The late prognosis of childhood encopresis is unclear: our literature reviews have failed to reveal any studies of it. Halpern (1977), discussing the effectiveness of treatment, states that this is difficult to evaluate “since encopresis is a self-limiting symptom”. Bellman (1966) followed up 186 children with encopresis seen at two Stockholm clinics; their age range at follow-up was 6–19 years. She found a steady decline in encopresis from the age of six in boys and eight in girls. It disappeared by the age of 16, although there were two relapses—one at 17 and one at 19.

In England, public intoxication has been a criminal offence ever since an Act of Parliament was passed in the reign of James I, somewhat over three and a half centuries ago. Edwards (1970) compiled some figures on these offences for the last two hundred years, showing that the rate of arrest was much higher in the nineteenth century than at present. For example, in 1878 there were 70 arrests per 10,000 of the population, compared with a comparable figure for 1968 of 16. Nevertheless, the latest available figures from the Home Office (1971) show that 82,961 persons were found guilty of simple or aggravated public drunkenness in 1971. In the U.S.A., with its apparently much larger alcoholism problem, there were nearly one and a half million arrests for this group of offences in 1966 (Pittman, 1969); this accounts for one third of all arrests in that country (Chafetz, 1971).

This paper describes a patient who has had two episodes of mania, both of which occurred immediately after weaning. Although no recent reference to weaning as an aetiological factor in psychiatric disturbances could be found, it is suggested that weaning was an aetiological factor in this case.

Nuclear magnetic resonance (NMR) imaging of hydrogen in body water and fat is proving valuable in clinical investigation of the brain. An introduction to the technique and to the biological significance of the images is presented here. The ‘multi-parameter’ nature of these images is stressed, and the individual parameters described. NMR imaging may well be of value in investigating the pathology of organic and functional psychoses.

Seasonal affective disorder has not previously been linked with neuroanatomical abnormalities despite its relationship to biological rhythms. A 45–year-old woman is described with an arteriovenous abnormality in the right frontotemporal region who developed recurrent winter depression and summer hypomania.

An analysis has been reported of the in-patient case-load of a comprehensive psychiatric department (Queen's Park Hospital, Blackburn) for the twelve months ending 28 February, 1961 (Silverman, 1961). This analysis showed that a department of 99 beds was coping with virtually 95 per cent. of the total in-patient problem from a population of approximately 250,000. However, the criticism has not uncommonly been made that, although a department of this kind might appear to function with reasonable success at the outset, the nature of the psychiatric case-load is such that, sooner or later, an excessive number of beds would become blocked by long-stay patients and the service would become unworkable in its original form. It was therefore decided to report and analyse admissions and discharges over a much longer period, and the statistics for the four years ending 31 December, 1965, were utilized for this purpose.

One hundred and twenty-seven accidentally poisoned children from the emergency room of the Islamic Girls College, Cairo, were compared with an equal number of controls.

The highest age incidence for both sexes in poisoned children was 36 months. Males outnumbered females at a ratio of 3:2. Behavioural problems such as hyperactivity, temper tantrums, aggression, stubbornness, nocturnal enuresis and impulsiveness occurred more often in poisoned children than in controls and more often in those (24 patients) referred with accidental poisoning on more than one occasion. The families of poisoned children differed significantly from the controls in their large size, low level of education, disturbed home atmosphere and the accessibility to the child of the poisonous substance.

Anxiety states sometimes lead to hyperventilation (HV) which may, in turn, give rise to a variety of physical symptoms. One way in which HV may present is with unilateral somatosensory symptoms, often left-sided. We report nine such cases. The mechanism of lateralisation was examined using EEG and bilateral somatosensory evoked potentials which were carried out before and after HV. No difference in conduction velocity was found between affected and unaffected arms, but non-specific abnormalities were frequently noted in the EEGs. The results support the role of a central rather than a peripheral mechanism in the production of unilateral symptoms in HV.

Cortisone therapy has been claimed to produce favourable results in clinical schizophrenics (Cohn and Karnosh, 1951; Cohn et al., 1953). Rees and King (1952) carried out a controlled investigation on the effects of Cortisone given in moderate doses over a four-day period to a group of schizophrenic patients and found no significant changes in symptomatology, behaviour or in a series of psychological and physiological tests.

In a personal communication Dr. Cohn suggested that Cortisone given in higher doses over a longer period would probably be therapeutically more effective in chronic schizophrenia.

