The theory that many diseases were produced by focal infection or chronic sepsis enjoyed a brief vogue in general medicine in the first quarter of the twentieth century. This paper explores its practical applications in psychiatry, which extended well into the 1930s. The analysis focuses particularly closely on the activities of Henry A. Cotton at the Trenton State Hospital in New Jersey.

Western European belief in demonic possession as a cause of mental disorder has been traced through the medieval and early modern periods. Generally it appears that the range of disorders attributed to demonic possession has gradually narrowed. In any period, however, there seem to have been marked individual and cultural differences in outlook; some of these differences are still evident today in the survival of belief in demonic possession in pentecostal sects.

The contemporary practice of involuntary commitment to psychiatric institutions of individuals diagnosed as mentally ill is based upon practices established by psychiatrists in the nineteenth century. The justifications given by nineteenth-century German-speaking psychiatrists for involuntary commitment are considered. An examination of sixty-seven texts by German-speaking psychiatrists reveals that involuntary commitment was justified more often as benefiting the mentally ill individual than as benefiting society. Justification for involuntary commitment was made somewhat more frequently during the second part of the nineteenth century than during the first part

An historical analysis is made of the word and of the concept of ‘dementia’ before the nineteenth century. With regard to the word, it is shown that it had legal and medical meanings and that, while the former developed during the seventeenth century, the latter did so only during the eighteenth century (earlier than psychiatric historians have suggested). As evidence for the latter point, rare historical material on ‘Démence’ from the first edition of the Encyclopédie Française is presented for the first time in English. It is also shown that the legal meaning was finally enshrined in the ‘Code Napoléon’. With regards to the concept of dementia, it is shown that it took final shape in the work of Willis, Hartley and Cullen in whose view it was made to include terminal states of behavioural incompetence due to severe failure of almost any mental function. During this period, dementia was not yet associated with a particular age group nor was specifically defined in terms of cognitive deficit. The origins of the ‘cognitive’ paradigm of dementia and of the clinical boundaries of the future concept of dementia are briefly outlined.

Plasma cortisol, ACTH and beta endorphin were measured before and after dexamethasone in 8 severely depressed patients and 8 age- and sex-matched controls to examine the relationship of ACTH and endogenous opioids to cortisol in depression. Despite having significantly higher plasma levels of cortisol than the controls, the depressed patients did not have correspondingly elevated plasma levels of ACTH. Beta-endorphin levels were also similar in the two groups. All three hormones suppressed to some degree after dexamethasone, but cortisol suppressed less in patients than controls. Our findings suggest that in severe depressive illness abnormalities exist in the hypothalamic–pituitary–adrenal axis peripherally as well as centrally.

The pharmacological actions central to the therapeutic effects of lithium have not yet been established, despite almost 40 years of clinical use and scientific investigation. We review the biochemical and neuropharmacological data relating to this problem and attempt to identify profitable areas for further research.

The increase in plasma prolactin which follows intravenous administration of L–tryptopha (LTP) was used to assess changes in brain 5-hydroxytryptamine (5-HT) function in normal male and female subjects, following a three week period of dieting. In women, but not men, there was a marked increase in the prolactin response to LTP, suggesting that dieting had caused alterations in brain 5-HT-mediated responses. In contrast, dieting did not alter the prolactinresponse to thyrotropin releasing hormone in either men or women, indicating that the changes in response to LTP could not be attributed to an increase in pituitary reserve of prolactin. These findings suggest that dieting alters brain 5–HT function in women but not in men. Biological factors as well as greater psychosocial pressures to diet may contribute to the high prevalence of eating disorders amongst women.

This research was aimed at studying the rate of action of tricyclic drugs in depressive disorders, specifying the behavioural effects associated with recovery, and predicting clinical response. The research design involved comparison of a recovered group with a group treated for the equivalent four weeks, who showed minimal to no response. The findings indicated significant differences in baseline characteristics between responders and non-responders. Further, the drugs were found to act early in the responders, within the first week of treatment. Specific changes at one week which distinguished responder and non-responder groups occurred in the disturbed affects, and in cognitive functioning. Improvements also occurred in somatic symptoms, but these latter changes were general and not associated with later recovery. At 2½ weeks, all facets of the depressed condition showed positive change in the responders. Implications of the results for assessing rate of tricyclic drug actions, their effects on the interaction of affect and neurochemistry, and the practical application of the results for the clinical situation, are discussed.