In the first place I would like to thank the Association for the great honour they have seen fit to do me in appointing me their President for the ensuing year. It is indeed a great honour and a sobering experience to occupy a presidential chair which has been filled in the past by such illustrious psychiatrists as Conolly, Maudsley, Crichton-Browne, Clouston, Mercier and Mott, to mention only a few. Not least amongst these names, one day I am sure will rank that of my immediate predecessor, Dr. Drury.

The prefrontal region lies in front of the motor and premotor areas of the frontal lobe. In Brodmann's terminology this corresponds to areas 8, 9, 10, 45 and 46 on the convexity; 11, 47 and 13 on the orbital surface; 24, 32 and 12 on the mesial surface. When speaking of selective prefrontal surgery, we mean topectomy or cortical undercutting or partial leucotomy of one or several of these areas.

During the last eight years the E.E.G.'s of over 100 persons awaiting trial on charges of murder have been examined, at first at Sutton and since 1947 at the Maudsley Hospital. While a few cases were seen during the war, the majority of these prisoners have been examined since the end of hostilities and about 50 of them between 1948-1950. It is difficult to assess to what extent this group constitutes a cross-section of the murderer population. During the four years 1945-48 inclusive some 300 prisoners were committed for trial at Assizes over the whole country on the charge of murder and this is the stage at which the majority of our subjects have been examined. Some 50 prisoners were examined during this period so that approximately one-sixth of all cases have been seen here. There were no formal criteria of selection, which was usually made by the prison medical officers, but inevitably there has been a greater concentration within the group of individuals suspected of epilepsy or brain disease. Nevertheless, in the last two years the majority of prisoners accused of murder in the London area and home counties have been examined. At the time when the examinations were made, we were supplied in each case with full clinical details and some information regarding the alleged crime by the prison medical officer. By far the largest number of such prisoners has come to us from Brixton Prison. We are greatly indebted to Dr. J. C. Matheson, Dr. Hugh Grierson, Dr. F. H. Taylor, as well as to medical officers of other prisons throughout the country, who have given us all the information available and have collaborated with us in an invaluable way in our investigations.

The starting-point of the line of thought to be pursued here was some work reported in detail elsewhere (Roth, 1951), on the changes in the electrical activity of the brain produced by electro-convulsive therapy. When the findings were related to the known clinical and physiological effects of E.C.T. three converging lines of evidence could be discerned:

(1) The Changes in the Electrical Activity of the Brain Produced by E.C.T. and their Significance.

The subject of this investigation is the study of the immediate mental changes after standard leucotomy up to a time when the more acute manifestations of the brain operation have subsided and a stage of stabilization has been reached. Altogether twenty cases were examined, most of them schizophrenics. The observation time was between eight weeks and twelve months. The patients were examined in the first eight to ten days every day, and later at longer intervals according to their stabilization. In about half of the cases a detailed assessment of the patient's personality and intellectual faculties with a battery of tests was made before the operation. An assessment was also made of the patients' special abilities and knowledge, their general outlook and interests that had not been covered by the routine testing. The aim of the investigations was first to obtain a detailed picture of the acute condition following the operation, generally referred to as a confusional state, and to follow up the reorganization of these defects. Our next objective was to find out what significance these initial changes, or particular components of them, might have on the final result of the operation.

Recent statistics of old age mental disorder have drawn an alarming picture of rising rates of admission to mental hospitals in many parts of the world. One of the predictions made on the basis of such statistics has been that old age psychoses might, in due course, relegate schizophrenia to second place in number of admissions. There are, however, dangers in drawing conclusions about a complicated problem, such as mental disorder in old age, on statistical grounds alone. Before the figures can be properly evaluated more detailed information about the social, economic and, above all, clinical aspects of the problem will be required than is available at present.

Any patient who shows a regularly recurring change of mental state will be of particular interest to the research worker, for in the recurrence, by acting as his own “control,” the patient provides the best of all comparisons.

Such a patient, a woman aged 39, provided the basis for this work. Usually sensible and well spoken, she would, about every twenty-first day, become confused and incoherent. Convulsive therapy (E.C.T.) always caused an immediate improvement, and within two or three days she was well again. (Previous experience had established that the confusion had little spontaneous tendency to recover.) As she provided this regular cycle, a systematic investigation was made over several months into those aspects more particularly relevant to the effect of E.C.T. on the adenohypophyseal-adrenocortical system, for a previous study (Ashby, 1949) had suggested that E.C.T. might owe its effectiveness to action through this system.

