Because of the widespread incidence of neurosis and the comparative lack of psychiatrists, much thought and activity is being directed into the treatment of a number of patients simultaneously. Apart from economy in time, group therapy has virtues of its own and would have a place in treatment even if there were a sufficiency of trained psychiatric staff.

The amnestic-confabulatory symptom-complex to which the eponymous title of Korsakov's syndrome is usually given was probably first described by the Swedish physician Magnus Huss (1807–90), who spent the greater part of his lifetime in the study of alcoholism. There is, however, no doubt that Korsakov's (1890) paper on the subject gave an excellent description of the syndrome, and stressed the fact that whereas it often developed in patients with alcoholism and polyneuritis, numerous other metabolic and neurological disorders could be complicated by the characteristic mental changes. Indeed, in Korsakov's (1890) own series of cases alcoholics were in the minority. One of the neurological conditions in which the syndrome has been described significantly often is spontaneous subarachnoid haemorrhage. The first reports of the association were probably those of Flatau (1918 and 1921), and it was discussed in some detail by Goldflam (1923) and Herman (1925 and 1926). Each of these authors described the mental symptoms exhaustively but gave no actual case-histories; the first fully documented cases in the literature were the two reported by Hall (1929). Single cases have since been described by Cubitt (1930), Popow (1930) and Kulkow (1935), and in 1939 Tarachow gave an extensive review of the literature and reported an additional 3 cases. It is remarkable that since 1939 the association has received little attention, although it has been mentioned by Sands (1941) and Meadows (1951).

Acute porphyria is a rare disease in this country. Although a typical case was described in the Journal of Mental Science over 50 years ago (Campbell, 1898), Petrie (1948) could find only three cases reported in Britain between 1940 and 1948; since then at least six more cases have been reported. The disease is relatively common in Scandinavia and, to a less extent, in North America—a distribution for which Discombe (1948) has suggested an explanation in terms of relative emigration rates.

A previous communication (Carpenter and MacLeod, 1952) described the application of a maze, together with a simple test of limb co-ordination, to the study of alcoholic intoxication in rats, as modified by acetaldehyde. As part of a scheme of work here, it was desired to observe the effect of drugs and other substances upon the degree of intoxication produced in rats by ethyl alcohol. Such studies, pursued by the methods previously given, soon led to a formidable mass of recorded material, some features of which were not adequately dealt with by the scoring technique employed. It became necessary to adopt a scoring system which would give an overall indication of the various manifestations of alcoholic intoxication, to serve for the purpose of compact tabulation of results and the drawing of conclusions.

As modification of electro-shock is becoming a routine procedure in every patient undergoing this therapy, it is necessary to find a muscle relaxant, or as it has been commonly called a “curarizing agent,” which will be ideal for this purpose. Ideal should mean no toxicity, rapid onset, short duration and rapid termination of neuro-muscular blocking action.

It is probable that the incidence of vertebral fractures during E.C.T. is greater than was formerly thought to be the case. Meschan, Scruggs and Colhoun (1950) found vertebral compression fractures in over 35 per cent. of 212 cases treated with E.C.T. Plattner (1949), in a series of 500 cases (200 men and 300 women), found fractures in 58 (37 men and 21 women). In 20 of his cases E.C.T. had to be abandoned on account of the fracture.

Interest in this problem on the part of parents, sociologists and paediatricians, among others, has grown of recent years. So much is this so that the casual observer might well conclude that there had been a real increase in backwardness, and that anxious parents now have a more genuine cause for anxiety on this score than was the case a generation ago. This view indeed is held by certain well established authorities in the fields of education and psychology, for example Burt and Professor Godfrey Thompson, who have expressed gloomy views about the intelligence of the nation. Moreover, considerable publicity by means of wireless broadcasts or otherwise has been given to these prognostications. It is not therefore surprising that many parents should be concerned as to whether their offspring will after all prove to be something less of a genius than they had anticipated. The smaller size of modern families is also a factor in increasing paternal anxiety. I say paternal advisedly, since it is more often the male parent, especially in middle-class circles, who has set his heart on his child being an infant prodigy. With only one string to his bow, the whole tension of paternal ambition is concentrated in a single object. Moreover in these days of compulsory examinations at the age of eleven, together with widespread coaching for the intelligence tests which form part of the examination, the unfortunate, innocent babe is barely able to lift a mug or a spoon when his rattle is whisked away and replaced by a host of constructional toys designed on similar lines to modern American intelligence tests. The slightest failure in performance or slackening of interest is liable to produce a state akin to panic in the proud parent, who has just been comparing notes about his prodigy with the owner of another (but naturally, somewhat inferior) budding genius next door.

