The present paper reports the results of certain experiments carried out in an attempt to obtain information on the increase in suggestibility which is often said to follow the administration of certain narcotics, in particular sodium amytal and nitrous oxide. The set-up of the experiment, and the results and conclusions reached, may be looked at from two different points of view, viz., (1) with regard to the light that is thrown on the action of the narcotics examined, and (2) with regard to the nature of suggestibility.

Whereas much has been published on the psychological reactions, normal and abnormal, in the personnel of the armed forces, little has been written about the neuroses in Civil Defence personnel.

This paper is a survey of cases of neurosis occurring among firemen who were admitted to Mill Hill E.M.S. Hospital from the outbreak of war to October 1, 1944. Altogether 70 patients came from the Fire Service. 40 of them came from London (postal area). No figures can be given about the incidence per number of personnel or per area. But, considering that these 40 men were probably all the firemen in London, north of the river, who required in-patient treatment on account of neurosis during five years, it can be taken that the incidence of serious neurosis was very low. The group of neurotic firemen can be compared with a population of neurotics from the armed Services (as analysed by Eysenck, Journ. Ment Sci., 1944, 90, 851).

The following paper is a description of a form of direct psycho-therapy with children undertaken in a Child Guidance Clinic, and some account of the results achieved in certain cases.

During the hypoglycaemia produced by insulin for the treatment of psychoses, disorders of speech occur as symptoms of the dissolution and restitution of cerebral function. Although transitory, they can be observed accurately, as the hypoglycaemic condition is repeated daily for weeks in the same patient. They have in fact been studied and commented on by several workers since the method was initiated by Sakel in 1934; we shall refer later to some of the findings and views in the literature. In this paper an attempt will be made to describe and classify the various speech disorders, and to relate their characteristic features to other hypoglycaemie symptoms occurring at the same time. Attention will be drawn to certain speech-like symptoms which hitherto have been scarcely noticed. The possible influence of the underlying psychosis will also have to be considered.

In 1899 Kaplan described the “explosive diathesis” as follows: “Following the most trivial and impersonal causes, there is the effect of rage with its motor accompaniments. There may be the most grotesque gesticulation, excessive movements of the face, and a quick, sharp explosiveness of speech; there may be cursing and outbreaks of violence, which are often directed towards things; there may or may not be an amnesia for these afterwards. These outbursts may terminate in an epileptic fit. There is an excess in the reaction, with inadequate adaptation to the situation so remote from a well-considered purposeful act that it approaches a pure psychic reflex act in the shape of an almost or entirely unmodified explosion not unlike a convulsion. The explosive diathesis is not characteristic of head injuries, but is also found in hereditary degeneration, in alcoholic degeneration, etc.”

Whatever the ultimate decision on the permanence of the results of electric convulsive therapy, there can be no doubt as to the present widespread popularity of this treatment in psychiatry. To meet the big demand there have become available in the last few years a number of different convulsant machines, most of which are fairly efficient, but not one being free from defects when exposed to the test of practical application. Some are too heavy and cumbersome, most are liable to minor technical breakdowns, which are the source of much annoyance because they disrupt the hospital routine, one has a faulty time switch which has caused the writer a considerable amount of anxiety when it jammed and allowed the current to flow for about 5 seconds—the patient developed a prolonged period of post-convulsive apnoea, but fortunately came round eventually and suffered no lasting ill-effects. Most machines incorporate one or more instruments to measure the current or the patient's resistance. Neymann et al. have shown the inaccuracy of such simple instruments, and it is doubtful whether they serve any useful purpose. The ammeters are relics of the early days of this treatment, when we were not sure about the safety range of the current, and they were included in the circuit as an extra safeguard. Our experience over the last five years has taught us what currents can be safely used, and an efficient convulsant machine can now be designed whose maximum voltage and maximum time give an output which is well within the limits of safety. A knowledge of the current used is of interest while the machine is undergoing the initial tests, but once this period is over its evaluation, even by an accurate method, is of little academic interest, and a waste of time from the point of view of the practical psychiatrist. The resistance measurements, too, are unnecessary in practice. They were originally made in the hope that they would enable the dosage to be correctly adjusted so as always to ensure a convulsion. But we now know, as Grey Walter has recently pointed out, that the convulsive threshold varies from individual to individual by as much as 1,000 per cent., and since it is a value which can only be found by a method of trial and error, the resistance instruments are of little use. Moreover, no great harm is done if an underdose actually is given—all that happens is that the patient has a temporary period of unconsciousness, and after a short interval a higher dose can be given, which will produce the desired convulsion. It is true, of course, as Kalinowsky (1939) said, that resistance measurements enable one to ensure that the electrodes are making good contact with the patient's skin, but one feels that this is an elaborate and costly method of doing something which could be more easily and quickly accomplished by training the nursing staff always to clean the patient's skin thoroughly before applying the dampened electrodes.

The unfailing regularity of the rhythm of his manic-depressive cycles each week renders the patient in question particularly suitable for investigation, and throws into relief changes which might be less marked if the transition between the phases was more gradual and the periodicity less certain.

In bilateral prefrontal leucotomy inter alia the fronto-subthalamic, the fronto septal and fronto-hypothalamic (posterior) projections may be severed, together with reciprocally projecting tracts. These may represent the anatomical basis for the altered autonomic visceral disturbances observed following operations. The reports on bilateral leucotomy emphasize the post-operative “improvement in autonomic functions with a tendency to gain weight” (Vonderahe). After lobotomy transient visceral disturbances make their appearance, such as disturbed sphincter control and slightly but permanently decreased blood pressure, whilst vasomotor disturbances and sweating on the contralateral half of the body have been noted following unilateral lobotomy.

