, 1968). The phenomenon is probably related to a current tendency to exchange ideas across the Atlantic, and to the need for a common diagnostic code emphasized by cross-national epidemiological data, mental hospital population movement statistics, and studies of the efficacy of treatment. Clearly adherence to universally accepted diagnostic criteria is mandatory if meaningful comparisons are to be drawn from these and other psychiatric statistics obtained from different national settings.

This study is mainly based on my work in psychiatry in the Clinic of Nervous Disorders, Khartoum North, and with my private practice patients. I have seen altogether 2,160 patients. The distribution of psychiatric illness in these is shown in the table below. The two populations of patients attending the Government clinic and private practice are comparable, and the same patients interchange. A comparison is made in this paper between psychiatry in the West, mainly British psychiatry, and Sudanese psychiatry.

In the following paper a short clinical, descriptive account is given of the first 1,000 patients attending Ain Shams University Psychiatric Clinic from the beginning of 1966. Although the clinic is in the centre of Cairo, its catchment area extends all over Egypt. Patients are referred through three channels; either general practitioners send them for a psychiatric opinion or they come from other medical out-patient clinics at the University. The third group represents those who come independently and ask for psychiatric examination. Usually these are patients from the countryside who have tried lay therapy in their villages but without improvement. This group represents a deficit in the organization of referral, as many of them, having been examined at the psychiatric clinic may have to be referred to another medical out-patient clinic because of a non-psychiatric organic pathology.

In European and American psychiatry, catastrophes like divorce and death of parents occurring in childhood are considered to be important factors, contributing to the psychogenesis of emotional disturbances. However, while dealing with neurotic Ethiopian students, the authors were struck by the conflicting role played by the apparent instability of marriage in this country, the frequency of death of one or both parents and the early departure from home of a child to get proper education. On the one hand there were such observations as the obvious unhappiness about his past of a neurotic student, who was deserted by his mother and left in a hospital for more than a year when her husband abandoned her. Later his mother accepted him once more, and he was called “the one who died and came back to life”. His father even started to visit his first wife again, among other things to tell her that the children of his second wife were so much more clever. Are these experiences exceptional and significant, or is the next observation more representative? Two small children were examined during a home visit, and afterwards directed to return to their mother. Without the slightest doubt and with evident affection they chose their grandmother, while their own mother, a next-door neighbour since she had taken another husband, stood looking at the scene with nothing more than neighbourly interest. It is obvious that the significance of a broken home (by which is meant death of one or both parents and permanent separation) needs to be reconsidered under the circumstances prevailing in a country like Ethiopia. One way of approaching the problem could be provided by a child's behaviour at school as related to the occurrence of above-mentioned catastrophes. Sherwin and Schoelly (1965) name the school-community as one “reference group” providing standards of normal behaviour. Employing the native teachers as observers would include an additional advantage. We, as European observers, might run the risk of introducing cultural biases when we judge a child's behaviour ourselves.

Since the Second World War the number of Italians working in Switzerland has greatly increased. In 1962 there were officially 454,000 Italian workers in that country and this is almost certainly an underestimate. In 1960 and 1961 one of the authors (Risso) investigated the social, cultural, genetic and other factors in the mental illnesses of 709 Italian patients in psychiatric clinics and mental hospitals in German-speaking Switzerland. These patients had rather unusual symptoms in that there was a mixture of normal ideas, which appeared to be derived from their cultural background, and psychotic or psychotic-like symptoms. It was therefore often difficult to allot these patients' illnesses to one of the usual diagnostic categories, so that it was not easy to decide if the patient had a schizophrenic episode, a schizophrenic reaction or a non-psychotic psychogenic reaction.

It is by now widely recognized that patients undergoing a course of electroconvulsive therapy (E.C.T.) may frequently be troubled by some form of memory disturbance. Despite some thirty years of research and speculation on this subject, we are still a long way from understanding the precise nature of these disturbances or their physiological basis. Opinions vary as to their severity and duration and even as to the possible role they may play in the therapeutic process itself. It is, however, generally agreed that a very considerable number of patients complain of memory disturbance during or after a course of E.C.T., and that this may constitute a source of anxiety and distress, if not of practical inconvenience. Treatment is occasionally refused or discontinued on these grounds, and some psychiatrists are reluctant to prescribe E.C.T. in cases where a patient's work might be handicapped by memory impairment. Some degree of disturbance is, however, usually accepted as a calculated risk when prescribing this treatment.

Electroconvulsive therapy, modified by intravenous anaesthesia and muscle relaxants, has long been accepted as a satisfactory form of treatment. Relatively simple and safe, and effective in selected cases, the technique has undergone little change in recent years and seems almost in danger of becoming fixed indefinitely in its present form.

Four years after E.C.T. was first introduced by Cerletti and Bini (1938), Friedman and Wilcox (1942) investigated the effect of unilateral E.C.T. in eleven psychotic patients, using a pair of electrodes on the vertex and on the left temple above the ear (or, in one case, the left frontal region). Since that time there have been a number of published reports of the effect of administering E.C.T. unilaterally, using a variety of electrode placements and shock parameters, some limited to the supposedly non-dominant right side of the head (Goldman, 1949; Lancaster, Steinert and Frost, 1958; Cannicott, 1962; Bilikiewicz and Krzyzowski, 1964; Dolenz, 1964; Martin, Ford, McDanald and Towler, 1965; Impastato and Karliner, 1966; Cannicott and Waggoner, 1967), others comparing right- and left-sided treatment (Blaurock, Lorimer, Segal and Gibbs, 1950; Pacella and Impastato, 1954; Zamora and Kaelbling, 1965; Gottlieb and Wilson, 1965).

A sociological study of hospital-treated psychiatric disorder, designed to discover what social groups make use of a particular service, and for what reasons, adds another dimension to the understanding of clinician and administrator. Such a study must also reflect the changes in mental hospital practice which have followed the Mental Health Acts of 1959 and (Scotland) 1960, and the effect of these changes on individual attitudes towards in-patient care. The recent opening in Edinburgh of a completely new psychiatric admission hospital provided appropriate stimulus and setting for the present inquiry.

The need for increased services for the treatment of alcoholism has been officially accepted and indeed emphasized in recent years (15, 20). The following evaluation of an Alcoholic Unit is based on the response to treatment over the course of one year shown by a cohort of 100 patients, half of whom were admitted to the Unit while the remainder were out-patients. The study aimed at describing the patients referred to the unit and at ascertaining what attributes of the patient and his treatment appeared to influence the prognosis.

In the second half of the fourteenth century, the whole problem of poverty became in England for the first time a matter of government concern. The contractual relationship between landlord and villein which had prevailed during the Middle Ages, was breaking down, and the Black Death hastened this process. Statutes dealing with vagrancy and poverty were promulgated in 1349, 1351 and 1388: the able-bodied beggar was punished in the stocks and generally repression was the keynote, but despite harsh laws vagrancy increased. In a series of statutes from 1531–1601 the Tudor sovereigns initiated a system of local relief based on the Parish unit. In 1576, Houses of Correction were established: