Since the author has been working for some fourteen years alongside psychiatric colleagues his slender assets are as heavily and inextricably invested in the future of Psychiatry as those of any psychiatrist. Such criticisms as are offered must, therefore, from this point of view be regarded as within rather than between group criticisms.

Enquiry into the occurrence and the pattern of S.† in different cultures promises to reveal information of importance, but there is as yet inadequate material from which definite conclusions can be drawn. Cavan (1928) and Dublin and Bunzel (1933) devoted chapters of their works on S. to this aspect of the subject. These, however, were but poorly assorted collections of descriptive items from various ethnologists, orientalists, and historians, and from them few significant relationships between S. and culture could have been deduced. Zilboorg (1936, 1937) tried to build a concept of S. as a preformed, archaic behavioural reaction on ethnological data, but it must be admitted that valuable though this formulation is he has made somewhat tendentious use of his material in weaving them into the fabric of psycho-analytic theory. His arguments have been subjected to criticism by Wile (1937). Ellenberger (1953) cited examples of S. from various cultures that could be classified under the three components of the S. impulse described by Menninger (1938), viz., the wish to die, the wish to be killed, and the wish to kill. Such a classification, however, cannot cover all the facts. The social sanctioning of S. for different motives in different cultures would seem to argue against the notion that S. everywhere involves the same “components”. The view that S. is rare in elementary and compactly organized societies has long been held, and has recently been confirmed as far as the Yorubas of West Africa are concerned by Lambo (1956).

Nowadays when clinicians feel happier guided by methodologists and statisticians, only the brash or the sophisticated care to report single cases in detail. Yet medicine has in the past profited greatly by careful observations of this sort, and so good is this precedent that we have decided to defy fashion and report the affair of Mr. Kovish, one of those curious happenings which, we think, deserves a permanent record.

The problem of differentiating impending hepatic coma from delirium tremens is one which arises less commonly in Great Britain than in the United States. It is a problem which occurs, of course, chiefly in connection with alcoholic patients and while alcoholism has declined in Great Britain it is becoming an increasing medical and social problem in certain sections of the United States (1). Thus, at the Boston City Hospital alcoholism was a factor in over 45 per cent. of patients with cirrhosis of the liver at post-mortem (2). At the Hammersmith Hospital in London alcoholism was an aetiological factor in 5 per cent. of patients with the clinical diagnosis of cirrhosis (3). There is no doubt that the problem of differentiating impending hepatic coma from delirium tremens is a common and relatively easy one in Boston, whereas in London it is a rare and therefore more difficult one.

Since the original article by Elkes and Elkes (1954) numerous reports have been published in the world literature on the use of chlorpromazine in chronic psychotic in-patients. The majority of these studies indicate that the drug is indeed effective in improving the behaviour of these patients; a small minority of authors is more sceptical including Mitchell (1956) using doses up to 300 mg. daily, Sarwer-Foner and Ogle (1956) with doses of 150–400 mg. daily, and Trelles and Saavedra (1954) using sleep treatment. The literature contains numerous reports of controlled and uncontrolled studies on chlorpromazine and comparisons of its effects with those of a placebo, Reserpine, Azacyclonal, etc.; attention is now turning to the effects of such drugs in various combinations.

Few problems in the whole field of psychopathology are more important than that of aetiology. While it is generally accepted that heredity and environment must interact in some fashion in the causation of most mental disorders, the nature of the roles played by the two classes of determinant is not known. Consequently, any study shedding light on this problem is of primary importance.

Some time ago the Department of National Health and Welfare of the Government of Canada became interested in the therapeutic effects of a preparation of nucleotides in the treatment of mental illness. It was decided that the research group from the Saskatchewan Hospital, Weyburn, should assess the usefulness of the preparation in the treatment of chronic schizophrenia.

Evidence is accumulating that schizophrenia is a disease involving “immunoallergic” sensitization of the tissues of the central nervous system. Variations in its symptomatology may in part depend upon the altered ability of the sensitized nervous tissue to bind or release serotonin, and perhaps other endogenous catechol amines. Accumulation of these products; their rates of turnover; the presence of endogenous enzyme enhancers or inhibitors; specific endocrine dyscrasias; blood-brain barrier conditioners; as well as cellular changes in electrolytes, may all play a part in the process. Genetic defects; lags in maturation; autonomic imbalance and pre-psychotic personality structure may lurk in the background.

There has grown up in the past 30 years in East Africa a school of medical psychologists which sets out to interpret African thought processes, personality traits and mental disorders in terms of a racially genetic and cultural disposition. A correlation is assumed or suggested between a specific brain structure, social behaviour, psychology and psycho-pathology. Explanations are couched in terms of a racial determinism, and involve an assertion of inferiority as compared with the White race.

The term “post-operative psychosis” refers to mental illnesses which follow in the wake of surgical operations. These conditions have received relatively little attention from psychiatrists. The text-books either do not mention them or, if they do so, consider them with the delirious or toxic-exhaustive states.

The senile emotional disorders are now a major problem in mental hospital practice and their incidence increases with age. It is fortunate, however, that a better understanding and recognition of these affective disorders has, in most cases, led to early treatment and recovery.

