The following account is based on the writer's experience of convulsion treatment at centres abroad, on a review of the literature up to the present date, and on three cases recently treated at West Park Hospital, Epsom. It is published at this early stage in order to make a knowledge of the technique and literature of a method which has already proved itself worthy of extensive trial, available to a larger number of workers in this country.

Salm (1) has recently described stuporous conditions which developed in schizophrenic patients undergoing the insulin shock treatment. He concludes that such cases constitute a serious problem, because, if they do not yield to the repeated administration of sugar, one is at a loss in regard to specific treatment.

There does not appear in the literature any method of treatment to which the term “prolonged narcosis” can be applied prior to the year 1897, when Macleod (47, 48) published his first article on the bromide sleep treatment. The Hippocratic “Aphorisms” (126) mention that immoderate sleep is bad for the patient, but Celsus (129) quotes Asclepiades as being in favour of procuring sleep, and remarks that some insane patients recover if sleep is obtained, and Paulus Aegineta (128) observes that sleep produces oblivion of mental suffering and rectifies the distracted powers of reason. Aretaeus (127) in discussing satyriasis mentions “very protracted sleep” as the proper cure for the condition”.

The subject of this essay has almost the blessings of antiquity. The increase in the knowledge of the aetiology of epilepsy makes the revision of its classification very necessary. It has been well said that complexity of nomenclature implies poverty of knowledge. This is conspicuously true of one branch, in particular, of medicine, where the desire for classification has outrun the accumulation of data. It is not so with epilepsy, where increased knowledge of causation necessitates a revision of the scheme of classification.

Prominal was first favourably reported on by several German and other continental observers (1, 2, 3, 4) in 1932. More recently (6, 7, 8, 9, 10) there has been evidence of its value from workers in this country, mainly of its use in epileptics with mental defect. In the reported cases results have indicated that only 3 out of 66 cases failed to show diminution in the number of their fits. In the epileptic psychotics treated at Claybury during the past eighteen months the drug has been found useful in a less striking way.

One of the most striking characteristics of patients in a mental hospital diagnosed as suffering from schizophrenia, or dementia præcox, is their dissimilarity. It is easy to pick out cases in which the onset, course, symptomatology and outcome of the psychosis are different. There is thus a tendency to regard the schizophrenic group as possibly containing many different clinical entities. One of the current major problems of psychiatry is to clarify what constitutes schizophrenia and to subdivide the clinical material further in a way which will prove useful for study.

A brief summary of this patient's condition was given in our article on “Hypnosis in Mental Hospital Practice “(1), where it was cited as Case 2, illustrating “the great value of hypnosis as a quick method of bridging amnesic gaps”. The hope was there expressed that the case would be published separately in full, as it contains numerous features of general interest. Similar cases appear from time to time in the newspapers, and it seemed to us that a detailed account, showing exactly how the amnesias arose and how the case was dealt with, might be welcomed.