It has been suggested that mongolism results from damage to the germ plasm from gametic mutation or the fertilization of an abnormal ovum, the theory being mainly based on the study of twins, one or both of whom has been found to be mongoloid (Benda, 1947).

During a domiciliary visit one of us encountered a child who appeared to be a typical mongol and who nevertheless behaved remarkably intelligently. This child was later shown to numerous colleagues, among them the late Sir Leonard Parsons, who spontaneously suggested that she was a “mongol.” The combination of mongoloid features, which she exhibits, and normal intelligence is of sufficient interest, we feel, to be recorded.

In April, 1946, an experimental form of hospitalization for psychiatric patients was set up in Montreal.∗ This form of hospital, described by Ewen Cameron (1947), admitted any type of patient, the only criterion being that they should be well enough to stay at home over-night. To such an institution he gave the name of Day Hospital. At about the same time J. Bierer (1951) was experimenting in the same direction in this country. in connection with his attempt to extend the principles of “social psychiatry” to the everyday treatment of patients. Since then there have been several other short communications on the subject such as those of A. E. Moll (1951) and H. Gilmore (1952).

This paper is based on a year's psychotherapeutic experience during 1950–51 in a well-known psychiatric clinic in America.

The psychiatric patient in the United States, like his brother and sister elsewhere, may be regarded from one viewpoint as a product of his culture. It has been said that the American scene is compounded of an unorganized mass of atypicalities; but, in fact, certain broad cultural trends are discernible. A brief look at the background of social and family patterns will help to give some insight into the psychic apparatus of the sick as well as the healthy person.

The effects of temporal lobe lesions on behaviour have recently received considerable attention. There is reason to believe that certain types of abnormal behaviour are related to neurophysiological disturbances localized in the temporal lobes (Hill and Watterson, 1942; Rey, Pond and Evans, 1949). The effects of excisions of the temporal lobes on behaviour have been studied in animals (Klüver and Bucy, 1938), and in human subjects (Penfield and Flanigan, 1950; Bailey and Gibbs, 1951), while those of therapeutic incisions have been described by Obrador (1947). They appear to have certain features in common with those resulting from lesions of the frontal lobes. However, knowledge in this field is still in its infancy, and the following two cases in which temporal lobe lesions supervened upon paranoid states are therefore considered as worthy of interest. They were observed at the Professorial Unit of the Bethlem Royal and Maudsley Hospitals.