Comparatively little attention has been devoted to schizophrenia in the extensive psychiatric literature which has accumulated during the War. While man-power was more important than Man, it could hardly be otherwise, for those who succumbed to this illness were usually invalided even in the event of full recovery. But there was perhaps another reason to be found in the belief that schizophrenia was merely an old friend of peacetime interjecting itself inconveniently into wartime medicine, but not having any special or unusual qualities save perhaps an acuter onset or a better prognosis.

After the cessation of hostilities with Japan some 60,000 Europeans were released from Prisoners of War Camps in territory under Japanese control. Of these, a high proportion were sick and were admitted to hospital. Nearly all the psychiatric cases among them were admitted to the 41 British General Hospital, Hospital Town East, Jalahalli. These cases admitted to this hospital were 60 in number, and of them 50 were considered psychotic, 6 neurotic, and in 4 no gross psychiatric disability was found. In order, adequately, to assess the significance of this incidence of mental disorder in the prison camps, a brief résumé of the conditions of imprisonment and of the state of the cases admitted to general medical wards is considered essential.

Innumerable attempts have been made to define pain by physiologists, by pathologists, by clinicians and by philosophers, who all see the problem from a different angle, and who discuss it each according to his own particular mode of expression and training. The distinguished writers of the past centuries devoted much attention to the subject of pain, but wrote largely on its origin and on the various types rather than on its actual nature.

Although the electrical treatment of mental disorders is still in the empirical stage, its use is well established. Certain features and principles of treatment have been elucidated in the published reports, and all are agreed that it is specific for melancholic states.

The evaluation of the scope and usefulness of E.C.T. would be enhanced by the comparative study of case material from various clinics, but much in the published reports is not strictly comparable because of the unavoidable variation in the assessment of diagnosis and the degree of recovery. In our case material collected over a period of five years we have endeavoured to present the facts with a minimum of subjectivity by limiting our observation as far as possible to measurable data. In order to reduce the variable factor of diagnosis, some 700 psychotics treated with electrically induced convulsions have been reconsidered and 500 selected for analysis after carefully excluding the overlapping types, particularly those cases presenting features of both affective and schizophrenic psychoses. The selected cases can therefore be regarded as classical examples clearly separated into the two large groups of biogenetic psychoses—schizophrenic and manic-depressive, including involutional melancholia.

Until quite recently the mortality from cerebrospinal spinal fever was considerable, and those who survived the illness were considered lucky to be alive at all. As a result of chemotherapy, which has already reduced the case mortality to less than 9 per cent., more and more persons are likely to recover and present new problems. That some of these survivors may continue to complain of symptoms which incapacitatate them for work for prolonged periods has been borne out by some recent contributions (Pai, 1944; Degen et al., 1945; MacKieth, 1945; Ballard and Miller, 1945). In a previous paper (Pai, 1945) it was pointed out that some of these symptoms were psychogenic in origin, and others probably physiogenic, due to organic changes in the brain. Among the latter symptoms were changes in personality, intellectual deterioration, mild but persistent depression, occasional disorders of conduct and pronounced tendencies to invalidism. As personality consists to a great extent of several patterns of behaviour acquired in infancy and childhood, it was decided to study a group of patients who had cerebrospinal spinal fever in early life, in order to determine to what extent this illness had contributed to the development or the warping of the personality in each patient.

Convulsion therapy may now be considered to have established a position for itself in psychiatry, and in particular there is now a consensus of opinion that in states of depression occurring in later life it offers a chance of recovery for the patient unrivalled by any other form of therapy. The treatment is associated with a risk of causing compression fractures of the spinal vertebrae, and especially in the age-groups above 60 one is still concerned with the violence of the muscular spasm produced at the treatment. In July, 1939, at the Woodside Hospital we first commenced to study the problem of vertebral fractures complicating convulsion therapy, and also to investigate the general problems involved in rendering the treatment safe for our involutional cases. Our first attempt was with curarine, which we were enabled to give to a few of our patients in the psychiatric department of the Middlesex Hospital owing to the facilities placed at our disposal by the research pharmacological department.

