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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.

At the Psychopathic Department of the Boston State Hospital, our first interest is, and necessarily must be, in the diagnosis of the cases seen by us, and making proper recommendation for their further care and treatment. In connection with the work, numerous papers on various phases of diagnosis and various types or classes of cases have appeared from time to time. Many of these papers have illustrated interesting types of errors in diagnosis. In the present communication I propose to report seven cases which seem to me to be of unusual interest and to represent some of the common types of error, attempting herein to analyze the causes for the individual errors. In connection with this it must be recalled that the patients stay at the Psychopathic Department very rarely longer than ten days, and that, in the majority of cases, our diagnosis and recommendation must De determined on the fifth day, counting the day of admission as one. It follows then that the work is done unusually rapidly, and oftentimes by men of not very great training in psychiatry. The attempt is made to equalize this by considering all cases before the entire staff, and by recording the opinions of every member of the staff, so that those with greater experience may correct any errors made by those with less. One of the commonest errors in diagnosis, at least at this Hospital, is to make a diagnosis of feeble-mindedness based on a low mental age, and some history of economic inefficiency, when the case really is one of dementia precox. It is for that reason that four quite interesting cases belong to this group of errors. A second type of error which could only occur in an institution such as this where large numbers of not insane cases are seen is one in

In a paper read before the American Medico-Psychological Association in 1907,1 I drew attention to certain forms of dementia pr cox which had been described by De Sanctis, Dercum, and others, and I feared at the time that I might be accused of having a classifying mania. My friends have been too considerate to make this charge concerning me, but I may run some further risk with my present paper. Perhaps the statement of my belief that the dementia pnecox group is susceptible of much further division may be an excuse for the advocacy of another form. During the past winter in one of our staff conferences Dr. Cornell applied the term cyclic dementia pr ecox to the case then under discussion and this seemed to me to aptly describe certain cases which I had mentally grouped and I therefore have adopted it. So far as I know its use is original with Dr. Cornell. It will perhaps be best to first give abstracts of these cases in order that it may be clearly understood what is included by the term, and especially as I am fully aware that there may be some who will disagree with my diagnosis. The first two cases (Case i, No. 541, and Case 2, No. 547) which I wish to bring to your attention have so recently been reported by Dr. Barnes’ that I shall not give abstracts but will merely call attention to the fact that while for a number of years they were regarded as typically cases of folie circulaire, which I believe is generally included in the maniacal-depressive group, yet there has been a gradual change and the excitement has become less typically maniacal; there has been a less marked flight of ideas and in the woman evidences of stereotypy, while in the man the excitement

The importance of the aged community has been realized recently, and has caused a re-examination of the methods of assessing mental deterioration. A review of the literature shows that, while the purely quantitative approach is now known to be inadequate, little attempt has been made to deal with the problem. qualitatively, apart from descriptive treatment of results. This paper presents a method which combines quantitative and qualitative data, and attempts to relate emotional reaction of the patient to his deterioration. The method has been applied to a series of forty senile-arterio-sclerotic patients. treated in a mental hospital. It is shown that, while the loss of ability to abstract determines the level of problem difficulty which the patient can master, his total efficiency depends not only upon this lose but also upon the emotional reaction to it. The results of the senile group were compared with those of children. We are indebted to Dr. P. K. McCowan, Physician Superintendent, for his kind permission to publish the material contained in this paper, and we wish to express our gratitude to Mr. J. C. Raven, Director of Psychological Research, and to Dr. W. Mayer-Gross, Director of Clinical Research, for the unfailing interest they have shown and for their much appreciated counsel.

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.

