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Laing and Esterson describe an investigation of 11 patients suffering from ronic or acute and episodic schizophrenia, and of their families. Patients and

ME~iBRITISIN 146210 eeme 1965 Pseudoipomia of Bre~ast-ShucksmP~Jit anld LDossett MEDICAL JOURNAL disk. The distribution of pseudolipomas by age-groups emphasizes the importance of the thickness of the breast disk. The pseudolipomas were found in four pre-menopausal and 14 post-menopausal women with cancer, a ratio of 1 to 3.5. This ratio is far higher than the ratio of 1 to 1.8 for the pre-menopausal to post-menopausal distribution of cancer found by Bonser et al. (1961, p. 351) in a series of 220 unselected breast cancers. The breast substance is 2 to 4 cm. thick in the pre-menopausal woman, but after the menopause it is often reduced to a thin sheet, less than 0.5 cm. in thickness. Clearly the cancer which starts in the thin postmenopausal breast can more readily affect the overlying fibrous septa.Although carcinomatous infiltration of the fibrous septa has been observed in this series it plays little part in the production of the pseudolipoma. When it occurs it produces firm adherence of the skin to the tumour.The oedema produced by the chronic inflammatory reaction in and around the expanded cancers seems the likely explanation of the production of the overlying pseudolipoma. When oedema is produced by severe or acute inflammation it may be so intense that oedema of the skin results.A swelling which was sufficiently defined to be easily felt under the pseudolipoma was found in 11 out of 18 cases, but a confident diagnosis of cancer could not have been made from physical examination except in three of these where the overlying skin was adherent. When an indefinite swelling was present under the pseudolipoma the cancer could have been entirely missed, and there were three patients with cancer in whom the only physical sign was the pseudolipoma. Conversely, in one of the patients in whom duct ectasia had produced a pseudolipoma involving nearly the whole of the upper part of the breast a definite swelling was palpated near the nipple and hard axillary nodes were felt.The finding of a pseudolipoma must be regarded as a signal that cancer is likely to be present. If the pseudolipoma is recognized directly over a readily palpable swelling and is symmetrically placed over that swelling, then the lesion is a cancer, and whatever treatment is preferred may be instituted. J., 1965, 2, 1462-1465 This is a report on the results of conjoint family and milieu therapy with hospitalized schizophrenics at two mental hospitals in the Greater London area. During the past 10 years the internal family milieu of schizophrenics has been intensively studied by workers in the United States-for example, Bateson et al. (1956), Lidz et al. (1958), and Wynne et al. (1958)-and by ourselves (Laing and Esterson, 1964. These studies, which have shown how frequently the person diagnosed as schizophrenic is part of a network of extremely disturbed and disturbing patterns of communication, have important implications for prevention, treatment, and aftercare.As a result of this work and that of psychotherapists with experience of prolo...

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