The thyroid, as one of the glands of internal secretion to be studied first and subsequently most intensively, was early regarded with interest in relation mental disorder. Its role in the production of cretinism and in myxoedema in which the activity of the gland is diminished, as well as the association of thyrotoxicosis with psychic changes, suggested that anomalies of this organ might be linked with some forms of mental disease.

The study of prognosis in mental diseases does not easily lend itself to exact definitions, nor can its conclusions readily be based upon scientifically prepared data.

Finding the blood-sugar level uncorrelated with the clinical symptoms of hypoglycaemia, Day and Niver (2) tried to establish the sugar level in the cerebro-spinal fluid as an indicator of the onset of coma. After examination of the sugar in both fluids every half hour from the injection of insulin until feeding of the patient, they found that coma began when the C.S.F. sugar reached a point between 30 and 15 mgm. per cent., whereas blood sugar was at its lowest point several hours before. The ratio C.S.F. sugar/blood sugar, normally between 10/8 and 10/6, was according to these authors “completely reversed” from the first hour after insulin injection onwards. They base their views on 43 observations of which only one was divergent, but no detailed figures are given. The four curves reproduced for illustration show the slow fall of C.S.F. sugar against the rapid falling blood-sugar level; but the alleged close correlation between coma and C.S.F. sugar can only be seen in one of the curves.

The reduction in the incidence of pulmonary tuberculosis among chronic psychotic cases has been one of the most striking indications of the improvement in conditions of institutional care during the present century. Provided that he is sufficiently co-operative, the patient who enters a mental hospital with an active lesion has generally at least as good a prospect of recovery as the patient who attends a general hospital or dispensary for a lesion of similar severity. For even if the nature of his mental disturbance may sometimes be such as to make his attitude to the illness unsatisfactory, he is often relieved of that fear of economic stress and feeling of obligation to his dependents to return to work as soon as possible, which so often prejudices recovery in the patient of sound mind.

The value of electro-encephalography as an aid to the study and diagnosis of nervous diseases is now accepted. The most valuable results have been obtained in cases of organic disease of the brain, particularly in space-occupying lesions and in epilepsy, but considerable attention has also been paid to the changes occurring in cases suffering only from mental disorder. The chief contributors to this subject are listed in the bibliography.

Derivatives of barbituric acid are in general sedatives, hypnotics and analgesics, but sodium amytal (S.A.) occupies a special position, because of its effect on certain mental and nervous conditions. It produces transient amelioration in catatonic schizophrenia and hypnosis-like conditions in neuroses. The latter is important through the fact that one is able to study hypnosis from a different pharmacological point of view.

In the normal individual toxic amines produced by bacterial action in the gut or elsewhere are readily destroyed by the amine oxidase, an enzyme which is present in the liver, intestine and other organs (Richter, 1938; Blaschko, Richter and Schlossmann, 1937). This process of detoxication is normally very rapid and efficient, but it has been suggested that in certain pathological conditions the detoxicating system may be defective, giving rise to an abnormally high level of toxic amines in the blood (Quastel, 1937).

In 1897 Ganser (1) gave a lecture entitled “Ueber einen eigenartigen hysterischen Dämmerzustand.” This has been translated literally as on “A specific hysterical twilight state,” which we consider unfortunate, as in keeping the words it loses the sense of the original, for the notion of a twilight state remains foreign to us, and is better rendered as a “dimming of consciousness” or “clouding of consciousness.” Further, the concept of hysteria has changed considerably since then and his cases would now be regarded as psychotic.