Beneficial results with procaine amide in the treatment of Huntington's Chorea were first reported by Goldman (1952). He was led to make an oral trial of the drug after having noticed a patient in the dentist's chair improve following an injection. He found improvement in six cases with the typical syndrome of Huntington's Chorea, of whom four had a positive family history of the disease. The evidence of improvement in these cases was partly based upon clinical observation and partly upon the patient's account of changes in his daily experience, for example, his first case had difficulty in eating, which had led to protests from other customers at a restaurant he had frequented, and this disability is said to have been satisfactorily reduced with the help of the drug.

A decrease of glucose tolerance in mental illness has been observed for over forty years (Kooy, 1919; Mann, 1925). Although this change in carbohydrate metabolism has been described in all types of mental disorders, the majority of investigators report that it occurs most frequently in melancholia (Kooy, 1919; Mann, 1925; McCowan and Quastel, 1931; Holmgren and Wohlfahrt, 1944). The phenomenon has usually been regarded as a secondary effect, and several theories have been suggested to explain how it is produced (Kooy, 1919; Mann, 1925; McCowan and Quastel, 1931; Holmgren and Wohlfahrt, 1944); however, no single explanation is firmly established, and the mechanism or mechanisms are still uncertain.

The part played by the endocrine system in psychiatric illness is still controversial. Mental disorders may occur at the menopause or in the Puerperium, accompany thyroid or pituitary dysfunctions, or appear in adrenocortical diseases. Castration in men and women may be followed by marked personality changes. But often there are little or no mental changes, and there is certainly no clear-cut mental accompaniment of specific endocrine diseases. It is probable that mental symptoms, when they do occur, are dependent upon the basic personality structure, not upon a particular diseased gland. It is also likely that glandular dysfunction in turn can be brought about by mental stress or disorder. In other words, the two systems function together and should not be artificially separated.

In an earlier study (Stengel et al., 1955), reactions of various types of mental patients to eleven different painful and noxious stimuli were described. Two groups of 54 females and 43 male low-grade defectives were included in the original investigation, but it was felt at that time that the results needed further amplification before they could be usefully commented upon. In this earlier investigation only one of us actually carried out the tests, the reliability of which, therefore, was not clearly established. Furthermore, in the original testing of low-grade defectives no assessment of “Overt Reactivity” was made. As the relationship between this factor and pain reactivity in the other patient groups constituted an important finding of the study, we came to the conclusion that it would be necessary to retest some of the low-grade defective patients with these points in mind. This seemed all the more desirable as it is widely assumed that mental defectives in general, and especially low-grade mental defectives, are grossly deficient in sensitivity to pain.

At various times attempts have been made to establish a specific pathological entity “acute lethal catatonia”. Stauder and Scheid (quoted by Mayer Gross et al., 1954) among the older writers have collected a number of fatal cases and more recently Locher (1941) has suspected qualitative difference in the type of illness of those mental patients who die suddenly in an acute catatonic state. However the general view nowadays seems to be that death is due to exhaustion or intercurrent illness. A fatal outcome is very unusual in current practice perhaps because of improved therapy. The symptoms of acute catatonic schizophrenia are so striking that a determined quest for a biochemical basis for the whole schizophrenic process has been sought in this, its most dramatic manifestation. Success in this direction has often been claimed (e.g. Fischer, 1953; Rieder, 1954; Gjessing, 1953, inter alia) but has also frequently been disputed (Georgi, Rieder and Weber, 1954). The following case is reported because the symptoms seemed to be clearly related to physiological change. It tends also to throw further doubt on the entity of acute lethal catatonia of Locher. Interesting EEG findings and characteristic response to amytal are also noted.

The so-called experimental psychoses have been in the focus of increased interest recently, as a result of the discovery of new hallucinogenic or psychotic agents and of the fact that the problems can be approached more closely even in the borderline fields of pathopsychological research (biochemistry, electrophysiology, etc.) owing to advance in technique. Thus, it appears that Kraepelin's dream of producing so-called miniature psychoses by the administration of substances foreign to the body will come true after all.

Meprobamate is the shortened name of 2-Methyl-2-n-Propyl-1,3 propanediol dicarbamate, which is also known as Miltown or Equanil.

A previous communication (Mittwoch, 1957) contained evidence that the leucocyte count in children with mongolism showed certain abnormalities. Although the total count was not affected, the lymphocyte count was lower and the neutrophil count seemed somewhat higher than in a comparable control group. It will be shown in the present paper that these differences between mongol and non-mongol children are dependent on age, and that the gradual drop with age of the lymphocyte count, which is found in normal children (Kato, 1935), does not occur in children with mongolism.

The problem of the increased number of elderly psychiatric patients universally encountered needs no stressing. The purpose of this paper is to assess the value of the electro-encephalogram (EEG) as an objective aid to diagnosis and prognosis in these persons. The great majority of the psychiatric patients seen over the age of 60 are either suffering from an affective disorder, almost invariably depressive in nature, or from an organic dementia whether senile or arteriosclerotic. The former is normally considered of good prognosis and the latter doubtful or bad according to the degree of the dementia and confusion.