1960 PSYCHOSOMATICS

Abstracted from the Medical Press

289

THE HAPPY COLLEGE STUDENT MYTH. M. L.Selzer, Arch. Gen. Psychiat., 2:131-136, 1960.

Culled from the 3,000,000 student body of 1,900colleges in the United States, Dr. Selzer has ac­cumul..ted statistics to disprove the almost uni-

. versally accepted impression that the averagecollege student's mental health difficulties areless serious than those of persons in the generalpopulation.

A total of 506 students in the University of:Michigan were interviewed in the Mental Hy­giene Clinic by three psychiatrists. Of these,40% were self-referred; physicians referred 29%,and 9% were referred by the faculty. Diagnosisshowed that 35.4% were psychoneurotic, 24.5%had personality disorders and 21.7% were schizo­phrenics. Some 8.3% were included in adjust­ment reactions.

As a closing remark, I quote Dr. Selzer:"here is reason to believe that patients seen by acollege health service psychiatrist are diagnosti­cally comparable to patients encountered in anyoutpatient psychiatric clinic accessible to thegeneral public."

Leo Wollman, M.D.Brooklyn 24, N. Y.

PRACTICAL PSYCHOTHERAPY-A VALUABLETOOL OF ALL PHYSICIANS. Franklin S. Du­Bois, M.D., Conn. Medicine, 24:7, July 1960.

Since there are too few psychiatrists to treatthe rising tide of emotional sickness, the majorpart of psychiatric work in any community canand should be done by the non-psychiatrists. Theauthor outlines a practical method of psycho­therapy which can be used to attack the basicemotional problem, anxiety.' The physician ispriMarily a teacher when he uses prophylacticpsychotherapy; he attempts to preserve thehome, prevent inconsistency and rejection in pa­rental attitudes, and helps promote tolerance andunderstanding.

Remedial psychotherapy is basically re-edu­cation and should be directive. After the prob­lem has been adequately ventilated and the pa­tient's strengths and weaknesses assessed, re­organization of his life may be attempted byutilizing the strengths and minimizing the weak­nesses.

F. W. Goodrich, Jr., M.D.New London, Conn.

THE PSYCHIATRIC TREATMENT OF OFFEND­ERS. New York Med., Vol. XV, No. 24, Decem·bel' 20, 1959

In an attempt to meet the problem of delin­quency, our community is seeking the assistanceof medically-trained minds. One figure in medi­cine prominently involved in this area is Dr. Me­litta Schmideberg. Through her efforts, the "As­sociation for the Psychiatric Treatment of Of­fenders" (APTO) , was established. This organi­zation ftlls a tremendous need. On the occasionof this report, the group met with representativesof the law, probation, correction and social work­ers interested in the offender.

The chairman, Prof. Herbert Block, introduced"The Magnitude of the Problem." Besides men­tioning that delinquency is on the rise, CUriouslymore so in the democracies, he emphasized theregrettable fact that its incidence is "movingdown into the lower brackets." All speakers rec­ognized the emotionogenic factor in crime andcomplained about the pitiful lack of psychiatricfacilities available for the diagnosis and treat­ment of the delinquent and for the traIning andsupervision of workers in the field. Julge PeterT. Farrell observed that in order to understandthe motivation of the criminal act, criminal jus­tice is in need of intensive help from psychiatry,since no longer is it exclusively the bad and thedeprived who appear before the court. To theroster are added those who come from superiorfamily and environmental backgrounds. He rec­ognized that the glib use of incarceration andpunishment are not constructive and appealedfor more clinics for guidance. Fastov, repre­senting the Correction Department, pleaded forthe reduction from the "giant" institution to oneof smaller size to provide more individual care.Edith Schwartz (social worker), defined the fric­tion of the court clinic in diagnosis and assign­ment. The mention of the tremendous case loadsocial workers maintain rings a familiar problem.Her reference to the need of the probation officeras a symbol of authorily is emphasized andshould be heeded by all concerned.