The present paper concerns the retinal pathology in a case of herpes simplex infection of the newborn. The patient was an infant, who, along with the eye disease, had a severe encephalitis that caused profound dementia and eventually death. The reason for indicting herpes simplex was a 32-fold rise in the herpes simplex titer during the course of the disease. The clinical symptoms and neuropathologic abnormalities in this patient are being described in the neurologic literature (Young et al 1 ) and will be reviewed only briefly in this paper. Report of Case The patient was an infant girl with an uneventful gestational and neonatal history. At the age of 3 weeks she developed fever (101.5 F [38.6 C]), irritability, and clonic seizures. No vesicles or other evidence of herpes simplex were seen in the patient's skin or mucous membranes. Study on the Neuropediatric Service of the Massachusetts General Hospital revealed

An editorial in theBritish Medical Journalin 1962 drew attention to the fact that research workers have taken relatively little interest in the psychoses of the elderly. The editorial commented on the important paper by Kay and Roth (1961), which analysed the condition known as “late paraphrenia”. Since the publication of this editorial, no significant contribution has been added to the analysis of this illness.

Radioactive Iodinated Serum Albumin (RISA) was given intrathecally to 83 neurological and neurosurgical patients. In order to evaluate the distribution of RISA in the subarachnoid space and its disappearance from it, AP and lateral brain scans were performed after 4, 24 and 48 h, and in some cases after 5 days. This method was called RISA cisternography by Di Chiro et al. (1964). This paper reports on 100 consecutive examinations by this method. The results of the investigation contributed significantly to diagnosis in patients with communicating hydrocephalus and with some other kinds of presenile dementia, in post-traumatic conditions and in other patients suffering from local obstruction or dilatation of the subarachnoid space. Eighteen patients without definite intracranial pathology or obstruction of the spinal subarachnoid space, showed pictures considered to be normal. Sterile meningitis developed in 3 patients, and 3 other patients showed brief transient pyrexia without subjective complaints. There are reasons to suppose that these complications can be avoided if the RISA is used within 6 days of delivery.

SUMMARYThis paper describes an investigation into the relationship between senile dementia and slowing of peripheral nerve conduction velocity. Twenty-eight demented patients and 19 controls were studied. Each patient was rated clinically and given a battery of simple psychological tests in addition to the physiological recordings. The results were as follows: (1) Motor nerve conduction was slower in the demented group than in the control group but this difference was not significant. (2) When subjects were divided according to their dementia score, those with scores above 7 were found to have motor nerve conductions which were significantly slower than those with scores of 7 or less. (3) There was a significant correlation between the severity of the dementia as measured by the rating scale and the psychological tests and the degree of slowing of motor nerve conduction. (4) In those patients who were retested after one year, increase in dementia was significantly correlated with a further slowing of conduction in motor nerves. (5) The possible role of vitamin deficiency was investigated in a small sub-group of demented patients. Deficiencies of thiamine, nicotinic acid, and vitamin B12were not thought to be important but some patients had low folate levels. The significance of these results is discussed.

The present paper reports the case of a 48-year-old patient with a clinical syndrome of dementia, visual disturbances, extrapyramidal disorders and a progressive evolution that lasted 6–8 months. Hist

A paper by Shapiro, Post, Lofving, and Inglis (12) has reported on the relationship of certain aspects of mental functioning to the psychiatric illnesses of old age. This study confirmed that performance on some tasks which appeared to involve “memory function” is relatively more impaired in elderly patients with organic brain pathology than in elderly patients with functional psychiatric disorders. It was also shown, however, that the difference between functional and organic groups on these memory tests was not as great as might be expected on the basis of the commonly held psychiatric hypothesis that memory disorder is one of the leading features of early cerebral involvement in old age. The relatively poorer performance on these memory tests of the organic patients could not be accounted for in terms of, for example, lower intelligence, since the memory tests produced significant differences between the organic and functional groups whereas the intelligence tests did not. A process of correlational analysis (Inglis, Shapiro, and Post (8)) showed that these tests did seem to have some psychological function in common which could usefully be labelled “memory”.

From a review of the literature Carstairs (1959) demonstrated that the sharp rise in admissions to mental hospitals since the Second World War has been due to the changing pattern of use of these hospitals, and not to any significant change in the prevalence of major mental disorder. The present paper examines statistics relating to admissions to Scottish mental hospitals in general, and to Dingleton Hospital in particular, in the 15 post-war years 1945–1959, with the object of showing some of the ways in which the character of admissions to mental hospitals has changed over that period.

