The Pharmacological Shock Treatment of Schizophrenia: By Manfred Sakel. (Nervous and Mental Disease Monograph Series 2. New York and Washington, 1938. Pp. 133. Price, $2.75.)

This is a first-hand account of the much debated modern method of pharmacological shock treatment of schizophrenia by the man who introduced it and has laid the foundations of it. The book contains an outline of the method of treatment, laboratory findings and a detailed clinical account of the technical and psychological management of the patients, illustrated by a number of case histories. There is also an interesting theory attached to it, which the author modestly describes as 'working hypothesis'.

All these details are of little concern to the psycho-analyst as long as he understands the essentials of the method. These consist of the following: by the injection of large doses of insulin a deep hypoglycæmia is produced. This is a lowering of the sugar level in the blood. In this way the patient experiences a number of hypoglycæmic shocks, deliberately produced, which can be ended deliberately as well by giving sugar. The effect of this is a clearing up of the patient's mind during the hypoglycæmia to begin with, but persisting more and more during the rest of the time. One can observe an interesting phenomenon called 'Inversion of the reaction', namely, that in a more advanced stage of the course of treatment the patient shows psychotic symptoms only during hypoglycæmia and is clear for the rest of the time. It is important to note that this is not merely an effect of shock as such, because a definite influence in the same direction can be observed sometimes by hypoglycæmia produced without shock. In a certain number of cases the result becomes more or less permanent,