Dr. Schmideberg then followed with an analy­sis of the inadequate facilities, observing thatmost psychiatrists reject the criminal fringe. Sheinsisted that special training in criminosis isneeded for those who have the interest and thecapacity for research and experiment. A usefuldifferential diagnosis between the neurotic and

290 PSYCHOSOMATICS SEPI'EMBER-OCTOBER

the offender was presented by the Departmentof Clinical Services of APTO. The offender isdescribed as a community problem because heinduces suffering in others and lacks those quali­ties of awareness and cooperability to seek help.In discussing criminal psychiatry, this depart­ment recommended special training for thera­pists, claiming that classical psychoanalytictherapy is ineffectual because of the absence ofinner sufferin~. The philosophy of treatmentrests upon reeducation and socialization, whichincludes the release from destructive tensions andthe building of inhibitions. The authority andsupport of the court is often essential for con­tinued treatment.

Ruth Ochrock, Ph.D., APTO therapist, indi­cated that therapy revolves about "reality con­frontation" and correction of the self-conceptWith "old-fashioned tact" and support.

A second section of the symposium is devotedto an equally complex subject, "Psychiatry andthe Law." Judge Farrell protested that the phi­losophy of responsibility is being challenged bythe philosophy of excuse, With Society standingaccused. Judge Tlmone said he was of the opin­ion' that immature psychiatric recommendationsmight invade the civil rights of a defendant anddeprive him of "due process of law" and "con­frontation of cross-examination." Of course thesepoints reqUire clarification. Dr. Schmideberg at­tempted to do so. She reassured the justices thatpsychiatry cannot replace the law nor substitutefor morality and proper upbringing. Neverthe­less, to her, psychiatry is a mercy "that tem­pers justice" as a "privilege rather than a right."As usual, the matter of "free will" complicatedthe issues. Cases obViously psychotic or withgrave disturbance or stress, Dr. Schmideberg ob­served, are unanimously recognized as not re­sponsible. But for others, the law is essentialand the social code is a standard of acceptablebehavior. This section rell.ects on both the con­fticts existing between law and psychiatry andthe justi1lable concern of the judiciary lest theyshould happen to overlook a "patient." It alsoraises the question of degrees of involvement ofunconscious motivation and how to translatethese concepts to satisfy the law. Moreover, howis one to deal with the presence of cerebral dys­rhythmia in certain offenders and interpret theirresponsibility? Currently, in New York State,a strong attempt is being made to clarify thecontributions of both law and psychiatry to bringabout a better approach to the problem of de­linquency.

The material contained in this paper is read­able and informative for all physicians. Aglimpse of the problems of law and psychiatryis provided and it acquaints one with the credit-

able work of APTO. It is highly recommendedreading.

George J. Train, M.D.Brooklyn, N. Y.

NUCLEAR SEX AND BODY-BUILD IN SCHIZO­PHRENIA. V. Cowie, A. Coppen, and P. Nor­man, Brit. Med. J., Aug. 6, 1960: 431-433.

One hundred male and one hundred femalemental hospital patients with a diagnosis ofchronic schizophrenia were measured for biacro­mial and bi-iliac diameters. The purpose of theresearch project, which was financed by a grantfrom The Medical Research Council, was toverify or disprove a recent survey on body-buildwhich showed that schizophrenics differ mark­edly from normal SUbjects with regard to thebiacromial diameter and the androgyny score.The androgyny score is obtained by the formula:3x biacromial diameter (cm.)-1x bi-iliac diam­eter (cm.). The androgyny score for normalmales shows a mean of 90.1 and for females amean of 78.9. This permits an effective discrimi­nation to be made between the sexes. The bi­acromial diameter and the androgyny score areclosely related to sexual development. There isreason to believe that a connection exists be­tween anomalles of nuclear sex and mental dis­orders.

