This paper argues that the attack on religious enthusiasm, a campaign against popular religious radicalism, prompted the governing classes in late seventeenth- and eighteenth-century England to embrace secular explanations of the nature of insanity and to repudiate treatments which were based on religious and magical beliefs. An objection to the argument is considered, and some of its implications are discussed.

Michel Foucault's Madness and Civilization contains a bold and influential account, over several historical epochs, of the relations between madness and society's institutions of care and control. Foucault's various theses are reviewed in the light of more empirical historical studies and are, on the whole, found wanting.

Psychiatry is, in a number of ways, a unique area within medicine. It is a subject of intense public interest, with a wide-ranging influence on non-medical culture; its practitioners have a perplexing variety of strategies of diagnosis and treatment, the diversity of which can be attributed to the lack of understanding of the physical basis of mental disease. It is argued here (using schizophrenia as a particular example) that the special nature of the signs and symptoms of psychiatric disorders, involving mainly behavioural disturbances, and alterations of thought and mood, have led to particular social, even political, attitudes towards the mentally ill, to the segregation of psychiatry as a medical discipline and to a view of the disease process different from that operating in other areas of medicine. The future progress of psychiatry, both in science and in society, might depend on changes of attitude among psychiatrists themselves.

The effect of Vitamin C in manic-depressive psychosis was assessed by a double-blind, placebo controlled, crossover trial. Both manic and depressed patients were significantly better following a single 3 g dose of Vitamin C than following a placebo.

Preliminary results of a double-blind, crossover comparison of normal vanadium intake with reduced intake in manic and depressed subjects are reported. Both manic and depressed patients were significantly better on reduced intake.

These results are in keeping with the suggestion that vanadium may be an aetiological factor in manic depressive illness.

The literature of the nineteenth century often referred to chiorosis. Some examples, taken from French sources, are mentioned. The illness was only given its name at the beginning of the seventeenth century, but the clinical picture of febris alba virginum had been known for a long time previously. The history of chiorosis is interesting because of the variety of explanations, including the psychological, it attracted before it came to be recognized as due to hypochromic anaemia or iron deficiency.

The concept of ‘stupor’ is subjected to historical analysis. Particular attention is given to the nineteenth-century, during which three evolutionary stages are identified. During the first stage stupor is considered as a simple state of non-responsiveness. The second stage recognizes that some stupors are accompanied by rich subjective experiences and separates them as ‘psychiatric stupors’. During the third stage some of its symptoms are reinterpreted as resulting from an interaction between patient and environment. A number of historical sources are reviewed in an attempt to illustrate the evolution of the concept and its association with cognate behavioural states.

A significant part of Schreber's illness up to the time of his dramatic ‘schizophrenic switch’ in February 1894 has been systematically re-evaluated in terms of the Research Diagnostic Criteria (RDC) and of certain additional phenomenological characteristics. On this basis it seems that Schreber suffered from a severe major psychotic depressive disorder with tendencies towards bipolarity for the period in question. A more global, non-systematic RDC-oriented interpretation is then offered for the remaining course of the illness until Schreber's death in 1911.

The clinical and neuropathological features are reported of 7 patients with organic intellectual impairment or dementia, hypertension and ischaemic destruction predominantly of the deep white matter of the cerebral hemispheres resembling that seen in infarction. The white matter changes have been dismissed as rare in the past, usually under the name of Binswanger's disease or subcortical arteriosclerotic encephalopathy, and without much concern for hypertension. There are now indications that this sort of case may not be uncommon. It can be suspected in life on CT scans. The accuracy of assessment of the pathological substrate of organic dementia, and therefore the strategies of research and treatment, might well benefit from further clinicopathological studies.

Serum and CSF choline levels were measured in 12 patients with pre-senile Alzheimer's disease before and 1 hour after administration of 1·5 g choline chloride or 25 g lecithin granules. Serum choline levels were increased threefold and CSF choline levels by 72%. CSF choline levels in the untreated Alzheimer patients did not differ significantly from age-matched controls. In 35 neurological controls, CSF choline levels increased with age (γ = 0·64, P<0·001).

Choline influx into erythrocytes from 10 male and female Alzheimer patients did not differ significantly from 40 male and 43 female controls. Choline influx into erythrocytes was not related to age or sex, although the range was greater (P <0·05) in females than in males.

Our results indicate that there is no impairment of choline transport into CSF or erythrocytes in patients with pre-senile Alzheimer's disease.

The ability of lymphocytes from manic-depressive and normal subjects to produce new pump sites in response to increased cell sodium was compared in a series of experiments. Ethacrynate or different potassium concentrations were used to increase cell sodium concentration. The lymphocytes of manic depressives had a significantly reduced ability to produce new pump sites. It is suggested that this may be the genetic defect underlying manic depressive psychosis.