This contribution reports a study of chronic schizophrenics hospitalized in state hospitals who suffer from serious and life-threatening medical and surgical illnesses. Four primary findings are described and discussed: lack of verbalization of pain and discomfort; bodily self-mutilation; toleration and exhibition of loathsome lesions; and inability or unwillingness to tolerate medical care. Some examples of exceptions to these four findings are also presented. Possible explanations for the findings are discussed in terms of their biological, social, and psychological components, recognizing that no single factor can explain the findings in this complex and varied population. It is concluded that treatment staffs in the hospital or community must be alert to changes in patient state, must utilize compromise methods of care and must anticipate or deduce a patient's needs while the patient is physically ill.
had the opportunity to observe the effects of intravenous administration of sodium amytal on a group of patients with dysphasia following shell fragment wounds of the dominant cerebral hemisphere. It was found that motor aphasia improved suddenly and dramatically in response to this medication. It was observed, too, that in some cases this improvement was sustained long after the effects of the sodium amytal had worn off. Furthermore, during the period of work with the patient, the helpless frustration reactions so commonly observed in aphasic patients did not appear and the patient was capable of sustained effort far beyond that which he showed without the drug. For these reasons, it was felt that the drug would be useful in the rehabilitation of soldiers with aphasia due to cerebral injuries. These observations have been verified by other investigators; in some cases the drug has had the anticipated beneficial effect.Since returning to civilian practice, I have been able to demon¬ strate the usefulness of this drug. Since the civilian physician has rela¬ tively little contact with military medical literature, a brief note bringing the matter to the attention of a wider circle of medical readers seemed advisable. The following 2 cases illustrate the effects of sodium amytal in aphasia.
REPORT OF CASESCase 1.-R. H., a woman aged 40, experienced right hemiplegia associated with mixed aphasia after operation for a meningioma involving the left temporoparietal region. She responded to her aphasia with incapacitating emotional out¬ bursts. In conversations she was quickly exhausted and discouraged. She was given, a simple group of tests to perform. First, she had to name five objects (fork, soap, pencil, rubber eraser, light bulb). Second, she had to indicate by word or action what these objects were used for. Third, she was given the Goldstein-Scheerer block test. The performance in each situation was recorded in detail. Then a 5 per cent solution of sodium amytal was injected slowly intravenously. After she had received about 4 cc, the patient displayed a sudden change in mood, which indicated that the optimum end point of the injection had From
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