It seems almost a work of supererogation to-day to present a study of the organic basis of dementia pr cox, since from the infancy of histological neuro-pathology all skilled observers have been united in recognizing certain essential changes in the central nervous system in cases of dementia prlecox. Beginning with Alzheimer’s statement in 18971 that he found severe changes in the ganglion cells with tendency to disorganization, sparing mitoses in the glia, pathological formation of glia fibres with encircling of nerve cells by these fibres, much swelling of the nuclei of the nerve cells, marked folding of the nuclear membrane, severe shrinking of the bodies of the ganglion cells. Then passing in review all the great names in neuropathology each in turn has contributed a histo-pathological picture of dementia pr ecox, differing only in the stress laid upon one or other element in the findings but in no case reporting contradictory results. A complete bibliography of the histo-pathological studies of dementia praecox would far exceed the limits of this paper but a few names stand out particularly. Of the earlier observers Cramer’ closely following Alzheimer in 1897 reports a case in which “not a single nerve cell shows normal Nissl’s granula.” Dunton in 1902,’ Laignel-Lavastine’ in 1904 and ,9o5, Klippel and Lhermitte’ in I9O5, Mondio’ in 19o5, confirmed the findings of Alzheimer and Cramer. Lhermitte adding a certain precision to the study by dividing the lesions found into fundamental (progressive atrophy of the nerve cells with disappearance of the dendrites which assure the connections of the neurons with one another, etc.) and accidental lesions caused by the direct cause of death or by intervening disease.

Since a knowledge of the Physiology of Mind is essential to a clear comprehension of its Pathology, we may fitly introduce a paper purporting to deal with one form of abnormal mental action, with a few considerations concerning mental action in general.

It has been indicated throughout this paper that great caution must be exercised in the interpretation of the alterations which the neurofibrils present in material from pathological sources, a cau...

Prognosis, the prediction of the outcome of an illness, has long been recognized as a necessary skill of a physician. Hippocrates (translated Chadwick and Mann, 1950) said:“It seems highly desirable that a physician should pay much attention to prognosis. If he is able to tell his patients when he visits them not only about their past and present symptoms, but also to tell them what is going to happen, as well as to fill in the details they have omitted, he will increase his reputation as a medical practitioner … It is impossible to cure all patients: that would be an achievement surpassing in difficulty even the forecasting of future developments … By realizing and announcing beforehand which patients were going to die he would absolve himself from any blame.”In addition to the reasons given by our distinguished forebear we now also require to read into the future so that we can make the best use of the limited facilities available for the sick. This is particularly true for elderly psychiatric patients for whom treatment facilities are still very inadequate. It has been suggested (Cook, Dax and Maclay, 1952) that mentally ill elderly people should by preference be admitted to short-stay units attached to general hospitals for the assessment of prognosis and probable response to treatment. They suggested that a 3-4-months stay might be necessary. Experience in a diagnostic outpatient clinic (Norris and Post, 1954) led one of us (F.P.) to believe that it should be possible to classify patients according to the best method of dealing with them in a shorter time even than the six weeks recommended by the B.M.A. Report (1947). The present study was designed to test this belief. Our hopes were only partly fulfilled, but a post hoc analysis of our original data, in conjunction with the known results of the follow-up of cases, has suggested that with more knowledge of the factors influencing prognosis over a short term, much more accurate forecasts could have been achieved. The second half of this paper is devoted to a discussion of these factors. A preliminary report was given at the Third International Congress of Gerontology (Kay et al., 1954).

