Von Winiwarter, in 1879, published his pathological findings in a case in which there was obliteration of the vessels of the leg due, as he considered, to a proliferative process in the intima, that is to say, an “endarteritis obliterans.” Other views on the pathology came to be propounded, notably that of van Manteuffel, who considered that consequent upon arteriosclerosis of the popliteal artery a white thrombus formed, which, spreading peripherally and becoming organized, produced the picture of an obliterative endarteritis. Twenty-five years after Winiwarter's paper Buerger published his observations based on 30 cases, with pathological studies on the vessels obtained from eleven amputated limbs. He disagreed with the views of both von Winiwarter and von Manteuffel. He found that besides an extensive obliteration of the larger arteries and veins there was a varying degree of peri-arteritis and arteriosclerotic thickening of the vessel wall, and concluded that the condition was a thrombotic process occurring in the arteries and veins, followed by organization and canalization, and not an obliterating endarteritis. He absolved the intima from any “considerable role in the genesis of the thrombotic process,” and attributed the thickening of the intima and the cellular infiltration and vascularization of the media and adventitia to the agency producing the coagulation of the blood and to the changes in the thrombus itself. He saw the final lesion as a vessel obliterated by dense connective tissue, canalized, together with some residual cellular infiltration and capillarization of the media and greater or less thickening of the adventitia and periarterial tissues, the thrombus having disappeared in the course of the development of this final result. He proposed the term “thrombo-angeitis obliterans” for the condition, and with the general adoption of the term Buerger's name came to be linked with it.

The value of prolonged narcosis as a form of treatment in mental disorder has been well recognized in Switzerland, Germany, Holland and the U.S.A., but, so far, there has been little tendency to adopt the method in this country. It is true that there has been considerable diversity of opinion about its efficacy, but it must be remembered that much of the literature published reveals that there has been a general lack of uniformity as to technique, duration and drug used, apart from discrepancies in the interpretation of results. Furthermore, one of the most potent arguments against the treatment has been its dangers— a fact which has deterred many psychiatrists from giving it a trial. These dangers, however, instead of stimulating research into possible methods which might eliminate toxicity of narcosis, gave rise to a search for a Utopian narcotic, which would serve therapeutically whilst being free from toxic effects. No less than forty substances (according to Palmer and Paine (1)) have been tried, with but little result except to increase the confusion. In a previous communication by one of us (2) toxic symptoms of narcosis were discussed, and a method was described whereby these could largely be eliminated with doses of narcotic sufficient to produce prolonged, continuous sleep. In the present paper it is proposed to summarize and comment on therapeutic results in 107 mixed cases of mental disorder, in which a total number of 128 treatments were carried out. In 117 of these treatments somnifaine was used, in 9 veronal, and in 2 dial.

The history, pharmacology, physical and chemical properties of cardiazol have been recorded in many publications recently, and our knowledge has been derived from them. Our technique and method of giving the injections have been more or less on the lines laid down by Meduna and described by Kennedy in the Journal of Mental Science of November, 1937. We used a 10% solution and usually commenced with 3.5 c.c. or 4 c.c., giving bi-weekly injections. The dosage necessary to produce a convulsion varied with different individuals. When a convulsion was not induced the dosage of the next injection was increasd by .5 c.c. or 1 c.c., depending on the reaction of the previous injection. The course was terminated by weekly injections. Our highest dose was 9.5 c.c. The injections were given in 10-15 seconds, and occasionally the first stage of the convulsion came on before the needle was withdrawn. Latterly we reduced the time of the injection to 10 seconds. No definite rule can be laid down as to the number of epileptic attacks to be induced.

This paper presents an example of the depersonalization syndrome as experienced and described by an intelligent patient. Considering the frequency of its occurrence, this syndrome has not been as often recognized nor as adequately described as would be expected. The syndrome was first described by Mayer-Gross (1935), later by Gordon (1936), Shorvon (1946, 1947) and Tayleur Stockings (1947). The psychopathology of depersonalization was given in analytical terms by Oberndorf (1935, 1936) and Feigenbaum (1937); Galdston has recently discussed this aspect (1947). As a symptom of organic brain disease, depersonalization offers an interesting field in the long-disputed question of body-mind relationship. Reidl (1942) described this symptom in a case of carbon monoxide poisoning, and Brock and Weisel (1942) discussed its occurrence in organic cerebral disease. Guttman and Maclay (1936) described the interesting relationship between mescaline intoxication and depersonalization. Cerebral anatomical localization was discussed in an anatomico-clinical study by Dide (1938).

There is already a comprehensive literature on the convulsion treatment of schizophrenia, and it is not the purpose of this paper either to attempt to assess these results, or to claim therapeutic success, or failure, in the cases mentioned here.

