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.

The Centenary Meeting of the Royal Medico-Psychological Association should have taken place in 1940. I was honoured in 1939 by the Association nominating me as President-Elect. Much has happened since then, and for five years we have met under the able presidency of Dr. T. C. Graves, whose inaugural meeting had necessarily to be a short one; it was held in London and was limited to the delivery of his presidential address. I feel that we owe a great debt to Dr. Graves for his constant attendance and work, often under difficult war conditions.

Sex hormone deficiency in schizophrenia has been suggested by the usual appearance of the psychosis in adolescence, the not infrequent somatic abnormalities, aberration of libido with often its eventual extinction, and, histologically, by the suggestive though not entirely accepted work of Mott (1919), Lewis (1923) and certain others implicating the testis. Accordingly, many workers have treated schizophrenia with sex hormone preparations empirically but without specific endocrine indications. The reported results have been inconsistent and disappointing. In this respect our experience with various hormones has been similar to that of others. The need for a physiological test to establish a diagnosis of endocrine deficiency and control appropriate therapy has been keenly felt. Values for the normal excretion of sex hormones at various stages during adolescence are not as yet established; estimations are not a practical possibility on a large scale, and with the exception of one excretion product of steroid metabolism with an androgenic action, namely, 17-keto-steroids, demand a biological technique. Testis biopsy, described by Charny (1940) and Lane Roberts (1939) is, therefore, a valuable diagnostic procedure, and possibly not without some therapeutic value. We have already described and classified a striking pathology of the testis in schizophrenia from studying biopsy material (Hemphill et al., 1940). The special features were atrophy of seminiferous epithelium, failure of spermatogenesis, thickening and hyalinization of the basement membrane and collapse or shrinkage of many tubules. We were unable to note consistent absence or marked reduction of interstitial elements in cases where secondary sexual characteristics were well developed, although the work of Mott (1919) drew particular attention to failure of internal secretion. The interpretation of the pathology is, of course, uncertain, but the atrophy of spermatogenetic structures suggested that there was a lack of normal or adequate gonadotrophic hormone necessary for the maintenance of spermatogenesis and the activity of the testis as a generative organ. For this reason we treated cases with gonadotrophic hormone of pregnant mare's serum (gestyl). This follicle-stimulating hormone is believed, in the male, to promote spermatogenesis. Treatment was dictated by the histology of the biopsy specimen. Gestyl was administered in 800 to 1,000 unit doses daily for variable periods of up to 48 days. Anti-hormones were tested for at the completion of treatment in the last series of cases, and further biopsies were made as a check-up for physiological efficacy.

The word “personality” is being used in psychological medicine with increasing frequency. Personality tests are now to a large extent replacing pure intelligence tests, the term is frequently encountered in psychological papers, monographs and text-books, and one modern journal is even entitled Character and Personality.

Since Hippocrates and his Roman followers described the habitus apoplecticus and the habitus phthisicus, linking these antithetical physical types with certain temperamental peculiarities and with susceptibility to specific diseases, much research has been carried out in an attempt (1) to prove the existence of physical types and to discover their nature, and (2) to investigate the relation of these types to temperamental traits. This work has done much to clarify the issues at stake.

The technique of electroencephalography has become to neurophysiology what the microscope is to histology. It is probable that by this technique neurophysiologists will achieve a comprehensive knowledge of the functional organization of the brain. While the EEG has been used most successfully for this type of research, it has also been applied with no less enthusiasm to clinical problems of neurology and psychiatry. In certain cerebral disorders, for example epilepsy, where knowledge had already made considerable advance, the EEG technique was immediately found to have application. But in what may be called “the problems of function” provided by the main psychiatric reactions of schizophrenia and manic-depression, and in relation to individual differences of temperament, intelligence and personality, in all these the EEG has so far proved of little value.

The interrelationship between neurotic manifestations and psychotic reaction types represents one of the major problems of psychiatry. Psychotic reactions sometimes develop in patients with old-standing neuroses. It is also well known that neurotic symptoms are not uncommon in the preliminary stages and during the course of psychoses. However, the knowledge of the interaction between neurotic and psychotic manifestations is still incomplete. In this study an attempt is made to elucidate some of the clinical aspects of this problem. It is not intended to discuss here such basic issues as the definition of neurosis and psychosis and their interrelationship in general. Those questions have been widely debated, and it seems doubtful whether much can be gained from a continuation of this discussion at the present stage of psychiatric knowledge. In a clinical study the question whether or not there is a fundamental difference between neurotic and psychotic symptoms and behaviour is better left open. An investigation into the interplay between various phenomena of mental illness occurring in individual patients is justified, even if one looks at them as manifestations of a single and continuous development.

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. “”

Graphology, the theory and practice of diagnosing character from handwriting, is gradually developing from its initial stage, in which it had been the mysterious art of a few people who claimed to be especially gifted, into a science which can be taught and studied. The widespread mistrust of it is partly justified by this state of development. From a scientific point of view it needs more precision of method and terminology as well as corroboration of its results by objective methods. The description of the character as a whole and assessment of the significance of single features still depend to a large extent on the graphologist's experience and knowledge of human nature as well as on his stylistic abilities, and some other subjective factors. Moreover, only part of the accepted graphological interpretations have been based on inductive methods using statistical comparison, experiment and the like; for the rest, they have regarded handwriting as the more or less unwitting expression of the subject's personality, and they have attempted to assess this either by empathy, or by an effort to understand and explain which might itself be founded on the graphologist's private philosophy or on the psychoanalytical system. The results obtained in this way called for corroboration by statistical evidence. The present writer therefore welcomed Dr. Eysenck's suggestion to submit her graphological reports to objective control in the following way: She was to answer a questionnaire on the temperamental qualities of 50 neurotic patients, a sample of whose handwriting was given her, assess their intelligence, give a short character description, and, last of all, match the specimens of handwriting against anonymous summaries of the case-records of the patients. Her results were then compared with the patients' own answers to the questionnaire, their score in the Progressive Matrices Test, and the psychiatrist's description of the patient's character. Dr. Eysenck has reported the numerical results. In the present paper the validity of the graphological opinion on personality traits confirmed by at least one of the sources of control will be examined, and the handwriting signs of these traits will be set forth.

