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).

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).