a. Introduction.

Neurological symptoms in hypoglycaemia seem bewildering and difficult to analyse because of their variety, covering, as one author puts it, the entire range of neurological and psychological manifestations. There are great differences between individual cases, each following a certain pattern of symptoms. Even this pattern may vary from day to day in the time and mode of onset and in the progression of symptoms.

It was generally expected, before the actualities of war arrived, that not the least effect of it would be a shattering of the mental health of the civil population.

War on great cities was to be a particular application of what the war lords called the war of nerves. Propaganda, threats and their ultimate fulfilment with bombs and fire were to be the weapons of the future. With this in mind, arrangements were made to receive psychiatric casualties on the assumption that the civil population, untrained and unprofessional, would suffer in at least as large numbers as soldiers in the last war.

Many different opinions are held about the value of metrazol (cardiazol) shock treatment. Large quantities of statistics are available which compare the recovery rates of treated and untreated patients (Bateman and Michael, 1940). Studies of the objective changes in treated cases have been less frequent. The present communication describes some experimental work directed towards elucidating clinical changes in patients treated with metrazol at the Ontario Hospital, London. Three psycho-physiological tests were employed: reaction time, tapping rate and strength of grip were measured. Psycho-physiological measurements, formerly used extensively (Kraepelin, 1920), have, for some years, been discredited as means for obtaining information about abnormal mental states (Stoddart, 1926). They retain their popularity as aids to the measurement of the effects of drugs such as alcohol and benzedrine (Thornton, Holck and Smith, 1939), and they have been used for the rating of general mental efficiency in aviators (Stamm, 1920), or as tests for loss of function due to anoxia (McFarland and Barach, 1937). Every test carries with it an element of experimental error and, in watching for improved performance attributable to a drug's effect, special care has to be taken to ascertain what improvement, if any, could be attributed to chance factors, to practice or to familiarity. Thus, the additional study of repeated performances of normal adults and control patients in the same test situation is necessary. It has, in the past, been amply demonstrated that the performances of psychotic patients on psychomotor tests are less efficient than those of normal people (Dorcas and Schaffer, 1934). Reaction time is lengthened, tapping rate slowed and strength of grip diminished. Moreover, an abnormal degree of variability in the response is common (Whipple, 1925) because the efficiency of some patients changes capriciously during a test. Other patients are found to show even less variety than normals (Shakow and Huston, 1936).

In the estimation of intellectual level the adherents of the Binet-Simon scales still claim for it a predominant position (1). This type of code is empirically constructed, and relies on obtaining small samples of cognitive behaviour of widely different kinds (2). There is, however, another system of testing, diametrically opposed in principle to the Binet plan. This, which is sometimes styled the factorial principle, acknowledges its theoretical dependence on the well-known conceptions on Intelligence of Prof. Spearman (3). The factorial tests are specifically designed to measure the statistically determined “general factor” only. Both methods have their advocates and the theoretical advantages and disadvantages have been hotly debated. The theoretical aspect is not of concern in the present study however. This was undertaken to discover whether the Cattell series of scales—perhaps the most important factorial test series (4)—could be used with advantage to replace or supplement the Binet scales, e.g. the widely used Terman-Merrill Revision—in the clinical examination of adult defectives, who are mainly of high grade. The scales have been compared, in other words, from the point of view of clinical practice, rather than of scientific theory.

The psychiatrist, the neurologist and the cardiologist all meet with patients who complain of their liability to a certain type of “attack” characterized by alteration of their apprehension of reality, varying degrees of subjective distress, and bodily symptoms of autonomic dysfunction, amongst which the cardiac components are given the most prominence. These attacks are often referred to as “acute anxiety attacks” by the psychiatrist and “vaso-vagal attacks” by the neurologist and the cardiologist, and vary considerably in their features and severity. The neurologist sees the most punched out clinical pattern, and in consequence it was the neurologist, Sir William Gowers, who first drew attention to them in his book, The Borderland of Epilepsy.

Therapeutic convulsions were introduced by Meduna in 1934, but it was not until the latter part of 1938, after many thousands of fits had been induced all over the world, that spinal injuries were first recorded (Wespi, 1938; Stalker, 1938). The reason for this is not far to seek; it lies in the fact that these injuries are for the most part symptomless, and consequently to be found only by means of routine radiographic examinations. In 1939 alarming reports of the high incidence of compression fractures following induced convulsions were published, and the possibility of subsequent permanent disability led in many hospitals to the abolition of a very useful form of treatment.

The following 50 cases are presented as representative of psychical illness among the Services in Singapore. The majority are R.A.F. personnel, though a few have been included from Navy and Army sources. There are also in this series six cases of such illness among wives of Service personnel. These last have been included, because nervous illness necessitating repatriation and occurring in wives presents the same quantitative inconvenience to the authorities as such illness in the troops themselves, for in these cases the husband is usually repatriated as escort.

Convulsion therapy in some form is now in common use in the majority of mental hospitals. A method of inducing convulsions by electrical stimulation of the brain was introduced into this country in 1939 (1, 2, 3, 4, 5, 6).

This method commended itself readily because of the ease of operation, the freedom from special disadvantages inseparable from the use of a blood-borne drug, and the greater accuracy of dosage possible. Several papers describing this method and some early results have already appeared (7, 8, 9, 10).