The present paper describes a controlled investigation into the therapeutic effects of Cortisone given in high dosage over a relatively prolonged period.

This report concerns 100 patients treated by prefrontal leucotomy. The technique employed has followed that of Freeman and Watts.

In the case of the 47 manic-depressive patients treated the prognosis without operation was considered very poor. The majority (34/44) had failed to respond to electric convulsive therapy, which was contra-indicated in the remainder by reason of physical health. Seven out of these 47 cases had been in hospital under two years, but there was a history of many years' poor social adaptation or recurrent mental illness. The average duration of illness in the recovered cases of this manic-depressive group was 31 months. That of the failures 45 months.

The problem of estimating objectively the value of any new form of treatment is constantly presenting itself in all branches of medical work. In the case of shock therapy applied in the treatment of mental disease, the task is especially difficult. Standards of initial severity and degrees of improvement in mental diseases are subject to very wide interpretations. Disagreement on questions of diagnosis is common even among psychiatrists who employ the same terminologies. Thus, it is not surprising to find that widely divergent claims have been made about the value of shock treatment in mental diseases. In most of the large surveys, patients have been classified as (i) Recovered, (ii) Much improved, (iii) Improved, or (iv) Unimproved after shock treatment, but little unanimity about the results has emerged. In Table I, the figures given by Malzberg (1938) and Pollock (1939) for New York State and those for Ohio, given by Bateman and Michael (1940), are compared with figures obtained in a survey of the Ontario Mental Hospitals in 1941.

It is interesting to recall that fifty-five years ago Maudsley wrote as follows:

When we face the crucial problem of the aetiological basis of the psychoses we have described, there are three main possibilities to be considered. Either they are to be regarded as symptomatic schizophrenias of purely epileptic causation; or they are independent schizophrenias which have appeared in these epileptic subjects coincidentally as the result of pure chance; or they are forms of schizophrenic illness which have arisen in individuals predisposed thereto by the stresses produced by the epilepsy. An investigation of the genetical background is capable of producing evidence which would assist in answering this question. If the first hypothesis is correct, the incidence of schizophrenic psychoses in the relatives of our subjects should be no greater than in the general population. If the second hypothesis is correct, the incidence of schizophrenic psychoses in the relatives should be the same as in the relatives of schizophrenics of the usual kind. If the third hypothesis is correct, we would expect an incidence of schizophrenia in the relatives of our patients which would lie somewhere between these two figures.

This paper reports an investigation in which it was found that, by dividing “paranoids” on a scale of “non-integrated psychosis”, two groups were formed which differed significantly from each other on several independent measures. When the same division was made within non-paranoid schizophrenics and within melancholics, very few such differences were disclosed.

The evidence suggests that integrated and non-integrated “paranoids” can usefully be regarded as differentiable groups, the latter being more closely related to other forms of schizophrenia.

The persistence of psychosurgery within the therapeutic armamentarium of psychiatry is something of an anachronism in the current era of evidence-based medicine. Robust evidence for efficacy does not exist and, indeed, can never realistically be gathered because of the extreme ethical difficulties of carrying out randomised controlled trials in this area. Yet there are undoubtedly patients who remain resistant to all conventional forms of treatment. Should they be denied what is possibly their last hope of recovery? Although the evidence is not watertight, modern neurosurgery is safer than ever before and appears to offer clinically meaningful symptom relief for ‘untreatable’ patients with chronic severe depression or obsessive–compulsive disorder (Matthews & Eljamel, 2003). The debate this month poses the question, ‘Should neurosurgery for mental disorder be allowed to die out?’ Dr Raj Persaud, consultant psychiatrist at the Maudsley hospital, argues in favour of the motion. The case in favour of retaining neurosurgery is made by two consultant psychotherapists, Dr David Crossley (Wrexham) and Dr Chris Freeman (Edinburgh).

In this short paper I have no idea of adding one to the already too numerous class-names of insanity, but I am anxious that asylum physicians should have their attention called to a clinical type of disease which may exhibit mental symptoms, and may thus add to the small store of useful knowledge of the subject.

While the best accounts of anxiety appear in the French literature, which contains a number of monographs on anxiety (19, 23, 32, 34, 40), psychoanalysis regards anxiety as the primitive reaction of the pain principle, and deals with it in a fair proportion of its investigations.