This paper should be considered a preliminary communication, tentative and suggestive. It is based on a psychiatric and electro-physiological study of 70 cases (children, adolescents and adults) referred for anti-social and/or criminal behaviour, and is an attempt to suggest more defined criteria for the assessment of a particular syndrome.

I once knew a child psychiatrist who had two treatments: Boy Scouts for all symptoms except enuresis, for which he prescribed Sea Scouts; but that was before the war, when we had a seaboard.

There is great satisfaction to the human mind in reducing multiplicity to unity, diversity to simplicity, but this exercise can be carried too far, especially in dealing with such a complex creature as the child. In contrast there is the school of thought which believes in intensive analytic treatment, four to five sessions a week, for every child. How can one steer a middle course in a modern Child Guidance Clinic where numbers must be dealt with, without the sacrifice of the deeper approach, where short and long treatments must be fitted in, where diagnosis and consultations are essential, yet treatment must always be one of the fundamental aims?

This paper describes an investigation into the significance of physique in effort syndrome.

Excepting hysteria, there is a wide divergence of opinion about the proportionate incidence of the various psychoneurotic syndromes. This is more extraordinary because there is general acceptance of the meaning of current terms. Thus, very roughly, in the sense of abnormality—

The purpose of this paper is to report some observations on the Rorschach test in two cases of severe concussional head-injury. Detailed studies of such cases in the Rorschach literature are relatively few, and none, so far as the present writer is aware, includes observations on the test during the more acute phases of the post-traumatic disorder. In addition, therefore, to placing further cases of head-injury on record, it is hoped that our observations may throw light on the psychological changes associated with remission of the post-traumatic confusional state and recovery of normal consciousness. It is further hoped that the Rorschach observations made at a later stage of recovery in these cases may have some bearing on our knowledge and assessment of the chronic post-traumatic condition.

Von Storch has induced headache by the sudden intravenous injection of minute amounts of histamine phosphate in three groups of persons—the first group consisting of those subject to migraine, the second group composed of those suffering from chronic recurrent non-migraine headache, and the third group consisting of those not subject to headache. He has found that in persons subject to migraine the headache produced by histamine is frequently similar in character to their habitual headache (though bilateral), while in those subject to chronic recurrent non-migraine headache the experimental headache is only occasionally similar to their usual headache. From the evidence presented by him, linking migraine and histamine, the latter would appear to be a useful drug for distinguishing migraine from other forms of recurrent headache. Using a technique similar to his, experiments were performed at this centre to determine the relation of histamine headache to post-contusional and psychogenic headaches, and the results are worth recording.

Abnormalities in the vestibular reactions in schizophrenics have been reported in the literature. Pekelsky (1921) observed transitory lack of caloric response in two cases of catatonic stupor. Rosenfeld (1926) described four cases of acute catatonia in which on calorization a slow deviation appeared instead of the physiological response. Claude, Baruk and Aubry (1927) examined four cases of catatonia, eight of hebephrenia and one of dementia paranoides. In one of the catatonic cases no caloric or galvanic response could be elicited, and in the three others the reactions were diminished. The other cases showed normal reactions. The authors stated that a diminution of the responses could sometimes be observed in hysteria. Claude, Bourguignon and Baruk (1932) found the Chronaxie of the vestibular nerves greatly increased in patients with catalepsy, but normal after the disappearance of that symptom. Joo and Meduna (1935) stated that in old-standing cases of schizophrenia a lack or a considerable diminution of the vestibular responses could nearly always be found. Sercl and Vinar (1937) examined the vestibular reactivity in twelve cases of hebephrenia and thirteen cases of paranoid schizophrenia. The responses to rotation were normal in all cases. The caloric responses were found to be diminished or lacking. Lack of caloric response was more frequent in the hebephrenic than in the paranoid cases. Löwenbach (1936), working on Gjessing's cases of periodic catatonia, carried out quantitative investigations taking into account the latency period of nystagmus, its duration and the number of oscillations. He examined thirty cases, each of them repeatedly, and attempted to correlate the results of the tests with the periodical changes in the clinical picture. He found that shortly before and during periods of stupor the vestibular reactivity dropped, and that sometimes only a slow deviation could be elicited. The lowering of the frequency was due to the prolongation of the slow phase. The abnormalities were independent of the duration of the illness, and in some old-standing cases the response was normal. Sometimes a temporarily diminished reactivity was noticed which did not coincide with a change in the clinical picture. Löwenbach noted frequent and often abrupt changes in individual cases, and in some he observed transitory complete loss of reaction. Angyal and Blackman (1940) studied vestibular reactivity to caloric and rotatory stimulation in 58 unselected male schizophrenics and in 20 normal controls. The response to caloric stimulation was found to be considerably lowered, the rotatory response only slightly reduced. There was no correlation to the duration of hospitalization or to the conventional subtypes of schizophrenia. However, in a group of five patients with extreme apathy, indifference and poverty of mental contents the reactivity was particularly low. In cases with a periodical course the vestibular reactivity was distinctly lower during the catatonic periods than during the intervals. The same authors (1941) investigated the nystagmic reactions to caloric stimulation under the influence of alcohol, hyperpnoea and CO-inhalation in schizophrenics and normal persons. While in normals alcohol intake results in an increase in the frequency of the nystagmus, in schizophrenics a decrease was observed. CO, which normally has a depressing effect on the nystagmic reaction, produced an increase in schizophrenics. Hyperpnoea, while causing an increase in normals, had the opposite effect in schizophrenics. Freeman and Rodnick (1942) studied the amount of sway induced by rotation in thirty schizophrenics and in an equal number of normal controls. The patients were found to be significantly less reactive than the normal subjects.

It is now three and a half years since the Navy opened Kielder Camp, and it has been suggested that some account might be given of its activities and of the results obtained there so far.