In recent years attention has been drawn afresh to a group of cases in which there is a hyperostosis of the flat bones of the skull, associated with various mental changes and signs of endocrinological disturbances. In 1761 Morgagni mentioned the existence of hyperostosis of the inner table of the skull, and referred to its association with virilism and obesity. Morgagni's brilliant observation was neglected until recently, when it was proposed to name the condition Morgagni's syndrome. F. Morel (1931) published his monograph on frontal hyperostosis of the skull, and expressed the opinion that hyperostosis frontalis interna is a well-defined disease. He suggested that the proliferation of bone is provoked by adhesions between the dura and the inner table of the skull. As characteristics of the syndrome he described obesity, polyphagia, polydipsia, disturbance of sleep, weakness of muscles, loss of sight, headaches, and sometimes epileptic fits. In his opinion a pituitary disturbance is the primary cause of the disease. Shortly before Morel, R. M. Stewart (1928) described cases of insanity with localized calvarial hyperostosis. He found sclerosis of the anterior lobe of the pituitary, which he considered was the responsible cause. Schiff and Trelles (1931) suggested that there might be a relationship with Dercum's disease. Dressier (1927) and Greig (1928) dealt with the pathology of the bony changes. Greig suggests that a disturbance of the calcium and phosphorus metabolism is the causative agent. Critchley (1931), dealing with the neurology of old age, emphasized the importance of hyperostosis frontalis interna. A very extensive series of skulls taken from the average hospital population was investigated by Sherwood Moore (1936), 6,650 in all. In his case material there was 1.4 per cent. of hyperostosis. He tried to classify hyperostosis into four forms.

In his book, Psychology and the Soldier, which gives a critical estimate of the psychologist's contribution during the last war, Bartlett (1) makes an interesting statement which takes on new meaning at the present time. Commenting on the fact that intelligence tests may safely “rule out a man” from participation in activities which may endanger the group, he queries whether a man can as simply be “ruled in” for filling a responsible position. “For practical purposes,” Bartlett says, “temperament is a more important factor in success than intelligence, as the latter is understood in the mental test movement. Slight variations in temperament may make a bigger difference to a man's practical value in any social organization, such as an army, than large variations in intellectual processes. No doubt much can be done by psychological examination to discover a man's real temperamental qualities; no doubt a psychologically skilled or a psychologically trained observer can detect such qualities speedily and with reasonable accuracy. But the satisfactory direct temperament test has yet to be devised, and very likely never will be found.”

In the world of mental diseases schizophrenia may well be termed “the sickness that destroyeth in the noonday.” Although the replacement of Kraepelin's nomenclature of “dementia praecox” by Bleuler's term, “schizophrenia,” has carried with it a general recognition that the chance of recovery is better than had been originally anticipated, the doom of those who do not recover is amongst the most dreadful meted out by any disease. It so frequently means a body apparently fully alive with a mind permanently impaired or virtually dead. Despite the obvious desirability of assessing the prognostic chances of the individual case, the statistical works published up to date have failed to establish agreement as to how this may be done. The object of this paper is to combine a detailed examination of the literature with a personal study of the histories of over 100 cases of schizophrenia in an effort to reach a definite conclusion in this matter. The paper will be divided into the following parts: I, a detailed survey of the literature; II, the outcome of 120 cases studied by myself; III, a comparison of remission rates and prognostic factors in cases treated by cardiazol.

The behaviour of animals and man may be approached from many points of view, but there is one feature of their behaviour which is outstanding in its importance and in its difficulty. I refer to the peculiar “adaptiveness” of animals' behaviour. The concept is vague, but everyone knows, roughly at least, what is meant by it. It is certainly one of the most remarkable features of animal behaviour. In psychiatry its importance is central, for it is precisely the loss of this “adaptiveness” which is the reason for certification.

