While it is usual among psychiatrists to express dissatisfaction with psychiatric classification and its problems it is by no means unusual for their psychological colleagues to advocate factor analysis as an effective technique for resolving such problems. For example, Burt (1954) describes factor analysis as “essentially a statistical device for securing the best available scheme of classification”. Yet the problems and the device tend to remain apart, the former becoming intensified, the latter undergoing continued improvements. Twenty-five years ago T. V. Moore (1930) demonstrated that the application of factor analysis to the study of psychiatric disorders was feasible, and more recent work, especially that of Eysenck (e.g. 1947) has impressively shown its fruitfulness. That some clinicians remain sceptical of the claims made for these techniques is, in part, due to the infrequency with which factorial studies bearing on psychiatry have been pursued far enough for their implications to be tested and the findings integrated with those established by other scientific methods. This deficiency may be attributable to the fact that large scale programme research (Eysenck, 1953) is an almost essential condition, if this is to be achieved.

Similarity between certain of the visual effects of mescaline and hypnagogic imagery has been independently noted by several investigators, one of the earliest of these being Weir Mitchell (1896). Our own research group first became interested in hypnagogic experiences when one of the writers, as subject, in seeking to communicate the character of his mescaline visions, likened them to images he had encountered just before sleep. This led to an investigation of hypnagogic imagery as such, the results of which have been published elsewhere (McKellar and Simpson, 1954). Further experiments with mescaline, and consideration of the relevant literature of the two fields, suggest that the mescaline-induced and hypnagogic states are more than superficially alike, and that a comparison may illuminate the processes at work in each.

One has to admit that the treatment of the mentally ill by psychological methods only leaves something to be desired, for even in the neuroses the long term results of psychotherapy are at times disappointing. Shorter methods of treatment, more economical of time and surer of outcome are constantly sought and, of course, there remains the very considerable problem of how to treat the not over-intelligent neurotic who can never hope to achieve profound self knowledge or insight.

It is now several years since acetylcholine was first administered intramuscularly in the symptomatic treatment of anxiety, on the theory that anxiety was sympathicotonic in nature and could be counteracted by the vagotonic action of acetylcholine. Unfortunately decomposition of acetylcholine is so rapid that there is little time for this action to be effective, and the majority of investigators believe that it has no effect, or at least a momentary one, when given either subcutaneously or intramuscularly. Maxwell Jones (1936) used carbachol, a drug with a similar but more prolonged action than acetylcholine to treat six patients with anxiety neurosis. He was able to report relief from the psychic and somatic symptoms of anxiety in all cases but unfortunately, following withdrawal of the drug, they tended to relapse. An entirely different rationale led Tomasson (1936) to claim both alleviation and shortening of the duration of attacks of mania in manic depressive psychotics using a combined ephedrine and acetylcholine treatment.

The first recorded attempt to use carbon dioxide inhalation systematically as a form of psychiatric treatment was by Lovenhart et al. (1929). The subjects were catatonic schizophrenics and such modification as occurred was fleeting in nature.

In 1943 Meduna began to use carbon dioxide inhalation in the treatment of the neuroses and his efforts were described in a series of papers and developed in a monograph (1950). This contains a full description of the physiological and pharmacological effects of carbon dioxide upon nervous function and the technique of administration is described as are also the results in 100 patients. These results are taken as giving some support to a neurophysiological theory of the neuroses based on homeostatic and cybernetic considerations. Efforts were made to minimize the effects of “suggestion” and, although the difficulties are acknowledged, the following passage suggests that the author was reasonably satisfied with his precautions.

In recent controlled trials, conducted by the authors (1956), we were interested to note the proportion of patients improving with the administration of placebos. A placebo is defined in the Shorter Oxford Dictionary (1944) as “A medicine given more to please than to benefit the patient”. It is presumed that, implicit in this definition, is the qualification that the doctor is aware of the relatively inert qualities of the substance, whilst the patient is not. There is, of course, a type of patient who derives considerable benefit mainly by virtue of the fact that he has been pleased. In spite of the discovery of increasing numbers of drugs with specific properties, the prescription of placebos is still common practice. Dunlop et al. (1952) analysed over 17,000 prescriptions of which about one-third were tonics, stomachics or sedatives; although barbiturates cannot strictly be called placebos, the spirit in which they are prescribed frequently puts them near to this category.

Developmental defects of the cerebellum may take various forms: agenesis of the entire cerebellum; aplasia of one or both hemispheres, or aplasia limited to the vermis. It is the purpose of this communication to review the first two groups and to place on record the clinical and pathological features of a case in which but for one small fragment the cerebellum was wholly absent.

In previous work (8, 9) the writer has found that measures of breathing activity during speech, and of output of speech per breath are related to the emotional intensity and to the extent to which emotions are restrained or given free expression in the exchanges during psychiatric interviews. A high level of ventilation, i.e. high breathing activity with low output of speech per breath was shown to belong to content implying outgoing affect (jealousy, appetite, sex, aggression, wishes and hopes), and a low level of ventilation in speech to be associated with topics of restricted emotionality, such as fear, inhibition, deprivation, as well as to reasoning.

