The Laurence-Moon-Biedl syndrome shows much variation in its clinical picture from case to case and the limits of this syndrome are indefinite. This clinical entity was first identified by J. Z. Laurence and R. C. Moon in 1866 and was more completely described by A. Biedl in 1922. In 1935, Cockayne, Krestin and Sorsby stated that some 30 isolated cases and 15 affected families were reported during the ten years from 1925 to 1935, and in 1939 Sorsby, Avery and Cockayne made a later review. In October, 1955, J. Todd described a case of Laurence-Moon-Biedl syndrome with paranoid psychosis in the American Journal of Mental Deficiency, and in 1950 R. A. Burn reviewed 82 cases giving the total number of reported cases as 260. Up to 1957 about 320 cases have been described in the world literature but even this number is likely to rise with the increased interest shown in this syndrome.

By 1975 Denmark should have 9 new mental hospitals, each, with one exception, closely linked to a general hospital. This is the most striking of the proposals contained in the Report∗ of a Commission set up by the Danish Ministry of Internal Affairs in 1952. This Commission was to “report on trends of development of the State Mental Hospital Service in respect of organization and buildings, with special reference to the necessary adaptation of the hospitals to present-day needs and forms of treatment. The Commission's deliberations, which should principally be concerned with the modernizing and extension of the hospitals together with their position in relation to the general hospital service, should also include the possible extension of treatment to categories of patients with mental disorders other than true insanity. The Commission's work should be so arranged that its report can constitute the immediate foundation for the practical organization of future reform work.” This Report contains much of general interest and much which might merit wider application.

Electro-convulsive therapy was first introduced by Cerletti and Bini in 1938, and has now become the principal physical method of therapy in psychiatry.

Recent research has shown that constancy of perception breaks down in schizophrenics. Size constancy in these patients has been investigated by Raush (13, 14), Weckowicz (16), and Crookes (2). Raush found that paranoid schizophrenics had increased size constancy compared with normals and other schizophrenics. He predicted that in other types of schizophrenia size constancy might be poorer than in normals. However the difference he found was not statistically significant. Weckowicz found that chronic hospitalized schizophrenics had poorer size constancy than other hospitalized patients and normals. These two investigators determined size constancy by instructing the subjects to adjust the size of an object (a rod or a square) to the size of a standard object at a distance. Crookes used a direct method. His subjects were instructed to reproduce the size of the image of the standard object seen at a distance and not the size of the object itself. He came to the same conclusion as Weckowicz that size constancy in schizophrenic patients was impaired.

Chlorpromazine (“Largactil”) was introduced to this country some five years ago, and since that time a considerable number of reports on its clinical efficacy have appeared, including Anton-Stephens (1954) and Garmany et al. (1954). There is now general agreement that it is a useful form of treatment in chronic schizophrenia, especially for the aggressive, disturbed patient (Salisbury and Hare, 1957). More recently another phenothiazine derivative, incorporating a piperazine ring in the side chain, has been produced.

Increasing use of the Rorschach Inkblots Test is being made in medical diagnosis, not only in psychiatry, but in neurology as well. Bibliography is too extensive to quote here, and the reader is referred to the standard work by Klopfer et al. (1956) which lists nearly 3,000 references specific to Rorschach literature. The inclusion of a long chapter on the clinical use of this test in the latest research monograph of the Association for Research in Nervous and Mental Diseases (1954) is evidence of the increasing esteem in which this test is held by specialists in neurology and psychiatry, supported by the growing use of the test in diagnosing intracranial organic pathology. It is interesting to note that in the latter field the Rorschach has proved superior in diagnostic accuracy to any other single neurological test, such as EEG, lumbar puncture, ventriculography, etc., and is often as good as the complete battery together.

The earliest case of cutis verticis gyrata reported in the literature appears to have been that of Robert (1) in 1843. The following instances were observed by Auvert (2) in 1854 and subsequent cases were noted by Poggi (3) in 1884 and Lombroso (4) in 1890. In 1893, McDowall (5) and Cowan (6) recorded the first occurrence of this abnormal scalp development in association with a microcephalic mental defective, and since that case report several other authors such as Möller (7) in 1903 and Judassohn (8) in 1906, described similar instances. In 1907, Unna (9) presented three cases and coined the name cutis verticis gyrata. It is also known under additional terms such as “corrugated skin”, “bulldog scalp” and “pachydermie occipitale vorticillée”.