Mr. President, Ladies and Gentlemen,—Last year I had the honour of delivering the Maudsley Lecture, and I brought forward a certain amount of evidence in favour of the genetic causation of dementia præcox. I have continued these investigations and published the results in papers entitled “Further Pathological Studies in Dementia Præcox, especially in Relation to the Interstitial Cells of Leydig,” Proc. Roy. Soc. Med., 1922, vol. xv (Section of Psychiatry), pp. 1–30; also “The Reproductive Organs in Relation to Mental Disorders,” Brit. Med. Journ., March 25, 1922. The former investigation included 27 cases of dementia præcox, the onset occurring in adolescence; also the results obtained in 9 cases of psychoses other than dementia præcox occurring in post-adolescence, and 4 cases of primary dementia, in which the demential symptoms came on in post-adolescence. From these investigations, and from others which I have been pursuing, I have come to the conclusion that it is better to speak of primary dementia, which may occur either in the pre-adolescent period, adolescence, or post-adolescence; moreover, I am of opinion that all the psychoses belong to one group and are genetic in origin. In those forms of psychoses in which recovery takes place—for example, confusional insanity or exhaustion psychosis, benign stupor, periodic insanity, or manic-depressive insanity—we may assume there is a suspension of neuronic function in the highest psychic level; but all these conditions I have found may end in a terminal dementia, in which the changes in the reproductive organs and in the brain do not differ from those met with in the primary dementia of adolescence, the dementia indicative of a suppression of function. In the primary dementias, naturally, the symptoms may be partially due to a suspension, and partially to a suppression of function, and I would explain partial remission of symptoms by a partial restoration of function in neurones in which the nuclear change was either not present or not advanced.

Between September, 1948, and January, 1958, we have encountered by angiographic studies 50 patients with nonfilling or thread-like filling of the proximal portion of one anterior cerebral artery (in 1 case bilateral) associated with neurologic and/or psychiatric (dementia, impaired insight, anxiety, loss of initiative, and impaired mentation) signs and symptoms. Stenosis or occlusion of one anterior cerebral artery has been seen in about 11% of the patients who either are admitted with a diagnosis of "stroke" or are proved to have cerebrovascular disease before discharge from the hospital. A portion of this material was reported in a former paper. 17 When nonvisualization of one anterior cerebral artery was encountered, a second, and sometimes a third, attempt was made to fill the vessel. In the more recent cases, simultaneous contralateral carotid compression was also used. Head turning was not used at the time of injection, and thus was not a factor

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 literature of familial pre-senile dementia is adequately reviewed by McMenemey (1963) and Pratt (1967) and that on familial forms of Alzheimer's disease by Tandy and Bain (1970). In non-familial cases of Alzheimer's disease it has been possible to correlate the clinical features with the histological diagnosis obtained from cerebral biopsy (Sim and Sussman, 1962; Sim et al., 1966), and the present paper is an attempt to see whether, by using similar diagnostic criteria as listed in Table I, including cerebral biopsy, a similar consistency could be demonstrated in the affected members of each family.

In his paper on “Amentia and Dementia “Dr. Bolton has intercalated such a vigorous dissent from some of my speculations on the localisation of cerebral function, and a complaint so bitter of my criticism of some of his earlier researches, that I am forced to offer a defensive response.

This paper reviews the literature on the relationship of social class status to the incidence and prevalence of mental disorder. For purposes of this review, social class is divided into three categories: the ‘affluent’, ‘working class’ and ‘poor’. Mental disorders referred to are: schizophrenia, manic-depressive psychosis, psychoneurosis, diseases of the senium, personality disorders and the combined category ‘mentally ill’. The general conclusion is drawn that the rate of existing mental disorder among the poor is substantially higher than among the affluent or working-class groups. This notwithstanding, low social-class status is held to be unrelated to the incidence of functional psychosis (i.e., schizophrenia and manic-depressive psychosis).

Eight cases of folie a deux seen at Prestwich Hospital are presented in this paper. A relevant review of the literature in conjunction with these cases suggests that whereas the principal in folie a deux is always a psychotic who initiates the delusions on the basis of his morbid psychotic illness, the associates have an assortment of abnormalities including schizophrenia, subnormality, susceptible personality and dementia which predispose them to acquire the delusions of their partners. The social milieu is considered as a determinant of the actual content of the delusional systems, and precipitant in some cases. It is the opinion of the authors that such a socio-clinical approach in folie a deux can be rewarding both prognostically and therapeutically.

This paper reports the successful results of treating three cases of pre-senile dementia by steroid therapy. The possibility of a reversible cerebro-vascular cause, such as arteritis, is discussed.