Buccal mucosa scrapings and smears of capil­lary blood from the ear were utilized to assessnuclear sex. No anomalles of nuclear sex werediscovered. The authors' conclusion: "It seemsimprobable, therefore, that nuclear-sex anoma­lies are associated in any signi1l.cant degree withschizophrenia, or that they are responsible forthe marked differences in body-build betweenEchizophrenic patients and normal individuals."

Leo Wollman, M.D.Brooklyn 24, N. Y.

HYPNOSI$-APPLICATIONS AND MISAPPLICA.TIONS. Harold Rosen, M.D., Ph.D., J.A.M.A.,Vol. 172, No.7, Feb. 13, 1960.

Hypnosis will, in all probability, turn out to bea potent medical research tool. The techniquesare easily taught and learned. About 25% of thegeneral population may be hypnotized. It is im­portant to know when not to hypnotize a patient.The motivations of the patient should be deter­mined.

Long term studies do not conftrm short termhopes. Short courses in hypnosis are growingin popularity and are concerned chiell.y with theseshort term hopes. Psychotic depression may beprecipitated.

The self-styled bypnoanalyst without years ofpsychiatric training can be dangerous.

1960 PSYCHOSOMATICS 291

Pain is a symptom which frequently drives apatient to a hypnotist. Emotionally based painfrequently masks severe and even suicidal de­pressions.

Borderline psychotics may be hypnotized. Un­less they are recognized as compensated psy­chotics, suggesting away a single symptom maybreak down this last defense against decompen­sation.

No one, ignorant of psychodynamics, shol,lldever treat patients on hypnotic levels beyond therange of his usual professional competence withunhypnotized patients.

J08eph Joel Friedman, M.D.Brooklyn, N. Y.

CLUES SUGGESTING EMOTIONAL DISTURB·ANCES IN CERTAIN DERMATOSES. Sadie H.Zaidens, M.D., N. Y. St. J. Med., 60:2874-2876,Sept. 15, 1960.

This short article is well worth the reading,as in recent years it is becoming increasinglyevident that the patient's derma may rellect anunderlying emotional con1lict. The author pointsout that "in many skin diseases a careful studyof the patient's personality as well as of the skindisorder may show evidence of an emotional dis­turbance. An evaluation of the patient's emo­tional reactions to therapy is important to thetreabnent. Some of the signs and symptoms aphysician should look for are: reticence or dUft­culty on the part of the patient in making an ap­poinbnent; an unusual history; atypical erup­tions; undue or unrelated symptoms; and the er­raticbehavior, bizarre appearance, and antago­nistic or ambivalent reaction to therapy and tothe physician on the part of the patient."

Jame8 L. McOartney, M.D.Garden City, N. Y.

SHAMANISM. Arthur G. King, Obstetrics & Gyne­cology, 16:1, July 1960.Doctors are "functional descendants of the

shamans who specialized in healing the sick."One of the most important aspects of this herit­age is the blind faith which our patients havein us because of our position as modem shamans.As knowledge increases and people become moresophisticated, this faith is apt to be shaken. Itis important that we nurture this con1ldence ra­ther than abuse it. Unnecessary surgery or theuse of the latest fad in medication, when we our­selves have doubts about the real therapeuticvalue of such treabnent, is an abuse of the pa­tient's faith. We can retain the faith of the pUblic"only by rising to the level of intellectual, psy­chologic, and social development which the restof the people have reached. Let us be more dis-

criminating in our medical beliefs; and let us bemore honest with both patients and ourselves."

Frederick W. Goodrich, Jr., M.D.New London, Conn.

TECHNIQUES OF HYPNOSIS. William S. Kroger,M.D., J.A.M.A., Vol. 172, No.7, Feb. 13, 1960.

Metftods for inducing hypnosis are direct, in­direct or mechanical. Preliminary testing forpatient's susceptibility is simple and advisable.All therapists must be capable of switching fromone approach to another, even during the sameinduction. Proper motivation and Instruction ofthe subject beforehand; a con1ldent approach bythe hypnotherapist; and a healthy rapport makesinduction much easier and the therapy morefruitful.

