In the second half of the fourteenth century, the whole problem of poverty became in England for the first time a matter of government concern. The contractual relationship between landlord and villein which had prevailed during the Middle Ages, was breaking down, and the Black Death hastened this process. Statutes dealing with vagrancy and poverty were promulgated in 1349, 1351 and 1388: the able-bodied beggar was punished in the stocks and generally repression was the keynote, but despite harsh laws vagrancy increased. In a series of statutes from 1531–1601 the Tudor sovereigns initiated a system of local relief based on the Parish unit. In 1576, Houses of Correction were established:

Gilles de la Tourette's syndrome is an unusual condition with undetermined aetiology, treatment, and prognosis (1, 2, 3). Less than 50 case studies have been reported in the literature. This paper will present a detailed report of a case treated for 18 months, and brief summaries of two cases treated for three weeks.

Investigations of schizophrenia have shown that the presence or absence of primary paranoid delusions is correlated with differences in dealing with information from the environment (Venables, 1964; Silverman, 1964) which may well relate to stable personality characteristics. Claridge (1967) has recently proposed a psycho-physiological model in which it is hypothesized that paranoid schizophrenics are more sympathetically reactive, but show lower levels of cortical modulation of subcortical functions than non-paranoid schizophrenics. At the descriptive level of behaviour, this theory would predict greater emotionality (neuroticism) and extraversion in the former group, and this proposition was examined in a sample of psychiatric offenders. Since aggressive behaviour is prominent in this population, it was also predicted from Claridge's theory that the paranoids would more frequently have a history of aggressive behaviour and would show higher attitudinal hostility. However, since extreme (i.e. homicidal) aggression appears to occur in individuals who are not characteristically aggressive (Megargee, 1966), it was predicted that such offences would be more frequent among the non-paranoid schizophrenics.

Lippold and Redfearn (1964) described the mental changes induced by the passage of small polarizing currents between two electrodes attached above the eyebrows and a single electrode on the right knee. When the forehead electrodes were positive with a total current flow of the order of 500 microamps, the mental changes consisted of an elevation of mood and an increased involvement in the environment. Forehead negative electrodes produced withdrawal and quietness. These observations were made on a group of hospitalized patients, the majority of whom were, or had been, mildly depressed. The authors state that “all would probably have been considered quite ‘normal’ by non-medical observers”.

The life expectation of even the most severely subnormal patients in hospital with IQs below 25, has risen dramatically since the beginning of the century. This paper reports the results of a survey carried out by the author into the expectation of life of patients with IQs up to 50 in the Stoke Park Hospital Group, Bristol.

The effects of ethyl alcohol in man may be classified into two main groups. The first, consisting of all those symptoms and signs that can be directly attributed to the action of alcohol itself, includes all the features of acute alcohol intoxication. The second group, with which this study is concerned, consists of a wide variety of conditions which do not appear to result directly from the action of alcohol and which may be regarded as secondary complications. They occur only when excess alcohol intake has occurred over a prolonged period.

Much confusion has resulted in recent years from the use of the word “community” to mean merely “outside hospital”. Community psychiatry is not just extramural work or a means of avoiding hospitalization. A community mental health service is a comprehensive psychiatric service of care and treatment for a defined population, including full hospital facilities (Freeman, 1963). The hospital is in fact part of the community, and provides one of its services. The size of population base that can most efficiently support a comprehensive service is probably between 150,000 and 200,000 in urban areas, judging by experience in Lancashire (Smith, 1965). This is large enough to contain all the basic services that are needed, and small enough to allow all key professional workers to remain in constant face-to-face contact. Within its defined area, the service must have continuous and final responsibility, whatever the clinical state of individual patients. It must offer a continuous spectrum of integrated services, from full-time, permanent care in an institution on the one hand, to occasional support for a patient or family at home on the other. Since the demand for services is potentially infinite, an essentially ideological choice must be made in assessing priorities for the resources that exist. I believe that if we try to act primarily on the basis of human needs within the total community, the first call on these resources must be for the three great problems of schizophrenia, subnormality and old age. Concentration on psychotherapy would make it more likely that these greater social needs remained unmet, and it may well be that any large-scale treatment of neurosis or personality problems would have to be outside psychiatric—or even medical—channels (Ryle, 1967).

A previous paper (Morgan, 1967) demonstrated the extent to which long-stay psychiatric patients are handicapped by ignorance of the names of people whom they see daily. The mean performance of a sample of patients was less than half as good as that of a control group of non-patients. It was postulated that knowledge of another person's name is a useful tool in social intercourse, and that ignorance of a name represents a handicap to communication. It was further suggested that some cause and effect relationship exists between the social withdrawal of long-stay schizophrenic patients and their ignorance of names. The data presented in the previous paper did not serve to show whether this ignorance is treatable at all or whether current methods of treatment are in fact helping to treat it. The present paper aims to present some further evidence on these points, derived from a deliberate attempt to teach patients the names of other people.