It is not uncommonly believed that convulsion treatment produces its successes mainly or entirely through the fear which it engenders. This opinion, more often implied than definitely stated, has been crystallized by McCowan (1), who boldly wrote:

“No reasonable explanation of the action of hypoglycæmic shock or of epileptic fits in the cure of schizophrenia is forthcoming, and I would suggest as a possibility that as with the surprise bath and the swinging bed, the ‘modus operandi’ may be the bringing of the patient into touch with reality through the strong stimulation of the emotion of fear,” and “that the intense apprehension felt by the patient after an injection of cardiazol, and so feared by the patient, may be akin to the apprehension of the patient threatened with the swinging bed. The exponents of the latter pointed out that fear of repetition was an important element in success.”

In a recent paper (1, 2) Abse elaborates at some length the psychological aspect of cardiazol therapy, and suggests, among other things, that “asa result of repeated danger-situations and perceptual stimulation repression and organization (synthesis) follow as a psycho-biological necessity. The convulsion gives rise to objective anxiety and repression results, so that the ego, whose function it is, may deal with the situation. There may be factors (e.g. quantitative) which make this desirable conclusion impossible to establish… . The physician can exploit his relationship to the patient to the latter's benefit… . and he (the physician) can increase his knowledge of the operative conditions in the patient's life by observation of the pre- and post-convulsive episodes.”

A small controlled series of cases of schizophrenia was treated with cardiazol at this hospital. A list of all those thought suitable for treatment was drawn up in order of date of admission and divided into two by selecting alternate cases. From the prognostic point of view there was little to choose between the two groups. The average duration of illness for all patients was six years. At the Berne-Munsingen Congress it was agreed that the remission rate falls rapidly with the duration of the illness, and that few cases of over four years' duration recovered with cardiazol treatment. This is also the opinion of others (1), (2), (3), (4), (5), (6), (7), (8), so no startling results were anticipated.

The purpose of this paper is to attempt to correlate results obtained from liver tests with the nosological demarcation of psychoses. The knowledge of the outstanding importance of the liver in general metabolism (it provides 12% of the turnover of energy of the body) and of its relation to some organic diseases of brain has been the subject of numerous investigations. Expectation of finding the starting-point of any disease in the liver, however, will at first not be placed too high if one recollects that every gland is only part of a system. Even where the symptoms of liver or other glandular impairment are characteristic for limited groups of psychoses deductions must be guarded, and the discovery of an unequivocal bodily symptom does not mean elucidation of the aetiology of a mental disease.

In the course of routine clinical work with excited patients I found that a dose of 3 drm. of paraldehyde with 3 gr. of dial (2 tablets) often produced a long and sound sleep where other powerful narcotics were relatively ineffective. It therefore seemed worth while to try the combination for prolonged narcosis. At the outset it was attractive in that it was cheap, was given by mouth, and that both drugs had a good reputation for efficiency and safety. Paraldehyde has also the special advantage of not being a cardiac depressant (Edmonds and Gunn, 1936; Sollman, 1937). Both drugs have been used before for prolonged narcosis, but not in this combination, and usually in much higher doses. [For references, see reviews of Palmer (1937) and Gillespie (1939).]

The Terman vocabulary test is probably used in mental hospitals more often than any other single test for measuring intelligence. The 1937 Stanford Binet Vocabulary List contains only 45 words selected from the original hundred. There is therefore a temptation to use it in place of the old one on account of its brevity. But this may cause serious errors.

Numerous workers (Plaut, 1935; Altaman, 1937; Monouni, 1937) have reported that the blood and spinal fluid ascorbic acid levels are low in the aged. No adequate explanation of this fact has been given. Wortis (1938) has suggested that, since oral administration increases the ascorbic acid level of the spinal fluid in the aged as in the young, defective absorption probably does not play a significant part. He believes that the lower values in older persons may be due to increased intensity of metabolic processes concerned with the elaboration of ascorbic acid. Friedman, in discussing this contribution, advanced the suggestion that in older persons there may be less need for ascorbic acid because metabolism is slowed.