Those who read the Police Court reports in the newspapers—and every psychiatrist should!—will have read, since the war, of persons guilty of unlawfully wearing military uniform or medals. Often the crime appears to be due, not to ordinary motives of gain, but to motives of personal prestige. Seven cases of this disorder of behaviour have been observed at the Royal Edinburgh Hospital for Mental and Nervous Disorders, and in these cases at least the problem has been one of gravely disordered personalities. It seems worth while reporting the cases, as so far little psychiatric interest has been taken in them. Petrie (1942) and Rossiter Lewis (1942) have each referred briefly to one case. Three of the cases were included in the figures in a previous paper on psychiatric states in ex-service patients (Stalker, 1944), but in one of these the masquerading was not known at the time. Their case-records were not reported in that paper.

In the opinion of psychiatrists it should be possible to detect at the time of recruitment a considerable proportion of those later destined to prove unsuitable owing to psychiatric disabilities. Examination by psychiatrists, however, takes a considerable time, and it is impossible for them to examine fully more than a certain proportion of entrants. Thus, in all countries during the war the need has been felt for a preliminary screening procedure to indicate those for whom a full psychiatric interview is desirable. It is the purpose of this paper to outline a method differing in certain ways from those previously described.

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.

The present paper reports the results of certain experiments carried out in an attempt to obtain information on the increase in suggestibility which is often said to follow the administration of certain narcotics, in particular sodium amytal and nitrous oxide. The set-up of the experiment, and the results and conclusions reached, may be looked at from two different points of view, viz., (1) with regard to the light that is thrown on the action of the narcotics examined, and (2) with regard to the nature of suggestibility.

It is felt that the following case and post-mortem report is of such clinical and pathological interest that it is worth while recording it in its present form. Under existing conditions of service we have been unable to go deeply into the literature concerning such conditions.

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).

The following paper is a description of a form of direct psycho-therapy with children undertaken in a Child Guidance Clinic, and some account of the results achieved in certain cases.

During the hypoglycaemia produced by insulin for the treatment of psychoses, disorders of speech occur as symptoms of the dissolution and restitution of cerebral function. Although transitory, they can be observed accurately, as the hypoglycaemic condition is repeated daily for weeks in the same patient. They have in fact been studied and commented on by several workers since the method was initiated by Sakel in 1934; we shall refer later to some of the findings and views in the literature. In this paper an attempt will be made to describe and classify the various speech disorders, and to relate their characteristic features to other hypoglycaemie symptoms occurring at the same time. Attention will be drawn to certain speech-like symptoms which hitherto have been scarcely noticed. The possible influence of the underlying psychosis will also have to be considered.

Whatever the ultimate decision on the permanence of the results of electric convulsive therapy, there can be no doubt as to the present widespread popularity of this treatment in psychiatry. To meet the big demand there have become available in the last few years a number of different convulsant machines, most of which are fairly efficient, but not one being free from defects when exposed to the test of practical application. Some are too heavy and cumbersome, most are liable to minor technical breakdowns, which are the source of much annoyance because they disrupt the hospital routine, one has a faulty time switch which has caused the writer a considerable amount of anxiety when it jammed and allowed the current to flow for about 5 seconds—the patient developed a prolonged period of post-convulsive apnoea, but fortunately came round eventually and suffered no lasting ill-effects. Most machines incorporate one or more instruments to measure the current or the patient's resistance. Neymann et al. have shown the inaccuracy of such simple instruments, and it is doubtful whether they serve any useful purpose. The ammeters are relics of the early days of this treatment, when we were not sure about the safety range of the current, and they were included in the circuit as an extra safeguard. Our experience over the last five years has taught us what currents can be safely used, and an efficient convulsant machine can now be designed whose maximum voltage and maximum time give an output which is well within the limits of safety. A knowledge of the current used is of interest while the machine is undergoing the initial tests, but once this period is over its evaluation, even by an accurate method, is of little academic interest, and a waste of time from the point of view of the practical psychiatrist. The resistance measurements, too, are unnecessary in practice. They were originally made in the hope that they would enable the dosage to be correctly adjusted so as always to ensure a convulsion. But we now know, as Grey Walter has recently pointed out, that the convulsive threshold varies from individual to individual by as much as 1,000 per cent., and since it is a value which can only be found by a method of trial and error, the resistance instruments are of little use. Moreover, no great harm is done if an underdose actually is given—all that happens is that the patient has a temporary period of unconsciousness, and after a short interval a higher dose can be given, which will produce the desired convulsion. It is true, of course, as Kalinowsky (1939) said, that resistance measurements enable one to ensure that the electrodes are making good contact with the patient's skin, but one feels that this is an elaborate and costly method of doing something which could be more easily and quickly accomplished by training the nursing staff always to clean the patient's skin thoroughly before applying the dampened electrodes.

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.”

The unfailing regularity of the rhythm of his manic-depressive cycles each week renders the patient in question particularly suitable for investigation, and throws into relief changes which might be less marked if the transition between the phases was more gradual and the periodicity less certain.