Medical Psychologists have long been familiar with a peculiar form ofdisease which is characterised by a combination of disorders of theintellectual and motor faculties. The French physicians, to whom is due thehonour of having first minutely described it, have given to it variousnames, according to the views then generally held and the special opinionsof the individual observers: General incomplete paralysis (Delaye); generalparalysis of the insane (Calmeil); general progressive paralysis (Requin,Sandras); paralytic insanity (Parchappe), &c. In Germany the termsgeneral paralysis, paralysis of the insane, and most recently paralyticdementia have been generally employed. Familiar though this disease hasbecome to medical psychologists, and though much discussion has taken placeregarding it, within a narrow sphere, still slight has been the interesthitherto taken in extending that sphere. These poor patients, whosetreatment either cannot or can only with great difficulty be pursued in theordinary relations of life, who from henceforth appear hopeless, are gladlyhanded over to physicians to the insane, and with the entrance of thepatient into the asylum all interest in the disease ceases. The time is, Ibelieve, at hand when in regard to this, as well as to many other matters,the veil of the asylum will be removed, when once for all the barriers willbe thrown down which divide mental pathology, as we must still call it, fromthat of the remainder of the nervous system. Each has a series of facts tooppose to the other, and it is certainly surprising how many points ofconnection there are between them. The question is merely one ofcomprehension: mental pathology often manifests itself in a manner whichoutwardly is not easily understood, though it must be admitted sufficientpains have not always been taken to understand these manifestations.

Amnesic aphasia has a peculiar position within the aphasic disorders, and it has always been found difficult to bring it into any aphasic scheme. The nearest to it in Head's (1926) classification of symbolic disorder is his nominal aphasia. This, however, is actually a sensory aphasia, in which the difficulty in finding words prevails; it has lost all the characteristics of the classical amnesic speech disorder. Goldstein (1926), on the other hand, while stressing the existence of the amnesic aphasia as a definite and well-circumscribed type of disorder, denies that it has anything to do with a speech defect—an opinion up to then held. According to him, it is fundamentally a defect in the thinking process in which the patients have sunk to a lower and more concrete level of behaviour. They have, according to Goldstein (1926), lost the categorical meaning and use of words; they may be able to name an object in a concrete situation, but are unable to generalize, to use the word in its class meaning. Since then this question has been critically examined by several authors (Hauptmann (1931), Isserlin (1936), von Kuenburg (1930), Lotmar (1933), Scheller (1938)) in the light of Goldstein's conception. In their conclusions, repudiating Goldstein's opinion, they reaffirmed the classical view of a basic speech disorder in the amnesic aphasia.

Five experimental incentive conditions were compared with a control condition in terms of their effect on work performance. Each of the six groups studied had a standard four-week baseline period (Block 1) consisting of an attendance payment, followed by a four-week experimental period (Block 2). Whereas all patients in the Control and Feedback groups produced less during Block 2, only two patients in the remaining four groups failed to improve. An analysis of variance indicated that Social Reinforcement, Piece Rate, Piece Rate plus Social Reinforcement, and Pay Increase plus Social Reinforcement were significantly superior to the Control and Feedback conditions.

Music, as a term, suffers much from diffusiveness. When we reflect that, in one sense or another, it denominates anything between the idle notes of the plough boy and the finished performance of an opera singer, between the productions of a Jew's harp and of a cathedral organ, between the playing of two or three foreign tramps and of a Philharmonic Orchestra; when we reflect that man's attitude to music is at one time active and at another passive, and when we also reflect that the acceptance of sound as music by man is largely dependent on his individual views and tastes, we must see how impossible it is to invent a definition of music that will serve as a universal standard, to which we can refer psychological observations without lengthy qualifications and limitations. I put forward this self-evident proposition in order to show how easily we may fall into error in particular considerations, if the term is used generally and without specialisation.

In 1955 I was a registrar at Claybury Hospital when a woman aged 52 was transferred from a general hospital, where she had been for several weeks following a stroke after which there were no signs of recovery. She could not speak, did not appear to be aware of her surroundings and needed spoon-feeding and total nursing care. She was therefore admitted directly to a long-stay psychogeriatric ward, without having been seen by a consultant in the normal admission ward. When I examined her I found she was in better physical health than I might have expected and she was free of any signs of pressure sores. Two days after admission she moved her limbs slightly and said ‘Thank you’ to a nurse who was feeding her. On each of the following days there was a steady improvement in her condition. The nurses on this ward, who were not accustomed to seeing such improvements, were surprised by the changes. I encouraged them to help her to sit up, stand up, move to a chair, walk a little with help, walk further without help, until she gradually became able to look after herself. Her speech improved at the same time, an occasional slurred word was followed by clearer sentences and within 3 weeks she was talking normally. She had no idea of what had led to her being in hospital, but accepted the fact that she had been seriously ill. Her family, who visited her daily, were very impressed and delighted by her rapid return to her old self. Five weeks after admission she had few obvious sequelae and went home. Her family thanked me very warmly for my endeavours. They told me that the very best thing that had ever happened to their mother was her transfer from a hospital where nothing could be done to a mental hospital where modern psychiatric treatment brought about cure. I told them that I had done little but that the nurses had been very good in helping to rehabilitate her. ‘No, no,’ they said ‘if it wasn't for you, Dr Bewley, none of this would have happened.’ I think they saw me as the greatest doctor since Paracelsus. In my next 40 years as a psychiatrist I never came across a more grateful family.

How contemporaneous guidelines interpret similar data is interesting but not relevant here. Conflicts of interest are important and various. Two clinically important recommendations in the National Institute for Health and Care Excellence (NICE) guideline CG178 deserve re-visiting.