Sichuan is the biggest province of the People's Republic of China, with a broad area of over 560 thousand square km and a population of over 90 million people. The central portion of it is a big basin about 200 thousand square km in area, surrounded by many mountains with average altitude between 1,000 and 3,000 m above sea level. About 90 per cent of the population of the province lives in this area. The west portion of the province, called West Sichuan Plateau with average altitude of over 3,000 m, is relatively unpopulated. According to a census of a district of Zigong in 1973, 39.2 per cent of the population was below age 15 and 4.3 per cent above age 65. [In Britain (1975) the corresponding figures were 25 per cent and 14 per cent—Editor].

Flash and pattern-reversal visual evoked potentials (VEP) were recorded in 35 elderly patients with dementia, and 19 controls of equivalent age. Dementia produced a slowing of the major positive (P2) component of the flash VEP but did not affect the latency of the flash P1 component or the P100 pattern-reversal component. This unusual type of abnormality was found in both primary and multi-infarct types of dementia, and has previously been found in primary presenile dementia. The results show that the VEP can be used for the diagnosis of multi-infarct, and primary presenile and senile dementias.

Nearly one hundred years ago, Anstie (1864) wrote: “Among the too frequent instances which are to be found in medical nomenclature, of confusion and uncertainty in the application of descriptive terms, there is none, perhaps, more striking than is occupied by the words Narcotic and Stimulant.” Both classes of substance embrace drugs of antiquity. Thus of the depressants, alcohol dates from the time of the Thracian god, Dionysus, while the earliest use of stimulants such as caffeine and xanthine is lost in the obscurity of the past (Goodman and Gilman, 1955a). Even today, there exists no systematized codification of response to the two classes of drug, although it is implicitly assumed that stimulants and depressants are invariably and mutually antagonistic in their effect on the central nervous system. Advantage was therefore taken of phenomena arising during drug intoxications to categorize abnormal features in the central nervous system common to each of the two classes of intoxicant and to essay a comparison, the one with the other.

Shortly before the end of the last century, Eijkman observed that fowl receiving a diet of polished rice developed a disease which he believed to be of the same nature as human beri-beri. It was subsequently shown that this condition in fowl (polyneuritis gallinarum), and beri-beri in man, could both be cured by the addition to the diet of rice polishings or an extract prepared from them. In 1911, Funk obtained from rice polishings a crystalline substance capable of preventing or curing beri-beri, which he named “vitamine” in view of its evident importance to life, and in the erroneous belief that it had the chemical structure of an amine. Four years later, McCollum and Davis demonstrated that at least two such dietary factors were necessary for growth in rats—“fat-soluble A” and “water-soluble B”. Before long it was recognized that the latter factor had the properties of the antineuritic “vitamine“, and a number of similar organic compounds were discovered, which were essential constituents of the diet in minute quantities, and for which the general term “vitamin”, was agreed upon. For several years it was assumed that water-soluble vitamin B (contained in yeast, rice polish, liver, etc.) was a single entity, but in 1919 Mitchell noted that certain vegetables rich in the antineuritic principle had little power to promote growth, and in 1926 two fractions were distinguished, each essential for growth—thermolabile vitamin B1, containing the antineuritic principle (thiamin), and thermostable vitamin B2.

A case of folie à quatre is described affecting a proband and his wife, sister and brother. The three family members retained their symptoms of paranoid schizophrenia. The wife was not mentally ill and her delusions disappeared in time (folie imposée). Coincidentally, there were several cases of Huntington's chorea amongst her relatives. Different categories of folie à deux are demonstrated in the various family members and relationships.

The significance of delusions for psychiatry is well recognised. Scientifically respectable, delusions are reliably identifiable clinically (Wing et al, 1974), widely acknowledged across diverse cultural norms as genuine symptoms of illness (Wing, 1978), and central to the historical notion of insanity (Jaspers, 1913). What is not so well recognised, however, is that delusions are also highly significant for philosophy. This is not well recognised either by philosophers or by doctors. Yet the key to recognising it lies not in some obscure philosophical analysis of delusions but in a feature of their everyday clinical phenomenology.

4-p-Chlorophenyl-1-(3-p-fluorobenzoylpropyl)-4-hydroxypiperidine (R.1625, Haloperidol) is a new compound synthesized by Janssen et al. (1959) and reported to have biological properties similar to those of the phenothiazines at a much lower dosage level. One difference, however, was a greater tendency to potentiate pentobarbitone hypnosis. Von Eiff and Jesdinsky (1960) conducted a “double blind” trial in 28 normal subjects using 4 mg. Haloperidol 2½ or 4½ hours before the experimental period. Subjective effects included fatigue or fatigue and agitation in females. The drug did not appear to influence intellectual function as tested, but reduced self-criticism. There were minor cardio-vascular effects and a tendency to fatigue in ergometry performances. A number of clinical reports have appeared (Divry et al., 1960; Delay et al., 1960) suggesting that Haloperidol is of value in psychomotor agitation and especially in mania in doses of 2–15 mg. daily. Gerle (1960) reports favourably on the drug in schizophrenic patients. Most authors note a high incidence of pseudo-Parkinsonian side-effects (40–80 per cent. of cases) and a section of a recent symposium on the drug in Belgium was devoted to “neurodysleptic syndromes” (dystonic reactions, oculogyric crises, etc.) produced by it. Pichot (1960) at the symposium reported that these reactions can be controlled by chlorpromazine.

Lack of speech, i.e. dumbness, has long been equated with backwardness, and probably for this reason and because of success in teaching some hearing impaired children to speak, the terms ‘deaf and dumb’ and ‘deaf mute’ have fallen into disrepute. When deafness is profound and prelingual (i.e. congenital or acquired in early infancy), there is a formidable barrier to the development of language. Many deaf children still leave school with poor language, incomprehensible speech and little ability in lip reading and consequently come to rely upon manual communication methods (finger spelling and signing).

Although anxiety disorders are common in later life, only a minority of patients receive appropriate treatment. The scarcity of clinical trials and decreasing effectiveness of current treatment modalities with advancing age, as shown by Wetherell and colleagues in this issue, argue for more clinical trials and development of age-specific psychotherapeutic techniques.

We investigated whether there is an association between anxiety disorders and mitral valve prolapse. We compared mitral valve prolapse prevalence in individuals with panic disorder (n = 41), social anxiety disorder (n = 89) and in healthy controls (n = 102) in an attempt to overcome the biases of previous studies. Our results show no associations between panic disorder or social anxiety disorder and mitral valve prolapse, regardless of the diagnostic criteria employed, and that the relationship between these conditions seems not to be clinically relevant.