AS PART of the nation-wide evaluation of penicillin in the treatment of syphilis, a study of the use of this drug with various forms of neurosyphilis has been in progress at the Johns Hopkins Hospital since October 1943. The preliminary results of therapy of asymptomatic neurosyphilis1and dementia paralytica2and the early changes in the abnormalities of the cerebrospinal fluid3have been reported in previous papers. This study, the fourth in the series, is concerned with the treatment of tabes dorsalis. The details of therapy and the methods of analyzing the results have been described in earlier publications and need not be repeated here. The same reservations made necessary by the changing character4of commercial penicillin during the period of this study are necessary. As of October 1946, 54 patients with tabes dorsalis have been treated with penicillin. Thirty-three of these patients (group A) received penicillin

The purpose of this paper is to call to the attention of neurologists, psychiatrists and neurosurgeons a group of meningiomas with dementia as the earliest and presenting symptom. The diagnosis in these cases is apt to be missed, especially if the patient is in the arteriosclerotic or presenile age-group. This is equally true of other tumours, but the practical importance of early diagnosis of meningiomas is that with the removal of the tumour the patient usually recovers from the mental illness.

The association of abnormal low frequency rhythms in the EEG with intellectual deterioration in old age has now often been described, but there has been no clear indication of a quantitative correlation between the degree of abnormality of the EEG and the severity of the deterioration. The present paper describes an attempt to explore the possibility of the existence of such a quantitative correlation.

In the last few years many studies have appeared relating directly or indirectly to the role of adjustment in the ageing process. What factors influence the adaptability of the elderly person to his or her own disability, isolation or approaching death? In general the studies done by sociologists stress the importance of the social situation in which these persons find themselves. P. Townsend's book “The Family Life of Old People” (1957), the articles of Havighurst (1958) and his group in Chicago, and of Post (1958) are examples of this view. In what may be regarded in some way as a reaction to this tendency, we have the theory of disengagement of Cumming et al. (1960), in which “ageing is seen as an inevitable mental withdrawal or disengagement resulting in decreased interaction between the ageing person and others in the social system to which they belong”. But it is Irving Rosow (1960) who emphasizes this point more clearly. After critically reviewing diverse approaches, he states (and I quote from different paragraphs throughout his paper), “The root of the problem lies in regarding adjustment as a state or a condition at a point in time”. “What gerontologists have called adjustment is actually the result of the product of the ageing process”. “Thus it follows that the only way to evaluate conditions in later life is to compare them with some earlier patterns”. From there on he presents his own sociological theory of adjustment. Strengthening this view still further, a psychologist, Robert Peck (1960), reporting on one phase of the “Kansas Study of Adult Life” by the University of Chicago Committee on Human Development writes, “Adjustment to middle age and old age, in so far as it has been measured in this research, seems largely determined by personality characteristics which have been laid down earlier in life”. It is psychiatrists, however, who have insisted on the importance of the previous personality in the problems related to ageing, as may be noted in the publications of Cameron (1956) and Roth (1959).

The standard Bender test and its repetition on Canter's BIP paper along with the WAIS Vocabulary and Block Designs were administered to 16 senile and 17 healthy elderly Ss. The defects of the senile Ss were clearly revealed by the tests but the conventional use of Bender error scores and the discrepancy between Vocabulary and Block Design scores would also identify at least a fourth of the healthy elderly as having mild to moderate deficit consistent with organic brain damage. On the other hand, the BIP reflected the normal perceptuomotor performance of the healthy Ss while retaining sensitivity to the degree of organicity of the senile Ss.

