Investigations into the possible causes of toxic symptoms arising during the course of prolonged somnifaine narcosis showed that a fall in serum calcium occurred during the course of the treatment (1). Previous investigations on blood calcium (3, 4, 5, 6, 15) made it clear that during barbiturate narcosis there was a fall of 10–20% of the normal value. Observations, however (7, 8, 9, 10), that therapeutic exhibition of insulin resulted in an increase in serum calcium suggested that no gross abnormality in calcium level was to be expected during the modified somnifaine-insulin-glucose treatment (2) practised in this hospital. The investigations here reported were undertaken to determine what fall in serum calcium occurred during this modified treatment, and to determine whether this fall was sufficient to cause toxic symptoms. If so the advisability of taking steps to avoid them could then be considered. The investigations showed a definite lowering in serum calcium during the course of treatment of psychotic patients by this method, and they suggested that somnifaine and insulin are only pseudo-antagonistic in their effect upon calcium metabolism. In the ten cases reported, a fall in serum calcium of from 3–20% has invariably been observed, the maximum being reached four to seven days after the beginning of the treatment.

When drugs are administered intravenously, the risk of causing injury to nerves in front of the elbow can be considerably minimized if the anatomical structure of this part is kept in mind. The operation appears to be so simple that the novice is frequently permitted to dig his way to proficiency, without first having been the recipient of instruction or warning regarding the procedure.

The investigations on which is based the form of therapy presented in this paper being partly several years old, and partly published in Scandinavian languages, it will be of advantage to review them briefly.

This case has shown so great an improvement by symptomatic treatment with parasympathetic stimulants and a sympathetic depressant that it seems worthy of record for its own value, apart from the interesting investigations to which it leads.

As there is still considerable hesitancy in the adoption of this valuable form of therapy, I am glad to have an opportunity of stating the case for a more widespread application of prolonged narcosis to the manic-depressive disorders. A legitimate diversity of opinion exists as to the propriety of using any drug with a toxic action over a long period, especially so when it introduces an extraneous, and maybe serious, risk into a disease of itself non-fatal, and with a large recovery-rate. With attention to detail in the treatment, and with the addition of the Cardiff modification of prolonged narcosis, we are satisfied that toxic symptoms arising during the administration of somnifaine—the drug used—can be controlled, and the risk heretofore associated with this form of therapy eliminated.

Narco-analysis is an eclectic technique based on the observation (6) that a combination of narcosis with psycho-therapy is quicker and sometimes more effective than the formal methods of analytical psychology. The earlier attempts of this kind were limited to the non-analytical methods of overt suggestion augmented by drugs.

In the following paper a case of état dysmyélinisé of the globus pallidus, or as it is often synonymously called, “Hallervorden-Spatz disease”, will be presented. Records of thoroughly studied cases of this condition are still rather scanty and there is much need for a systematic extension of experience, the more so since, as Helfand (16, 17) has recently pointed out, progress in the elucidation of the condition has not always been enhanced by generalizations from findings based on too small a case-material. We are happy in having at our disposal the vast resources of the London County Mental Hospitals. It is hoped to follow up this paper by publishing further cases of a rather different nature, though with some characteristics in common with the case described here.