Tension states as rated by physicians or as experienced subjectively, as well as anxiety states and other emotional disturbances have been shown to be associated with physiological changes in the muscular system as measured by the electromyograph (15, 19, 21). Increased muscular tension was also found to accompany hyperventilation (1, 6) and increased muscular tension as well as inhibited breathing have been reported to accompany intellectual effort (11, 22, 23). Rising gradients of tension from forehead and chin have recently been shown to accompany sustained attention when listening to read material (26).

I believe that it is customary for an address from the chair not to direct attention to some particular enquiry that has engaged the speaker, but to make a general survey of the broad issues of a society and its discipline, to take a bird's-eye view of the development of the subject, or to take up some fundamental issue or issues which at the moment have reached something in the nature of a turning point.

In spite of the large increase in the number of anticonvulsant drugs in the three decades since the introduction of phenobarbitone, new remedies are constantly being sought. The present state of therapy of the epilepsies remains rather unsatisfactory. Drug therapy, which is still the most widely used form of treatment, is at best a maintenance treatment, i.e. the patient has to continue with it at least for many years to control the attacks. Even then a large number of sufferers continue to have seizures, often as frequently as once a month, which elude treatment. Surgery, which has found a wider application recently, is not radical either in many cases, and has to be followed up by medication over many years. The situation is further complicated by the fact that many anticonvulsant drugs, even when effective, produce unpleasant or dangerous side effects and have to be abandoned. One has also to consider the enormous psychological effects of the disease on the patient. The social stigma which epilepsy confers and the continual threat of an impending fit are often far more disabling than the actual seizures.

Lately three favourable clinical reports have appeared in American journals on a new anticonvulsant drug called “Hibicon” (Gotton et al., 1951; Kaplan et al., 1952; Hawkes, 1952). Lederle Laboratories Division, American Cyanamid Company have kindly put a quantity of Hibicon at our disposal for a therapeutic trial in this country. We are reporting our experiences with this drug on a group of forty patients suffering from various types of epilepsy.

Although pure word deafness (p.w.d.) is a well-defined clinical picture it usually occurs as part of a more complex syndrome. Almost invariably there is some degree of aphasia and as a rule other auditory disturbances, such as imperception of specific sounds including musical tones, also occur. These associated symptoms tend to diminish or even disappear in time while the deafness for word sounds usually persists in its initial intensity. In the case we describe most of the associated symptoms, especially the aphasia, soon abated leaving an almost pure word deafness. Subsequently this too improved slowly and because of the partial recovery we were able to obtain data which are rarely available in these cases.

Through the generosity of the South West Metropolitan Regional Hospital Board a research unit for the study of apparently deaf children with defective speech was set up in Belmont Hospital in March, 1953. The primary object of the unit is to attempt to assess by methods which will be discussed later whether children who have acquired no speech are in fact only deaf or whether they are mentally defective, emotionally disturbed, or are suffering from these or other conditions. It is an undoubted fact that some children who have never spoken and who are therefore inaccessible and who may be asocial or antisocial in their behaviour are diagnosed as being mentally defective and spend their lives in mental defective institutions. It has however already been shown in our unit that a number of these children when under observation for a period of time prove to be deaf and probably educable. If facilities were available to continue their education under specialized conditions they could no doubt make useful citizens within their limitations. Before discussing the problems associated with these children in more detail it might be as well to describe the personnel and layout of the unit.

Prognosis, the prediction of the outcome of an illness, has long been recognized as a necessary skill of a physician. Hippocrates (translated Chadwick and Mann, 1950) said:

“It seems highly desirable that a physician should pay much attention to prognosis. If he is able to tell his patients when he visits them not only about their past and present symptoms, but also to tell them what is going to happen, as well as to fill in the details they have omitted, he will increase his reputation as a medical practitioner … It is impossible to cure all patients: that would be an achievement surpassing in difficulty even the forecasting of future developments … By realizing and announcing beforehand which patients were going to die he would absolve himself from any blame.”

In addition to the reasons given by our distinguished forebear we now also require to read into the future so that we can make the best use of the limited facilities available for the sick. This is particularly true for elderly psychiatric patients for whom treatment facilities are still very inadequate. It has been suggested (Cook, Dax and Maclay, 1952) that mentally ill elderly people should by preference be admitted to short-stay units attached to general hospitals for the assessment of prognosis and probable response to treatment. They suggested that a 3-4-months stay might be necessary. Experience in a diagnostic outpatient clinic (Norris and Post, 1954) led one of us (F.P.) to believe that it should be possible to classify patients according to the best method of dealing with them in a shorter time even than the six weeks recommended by the B.M.A. Report (1947). The present study was designed to test this belief. Our hopes were only partly fulfilled, but a post hoc analysis of our original data, in conjunction with the known results of the follow-up of cases, has suggested that with more knowledge of the factors influencing prognosis over a short term, much more accurate forecasts could have been achieved. The second half of this paper is devoted to a discussion of these factors. A preliminary report was given at the Third International Congress of Gerontology (Kay et al., 1954).

