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Many papers are written on psychiatry every year, but few deal with treatment. This year is an exception. Two new therapeutic methods have come into prominence; one has been discussed largely in the public press under the inexcusable name psychosurgery, and the other has caused a flood of literature in the medical press—the insulin shock treatment of schizophrenia. "PSYCHOSURGERY" Moniz, a Portuguese neurologist, well known for his studies on cerebral arteriography, and his colleague Lima 1 tried to alter by cerebral surgery the mental symptoms of twenty persons suffering from different psychoses; the condition presented by ten of these would probably be classified in America as severe agitated depression, three were manic and seven were schizophrenic. All those suffering from depression were improved by interruption of tracts in the frontal lobe; the results in the two other groups were dubious. In America Freeman 2 has taken up this work and

The occurrence of spontaneous subarachnoid hemorrhage always raises urgent diagnostic and therapeutic problems. The early determination of the cause of hemorrhage is of great importance; and if no localizing signs are found, cerebral arteriography is usually performed on one or both sides. If papilledema is present in the bleeding patient, the presence of an intracranial space-occupying lesion is usually suspected. Subarachnoid hemorrhage, however, may also be of spinal origin, usually from a spinal vascular anomaly 1 or a spinal tumor. 2 This condition seems to be rare, and only a small number of cases have been reported in the literature. In a series of 312 consecutive cases of spontaneous subarachnoid hemorrhage, only 2 such instances were recorded. 3 A case is here reported of repeated subarachnoid hemorrhages and papilledema due to a spinal neurofibroma. Report of a Case A woman, aged 49, was admitted to the Department of Neurology because of

CEREBRAL angiography as a method of localizing intracranial lesions was first introduced by Egas Moniz in 1927. 1 After injection of radiopaque substance into the carotid artery, roentgenograms of the cerebrovascular tree were taken. Lesions could be identified by their vascular pattern or by the displacement of the cerebral blood vessels. Although Egas Moniz strongly advocated the use of his method for the localization of cerebral neoplasms, for the present air insufflation remains the procedure of choice. There is agreement, however, that cerebral angiography is a useful technic for the localization of certain vascular lesions, 2 namely, intracranial aneurysm, angiomatous malformations, occlusion of the internal carotid artery and traumatic arteriovenous aneurysm. The usefulness of the technic will depend on the proper selection of patients. The case histories presented in this report illustrate the use of cerebral arteriography as an aid in neurologic diagnosis. TECHNIC The technic used was essentially that

This little book will be a must for all persons interested in studying the origins and physiology of migraine. It is the most technical book on the subject that I have seen. Chapters deal with such things as cerebral arteriography, blood flow, and electroencephalography in migraine. (The author says that the electroencephalograms are usually within the limits of normal.) The eminent Macdonald Critchley has a magnificent chapter on migraine as it was mentioned by ancient writers from Hippocrates onward. There is a discussion on the evolution of the cerebral circulation in animals. Other chapters deal with vascular spasm in the cerebral circulation, the possible role of the hypothalamus in migraine, the effect of drugs on blood vessels, and the function of polypeptides and amines in the genesis of migraine. The biochemical discussions are detailed. The only regret I have is that little if any mention is made of the work

Cerebral arteriography has not been widely employed in this country, and its value as an important adjunct to neurologic diagnosis has not been generally appreciated. The technic for the visualization of the vascular supply of the brain was introduced by Egas Moniz 1 in 1927. After experimenting with several radiopaque substances, Moniz finally advocated the injection of a colloidal preparation of thorium dioxide (thorotrast). This method has been used extensively by its originator and has also found favor in several European clinics. The objections to cerebral arteriography and its relative neglect by American neurosurgeons are due to the toxicity and potential hazards inherent in the use of thorium compounds. Abundant evidence is available that thorium compounds are radioactive. 2 Martland 3 stated, "The routine use of thorium dioxide sol is criminal." These substances may be injected into the vascular system or the body cavities with but slight immediate reaction. However

THE FIRST use in this country of iodopyracet (Diodrast) for cerebral arteriography was reported by Gross 1 in 1940. The procedure has been used with increasing frequency to visualize cerebral circulation in many conditions, particularly in patients suspected of harboring intracranial aneurysms and tumors. Although this substance is relatively safe, the occasional occurrence of untoward reactions has been reported. Engeset 2 described two fatalities in a series of 100 patients but did not believe that death was primarily due to angiography. In 1949, Chusid, Robinson, and Margules-Lavergne, 3 in a report to the New York Society of Neurosurgery, noted two instances of transient hemiplegia following intracarotid injection of 35% iodopyracet, and 21 similar complications were mentioned in the discussion following this paper. Since then, other reports have been published. 4 In searching for a substance of less toxicity, we thought the results of our preliminary clinical trials 5 with sodium