The case about to be described showed during the 18 months when she was under close observation certain remarkable pathological endocrine features. These, viewed together and in retrospect, throw considerable light on the relationship between pituitary function and so-called anorexia nervosa, and introduce a broader conception of the latter somewhat misleading designation.

This paper reports an attempt to determine the nature of dementia by analysing the results of mental tests applied to groups of patients clinically estimated to be demented in varying degree.

Previous investigations.—The relevant literature concerns the results of mental tests in psychosis and in normal senility. These topics having been recently fully surveyed elsewhere (Brody, 1942a), they need occupy no space here.

The important part played by alcoholism in the causation of suicide has been abundantly recognised by all observers of both these social phenomena; and so far as debate now touches the question, it is merely to deal with points of detail.

Various reports have suggested that the urinary excretion of adenosine cyclic 3'5’ monophosphate (cyclic AMP) is increased in mania and decreased in depression. However, our own serial studies from short-cycle bipolar manic-depressive patients showed no correlation between mood and cyclic AMP excretion (2). Jenner et al. (4) confirmed our findings, except in the case of a patient with a regular 48-hour mood cycle who did show a correlation between his mood changes and changes in cyclic AMP excretion. Paul et al. (5) also reported a general lack of correlation between these variables, but found a transient increase of urinary cyclic AMP during the rapid switch from depression to mania. We have investigated the situation in a bipolar patient who shows such a rapid switch in mood but have been unable to demonstrate any increase in cyclic AMP excretion during the switch period.

Three men presented to a single regional secure psychiatric unit over a twelve-month period, after taking their youngest child hostage in their own homes because of a threatened separation from the family. In each case the episode had escalated because of hostility to police involvement in what for them was a typical domestic upheaval. All cases ended without injury. In each man, substance abuse, a family history of domestic violence and fears of rejection were prominent, and the recent birth of a child may have been an added precipitant. There may be a common family structure which predisposes to such situations. Psychiatric intervention was deemed appropriate, with some evidence of benefit for the two men who engaged in treatment.

The study of infancy can provide us with new models for the genesis and treatment of psychiatric disorders. It allows us to observe development and can elucidate the contribution the internal and external world make to mental health and disorder. It can also help to define and describe developmental pathways which may be instrumental in creating a resilient or vulnerable adult.

A straightforward test for detecting clustering in patterns of parasuicide in individual patients is described and applied to data from the Edinburgh Regional Poisoning Treatment Centre.

During the course of routine investigations it was noticed that an abnormal number of low serum cholesterol results were occurring in our laboratory, and that these results appeared to come from mentally retarded patients. An investigation was therefore carried out on over 1,400 patients in the Stoke Park Group of Hospitals. Whenever blood was taken for routine haematological examination a serum sample was also collected for cholesterol determination. A preliminary report of these findings was made (Eastham and Jancar, 1967).

There has been much speculation but little evidence concerning the view that personality characteristics, like cognitive factors, change with age. Consequently, the lack of information on the MMPI for aged populations may well have led to its inadvertent misuse on the assumption that the standard normative data given in the revised Manual (Hathaway and McKinley, 1951) are applicable to the elderly. The authors present data on a sample of the aged taken from the community which shows this assumption to be misleading, and attempt to improve this situation.

In view of the promise attached to the recent attempts to integrate learning and personality theory (Eysenck, 1957), and the suggestion that drug addiction might be a learned response, it would appear profitable to consider the relevance of this integration to a better understanding of addiction, a suggestion reinforced by two recent papers by Partridge (1959a, b). On the basis of a clinical survey of addiction he came to the conclusion that the extent and severity of addiction was dependent on “… the extent to which the particular personality can tolerate them (i.e. the symptoms, such as anxiety, which would arise without the drug) … patients with a low tolerance of discomforts and frustrations are those more likely to be addicts, just as they are more likely to turn to drugs in the first place … the development of addiction, in fact, depends much on the personality … the form of addiction depends more on the circumstances and opportunities with which the particular personality has been confronted.” Such considerations and conclusions can be conceptualized within and predicted from the theoretical framework to be proposed later in the present review.

Recent interest in the surgical alleviation of mental disorders has centred in the trial of new and different operations. Fairly early in the development of the subject Freeman and Watts (1944) themselves reported the fairly constant observation that under local anaesthesia gross mental change did not occur until certain stab incisions had been made deep in the infero-medial quadrants. Marked mental change, with confusion, unresponsiveness and disorientation, seemed to occur on section of a small bundle of fibres located interiorly close to the midline. Most of the modifications of Moniz's original procedure have, however, been made on an essentially empirical basis.