Adolf Meyer writes, “In the end our task is the amplification and specification of the complaint, expressed in the most factual objective and potent terms”. Robert Hutchison also emphasizes the importance of the complaint when he stresses the presenting symptom in his treatment of medicine. A patient always comes to his physician with some complaint, which it is the duty of the physician to investigate and treat. In the majority of cases the complaint is a bodily one; the patient goes to his physician complaining of an ache or pain or some other bodily discomfort. This bodily complaint may or may not be due to some physical illness. In Sir Walter Langdon Brown's words, “Some are unhappy through illness, some are ill through unhappiness”. This paper deals with those patients who have bodily complaints for which no adequate physical basis can be found. This condition is now known as hypochondriasis.

The theme of this essay is not new. It is humbly suggested that the method involved in it, while not original, is not usual. We have employed no original technique and formulated no new doctrine. We claim to have approached the subject in the appropriate, inevitably laborious fashion.

The contractile response of the anterior abdominal wall to the stimulus of a scratch or stroke has become an observation of great value in the routine examination of the nervous system.

Investigations into the possible causes of toxic symptoms arising during the course of prolonged somnifaine narcosis showed that a fall in serum calcium occurred during the course of the treatment (1). Previous investigations on blood calcium (3, 4, 5, 6, 15) made it clear that during barbiturate narcosis there was a fall of 10–20% of the normal value. Observations, however (7, 8, 9, 10), that therapeutic exhibition of insulin resulted in an increase in serum calcium suggested that no gross abnormality in calcium level was to be expected during the modified somnifaine-insulin-glucose treatment (2) practised in this hospital. The investigations here reported were undertaken to determine what fall in serum calcium occurred during this modified treatment, and to determine whether this fall was sufficient to cause toxic symptoms. If so the advisability of taking steps to avoid them could then be considered. The investigations showed a definite lowering in serum calcium during the course of treatment of psychotic patients by this method, and they suggested that somnifaine and insulin are only pseudo-antagonistic in their effect upon calcium metabolism. In the ten cases reported, a fall in serum calcium of from 3–20% has invariably been observed, the maximum being reached four to seven days after the beginning of the treatment.

Narco-analysis is an eclectic technique based on the observation (6) that a combination of narcosis with psycho-therapy is quicker and sometimes more effective than the formal methods of analytical psychology. The earlier attempts of this kind were limited to the non-analytical methods of overt suggestion augmented by drugs.

Since October, 1934, we have treated 40 cases of psychoses by somnifaine narcosis in the Glasgow Royal Mental Hospital. The technique employed by us was that recommended by Ström-Olsen. The patients were isolated in a quiet room, in partial darkness, and a nurse was constantly in attendance by night and day. As a preliminary to the treatment, insulin and glucose were given for a few days beforehand, while the patient received daily bowel wash-outs. The amount of glucose given was 1 oz. to 1½ oz. three times a day, along with 10 units of insulin. This insulin and glucose routine was continued during the treatment, and for some days after the administration of the somnifaine was discontinued. The somnifaine was injected intra-muscularly in 2-c.c. doses. The degree of narcosis one wished to produce was that approximating as nearly as possible to natural sleep. Throughout, one tried to keep the patient in such a state that they were able to be roused from time to time for feeding. The amount of somnifaine necessary to produce this state varied with each patient, but as a rule we found that 6 c.c. of somnifaine given in 2-c.c. doses in the 24 hours was the average amount required. The treatment was continued for 10 to 14 days.

It was with some diffidence that I agreed to contribute towards this discussion because I felt that, having had no personal experience of the use of hypnotic drugs in the modern method of prolonged narcosis, anything I might say might be held by some to be spoken without authority.

I want to speak of the work we have been doing in Cardiff on the metabolism of the nervous system. The work was carried out there because of the importance of the narcosis treatment. It seemed to us there a pity that a treatment such as that should be given up because of the considerable toxicity possible in relation to it. The research was undertaken to see if we could diminish the toxicity, at the same time seeking an idea as to how narcotics work. I ask that you will realize that the main substance burned by the brain is glucose. The dominant form of metabolism in the nervous system is connected with the breakdown of glucose and lactic acid, and this can be proved by experiment in the living animal and with brain-tissue in vitro. In doing experiments we are not able to carry out work with human brain, because we cannot get human tissue fresh enough, so we have to carry out experiments with animals. They are carried out in this way. We cut slices of the cortex of the brain as soon as the animal is dead, that is to say, within ten minutes of death the brain is out and slices have been cut. They are placed in a physiological medium in the presence of glucose, and we follow the metabolism of that tissue, which allows us to estimate the amount of oxygen being taken up by the brain. If luminal, chloretone, hyoscine or somnifaine be placed with the brain-tissue, then the respiration, instead of being at the usual level, starts lower down, and maintains a straight line. We wanted to see whether this action is reversible or irreversible. If the latter, then on removing the brain-slices from the narcotic it should no longer behave like a normal piece of tissue. Actually, when the brain-slice is removed and placed in Ringer solution, with no narcotic, the respiration goes up and becomes equal to that shown by the slice which had no narcotic. That is to say, the process is reversible.