William Osler39considered Huntington's27original description of chronic chorea a model of cogent observation and concise presentation. The classic paper set forth the characteristic movement disorder and mental changes and implied a dominant heredity which was ultimately proven correct by Entres18and others. In addition, hypotonia was soon added as a characteristic if not constant finding in this disorder which set it apart from the other heredodegenerative diseases of the basal ganglia. Davenport,12in 1916, noted individual and familial variations in the age of onset of the chorea, as well as the delayed onset or complete absence of dementia in some cases. His concept of different "biotypes" was more fully developed by the Continental neurologists to include a variety of hitherto unrelated neurologic and psychiatric phenomena into a broadened concept of "Huntington's disease." One outgrowth of the biotype theory—an enhanced appreciation of the variations of tone

A geriatric unit containing 200 female and 110 male beds was fully opened at this hospital in March, 1953. There were then resident in hospital 226 females over 70, and 165 males over 65. The aim of this paper is to discuss the mental and physical health of the inmates and assess their medical and nursing requirements. It is hoped that this information will be of value to those intending to open similar units.This hospital is unique in having a catchment area of over 1,000,000 and only 2,000 mental beds. Three hundred of these are taken by mental defectives, and 500 are over 65 years of age. There is a severe bed shortage with resulting delay in admission of elderly patients from the observation wards. The large initial death rate in the month following notification occurs mainly outside this hospital, and many patients are discharged from the observation wards without reaching the hospital. Admissions are restricted to those with severe conduct disorder. Thus the death rate and discharge rate will be lower than hospitals with a more fortunate bed-population ratio.

This paper reports part of a research into the relationship of certain aspects of mental functioning and the psychiatric illnesses of old age. One of the apparent deficits of function to which much importance has been attached is “memory impairment”. This is commonly considered part of various clinical syndromes, especially of the “organic” mental disorder of the senium. The measurement or estimation of memory function is, therefore, thought to be of considerable importance and most clinicians working with elderly patients use some kinds of tests which purport to measure it. There are, however, some points of conflict between clinical usage and the evidence of objective investigations in this area. It has never, for example, been demonstrated in relation to memory assessment that “memory” as such, can usefully be considered as even relatively independent of intelligence in young normal adult subjects (Eysenck and Halstead (1)).

Previously we reported upon the results of arginine tolerance tests carried out in patients with amyotrophic lateral sclerosis (ALS) and hospitalized controls, both groups consisting of Caucasians living in the Kansas City area. 1 The levels of arginine were noted to be significantly lower in the patients than in the controls. Later, because of the extraordinarily high incidence of ALS among the Chamorros on Guam, and because there have been suggestions that the disease there might be different from the sporadic ALS encountered in Caucasian Americans, 2 the Metrecal arginine lysine tolerance test (MALTT) was also carried out both on Chamorro patients with ALS and hospitalized controls at the Guam Memorial Hospital, Agana, Guam in March 1964. The present paper describes and discusses our observations in these patients and controls. Material and Methods Patients and Controls.— A myelogram was performed on all patients whose disease had been diagnosed as ALS

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.

This paper describes treatment with cortisone and A.C.T.H. of two patients in whom Alzheimer's Disease (A.D.) had been confirmed histologically by cerebral biopsy.A.D. is a progressive dementia which usually occurs between the ages of 40 and 60 years, and there is no known specific treatment. Intellectual deterioration, which progresses insidiously over a period of 2–10 years, leads to gross dementia, and the inevitable problems of care and supervision often necessitate removal to an institution. Histologically the disease is characterized by atrophy of cortical nerve cells and the presence within the cortex of argentophile plaques which are demonstrable by the silver impregnation techniques of Bielschowsky or von Braunmühl (see Fig. 1); these plaques have a mixed granular and fibrillary structure. The same silver methods also show irregular thickening and disorientation of the nerve cell fibrils, which form “tangles” and “loops” (see Fig. 2). Identical plaques and neurofibrillary changes are also seen in senile dementia, the term “senile plaque” being used in both diseases.

The problem of the increased number of elderly psychiatric patients universally encountered needs no stressing. The purpose of this paper is to assess the value of the electro-encephalogram (EEG) as an objective aid to diagnosis and prognosis in these persons. The great majority of the psychiatric patients seen over the age of 60 are either suffering from an affective disorder, almost invariably depressive in nature, or from an organic dementia whether senile or arteriosclerotic. The former is normally considered of good prognosis and the latter doubtful or bad according to the degree of the dementia and confusion.