The endocrine system is one of the foremost links in the psychosomatic relationship, and its special significance in the study of mental disease needs no emphasis. Compared with our knowledge of the chemistry and basic functions of the hormones very little is known about their more intimate mechanisms of action. It has been possible to assign to some hormones the function of controlling the rate of specific metabolic processes, but whether they do so by a direct reaction with a component of one or more enzyme systems or indirectly by influencing the mutual accessibility of enzyme and substrate is still a matter of discussion. The latter mechanism would depend on a spatial organization involving membrane barriers, phase boundaries or similar discontinuities and, in fact, many hormonal effects which can be demonstrated in vitro with the aid of intact or sliced tissues disappear when the structural organization of the cell is destroyed. It is, however, well to remember that synthetic and other energy-consuming reactions were believed until recently to depend on the integrity of the cellular organization, but when some insight was gained into the mechanism of biological energy transformation and the function of labile phosphate bonds in these processes, it was possible to demonstrate many such reactions in homogeneous systems. Similarly, the interactions of hormones and enzymes may require the intervention of unstable mediators, and control of these factors might allow their reconstruction in cell-free extracts. In any case, it is more satisfying to account for the great specificity of hormonal action on the basis of a chemical reaction with specific enzymes than by a mechanism leading to predominantly physical changes.

The following experiments on glutamic acid were carried out in view of the conflicting reports of Price, Waelsch and Putnam (1943), Waelsch and Price (1944), and Goodman et al. (1948) on its effect in epilepsy. A number of preliminary experiments were made which suggested that there was an apparent difference between the effects of glutamic acid and sodium glutamate. Such a difference does not appear to have been considered by most other investigators. It was decided therefore to try to determine whether a possible reason for the difference was the effect of the sodium ion on water balance, since this is known to be related to the tendency to seizures (McQuarrie et al., 1932, Swinyard et al., 1946, and Weinland, 1949). For comparison potassium glutamate was given in a way to be described below. The experiments will be reported under the following headings:

1. 1. The acute E.E.G. and clinical effects of intravenous sodium glutamate.

2. 2. The short term (one week) E.E.G. and clinical effects of glutamic acid, its sodium and potassium salts and a placebo.

3. 3. Longer term clinical effects in out-patients.

4. 4. Biochemical studies of the blood and urine levels of glutamic acid by paper chromatography of 7 epileptic patients and 5 non-epileptic control subjects, including salt and water balance studies of patients and controls.

Effects of substances on the respiration of unstimulated portions of mammalian brain have been used in the past as aids to understanding or suggesting their actions on the brain in vivo. The present paper gives data with respect to glucose and glutamic acid, which show some of the limitations of such interpretations. It also describes the application of new experimental means of examining the metabolic effects of added substances in relation to the functional activity of the brain.

The possibility of using the Rorschach test to predict outcome of insulin coma treatment of schizophrenia has been investigated by Piotrowski (1938, 1939 and 1941).

The widespread use of group treatment as one of the modern methods of psychotherapy has provided us with an opportunity to study psycho-social phenomena in a fairly uniform social setting.

Cytochrome, an intracellular enzyme widely distributed in all oxygen-using tissues, consists of a mixture of three haemochromogen-like substances referred to as a, b, and c. Of these cytochrome c has been isolated and is available commercially. In living cells cytochrome can be seen spectroscopically to be undergoing alternate oxidation and reduction. It plays an important part in tissue respiration, the respiratory activity of a cell being indeed proportional to its cytochrome content.

Ability to learn and retain relatively unfamiliar materials has been shown to be impaired in many clinical syndromes, both organic and functional. The testing of this ability features in some form or other in several clinical tests of intelligence, such as the Wechsler Scale and the Binet, while it is more directly tested in the various memory scales. As is well known, efficiency of learning declines with age, and can be greatly reduced by organic brain damage. There is evidence also, which we shall briefly review, that it can be variably reduced in schizophrenia and in psychoneurosis.

In recent years several writers have attempted to bring the known aetiological effect of maternal age in mongolism into direct relationship with its causation. Brousseau (1928) sifted the available data very carefully, but failed to come to any conclusion as to how maternal age could exert its effect. Benda (1947) considers that advanced age is only a subsidiary factor making maternal illness or endocrine disorder more significant, and a similar view seems to be held by Ingalls (1947). The conclusion is drawn by Geyer (1939) that mongolism is due to an abnormal ovum; if so, the older the mother, presumably the more likely are ova to be abnormal. Conversely, Engler (1949) believes that the foetal dysplasia is caused by faulty embedding of a normal ovum in uterine mucosa which has deteriorated in consequence of age, infection or surgical interference. Jenkins (1933) lays stress on the analogy with certain phenomena seen in animal genetics, for Wright (1926) had shown that the manifestation of hereditary Polydactyly in guinea-pigs was influenced by the age of the dam: young mothers produced more polydactylous offspring than older ones. A similar effect has been found by Holt (1947) in polydactylous mice. There is no experimental evidence as to the nature of the mechanism involved, but it may be supposed to be physical or chemical. The search for a process akin to antigenic incompatibility has also been suggested (Penrose, 1946), immunity developing with greater ease in maturer than in younger maternal tissues. It is not necessary to look for a specifically pathological process, however, since the maternal-foetal reaction might be analogous to that in the aetiology of fraternal twins, which especially occurs at late maternal ages, which centre around 38 years.