In previous papers (Roth and Morrissey, 1952; Roth, 1955) evidence for the importance of affective psychosis in old age was presented. It was shown further that in some half of those admitted after the age of 60 no attacks had occurred before this age, and that no new aetiological factor such as cerebral degeneration was associated with these cases of late onset (Kay, Roth and Hopkins, 1955). The problem is to elucidate why it is that defences against illness effective throughout most of these patients' lives prove inadequate in old age. Now in the study just referred to, a tendency for physical illness to be commoner in patients having their first attack after 60 was noted. A more detailed analysis of the incidence of physical illness in the two groups has therefore been carried out in order to investigate its possible aetiological role in old age affective disorder.

The pharmacology of chlorpromazine (Anton-Stephens, 1954; Hopkin, 1955) and its use in psychiatric practice (Garmany et al., 1954; Elkes et al., 1954; Charatan, 1954; Labhardt, 1954) have been described in several recent papers. The present paper briefly describes a controlled experiment on the use of the drug in a group of chronic disturbed schizophrenic patients, the object being to introduce as few variables as possible into the experimental situation, with a view to making the results as objective as is ever possible in a psychiatric investigation.

Cortisone therapy has been claimed to produce favourable results in clinical schizophrenics (Cohn and Karnosh, 1951; Cohn et al., 1953). Rees and King (1952) carried out a controlled investigation on the effects of Cortisone given in moderate doses over a four-day period to a group of schizophrenic patients and found no significant changes in symptomatology, behaviour or in a series of psychological and physiological tests.

In a personal communication Dr. Cohn suggested that Cortisone given in higher doses over a longer period would probably be therapeutically more effective in chronic schizophrenia.

The present paper describes a controlled investigation into the therapeutic effects of Cortisone given in high dosage over a relatively prolonged period.

Photic stimulation, the exposure of the human eye to repetitive flashes of light, has been employed in recent years in three ways; as a diagnostic, as a therapeutic, and as a research method. In each case, its use has opened new frontiers of inquiry into the borderlands of neurology and psychology.

This paper presents certain observations which stem from the testing of exploratory hypotheses with regard to an expected relationship between photic stimulation and imagery, alpha rhythm, critical flicker frequency (CFF), personality test data, overt reactions, and after-images in three major diagnostic groups: schizophrenics, organic brain damage (paretics and others), and normal individuals (no history of brain damage or emotional disorder).

Since this is a report of exploratory work, no attempt has been made to apply rigorous statistical tests nor to arrive at final conclusions. The aim is rather to stimulate further research which may employ more adequate instruments, larger groups, or different conceptual schemes.

In previous investigations of changes observed in the blood levels of acetylmethylcarbinol and butane-2: 3-diol in patients with manic-depressive psychosis (Dawson et al., 1954), the blood levels of a large number of patients in one mood phase were compared with the levels in another group of patients in a different mood phase. This procedure showed that the differences between the various mood phases were statistically significant. A lack of correlation in time between the chemical changes and the alteration in mood might account for the limited degree of correlation obtained. Thus, if the chemical change preceded the mood change, some of the data would not correspond with the observed mood state during which the blood sample was taken.

Another uncontrolled factor in the previous investigation was the diet; whilst all the blood samples were taken after a 12 hour fast, there was a large difference in the previous dietary history of the patients due to their mental state. Again, only blood levels were investigated and these might have been considerably affected by alterations in kidney activity.

For all these reasons, a different approach to the problem was made, and a small number of patients has been studied closely through a series of mood changes so as to enable us to determine the time relationship, if any, between the change in mental state and the chemical change. The patients were segregated into a small ward where their food intake was determined and 24-hour urine collections made; whilst in the unit, patients were maintained without sedation and without electroconvulsant therapy.

On the basis of the previous work, it was concluded that the variations observed in the blood levels of acetylmethylcarbinol and butane-2: 3-diol did not, in themselves, determine a change in mood but were indicators of some other, more fundamental alteration in the metabolic state of the subject. Consequently, changes in extracellular fluid volume as estimated by determinations of the thiocyanate space, were also investigated with these patients. Estimations of urinary constituents were also made to determine the effect of the kidneys in influencing blood levels.

This is a report of the chemical analysis of iron and calcium in the brains of three cases of Sturge-Weber disease. Although the clinical and pathological features of this syndrome have been well described, the chemistry of the characteristic deposits is less well understood, and there is a conflict of opinion as to whether iron is present in increased amount.

Owing to the kind co-operation of Mr. Alexander of the Neurosurgical Unit, Frenchay Hospital, it has been possible to re-investigate this problem using material derived from lobectomy specimens. The material had been stored in formol saline for some months before the analysis was carried out.

Microscopic examination showed the usual picture of meningeal angioma and massive mineral deposits in the outer part of the affected grey matter. There were also a few concretions lying more deeply in the white matter in all the specimens (Dr. R. M. Norman).