Schizophrenia occurring in the early years is generally recognized to be a deteriorating illness and one in which therapy has little effect. Tredgold (6) recognized schizophrenia as a cause of oligophrenia and most mental deficiency hospitals have a number of these patients. Although not numerically a large problem, they are among the most difficult patients to handle.

7044 is a new phenothiazine derivative which can be regarded, pharmacologically, as resembling chlorpromazine much more closely than it does promethazine. It is said to have the characteristic central properties of chlorptomazine more highly developed, and in addition anti-adrenaline properties with anti-histamine properties comparable to those of promethazine. On a theoretical basis it might have the clinical indications of chlorpromazine.

Prochlorperazine, 1-[3-(3-chloro-10-phenothiazinyl)propyl]-4-methyl-piperazine dimaleate, a phenothiazine derivative related to chlorpromazine, was discovered in the Rhône Poulenc laboratories, and studied pharmacologically in 1956, by Ducrot and Koetschet, for its anti-emetic properties. Clinical trials, following this experimental evidence, suggested that, as well as possessing powerful anti-emetic properties, the drug was of considerable therapeutic value in migraine, Ménière's syndrome, and vertigo of other origins.

Trifluoperazine, which is 2-trifluoromethyl-10-(3′-[1″-methylpiperazinyl-4″]-propyl)-phenothiazine dihydrochloride—a preparation manufactured by Smith, Kline and French Laboratories Limited under the description SKF5019—is the most recent phenothiazine derivative reported to have a beneficial effect on certain types of mental illness. On the basis of animal tests trifluoperazine is described as having nine times the potency of chlorpromazine in blocking the conditioned response, and its specificity is greater than that of chlorpromazine.

It is often of importance in a psychiatric department to ascertain whether a patient has consumed the Largactil prescribed, e.g. on occasions when a patient appears only to be slightly affected by Largactil. Dubost and Pascal demonstrated that a Largactil solution mixed with equal quantities of concentrated sulphuric acid gives a marked carmine red colour which is so stable that the intensity of the colour may be measured in a spectrophotometer. In biological fluids, Largactil must first be extracted with ether and then transferred to the aqueous phase before the determination can be undertaken. By experiments on rabbits and dogs, these authors found that up to 5 per cent. of the Largactil administered is excreted in the urine in the course of 24 hours and a total of up to 8 per cent. is excreted in the course of the first few days.

In spite of the enthusiasm with which schizophrenic patients have been treated by physical methods over the past twenty years, there is surprisingly little evidence enabling us to compare the results of one physical treatment with another, or the physical treatments themselves with the treatments they replaced. Some writers (Polonio and Slater, 1954; Rees, 1949) point out a significant improvement over the spontaneous recovery rate with the use of insulin, while others (Jensen, 1952) find no such improvement. Bourne (1953) and Notkin et al. (1939) go so far as to claim that any improvements of insulin-treated patients are due to the extra care and attention they receive, and the work of Ackner and his colleagues (1957) may support this conclusion. Linford Rees (1949) comparing electrical treatment with insulin concluded that electro-shock therapy was far less effective than deep insulin therapy in the treatment of schizophrenia—a conclusion in line with that of Finiefs (1948). On the other hand Impastato and Almansi found very little difference between E.C.T. and insulin treatment in this respect.

It is not only the directly observable therapeutic effects of treatment which will determine the value of that treatment—in many cases the accompanying side effects are equally, if not more important, depending upon their nature and severity.

Promazine hydrochloride (“Sparine”) is a phenothiazine derivative which has recently been introduced to this country with claims to be a “tranquillizing” drug. It is closely related chemically to chlorpromazine but does not contain the chlorine atom which has been thought to cause the undesirable side effects of the promazine group. The structural formula of Sparine compares with that of chlorpromazine as follows: