Therapeutic convulsions were introduced by Meduna (1937) in 1934. After preliminary trial with intramuscular camphorated oil, Meduna soon discovered the great advantages of intravenous cardiazol (leptazol, metrazol), which remains the best of the chemical methods of fit production. Many descriptions of the various aspects of the cardiazol fit are available (Cook, 1938a; Ebaugh and Shanahan, 1939; Katzenelbogenet al., 1939; Strauss, Landis and Hunt, 1939; Dean, 1940; Hemphill, 1940).
EMPHYSEMA BIUTISH~~~~~~~~~~~~~~~~~~~~~~~~~~~~M EDICALJ OURNALMeasures to control infection and relieve bronchospasm are the essentials of treatment. The value and dangers of oxygen therapy are pointed out and the lethal effect of morphine is stressed. REFERENCES Aslett, E. A., Hart, P. d'A., and McMichael, J. (1939). Proc. roy. Soc. B, 126, 502. Baldwin, E. de F., Cournand. A., and Richards, D. W. (1948). MedIcile. 27, 243. (1949). Ibid., 28, 201. Bloomfield, R. A., Lauson, H. D., Cournand, A., Breed, E. S.. and Richards, D. W. (1946). J. clin. Invest., 25, 639. Brock, R. C. (1948. Thorax, 3, 88. Christie, R. V. (1934). J. din. Invest., 13, 295. -(1939). Edinb. med. J., 46, 463. -(1944a). British Medical Journal, 1, 105. -(1944b). Ibid., 1, 143. -and McIntosh, C. A. (1934) Many writers have expressed the view that no form of psychiatric illness occurring in pregnancy or the puerperium is a specific clinical entity. The general opinion seems to be that the ordinary stress and strains of pregnancy, operating in predisposed individuals, produce non-specific mental illnesses which are indistinguishable from other mental reactions and are due to the interaction of factors-the pregnancy being of psychological importance only. Brew and Seidenberg (1950) state that these disorders occur only in predisposed individuals, and disregard the possibility that a physiological or endocrine disturbance may be the primary activating factor.As other surveys have been made only on patien.s who have been admitted to mental hospitals these conclusions are not justified; and as no psychiatric survey of women confined in maternity hospitals has been undertaken there is no evidence about the importance of alleged psychogenic factors.The question has been considered afresh by studying the case records of all the women delivered at maternity hospitals in Bristol between January, 1938, and June, 1948, a period of 104 years, the cases numbering about 37,000. Physical and psychological factors were noted in order to ascertain their importance. The incidence, nature, and outcome of mental reactions were studied, and all cases of mental illness related to the puerperium or pregnancy that were treated in Bristol Mental Hospitals during the same period were examined by me, thus there was a double check and control. The tables relate to these surveys. Reference has also been made to some other cases, which were not included in the surveys as they occurred in other years or outside Bristol.
Pain and fatigue, subjectively experienced, are two of the commonest complaints made by patients suffering from a variety of psychoneurotic and psychotic disorders. Neither phenomenon has so far been adequately studied with the available objective techniques, and the present paper embodies results of preliminary experimental investigations of fatigue and pain tolerance, together with a review of some of the clinical aspects of the problem.In psychiatric disorders pain rarely produces overt signs which allow the observer to judge its severity, and the excruciating pain complained of by some patients appears to be accompanied by much less emotional reaction than, for example, the pain experienced by the normal individual after a burn, a crushed finger, or an abdominal catastrophe.
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