The Industrial Neurosis Unit of Belmont Hospital has one hundred beds, two-thirds of which are occupied by males. The vast majority of the patients are chronic psycho-neurotics and psychopathic personalities, who show poor social adjustment. The material treated here is what is usually labelled as “hopeless.” Letters from Out-Patient Departments, seeking admission are prefaced, “We know this is a hopeless case …,” or “If you cannot help him then there is no hope for him …,” etc. During the four years of its existence the Industrial Unit has evolved and practised a variety of techniques of group psycho-therapy, in addition to the orthodox psychological and physical treatments available in modern psychiatric hospitals. More and more importance is being attached to the value of group methods here, to the extent that some doctors, after taking a brief history, thereafter employ group-therapy exclusively. This paper is an attempt to discuss the relative values and roles of therapy carried out at individual and group levels in the Industrial Unit.

In previous communications (1951, 1952) we have shown that lysergic acid diethylamide (LSD-25), a drug which has a remarkable psychological effect in minute oral doses, also has an effect on carbohydrate metabolism resulting in an increased concentration of hexosemonophosphate in the blood. This observation has been confirmed by Cornforth and Long (1952). What was less clear from the experiments in mentally healthy subjects was the relation in time and severity between the psychological symptoms and biochemical changes.

The purpose of this experiment has been, in the first place, to bring about improvement in certain patients who were responding insufficiently or not at all to psychotherapy, by the use of this drug for which claims have been made that it is of value in the therapy of some anxiety states, such as those characterized by tension; and in the second place to gain by experience an understanding of how much we are justified in expecting from its use. Within the limited series of eleven patients so far treated, results have been sufficiently encouraging to make us wish to continue.

In the course of treatment by psychotherapy progress is often hampered by the patient coming to rationalize his reaction to problems; while he attains an intellectual insight, he fails to respond at emotional levels sufficiently to enable him to gain relief from tension or to alter existing patterns of behaviour.

The use of muscle relaxants as a help in minimizing the hazards of E.C.T. has been reported by a number of workers (Hobson and Prescott, 1947; Davies and Lewis, 1949; Shepherd and Watts, 1949; Smith and Thomas, 1951; and Thompson and Norton, 1951). From these observations the value of such substances in reducing the muscular force of electrically-induced convulsions is clear. Nevertheless the trial of a new substance was embarked upon in order to establish whether it approaches more closely the ideal drug for the purpose.

Harris (1951) adequately summarizes the work done on nitrile compounds and their therapeutic use in psychiatric disorder. This work is highly controversial and the results contradictory. He adds a series of thirty cases of his own treated with dinitrile succinate (“Suxil” or “Psychil”), and concludes that no clear evidence of its therapeutic value was obtained. Twenty of his cases were treated by six or less injections of 0.1 gm. for the first, and 0.2 gm. for subsequent injections. He says: “Later, following representations by the manufacturers, this was extended to twelve.” He also comments on the suggestibility of some of his patients and the high spontaneous remission rate which make assessment of the efficacy of therapy peculiarly difficult. As far as can be seen from his paper, the assessments were made entirely impressionistically. Our preliminary trials, confirmed by our further experience with this drug, indicated (in complete harmony with Harris's opinion) that the drug is “safe, easy to administer, and quite free from toxic effects in the doses recommended.” We felt, therefore, that a further experimental trial was indicated.

The present investigation covers a series of 110 treatments with electroplexy in which RO/3/0386 has been used as an ultra short-acting relaxant. This is a heteropoly-methylene-bis-trimethylammonium diiodide, Me3N + (CH2)4. S. S. (CH2)4N + Me3. 2I in aqueous solution which, being related to the decamethonium compounds, acts by depolarizing the motor end plate, and results in similar clinical effects to those produced by succinylcholine as described recently by Richards and Youngman (1952), Mayrhofer (1952), Bourne Collier and Somers (1952), and others.

Symptoms of mental disorder are common in cases with cerebral tumours and malformations. Progressive dementia, clouding of consciousness and personality changes make their appearance sooner or later. They have been understood as the result of interference with cerebral functions. However, there are patients in whom the relationship between cerebral lesions and mental disorder is obscure. They present conditions not usually associated with demonstrable structural changes, and the coexistence of mental and physical symptoms appears purely accidental, both running their course independently.

Achondroplasia (micromelia, chondrodystrophia foetalis) has been defined as “an absence, arrest or perversion of the normal process of endochondral ossification of the most definite and universal character in every element of the skeleton, in which the process normally takes place during intrauterine life” (Symington and Thomson, 1892).

Celastrus paniculata (c. multiflora and c. mutans) is a large climbing shrub found in the hilly districts of India, Burma and Ceylon. The seeds, leaves and an oil extracted by distillation are used in Ayurvedic medicine and are believed to increase intelligence. The Sanskrit name Jyotishmati or “light-bringer” is an allusion to this reputed property. Other members of the family Celastraceae, notably Gymnosporia deflexa Sprague and Catha edulis Forsk, are favoured by the natives of Africa as mental stimulants (Watt and Breyer-Brandwijck, 1932).