The neuropathological problems which arise from prefrontal leucotomy may be conveniently divided into three groups.

The first group is concerned with the analysis of the anatomical and possible other factors which may influence the prospect of recovery. This group is naturally of the greatest practical interest to the psychiatrist and, for this reason, will require our foremost attention.

Psychiatric research has elucidated many unrecognized facts, and added much to our knowledge of the causes of criminal behaviour in mentally abnormal persons. At the same time the fluidity of modern psychiatry, itself evidence of progress, makes it difficult always to present simply and clearly modern views in a court of law. “”

Psychiatry made a great advance when it began to recognize the psychological meaning of mental symptoms—when it took the stand that it is not enough to establish that a patient has, say, delusions, but that one must relate the content of the delusions to the patient's life experience. Another stride has yet to be made, and that is the recognition of the physiological meaning of symptoms. Mental activity being the manifestation of cerebral activity, mental aberration must signify some aberration in the function of the brain, however normal this organ may appear to the eye. In a case of mental disorder, therefore, just as much as in hemiplegia, one must inquire how the laws of physiology reveal themselves in the signs and symptoms of the disease. To return to the example, it is not enough to show that the content of a delusion represents the patient's thoughts and strivings, but there remains the question: What has happened to his brain to cause his thoughts and strivings to assume the guise of delusions, when in a normal man they merely take the form of fancies? When a deluded patient says he is a very rich man, a certain psychological cause is at work. A healthy man, too, may be worried about money, but, in response to this cause, he merely fancies himself a rich man. The demonstration of a psychological cause, therefore, does not explain the sick man's delusion. All it explains is the content of the delusion; since the patient is worried about money, his delusion deals with wealth rather than some other topic. But it does not explain why the patient has delusions. The explanation of this must lie in some cerebral defect which permits inferior modes of thought to occur in response to certain situations. Psychiatry will not reach its full stature as a science until it regards each mentally sick person and each of his symptoms as a problem in cerebral physiology.

Whereas much has been published on the psychological reactions, normal and abnormal, in the personnel of the armed forces, little has been written about the neuroses in Civil Defence personnel.

This paper is a survey of cases of neurosis occurring among firemen who were admitted to Mill Hill E.M.S. Hospital from the outbreak of war to October 1, 1944. Altogether 70 patients came from the Fire Service. 40 of them came from London (postal area). No figures can be given about the incidence per number of personnel or per area. But, considering that these 40 men were probably all the firemen in London, north of the river, who required in-patient treatment on account of neurosis during five years, it can be taken that the incidence of serious neurosis was very low. The group of neurotic firemen can be compared with a population of neurotics from the armed Services (as analysed by Eysenck, Journ. Ment Sci., 1944, 90, 851).

In 1899 Kaplan described the “explosive diathesis” as follows: “Following the most trivial and impersonal causes, there is the effect of rage with its motor accompaniments. There may be the most grotesque gesticulation, excessive movements of the face, and a quick, sharp explosiveness of speech; there may be cursing and outbreaks of violence, which are often directed towards things; there may or may not be an amnesia for these afterwards. These outbursts may terminate in an epileptic fit. There is an excess in the reaction, with inadequate adaptation to the situation so remote from a well-considered purposeful act that it approaches a pure psychic reflex act in the shape of an almost or entirely unmodified explosion not unlike a convulsion. The explosive diathesis is not characteristic of head injuries, but is also found in hereditary degeneration, in alcoholic degeneration, etc.”

This paper should be considered a preliminary communication, tentative and suggestive. It is based on a psychiatric and electro-physiological study of 70 cases (children, adolescents and adults) referred for anti-social and/or criminal behaviour, and is an attempt to suggest more defined criteria for the assessment of a particular syndrome.

Excepting hysteria, there is a wide divergence of opinion about the proportionate incidence of the various psychoneurotic syndromes. This is more extraordinary because there is general acceptance of the meaning of current terms. Thus, very roughly, in the sense of abnormality—

It is now three and a half years since the Navy opened Kielder Camp, and it has been suggested that some account might be given of its activities and of the results obtained there so far.

We wish to record a case of obsessional neurosis remarkable for its strange content and unusual form, and in doing so to draw attention to the comparative rarity of this condition as a primary diagnosis in Naval Psychiatry. Our observations on the last point may not be without interest in considering the aetiology of this condition.

In view of the many problems that are bound to arise in dealing with “displaced children” in Europe, we thought it might be useful to report the following cases, which illustrate the dangers in accepting accounts, however circumstantial, from children about traumatic situations which had occurred to them. The young child's difficulty in separating fact from phantasy is normally fairly pronounced. Under the impact of traumatic situations, such as personal injury, death or separation from the parents, this tendency to confuse fact and phantasy becomes still more marked.

This is a description of a case of depression associated with post-encephalitic Parkinsonism, with signs predominating on the left side, treated by unilateral (right) prefrontal leucotomy.

An Insulin Clinic for treating female schizophrenics by insulin coma therapy has been working now for over two years, and although it is too short a time to draw conclusions as to the ultimate benefit to the patient, some points may be of interest.

From the point of view of the psychiatrist, if not from that of the general public, which still needs much education, Child Guidance Clinics have two quite distinct functions: one, diagnostic and advisory, the other, treatment by psychotherapy.

Certain disturbances of a higher order, e.g. aphasia and agnosia, follow as a rule a lesion of the left hemisphere in right-handed persons and vice versa. This dominance of one hemisphere for certain functions has been well established from abundant material. The Gerstmann Syndrome, recently studied, seems to obey the same rule of dominance; other disorders, such as the attitude toward paralysed limbs and defective functions, appear to be caused by lesions of the non-dominant hemisphere. The relations of the latter group, however, to the hemisphere cannot be regarded as firmly established, since the material presented is still limited.

On studying the behaviour of mental defectives one cannot fail to note that their deficiency is not confined to the intellectual or emotional plane. They are clumsy not only in their way of thinking and reasoning, but also in their bodily movements. Their muscular co-ordination and their manual dexterity are poor; they are awkward in their rhythmic work, and they rarely reach average standard at games. Their ocular movements show much the same shortcomings. They are sluggish at following a moving object with the eyes, they easily lose sight of the finger which they should fixate, and they are equally clumsy when they are called upon to look at will at an object in the fringe of their visual field. In some feeble-minded defectives of medium or even higher grades this inability may be clearly reminiscent of motor apraxia in other spheres of neuro-muscular functioning. More often than not precisely these patients are found to be particularly backward readers, able to decipher short words only and incapable of grasping the meaning of a printed sentence.