Hypnotic induction can be readily learned butthis is only the first step. Much clinical expe­rience is needed to gain proficiency.

Hypnosis should be employed only by doctorsfor specific purposes in selected patients. Thesedoctors should realize their limitations and notexceed their psychotherapeutic orientation orability.

J08eph Joel Friedman, M.D.Brooklyn, N. Y.

HYPERVENTILATION FROM ORGANIC DIS­EASE. P. R. Aronson, Ann. Int. Med., 50:554­559, 1959.

Cardiovascular, intrathoracic and other disor­ders may be the cause of the hyperventilationsyndrome. The frequent association of anxietywith the latter diagnosis may produce di1Iicultiesin di1ferential diagnOsis. Among the organic pos­sibilities are: coronary artery disease, pericar­ditis, dissecting aneurysm, cardiac arrythmia,pulmonary hypertension, pulmonary emboli, eso­phageal disorders, hiatus hernia, Tietze's syn­drome, fibromyositis, intercostal neuralgia, chole­cystitis, splenic lIexure syndrome, cervical arth­ritis, herniated disk, herpes zoster, collagen dis­eases and salicylate poisoning.

The author stresses the importance ot a de­tailed history, in which the sequence of the ap­pearance of the symptoms is stressed. Electro­cardiograms and roentgenograms are needed notonly to evaluate the presence of organic diseasebut are also necessary for reassurance.

DIAGNOSIS AND TREATMENT OF BEHAVIORDISORDERS IN CHILDREN. G. J. Lytton, M.D.,and M. Knobel, M.D., Dis. of the Nerv. Syst., 20:334-340, August 1959.

This paper discusses the hyperkinetic syndromeand behavior disorders in general and presents

292 PSYCHOSOMATICS SEPTEMBER-OCToBER

the results of a study of the action of methylphenidate (Ritalin) in this type of problem.

The authors postulate a psychoneurologicalpoint of view rather than a purely psychogenicone in their understanding of the cause of thebehavioral problem.

As to the action of methyl phenidate, thereseems to be strong evidence that the effect maybe due to direct action on the cortex as well asthrough subcortical structures. The dosage va­ried from 15 to 200 mg. daily. It was felt thatin 15 of 20 patients a definite improvement wasobtained.

RECENT CONCEPTIONS AND MISCONCEP.TIONS OF SCHIZOPHRENIA. S. Arieti, M.D.,A. J. of Psychotherapy, 14:3-29, Jan. 1960.

The author readily admits at the outset thatour knowledge of schizophrenia is far from com­plete and attempts to review and evaluate cur­rent specific psychologic theories. He omits theorganic theories "because he does not subscribeto them."

In Bateson's theory of the "double bind," thechild is exposed repeatedly to situations andmessages that are double bind; for instance, themother tells the child, "Pull up your socks," andat the same time her gesture implies, "Don't be80 obedient." In this atmosphere, the child isdamned if he does and damned if he doesn't. Theauthor, in his critique of this theory feels thatdouble bind situations are characteristic of man,not of schizophrenia, since we. are all exposed tothem.

In Szasz's theory, in which schizophrenia isdue to a "deficiency of incorporated objects," thepatient has no models to use in his life. He isawkward and inadequate. The author feels thatthis theory is also difficult to accept because thehistory of the pre-psychotic denies such poverty.Instead there is a vulnerability or fragility of theorganization of social symbols and internal ob­jects caused by the emotional conditions underwhich they took place.

As to the contributions of the existentialistschool of pSYChiatry, which is particularly con­cerned with the "here and now," the therapist isnot concerned with Why the patient became psy­chotic but with how it occurred. The author feelsthat this is tantamount to looking at only thetop of an iceberg and not being aware of thegreater portion which lies under water.

