I carried out 2,443 treatments by electro-narcosis on 152 patients, between 29 January, 1948, and 19 February, 1949, without fatality, and without any adverse personality change attributable to the treatment. Of these patients 105 were schizophrenics, whose treatment was completed before 29 January, 1949. This series alone is considered in detail here, but the experience gained from the treatment of the remaining patients is taken into account, especially in relation to difficulties and dangers.

Early in 1950 we treated 34 depressed patients with desoxyephedrine, in an attempt to discover whether it is comparable in efficiency to electroshock in the treatment of depression in a substantial proportion of cases. We originally intended to treat approximately 100 consecutive depressed patients admitted to hospital, and to compare the results with those obtained in the previous 200 consecutive depressions treated by electroshock. The results, however, caused us to stop the experiment at a much earlier stage.

In a previous article (Rudolf, 1949) an account was given of the results of treatment of 90 defectives with 3 mgms. of aneurin daily for a period of six months. The patients had been resident in Hortham Colony for periods of from 3 to 17 years. None had shown any improvement for at least one year prior to the beginning of the treatment.

Electronarcosis (E.L.N.) is a state of unconsciousness brought about by the passage of an electric current through the forebrain. The current has a much lower milliamperage than that which is used in electro-convulsive therapy (E.C.T).

During the early winter of 1943 a series of cases was seen that presented syndromes of emotional disturbance, varying from acute excitement and confusion to depressive traits such as hypochondriasis, vague fears and insomnia. Hallucination, delusions, or ideas of reference, appeared in all. The patients concerned, six in number, were Indian males, all between 20 and 40 years of age, and were referred to the psychiatric section of the combined general hospital at Basra between October and December, 1943. They had a common background, inasmuch as they had all been away from India with their units for a year or more, and were members of military units working in S. Persia, closely in contact with petrol, either as can fillers or can stackers in enclosed spaces. The hours of work were long, and the men were kept at this work for extended periods. It was, at the time, essential to maintain heavy deliveries of petrol, and the men concerned were at work in high natural temperatures with only little consideration being given for possible ill effects from the freely evaporating petrol.

In this short paper I shall set out a theory of the origin of head-banging and head-rolling which I do not claim has never been advanced before (since my reading has admittedly been far from exhaustive), but which I personally have not so far encountered in the literature, and which is certainly not widely known at the present time.

The metabolism of nitrogen-containing compounds, and in particular amino-acids, in mental patients, has aroused interest in recent years for the following reasons.

Although one of the important objects of a mental deficiency colony is the return of patients to the general population, the number of cases on licence, or discharged from the provisions of the Mental Deficiency Acts, is not an accurate indication of the improvement-rate. Cases proceed on licence because their behaviour is sufficiently satisfactory for the houses to which they go. A defective may show no change whilst in the colony, but the environment to which he goes may be better than that which he left before entering the colony. Alternatively, the defective may return to the same home circumstances which he left, but he may have improved. All gradations of combinations of change of environment or of defectives occur.

The purpose of this paper is to establish two points: first, the safety and relative simplicity of curare-modified E.C.T., and secondly, the need for such a treatment.

Harrell (1943, 1946), working with children in an orphanage, reported that improvement during administration of aneurin continued during the year following cessation of the treatment. The improvement which continued occurred in intelligence tests, educational achievement, reaction time, and height and weight gains.

Fifty years ago in a discussion on the pharmacology of cannabis indica, Dixon (1899) said, “Hemp therefore exerts its effect differently according to the preparation used … In fits of depression, mental fatigue, nervous headache, and exhaustion a few inhalations produce an almost immediate effect, the sense of depression, headache, feeling of fatigue disappear and the subject is able to continue his work feeling refreshed and soothed. I am further convinced that its results are marvellous in giving staying power and altering the feelings of muscular fatigue which follow hard physical labour … It is to be feared, however, that cannabis indica can never become popular until its active principle has been isolated, that is, the isolation of a compound of fixed strength.”

In cases where there is known to be a disturbance of metabolism it is natural to speculate upon the possible site of dysfunction in the organs and tissues of the body.

In phenylketonuria the basic biochemical error is a disordered metabolism of phenylalanine, the patient being unable to dispose of this substance at a normal rate (Jervis et al., 1940). The phenylpyruvic acid in the urine of phenylketonuric patients is derived from a deamination of phenylalanine in the kidney.

Electric convulsion therapy has been generally accepted as a valuable method of treatment in depressive states. Assessment of the results of this form of treatment has generally been based on a small series of cases, and percentage rates of recovery and relapse have usually been computed on one hospitalization. No report has so far been published of a complete follow-up of patients throughout their frequent hospitalizations and remissions. Nevertheless, it is only on such a long-term basis that treatment of depressive states can be accurately evaluated. It was with this ideal in mind that the present study was undertaken. The clinical cases on which it is based are those of 923 patients treated in the Royal Edinburgh Hospital for Mental and Nervous Disorders between the years 1930-48.

Concurrence of the above-named symptoms does not appear to have been reported in the literature. Congenital double athetosis and deaf-mutism usually occur independently of one another. Out of about 1,500 patients at this institution there are 14 with the former condition and 25 with the latter. The relation of the syndrome to its chief constituents may be clarified by a preliminary account of this larger context out of which 3 of the 5 cases here reported are drawn.

This paper is concerned with two schizophrenic patients showing unusual complications of Sakel's insulin coma therapy. The first had a series of attacks of spontaneous hypoglycaemia apparently uninfluenced by the temporary withholding of insulin; the other developed diabetes mellitus a short time after finishing his treatment.

Results of a previous investigation of manic-depressive psychosis with a continuity of cycles of short duration (Klein and Nunn, 1945) seemed to justify further study of this group. As such cases suitable for investigation are rare, we are again reporting observations on a single case, although the cycles were not as short and regular as in the earlier case. The patient at the time of his last admission to this hospital (in 1944) was aged 40, married, had a healthy child of 16, and was an employee of a tobacco factory. He was said to have been always very quiet and reserved, and had no history of mental illness before joining the Army in 1941. He went to the Middle East in July, 1942, and began to feel listless, tired and sleepless for the first time at the beginning of 1943. After spending four weeks in a military hospital he still felt low on returning to his unit, but soon afterwards was full of life; in his own words, “I could tear anything down.” A fresh period of depression set in later, and he was sent to a military mental hospital for six months, during which time he apparently changed several times from a depressive state into a manic one in which he felt “overstowed with vitality,” “with the energy of ten men.” From this hospital he was returned to England and invalided from the army in October, 1943, at which date he first became a patient in this hospital. An initial depression of about three weeks was followed by a manic condition, and on becoming more settled he took his discharge (at the beginning of December, 1943). In February, 1944, he was readmitted in depression, but went out again whilst in moderate mania in April. Whilst at home he continued his work in the factory, but in September, 1944, was once more admitted to hospital and has since remained. From the latter date till October, 1948, depressive periods have alternated with manic conditions. Wide variations have been noted in the duration of the two phases; at the beginning of the observation period of 21 cycles the manic state lasted longer than the depression, whilst in the last year the reverse was usually true. Manic periods varied between one week and 35 days, with an average of 18 days, while the variation shown by depressive phases was between 6 and 24 days, with an average of 13 days.