There is a large body of research that has established change in reaction time as one of the major psychological performance deficits in schizophrenia (Shakow, 1963). In addition to consistent differences between patients and normals, relationships have been reported (Rosenthal, Lawlor, Zahn and Shakow, 1960) between general severity of illness and reaction time within a group of chronic schizophrenics. More recently, Zahn and Rosenthal (1963) have shown that acute schizophrenics also perform deficiently in reaction time; they hold an intermediate position between normal subjects and chronic schizophrenic patients. Shakow (1963) reports that in some of the earlier work with chronic patients “paranoids” tended to show little, if any, reaction time deficit, but that it was the hebephrenic patients who performed poorly. Thus it seems unlikely that reaction time is a general measure of deficit in schizophrenia, since available evidence shows it to be related to chronicity (in terms of duration of illness), general severity of illness, and schizophrenic subtype. The deficit reflected in reaction time has been characterized by Shakow (1963) in terms of associative interference. That is, the schizophrenic is distracted by “irrelevant aspects of the stimulus surroundings—inner and outer—which prevent his focusing on the ‘to-be-responded-to’ stimulus”.

Behaviour therapy is based on the principles of learning theory, and assumes that neurotic behaviour consists of learned maladaptive habits. Following the work of Pavlov (1927) with experimental neuroses, and that of Watson (1920) on the elimination of children's fears, Wolpe (1958) devised a method suitable for treating patients with phobias. This involves deconditioning with the aid of reciprocal inhibition. The patient is introduced to a graduated series of the relevant anxiety provoking stimuli, and at the same time the anxiety responses are inhibited by means of relaxation. The latter state may be induced by hypnosis, Jacobson's method (1938), or by drugs.

Methohexitone sodium (Brietal, Brevital), an ultra-short-acting barbiturate, has recently been introduced as a method of relaxation in behaviour therapy (Friedman, 1966; Brady, 1966). It appears to be safer than thiopentone (Pitts et al., 1965), and has the added advantage that the recovery time is quicker (Jolly, 1960). The present report refers to two patients suffering from premature ejaculation who were successfully treated by systematic desensitization using methohexitone.

The concept of the ‘body image’ rests on a broad foundation of neurological and psychological observations. Neurological observations of phantom limbs, agnosias, apraxias, and similar phenomena led to an initial formulation of the body image as a postural, spatial image of the body (2, 6). Schilder greatly expanded the concept by delineating the importance of libidinal (instinctual) and sociological factors in the make-up of the body image (7). Current psychiatric usage has (perhaps too loosely) equated the term body image with phrases such as 'self system’, 'self concept’, ‘ego identity’, etc. (8). The importance of the body image as a postural or spatial model, a ‘base of operations' from which a person extends himself into space, with its implications for movement and motor activity, is often overlooked but vividly evident in many endeavours, particularly aviation.

The national cost of prescriptions for drugs for use in medical practice in the United Kingdome has risen progressively from £35,000,000 in 1949 to well over £100,000,000 a year now (Dunlop, 1965). The number of drugs taken by patients is vast, and the variety of drugs available for prescription is considerable. Prescribed in order to produce a specific therapeutic effect, few drugs, if any, are wholly free from the potential of producing undesirable side-effects. These vary from the trivial to the lethal, from the transient to the permanent. Methods for their accurate detection, qualitative evaluation and risk identification are vital prerequisites to therapeutic safety and refinement. Experimental techniques, using detailed observation on large samples of patients being treated by drugs, have been developed recently. A monitoring system which scans for side-effects of drugs represents a means whereby prospective and cumulative data on the frequency of occurrence and nature of these side-effects can accrue. This is referred to as drug monitoring.

Though Young and Scoville (11) first described the paranoid schizophreniform psychoses associated with amphetamine ingestion in 1938, amphetamine-induced psychoses were not recognized as a major problem among English speaking nations until Connell (3) published his monograph in 1958. Connell's report of 42 cases documented the frequent presence of the syndrome and subsequent reporting of over 200 such cases has borne out the seriousness of the problem (5).

Over the years 1959 to 1962 a study was made of a series of 72 male neurotic patients referred to general hospital and private psychiatric practice in Leeds, the results of which were submitted for an M.D. Thesis (Little, 1966). It emerged clearly that the neurotic group was divisible into two major sub-groups differing significantly in a wide range of personality and other premorbid variables. Various objective tests and measurements were used; in the present context we wish to concentrate attention on five: (1 and 2) The N and E Scales of Eysenck's Maudsley Personality Inventory, (3) Tanner's Discriminant Androgyny Scale, (4) Parnell's Ponderal Index, and (5) The Rees-Eysenck Body Index.

Huntington's Chorea is a hereditary neurological disease which occurs in adulthood and manifests itself in involuntary bodily movements and progressive physical and mental deterioration. It is irreversible and responds to no therapy. Its course is about fifteen years in duration, death usually resulting from an intercurrent illness. Not only does it entail a catastrophic health problem for the person affected, but it also creates major emotional-social-financial problems for his family, and challenges the medical-social resources of the entire community.