CONTEMPORARY CONVERSION REACTIONS:A CLINICAL STUDY. F. J. Ziegler, et aI., Am.J. of Psychiat., Vol. 116:901-910, April 1960.

This is a report on the records of 134 consecu-tive patients diagnosed as conversion reactions

who were seen in consultation at the Johns Hop­kins Hospital dUring the last four years.

Patients illustrating classical conversion symp­tomatology simulate organic disease processes asthey conceive them. Some patients are "expertsimulators," especially those who are medicallysophisticated. The type of symptom most oftensimulated was that of pain, which is often thesomatic representation of an affect. A factor inshaping symptoms, in addition to identificationand simulation, is that of symbolic transmutationof specific unconscious confiicts and affects.

Depressive features were present, althoughovershadowed by conversion symptoms, in 40 ofthe 134 patients. Conversion symptoms may beused as defenses against more overt depres­sion. Nineteen patients showed clinical evidencestrongly suggestive of an underlying or incipientschizophrenic process. In a large number of pa­tients the standard formulation of conversion asa defense against potential neurotic anxietyseemed to apply.

Phenomenologically, conversion reactions ingeneral enable the patient to avoid or reduceaffective distress by substituting fantasy-inducedand symbolically expressed somatic distress ordysfunction. In this way an intolerable affectiveproblem may be converted into a face savingphysical-medical one, in which the patient shiftsthe responsibility for remedial action from him­self to others, including the physician.

The refractoriness to .psychotherapy usuallytook the form of continued insistence that theirproblems were physical and not emotional. Anyobvious anxiety or depression was rationalizedby the patients as secondary to alleged organicdiseases. Most of the patients refused psycho­therapy even on a tentative trial basis.

PSYCHOTHERAPY. Kenneth E. Appel, M.D.JAM.A., Vol. 172 (13): 1343-1346, March 26,1960.

Psychotherapy is widely misunderstood; it isnot a transfusion of ideas to the patient nor is itan injection of correct notions or soothing plati­tudes. It is not making decisions or solving prob­lems for the patient. It does not preclude theuse of drugs; drugs may facilitate psychother­apy. It is a collaborative search for a betteradjustment for the patient; it is helping him todevelop solutions, capacities and confidencethrough discussions, guidance, talking things outand the release of pent-up feelings.

Physicians and surgeons will be called on todo more psychotherapy than ever, since the in­troduction of the new tension-reducing drugs.

Various methods of psychotherapy are avail­able to the general physician: 1) aeration or ven-

1960 PSYCHOSOMATICS 293

tilation; 2) supportive psychotherapy; 3) ma­nipulative psychotherapy (occupational therapy,hobbies); 4) explanatory psychotherapy (desen­sitization, persuasion and reeducation); 5) dy­namic growth therapy (mobilization of the in­terests, assets and resources of the patient toenable the patient to expand, take the initiativeand develop).

"One of the essential qualities of the clinicianis interest in humanity, where the secret of thecare of the patient is in caring for the patient."

"TRIFLUOPERAZINE (STELAZINE) IN ANXIETYSTATES. F. R. Souder, Antibiotic Med. & Clin.Therapy, 6:711, 1959.

In a study of the use of the drug in 142 out­patients, a lessened anxiety was noted within oneweek in 118 patients. Its greatest value lay inthe reduction of the emotional overlay in thosewith concomitant physical disorders. Failureswere seen in those instances where the symptomsprovided secondary gain. The dose employed was1-2 gm., two to four times day.

CHRONIC SUBDURAL HEMATOMA. M. Depaus,Semaine des Hopitaux, 35/52:3028-32.

A latent period of weeks or months occurs be­fore patients develop headache, psychic changesand neurologic localizing signs. The localizingsigns are unilateral slight central facial paresisor slight pyramidal syndrome, unilateral absenceof abdominal skin reflexes, unequal pupils, changein muscle tone, cortical type of sensory deficiencyand pain on pressure or percussion over the tem­poral bone. Radiography may reveal displace­ment of the calcified pineal gland away from theside of the lesion. EEG and angiography estab­lish the diagnosis.

