The comparatively old belief, that the epileptic patient shows a retention of water before the onset of a major seizure and an increase in the water excretion afterwards, achieved great importance from two findings of more recent date : on the one hand, the frequency of the seizures may be increased on hydration of the organism by administration of excessive amounts of water in combination with antidiuretics; on the other, the frequency may be decreased on dehydration either by restriction of the water intake or by other means (see for example Fay, 1929, 1930; McQuarrie, 1929; McQuarrie and Peeler, 1931; McQuarrie et al., 1932; Engel et al., 1934; Clegg and Thorpe, 1935; Stubbe Teglbjaerg, 1936; Ziskind et al., 1939; Hagenmeyer and Langelüddeke, 1939; but contrast Cameron, 1931; Fetterman and Kumin, 1933; Wilson and Limberger, 1933; Stone and Chor, 1937; Pette and Janzen, 1938). It is therefore most desirable that the value of the evidence connecting water balance and the occurrence of spontaneous seizures should be assessed.

The development of psychological medicine in Great Britain has been accompanied by a certain feeling of inferiority amongst psychiatrists and psychotherapists. This has shown itself in rivalry, at times brisk and even acrimonious, which may be understood as a striving to obtain the object which another is thought to be pursuing. This state of affairs arises when there is uncertainty of objective; and all will agree that the objectives have been ill-defined and at times nebulous. Here as elsewhere the familiar characteristic has been” muddling along somehow When we come to consider possible reasons for this, one feature stands out, namely, the lack of originality in our insular school of thought. We have produced no Copernicus to revolutionize our methods and systems, and so sweep away intellectual vested interests. To meet the needs at home we have built up a national debt by borrowing. Our source of inspiration has been largely Continental. Freud, a little bitterly perhaps, alludes to ‘1 the numerous psychiatrists and psychotherapists who warm their pot of soup at our fire — without indeed being very grateful for our hospitality “(I). The genius of Freud and of Jung lay in speaking from the heart and setting at naught traditional views. Their very different contributions have been so refreshing that many accepted, without questioning, the teaching of one or other of these pioneers. Others rejected in toto (and often unread) what was described as “the new psychology But a more hopeful note has recently been sounded in this country; for the question of method, or way by which we proceed to the attainment of some aim, has been the subject of numerous contributions; and less attention is being paid to the technique embodied in the method. In this paper certain suggestions upon methodology will be made; and the subject will be examined critically, especially from the clinical aspect.

A survey of the creatine and creatinine excretion of large numbers of mentally defective patients in circumstances which precluded both keeping them on creatine-free diet and the obtaining of 24-hour specimens, led Penrose and Pugh (1939) to the use of the creatine creatinine ratio in early morning specimens of urine as an index of the metabolism of these substances in each patient, as compared with controls. The use of the ratio was found to yield results of qualitative significance. Patients suffering from conditions known to affect creatine-creatinine metabolism, such as muscular dystrophies, diplegias, and hyperthyroidism, were readily picked out, and the creatinuria of children was marked; conclusions could be drawn as to the creatine-creatinine metabolism in certain other conditions. In the above survey the numbers allowed of statistical treatment to a considerable extent, and this confirmed the validity of the conclusions drawn from the ratio.

Unhydrolysed urine does not usually give a strong Millon's reaction in healthy people, but various workers have reported a strongly positive Millon's reaction in the unhydrolysed urine of mentally defective patients. Schemer (1927, 1928) worked up such urines for tyrosine with negative result, and also showed that the reaction was not due to free phenol or oxy-acid. He claimed (1929) to have isolated the substance responsible, but did not identify it. Lieb and Schadendorff (1929) showed that the substance isolated was impure sodium acetate formed in the method of isolation. The mystery of the substance giving the Milon's reaction was thus left unsolved.

Treatment by convulsion therapy implies the administration of analeptic drugs in massive doses to induce major epileptiform convulsions. Usually a single convulsion is induced on each occasion and this is done two or three times weekly. The number of convulsions varies greatly in different cases, but is commonly from five to twenty.

It is proposed, firstly, to summarize some anomalous cardiac occurrences observed and recorded by the writer in a series of seventy-five cases which underwent treatment with cardiazol for various types of mental illness in the mental observation wards of the Southern General Hospital during the period November 11, 1938, to April 30, 1939; secondly, to suggest an explanation for the occurrence of these anomalous cardiac occurrences, hereinafter referred to for the sake of brevity as abnormalities.

Since Hildebrandt (1926) described the convulsant effect of cardiazol injection, several studies have been carried out on the mechanism of such convulsions. Zung and Tremonti (1931) suggested a direct action on the respiratory centre when cardiazol is used as a stimulant; Kerr and Antaki (1937) found no effect on brain glycogen or phosphocreatine in cardiazol-induced convulsions; Hashimoto (1937) found differences in distribution of calcium and potassium ions in the central nervous system after cardiazol. Goodwin and Lloyd (1938) recorded a direct effect on brain potential changes as shown on oscillographic records. Leibel and Hall (1938) found a large (75 per cent.) diminution of cerebral blood-flow at the onset of cardiazol convulsions. Weigand (1938) found no effect on liver glycogen or vitamin A content, reducing power of suprarenal cortex or blood picture. Denyssen and Watterson (1938) and Watterson and Macdonald (1939) attribute the convulsions to action on the vasomotor centre and note the action of vasodilator drugs in inhibiting convulsions. Wortis (1938) quoted by Quastel (1939) found no effect on brain respiration.

This paper represents a preliminary attempt to investigate some aspects of the influence exercised by the endocrine glands on the cerebral blood supply at various stages of development.

The management and treatment of patients suffering from catatonia are constantly presenting a problem for mental hospital staffs, particularly in modern times, when more emphasis is laid on treatment than on custodial care.

The problem of making people suffering from catatonia into useful members of the hospital community seemed, from the very beginning, to be bound to fail, as long as the difficulty of inducing them to active and voluntary movements was not overcome.