Mr. W. T. O—, aged 48. Admitted to Han well (now St. Bernard's) Hospital on 15. iv. 1904.

The patient was admitted from Wormwood Scrubs prison, and there is no available information regarding his condition before his admission to hospital. At this time it was stated that he was confused and unable to give any accurate information about himself. He was garrulous and his conversation was largely incoherent. There are no details of his physical condition on admission. In 1908 he is described as being elated and garrulous. He expressed many delusions of grandeur, stating, for instance, that he was owed large sums of money and possessed his own private carriages, etc. He was rather childish and his memory was impaired. His physical condition was stated to be “much improved “and he was able to be up and about. Even so he showed definite and obvious physical signs of general paralysis (unequal pupils, reacting only sluggishly to light, tremor of lips, etc.).

Many papers have already been published on the technique of insulin therapy for the psychoses (Müller, 1936; Sakel, 1937 and 1938; Frostig, 1937; Küppers, 1937; Braunmühl, 1938, and others). Nevertheless, some of the details of the method still offer problems to the careful therapist who wishes to avoid impairing his therapeutic effects by excessive caution, but is unwilling to incur unpredictable risks. While investigating this therapy during 1938 at the Maudsley Hospital, we endeavoured to evolve a technique which was both effective and safe, and which could be individualized to each patient without thereby losing its precision. In the following paper we offer suggestions concerning some of the technical details that have appeared to us important in achieving these ends. As far as possible we have omitted points on which previous papers have given adequately clear and consistent instructions.

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.

The anti-convulsant value of sodium diphenyl hydantoinate (S.D.H.), marketed in America as Dilantin and in England as Epanutin, as found by Putnam and Merritt and introduced by them in the treatment of epilepsy has been amply confirmed by all subsequent reports, as it is by this one. Its clinical application, however, will, it is thought, be modified by reason of its toxic nature becoming more generally known.

Recent hysteria is not a disease. Its manifestations represent the pathological exaggeration of a normal protective mechanism. By this mechanism otherwise well-adjusted individuals are enabled to gain time when a sudden reverse of fortune or an overwhelmingly difficult decision presents itself. Its purpose is to ease the blow and thus to prevent that paralysis of effective response which may result from the too sudden realization of the full implication of a situation.