(Quoted by World-Wide Abstracts, Vol. 3, No.3, March 1960.)

SEPARATION ANXIETY. The Psychiatric Bulle­tin, Vol. 9, No.4. Fall, 1959.

Three manifestations that the family physicianmay observe in Insecure children are insomnia,so-called school phobia and invalidism. In in­fants with Insomnia, parents must be helped tostabiUze the environment for the infant. Regu­larity in feeding, bathing and bed time will help.

In cases where the child cannot be separatedfrom the parent to go to school, It isn't that thechild fears school, but instead fears separationfrom the mother. Often separation is unwel­come to the mother as well as to the child. Somefear to leave home because a younger siblingwill then have unchallenged possession of themother's attention. In milder cases the general

physician should try to get the child to attendschool for limited periods dUring his therapy.The child may then begin to take pride in his be­ing able to stay for longer and longer ..R.eriods.In some, however, compulsory attendance maybe unwise if there is any likelihood of preCipi­tating a more serious Illness.

Whether the treatment is conducted by thegeneral physician, or by the psychiatrist, thegoal cannot be simply returning the child toschool. Some change must be made in the inter­family relationships.

One way that children have of solving theiremotional problems is to become ill. In manyinstances, the mother has encouraged regression.The child's dependency answers the parent's needfor se.curity.

The principal cause for neurosis in a child ishis liVing with parents who are neurotic. It isimportant for the physician to evaluate the fam­ily circumstances and interaction if he is to besuccessful in treating the child.

ENCEPHALITIS AND ENCEPI1ALOPATHY. HansZellveger; Deutsche Mediz. Wochen., 84/43:1921-25.

The etiology of acute encephalitis may be dueto a wide variety of microorganisms, such as hel­minths, fungi, protozoa, bacteria, rickettsias andviruses, and also toxins, drugs, and exogenousor endogenous antigens. Pseudotumor must bedifferentiated; also acute cerebellar ataxia dueto toxic causes.

During or after many viral or bacterial infec­tions, encephalitis-like conditions may develop.They may also develop after smallpox vaccina­tion, pertussis, rabies, the injection of serum andthe ingestion of certain drugs.

Acute demyelination encephalitis may be theresult of an antigen-antibody reaction. Toxicvascular encephalopathy may be caused by dam­age to the vascular endothelium. Ischemic en­cephalopathy is probably caused by anoxia.

(Quoted by World-Wide Abstracts, Vol 3, No.3, Mar. 1960.)

PSYCHOLOGICAL FACTORS INVOLVED IN BI­ZARRE SEIZURES. M. E. Chafetz, M.D., andR. S. Schwab, M.D. Psychosom. Med., 21:96-105,March-April 1959.

The authors report on 20 patients whose seiz­ures required extensive neurologic and psychia­tric study. It was found that marked psychologi­cal difficulties existed prior to the onset of theseizures; the seizures were often used to controlthe environment and frequently occurred in clus­ters dUring periods of extreme tension.

294 PSYCHOSOMATICS SEPrEMBER-OCTOBER

In most instances the EEG findings were equiv­ocal; the response to anticonvulsants was un­predictable. The authors feel that these pa­tients can best be treated by a team approach,utilizing both the neurologist and the psychia­trist, since the patient can make use of physicalneeds as a defense against psychiatric explora­tion.

PHYSIOLOGIC, PSYCHOLOGIC AND SOCIALDETERMINANTS OF PSYCHOSOMATIC DIS·EASE. I. A. Mirsky, M.D., Dis. of the Nerv.System, Vol. 21, No.2, Sect. 2, pg. 50-56, Feb.1960.Psychosomatic medicine developed as a hybrid

-the result of the convergent approaches rep­resented by Cannon and Freud. When viewedas another branch of medicine, it is sterile-butwhen seen as a method whereby tools and con­cepts of the behavioral sciences are integratedwith those of the other disciplines, it has vigor.Psychosomatic does not mean psychogenic-nordoes it imply the absence of a genetic determi­nant.

