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Of 106 patients admitted for investigation to a neurological hospital with a presumptive diagnosis of dementia, 84 were confirmed to have intellectual impairment or loss of learning and memory function or both. A possible aetiology for the dementia was found in 36 of these 84 patients; the commonest causes discovered were intracranial mass lesions, arterial disease, and alcoholism. Fifteen of the 106 patients were found not to be demented but to have some other illness, most commonly depression. Of the whole series some 15% of the patients suffered from conditions that were amenable to treatment.

Studies of the circadian rhythm in plasma 11-O.H.C.S. levels showed that a subgroup of affective psychotics had higher plasma 11-OHCS values as compared with schizophrenic and other psychotic subgroups, and a somewhat less regular rhythm. One patient with depression who was studied over 48-hour periods showed a reduction in plasma 11-OHCS levels with clinical recovery. An accentuated fall and rise in plasma 11-OHCS values in the night and early morning samples, respectively, was observed in the schizophrenic subgroup.

The limited value of plasma measurements in the management of treatment with lithium is discussed in the light of the mechanisms of its therapeutic actions and toxic effects.The plasma level of lithium usually rises twofold or threefold in the three to five hours after ingestion of each dose of delayed-release tablets and then gradually falls. The precise shape and height of the lithium curve depend on gastric emptying, which can be slowed with propantheline or speeded with metoclopramide. Depressed or demented patients may be irregular in taking their tablets and variable in food intake. Both the time of the blood test and this behaviour must be considered before changing the prescribed dose of lithium salt because of a laboratory result. A lithium tolerance curve may be a safer guide to treatment than single measures.Mild intermittent thirst is a common early side effect, and severe persistent thirst with polyuria is an uncommon later effect of daily intakes of at least 1,500 mg lithium carbonate. This diabetes insipidus is reversible, non-progressive, unrelated to plasma level, and distinct in attack from lithium-induced hypothyroidism, which may occur at low dosage but is also usually of late onset and reversible or treatable with thyroxine while lithium is continued. Obesity is another occasional effect of large doses. These side effects and the antimanic and prophylactic effects may have different mechanisms.

The clinical presentation of three patients with meningiomas at different frontal sites is described. They had been ill for 3, 25, and 43 years before the tumour was demonstrated radiologically. Apathy, incontinence, dementia, and fits were seen in association with middle and superior frontal lesions, and may be mistaken for symptoms of involutional depression or presenile cerebral atrophy. In contrast, excitement and hallucinosis were seen in association with a basal frontal lesion, and may mimic psychotic syndromes like hypomania and schizophrenia, particularly if the tumour encroaches on the third ventricle and adjacent structures. Irreversible loss of myelin and axons in the frontal areas of brain surrounding the tumour may have contributed to the clinical picture of the syndrome shown by these patients.

This paper describes a clinical trial of the effect of "'gerioptil " on certain psychological dimensions in a group of senile patients. Gerioptil is the trade name of a preparation which contains Professor Anna Aslan's compound H3 together with a variety of vitamins and vitamin derivatives. It is manufactured by a German drug firm, but is available to hospitals and general practitioners in Britain. H3 is the name given by Professor Aslan, of the Geriatric Institute in Bucharest, to diethylaminoethyl para-aminobenzoate, better known as procaine. This substance has been used for half a century or so as a local anaesthetic, and from time to time for other purposes, including coronary and peripheral vascular disease, allergic states, and rheumatoid arthritis, although for these lesser-known uses it has been super seded by other more efficient or more convenient remedies. During the last few years, however, a number of papers have appeared, many from Professor Aslan and her colleagues (1959) themselves, advocating the use of H3 in a wide group of disorders, including senility and the physical and psychiatric syndromes seen in association with it. However, much criticism has been levelled at the clinical reports of these workers, whose papers fall below the standards of statistical method, scientific control, and trial procedure which the modern clinician is entitled to expect from workers making the extensive therapeutic claims that have been advanced by this group. The evidence which Aslan puts forward cannot rival her therapeutic optimism ; frequently there are impressive clinical reports and anecdotes, but the use of controls and standardized procedures are not apparent. These criticisms have been the subject of a leading article in the British Medical Journal (1959a). Professor Aslan herself delivered a lecture on H3 in November, 1959, and this has also been reported with considerable criticism in the British Medical Journal (1 959b). Accordingly, since with this freely available prepara tion there appeared to be a discrepancy between the therapeutic claims on the one hand and the acceptable evidence of its value on the other, it seemed suitable to make it the subject of a controlled trial.

Introduction The object of this paper is to give a full description of a rare nervous disease, of which, as far as I am aware, no instance has been recorded during the last twenty years—a disease to which, for reasons which will hereinafter become evident, the name of "Progressive Lenticular Degeneration" may be conveniently applied.... This affection, where it occurs in an uncomplicated form, isan extrapyramidal motor disease, the importance of which is apparent not only because of its rarity, but also by reason of the light it sheds on such diseases as paralysis agitans.... Progressive lenticular degeneration, as the disease may be called, is not one with which the medical profession is familiar. As far as I can discover, no case has been recorded since 1890, with the very doubtful exception of one reported by Anton, of Halle, under the title of "Dementia Choreo-asthenica, with Juvenile Nodular Cirrhosis

The first psychiatric day-hospital in the United Kingdom was established in 1946 through the initia tive of Bierer. This innovation was received with some scepticism (Bierer, 1955) and five years passed before a second day-hospital was created. Interest gradually increased, and by 1959 there were at least 38 psychiatric day-hospitals (Farndale, 1961). In the early sixties the movement received an impetus from the drive to reduce the number of in-patient beds in mental hospitals, and by 1966 the number of day hospitals had increased to 65. In recent years a growing emphasis on community psychiatry has stimulated clinicians and adminis trators to take an interest in day-patient care. Large numbers of patients throughout the country are currently enrolled as day-patients. It is therefore clearly important to examine the functioning of existing psychiatric day-patient services. Few syste matic studies have been carried out so far. The aim of the present study was to examine the functioning of the seven day-patient services in the City of Birmingham. The procedure was to identify the population of patients attending these facilities, to examine the social and psychiatric characteristics of these patients, and to follow their progress in the day-hospital over a 12-month period. This paper presents the findings of the first stages of the enquiry. The day-hospital facilities are described; the demographic and diagnostic character istics and previous psychiatric histories of the patients are presented.