208 ELKES
about the effects of drugs interfering with the turnover and interaction
of these substances in the brain and gradually the idea came through
and then the whole term “regional neurochemistry” began to circulate.
It is into this Department of Experimental Psychiatry that, one day,
there walked W. R. Thrower, Clinical Director of May and Baker, a
company in England. He showed me, in English translation, the find
ings of Jean Delay and Pierre Deniker concerning chlorpromazine,^9 find
ings that have been so admirably reviewed by Frank Ayd.^10 Thrower told
me that May and Baker had acquired the British rights for chlorproma
zine. They had a 500 grams supply and could make up the necessary
chlorpromazine and placebo tablets if we performed a double blind-
controlled trial. Being very impressed by Delay and Deniker’s reports, I
said we certainly would and suggested that we could do so at Winson
Green Mental Hospital.
Charmian assumed full responsibility for the management of
what was to prove, I think, a rather important step in clinical psycho-
pharmacology. For, as I think back on it, all the difficulties, all the
opportunities, all the unpredictable qualities of conducting a trial in a
“chronic” mental hospital ward were to show up clearly, and to be dealt
with clearly, in that early trial. I still remember the morning when we all
trooped into the board room of the hospital, spread the data on the large
oak table, and broke the code after the ratings and side effects had been
tabulated. The trial involved 27 patients chosen for gross agitation,
overactivity, and psychotic behavior: 11 were affective, 13 schizophrenic,
and 3 senile. The design was blind and self-controlled, the drug and placebo
being alternated three times at approximately six-week intervals. The
dose was relatively low (350 to 300 mg per day).
We kept the criteria of improvement conservative yet there was no
doubt of the results: 7 patients showed marked improvement; 11 slight im
provement; there was no effect in 9 patients. Side effects were observed
in 10 patients. Our short paper, which conclusively proved the value of
chlorpromazine, and was the subject of an editorial in the British Medical
Journal, was on a blind self-controlled trial.^11 But it was more; for it was a
statement of the opportunities offered by a mental hospital for work of
this kind, the difficulties one was likely to encounter, and the rules that
one had to observe to obtain results.