Gastric hypersecretion is an essential but notthe i10le cause of duodenal ulcer. Patients withthis illness exhibit strong infantile, oral, depend­ent wishes. They also have tendencies to pleaseand placate, yet similar patterns Cl'n be demon­strated in subjects without ulcers. Some socio­cultural event is a major factor in the precipi­tation of duodenal ulcer; it is not the situationitself, but the specific meaning of the event tothe particular individual that determines the re­sponse.

The high familial incidence of duodenal ulcerand the greater incidence of blood group type 0among these patients suggest some genetic fac­tor.

Studies indicate three parameters which con­tribute to the development of duodenal ulcer:1) physiological-gastric hypersecretion; 2) psy­chological-specific psychological conflict; 3) so­cial-an environmental event which will provenoxious to the particular individual.

The rate of gastric secretion with which achild is born may of itself play a significant rolein the relationship between mother and child. Inthe Infant with gastric hypersecretion, even anormal rejecting mother may be only partiallysuccessful in meeting the infant's needs for phys­iological satiation which In turn permits the in­fant to pass successfully through the earliestphases of emotional and social development. Inthe degree In which these needs fail to be met,subsequent environmental events are perceivedas noxious ones in terms of persistent infantileneeds.

URINARY EXCRETION OF PHENOLIC ACIDSBY NORMAL AND SCHIZOPHRENIC MALEPATIENTS. J. D. Mann and E. H. LaBrosse.A.M.A. Arch. Gen. Psychiat., 1:547·551, 1959.The excretion of phenolic acids was studied

and found to be different for schizophrenics ascompared to normal males. Since these samecompounds had been reported as metabolic prod­ucts of substances present in coffee, the authorsstudied the correlation between the findings andthe coffee-drinking habits of their patients. Theirfindings indicated that the excretion of theseacids correlated significantly with the coffee in­take. It is apparent that a careful search foruncontrolled variables is necessary. This is es­pecially needed because of the high sensitivityof paper chromatographic methods to variationsin the diet.

ESTROGEN AND PSYCHOSEXUAL DISORDERS.L. H. Whitaker, M. J. Australia, 2:547-549, Oct.1959.The author reports' that it has been routine

practice to administer large doses of estrogenprior to surgery in adult males who are to becircumcized so that an inhibition of the erectilemechanism can occur. It is also reported thatthe use of estrogens in preventing orchitis afterinfectious parotitis results in impotence whichlasts for weeks. These observations promptedthe treatment of patients with psychosexual dis­orders. The group included patients with homo­sexuality, abnormally powerful heterosexualdrives and exhibitionisms. Stilbesterol was givenby mouth in dosage of 5 mg. for two weeks toproduce complete inhibition; where it was desiredto merely reduce the intensity of the sexual drive,the dose was 1 mg. daily until the reduction wasnoted by the patient. The results indicated thatthis form of treatment can control but cannotcure the deviation of aim or object of the sexualdrive. The author stressed the need for repeti-

. tion of the treatment at intervals.

CEREBELLAR ATAXIA. S. Weiss and S. Carter,Neurology, 9:711, 1959.Records of patients under 17 years of age with

acute cerebellar ataxia were reviewed. Non-spe­cific infectious disease often precedes the suddenonset of severe gait ataxia. Other initial signsinclude tremor of the trunk or extremities, ab­normal eye movements and myoclonic or ticmovements. In 6 of the 18 patients studied, neu­rologic abnormalities persisted during the followup period of 9 months to 6lh years. In the ma­jority of patients complete recovery occurs withinsix months with no evidence of neurologic defect.

W.D.