Conscious generalized immobility, in which the musculature remains in the tonic state in which it has been placed voluntarily, is known amongst naval officers, printers and nurses, amongst the last being known as “night nurses' paralysis.” Its duration is of a few seconds or minutes, and it appears to be a cataleptic phenomenon. It differs from cataplexy in that the musculature is tonic, and perhaps hypertonic, with the eyelids open, whereas in cataplexy the subject falls to the ground with muscles limp and eyelids closed, as if asleep.

Since the influence of the autonomic nervous system on epileptic phenomena became the subject of intensive investigations, several contradictory reports have been published. Williams and Russell (1941) and Williams (1941) found that parasympathetic overactivity (induced chemically and registered by electro-encephalography) increases epileptic activity. Darrow (1944) reported opposite results, his observations being based on electrically induced parasympathetic overactivity on animals. He registered his observations by electroencephalography. Cohen, Thale and Tissenbaum (1044) induced convulsions for therapeutical purposes by administering the parasympathomimetic drug, acetylcholine, and Chatfield and Dempsey (1942) observed the production of fits in cats, when giving acetylcholine and prostigmine together. Though the results were contradictory, the main aim of all these investigations was to establish the cholinergic neurohumoral changes in relation to epilepsy. But, as Williams pointed out, it is impossible to say whether the results are due to a direct central action, are consequent upon changes in the pH or of a respiratory or a circulatory nature. The investigations described in this paper were devised to re-examine these problems clinically. They were based on the hypothesis that if cholinergic overactivity enhances epileptic cerebral activity, the convulsive threshold of the brain should be lowered after administration of anticholinesterases, in particular prostigmine.

The favourable results obtained in the treatment of early and late syphilis by penicillin fostered the hope that it would also be of benefit in cases of G.P.I. Accordingly, this method of treatment was instituted in a psychiatric hospital in M.E.F. (No. 78), and the results obtained in six cases are here recorded.

The following two case-records furnish an interesting example of similar mental illness occurring in identical twins, in which, however, in the one case the illness had come on endogenously, whereas in the other there was an apparent precipitating cause. Their age when seen was 25 years.

The psychiatric aspects of ageing are a major problem in any country which, like our own, has a low net reproduction rate and a high standard of social responsibility: the proportion of old people in the community steadily increases, so that they provide an increasingly high proportion of our mentally infirm population who must be cared for. But it is not only senile dementia and the other senile and presenile psychoses described in textbooks that make up the problem: less conspicuous failings which may accompany old age also call for attention if the social and preventive sides of our work are to be given due weight. Therefore it is psychiatric aspects of ageing rather than senile psychoses alone that are intended by the title of this paper.

An interesting field for investigation and experiment is provided by the conditions formerly known as Little's disease or spastic diplegia, or hemiplegia, or spasticity with athetosis.

One hundred years ago Little studied cases of types now grouped under the common term “cerebral palsy.” His conclusions justified attempts at rehabilitation rather than surgical intervention.

Perhaps the earliest adumbration of modern interest in problems of old age was Quetelet's important two-volume work on Man and the Development of his Faculties in 1835 (55). In this book appeared for the first time data of a kind since become very familiar: ages when various crimes are committed, when literary masterpieces are written, ages of admission to hospitals for the insane, and so on.

The object of my study was an attempt to discover what social factors might be said to contribute to either mental health or mental ill-health in old age. I studied the histories of four groups of 50 aged in four different settings which in retrospect might be said to form a spectrum. That is to say that each subsequent social background seemed to be more conducive to normal ageing than the preceding one. The actual sequence of the whole investigation, for technical reasons, was, however, as follows: In the first place I made contact with patients in Tooting Bec Mental Hospital; as a second group I chose people in a Club for Old Age Pensioners in Streatham; thirdly, I visited old people living by themselves in Fulham; and finally, 1 interviewed a group who are living on an Estate at Mill Hill, the Estate being maintained by the Society of Linen and Woollen Drapers. In all but the last sample I studied the cases of 25 men and 25 women.

In setting up the definitions of psychiatric conditions, the term “disorder” has been used for the designation of the generic group of the specific reactions, while the specific reaction types have been termed “reactions.” In classifying psychoneuroses, the dynamics of the psychopathology was chosen as the basis. Of necessity, a few terms remained descriptive (symptomatic). In general, an attempt has been made to retain only such formerly used terms as could be fitted into this general plan and omit categories which are “catch-alls,” such as “Simple adult maladjustment,” “Constitutional psychopathic state,” etc.