The symposium of the 1950 General Meeting of the British Psychological Society on the use of tests in clinical psychology showed that there was considerable difference of opinion on the way in which tests could and should be used in diagnostic work. As testing is one of the main activities of psychologists working in the clinical held, it is of some importance that this discussion be continued in written form. In this way misunderstanding can be clarified and opinions fully expressed.

The concept of “orality” as used in this paper indicates a certain constellation of traits or habitual reactions which are, or are assumed to be, derivatives, whether direct or modified, of behaviour patterns characteristic of early childhood. The importance of the mouth as the first erotogenic zone and as the organ generating fundamental attitudes of giving or receiving, waiting or being impatient, and hoping or despairing, has been stressed by psychoanalysis. According to psycho-analytic theory, the oral phase, that is, the first period of libidinal development, plays a most important part for later character development in as far as gratification, or frustration, of the oral impulses is assumed to have a determining influence on character-formation in later life.

It was recognized long before the birth of Freud and of psychoanalysis that the mental attitude of the patient has an important if not a decisive influence on the course of bodily disease. Milton expresses the almost universal striving for life in spite of the sufferings of illness when he says:

“And that must end us : that must be our cure—
To be no more. Sad cure ! for who would lose,
Though full of pain, this intellectual being,
Those thoughts that wander through eternity,
To perish rather, swallowed up and lost
In the wide womb of uncreated Night,
Devoid of sense and motion? ”

In more recent times, almost the whole of the work of Pavlov (1928), and particularly that of his pupil Bykov, is devoted to emphasizing the role of the cortex and higher brain centres in the determination of bodily reactions.

The problems of the interdependence and unity of the brain and body have been put on a scientific basis by Pavlov and his successors. Bykov (1947) has, for example, been able to demonstrate that the cortex plays a leading part in the regulation of somatic processes, such as secretion of urine, blood pressure, peristalsis and metabolism. It is therefore reasonable to argue that lesions of the central nervous system will be reflected in the pathogenesis and course of morbid processes in the body. It does not follow, however, that this influence will necessarily be in the direction of greater lability, more rapid pathogenesis or more extensive destruction. The outstanding feature of the central nervous system is its plasticity and power of compensation. It is therefore possible and probable that those parts of the nervous system which remain intact will take over and compensate for the function of the lost ones. Emotion may, for example, lead to polyuria, but it does not follow that urinary secretion will be impaired in a leucotomized patient. The brain may well play an important part in the infective processes of a normal person, but the defence against infection in a microcephalic idiot may remain perfectly adequate, and may even be more effective than in a normal person, provided that the mechanism of the immunity and phagocytosis had been more fully mobilized in the course of his previous life.

The study of dreams is a study of a group of epiphenomena associated with states of diminished awareness. No matter whether such dreaming occurs in natural sleep, in states of reverie interspersing normal levels of consciousness or in pathologically or pharmacologically induced aberrations of consciousness, it would appear that the principle that dreams do not occur other than at levels of lessened awareness is generally accepted. From the point of view of neurophysiology, it also seems reasonably clear that the formation of the visual and auditory hallucinations, illusions and delusions forming the manifest formal content of dreams is dependent upon fairly precise cerebral localization, the temporal lobe and Brodman's area 19 being especially important in these respects (Penfield and Erickson, 1941). Psycho-physiologically a number of attempts have been made to assess the nature and quality of stimuli normally inciting dreams. From Maury (1861) onward the effects of various physical stimuli (Klein, 1930), of auto-suggestion (Arnold-Forster, 1921), of post-hypnotic suggestion (Prince, 1939) and of projection phantasies (Malamud and Linder, 1931) have been noted. Psychologically the dynamics underlying the mechanisms of the dream instinct have been investigated especially by Freud and his followers. Freud's opinion that the dream represents an attempted wish fulfilment has been modified by Jung, who emphasizes its compensatory function, by Adler, who conceived of the dream as a method for testing possible future situations in phantasy, and by Stekel (1943), for whom the dream was a symbolic manifestation of the “internal conflicts” of the individual. Finally, the observations of Monge (1929) concerning the increased incidence of disturbing dreams when dwellers at high altitudes suffer from chronic mountain sickness, and of McFarland (1937) on the changing dream habits of a party of mountaineers in the Chilean Andes as they ascended steadily to ever-increasing altitudes (and hence to progressively greater degrees of anoxic anoxia), are of immediate interest. They are in direct line with the findings of anoxaemia in sleep (Lovett Doust and Schneider, 1951), and suggest a positive relationship between the manifest content of dream patterns, emotional tension, reduced awareness and anoxaemia.

A multiple channel electroencephalograph permits the simultaneous recording of several leads in electrocardiography. In order to utilize for this purpose the electroencephalograph installed in this hospital, a method has been worked out to record in groups of three the 3 standard leads, the 3 augmented unipolar limb leads, and 3 unipolar precordial leads consecutively, changing over from one group to the other simply by turning a switch. The technique here described is used in connection with a four-channel Marconi electroencephalograph.