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.

On 1 May 2004 ten new countries will join the European Union (EU), which as a result will comprise 25 culturally quite different countries. Each enlargement of the EU so far has been a difficult experience for both the existing member states and the new entrants, since each membership change has altered the structure and the sharing of costs and benefits of membership. Furthermore, each new member brings its own traditions, preferences, strengths and weaknesses, including the mental health of its population and its psychiatric services. Are we ready for the changes to come?

Leucotomy studies are now commonplace and this preliminary report on the clinical aspects of our series has probably little to add to existing ideas on the subject. Neither the case material nor our initial approach to the problem differ fundamentally from the observations expressed by various workers at a meeting held at the Royal Society of Medicine on 9 April, 1946.

The safety of electro-convulsive therapy (E.C.T.) has been greatly increased since muscle relaxants were first introduced for this purpose. Short-acting relaxants such as suxamethonium and suxethonium reduce the usual strong tonic and clonic contractions to faint muscle twitchings, and fractures do not occur. Respiration can be maintained throughout by positive pressure inflation so that cyanosis and stertorous breathing are avoided. This may ensure that material from small pulmonary lesions is not disseminated to other areas. It is disappointing that the cardiovascular commotion is only slightly reduced, and deaths still occur, albeit rarely.

The social problems connected with alcohol are always before us, but social reconstruction after the great war has brought them into greater prominence than ever, while America having gone “dry” and the prohibition campaign starting in this country have brought the question of alcohol home to even the unthinking section of the community. In the past we have had the physiological effects of alcohol put before us almost ad nauseam, and everyone is fully aware of the disastrous wide-spread results of excessive drinking. Well-meaning temperance reformers are continually pointing out the intimate relationship existing between alcoholic excess and illness, crime and pauperism. Not so very long ago in the press, we had the almost amusing incident of a manifesto issued by a list of eminent physicians, who decried its use in medicine, followed not long afterwards by another manifesto signed by an equally eminent catalogue of medical men, who laid much emphasis on the beneficial effects of alcohol as a therapeutic agent. The personal factor is always apt to colour one's views, and I may be no exception to the rule. It is a common fallacy to suppose that science is free from bias and prejudice, but the facts I shall bring before your notice with regard to the relation of alcohol to mental disease will tend to indicate their presence.

It is a recognised fact that nervous and mental disorders are more frequent after influenza than after any of the other zymotic diseases. Dr. Risien Russell has specially referred to the action of the influenza bacillus and its toxin on the nervous system. Dr. Clouston has expressed the opinion that the effects of influenza on the mental condition of Europe far exceeded in destructive powers all the continued fevers put together. An increase in the admissions of melancholic patients into several of the asylums of this country during the prevalence of influenza has been reported at Edinburgh, Hanwell, Birmingham, Nottingham, and other institutions. Dr. Macpherson and Dr. Farquharson have discussed the pathological aspects of depressed emotions, and the physical reduction caused by influenza, as favourable to the onset of melancholia.

One of the common clinical interests shared by physicians and psychiatrists is the genetically determined syndrome to which Klinefelter has given his name. Over the past few years positive identification has become possible through advances in cytogenetics, and more recently evidence has been accumulating which seems to indicate that a significant correlation may exist between Klinefelter's Syndrome and the development of other diseases, malignant disease in particular. Mental retardation is one of the most common symptoms found in the syndrome, so the psychiatrist is often in the best position to detect it. The case to be described here as well as having a few interesting facets of psychopathology may also provide more evidence of the pathological loading which the basic genetic abnormality seems to carry.

Ferenczi (1927, orig. 1911) thought that on clinical grounds he had clearly established two types of homosexual males. One type combined masculinity and a preference for pubescents, and the other type combined femininity with a preference for physically mature partners. However, Hirschfeld (1920, p. 267, 277, orig. 1914), who had examined a very large number of homosexual males, doubted the existence of any relationship between femininity and age preference.

2,3-butanediol appears in the blood of some alcoholics following ethanol ingestion. Whether it be a genetic trait or a phenomenon of induction remains to be determined. It may be associated in some way with depression.

Most studies on the personality of homosexuals have been based on patients or prisoners (e.g. Cattell and Morony, 1962), and much less is known about those who do not fall into these categories. This report summarizes a comparison of the personalities of a sample of normal British homosexuals with a patient group who sought treatment. It was hoped through this investigation, an offshoot study of a major treatment programme for homosexuals, to determine the relationship between personality characteristics and referral for treatment; also to obtain further information about the personalities of non-treatment-seeking homosexuals.

One major characteristic of behaviour disorder is persistent hostility towards authority. Those offenders who appear repeatedly before the Courts and are eventually diagnosed as cases of behaviour disorder, almost uniformly exhibit histories of difficulties with authority (8). Indeed, when a study was made of 87 case-notes of patients in a hospital for the mentally subnormal who were admitted as suffering from behaviour disorder, in order to discover those features of their previous histories which were common to all, it was found that every one showed a persistently troublesome relationship with authority figures (9).

It is now generally conceded that slow wave activity tends to appear in the EEG as age advances. Attempts have been made with varying success to relate these slower rhythms to the presence of organic cerebral deterioration.

As a physician with a special interest in respiratory disease, I have been concerned with the semantic problems of my own specialty (Scadding, 1959, 1963) and of medicine generally (Scadding, 1967, 1972, 1975, 1988), and more recently have been invited to consider how far my approach may be applicable to psychiatry (Scadding, 1980, 1982, 1990). I therefore read the essay on nosology, taxonomy and classification of the functional psychoses by Parshall & Priest with interest, and venture to make the following observations.

This study follows the psychological profile of a group of Antarctic explorers on a remote base in British Antarctica. Each month for 1 year the 60-item General Health Questionnaire (GHQ) was administered to the 12-man complement and the results compared to those of a control group. Three men resigned and left, 4 months later, at the end of winter. Their scoring showed marked differences from the others, including the highest scores in the severe depression factor scale. The GHQ was accepted by the men despite the intrusive threat it offered in such a small community; there was also a seasonal variation in scoring, with higher scores in the winter, and no evidence of long-term psychological sequelae in those who stayed.

In a longitudinal study in South-west Scotland of patients suffering mainly from affective illness, the introduction of lithium as prophylactic therapy was associated with a significant reduction in the number and length of hospital in-patient admissions, as well as in the number of courses and total number of electro-convulsive treatments. However, there was no significant reduction in the length of time patients received either antidepressants or major tranquillisers. A rating of individual patients suggested that a bare majority (52%) had improved considerably following the introduction of lithium.

In 1937 an excellent investigation, by Pentreath and Dax, of the work of a London observation ward appeared in the Journal of Mental Science. In the course of their conclusions, they pointed out that: “observation wards are still in their infancy so far as their developmental possibilities are concerned—in fact, we are still in the process of deciding what their purpose should be.” In the ferment of ideas that culminated in the Mental Health Act of 1959, and the fresh insights into administrative psychiatry which have followed, the future function of such units seems to have received little attention. Freeman and Farndale's book Trends in the Mental Health Services (1963) does not introduce the concept of the psychiatric emergency, nor does it consider any special provision for these patients.