During the clinical observation of a female patient suffering from recurrent schizophrenic attacks, it was noticed that each psychotic episode was associated with the appearance of acne, and also that during remissions the patient showed an unusual craving for salt. These observations, together with the automatic disturbances characteristic of the onset of attacks, suggested that the adrenal cortex might play a part in the metabolic changes in this type of case, particularly the changes in nitrogen balance which have been demonstrated by Gjessing (1932, 1938). The work here reported was therefore primarily concerned with investigating the possible relationship between adrenal cortex activity and nitrogen metabolism in two patients of this type.

The E.E.Gs. of schizophrenic patients have been studied by a number of workers, notably Davis and Davis (1939). P. Davis (1939, 1940, 1942) attempted a classification of schizophrenic records, defining the main types of pattern. Gibbs et al. (1938), Jasper et at. (1939), and, more recently, Hill (1946), have noted the presence of epileptic activity in the E.E.G.s of catatonic schizophrenics.

It is now well recognized that many of the syndromes previously described as pellagra, such as nutritional retrobulbar neuropathy, the ataxic, and burning feet syndromes, may occur as isolated manifestations of nutritional deficiency. The term “pellagra,” as it is often used, is no more than a generic title embracing a wide variety of nutritional disorders. The clinical status of the individual deficiency syndromes has been elucidated of late years in America (Spies et al., 1939; Harris, 1941), and with particular regard to the neurological disorders, in groups of prisoners of war in the Far East (Denny Brown, 1947) and Middle East (Spillane, 1947). The majority of the pathological studies of pellagra were completed in the era before advancing biochemical knowledge provided the impetus to further these clinical studies, and this is reflected in the great diversity of neuropathological changes described as “pellagrous.” The extensive literature contains many excellent studies of cases dying from malnutrition, and it now seems possible to attempt a correlation between the pathological findings and the more recently described individual syndromes. A review, therefore, of the neuropathological changes encountered in “pellagra” might be not untimely.

The purpose of this paper is to outline the application to various psychiatric conditions of a test which measures peripheral capillary oxygen saturation and to discuss the significance of the findings. It is convenient to commence with a brief review of some previous work concerning the relevance of anoxaemia to psychiatry.

Paton and Zaimis (1949) showed that the members of a series of compounds composed of two tri-methyl ammonium groups linked by a polymethylene chain had various actions, such as producing neuro-muscular blocking, inhibition of cholinesterase, a muscarine-like action and a blocking of impulses at the autonomic ganglia. It has been found that hexamethonium is the most active of the above compounds in these respects, and the autonomic ganglionic blocking properties have clinical applications. Hexamethonium is usually used clinically as a dibromide.

The study of moderate degrees of alcoholic intoxication in such an animal as the rat demands methods of assessment of the state of the animals, which is a requirement not easy to provide. So far as the more complex integrated activity of the central nervous system is concerned, the use of a suitable maze affords some information of an objective kind. The book by Warden and others (1935) gives much information about construction and operation of mazes. Methods of recording based on projection by a lens (Yerkes and Kellog 1914; Watson, 1914) and the use of electrical contacts (Tolman and Jeffress 1925; Heron, 1933) have been described for rat mazes, while Miles (1928) has suggested the use of blotting-paper in conjunction with an ink writer to show relative speeds within a maze.

Students of the paintings produced by mental hospital patients believe that schizophrenics show peculiarities in their use of colour. Impressions in the matter have been summarized by Reitman (1950). Schizophrenics, especially the chronic, seem to favour colours avoided by others, particularly shades of mauvish-red. They put colours into relationships that others find displeasing. They employ colours more boldly than others. Sometimes, it would appear, they purposely depict objects in colours at variance with those possessed in real perception.

The a-b ridge count, called the a-b count for short, is the number of epidermal ridges crossing or touching a fine straight line drawn joining the triradii a and b on the palm. The triradial point or the radiant when the former is absent is not included in the count. It was pointed out in a previous work (Fang, 1949) that on the assumption that the university students are more intelligent than the general population there is a consistent increase of the mean a-b count with intelligence. The results of the present study seem to agree with this finding.