The honour which the R.M.P.A. has bestowed on me fills me with a mixture of pride and apprehension; pride that I occupy the Chair where have sat so many distinguished psychiatrists and apprehension lest I might be unequal to the task of upholding the noble traditions of my predecessors. In offering you my thanks and appreciation I wish to express my most devout hope that I will prove worthy of the mantle you have placed on my shoulders and pass it on to my successors untarnished. It is pleasant to think that the Irish Division of the R.M.P.A. has held such a long and happy relationship with its Royal parent and that in the field of psychological medicine there has been no cleavage between the Sassenach and the Gael. I am proud to be the figurehead which expresses that unity today.

I value very much the honour of giving the Maudsley Lecture. Henry Maudsley was a pioneer in the study of the physiological basis of mind, and hence of the physiological interpretation of mental disorder. In the preface to his book, The Physiology of Mind (Maudsley, 1876), he said with a blend of optimism and modesty: “The current of psychological thought having set so strongly in physiological channels, it is pretty certain that the reflections which one person has had, however original they may seem to him, some other person has had, has now, or will very soon have.” But half a century was to pass before physiology and psychiatry began to develop techniques which could illuminate the physiological basis of mind, and even now we are only entering the era which Maudsley would have found the fulfilment of his hopes and anticipations. Though intolerant of the idea that metaphysical speculation about mind could take the place of scientific study, he was nevertheless a philosopher, and my aim in this lecture is to try to use a philosophy of perception to interpret the clinical observations of perceptual disorder.

The aim of the research of which this study forms part, is to examine the relationship of certain aspects of mental functioning to the psychiatric illnesses of old age.

One of the apparent deficits of function to which psychiatrists commonly attach importance is “memory impairment“. This is considered part of various clinical syndromes, especially of the “organic” disorders of senility. The assessment of memory is, therefore, of considerable practical importance and most psychiatrists working with elderly patients use some kind of “memory tests”. Such tests are usually unstandardized and lack objective scoring criteria.

There are, in relation to memory assessment, some points of conflict between clinical usage and the evidence of objective psychological investigations. For example, the existence of a “memory function” which could be considered as relatively independent of general mental functioning or intelligence, has not been well substantiated when some such clinical tests have been put to critical examination. Eysenck and Halstead (2) after a brief review of the literature and an experimental attack on this problem, conclude that “… the ability involved in the clinical tests of memory studied in this research was identical with that involved in the intelligence test used, and that, therefore, it was misleading to accept scores on these various tests as estimates of a person's ‘memory’ ability.”

A geriatric unit containing 200 female and 110 male beds was fully opened at this hospital in March, 1953. There were then resident in hospital 226 females over 70, and 165 males over 65. The aim of this paper is to discuss the mental and physical health of the inmates and assess their medical and nursing requirements. It is hoped that this information will be of value to those intending to open similar units.

This hospital is unique in having a catchment area of over 1,000,000 and only 2,000 mental beds. Three hundred of these are taken by mental defectives, and 500 are over 65 years of age. There is a severe bed shortage with resulting delay in admission of elderly patients from the observation wards. The large initial death rate in the month following notification occurs mainly outside this hospital, and many patients are discharged from the observation wards without reaching the hospital. Admissions are restricted to those with severe conduct disorder. Thus the death rate and discharge rate will be lower than hospitals with a more fortunate bed-population ratio.

The speakers for this morning's discussion were asked to be practical, to limit themselves to giving an account of the essential uses of the EEG technique for clinical psychiatry, and to avoid, as far as possible, the theoretical and speculative aspects of the subject. No doubt the time has come for an attempt at re-appraisal. In the last 10 years EEG departments have been developed in most of the larger mental hospitals and nearly every psychiatric centre or group, be it mental hospital, out-patient department or child guidance clinic has access to an EEG department and refers patients for examination in increasing numbers.

Marquis (1948) has suggested that psychological research can be carried on at three fairly distinct levels: isolated experiments on particular topics, programmes of work on general topics, and long-term investigations of whole areas. This report is intended as a contribution to the third level, i.e. the level of policy design, and makes recommendations about the general nature and scope of psychological research on maturity and old age. The advantages of a generally accepted but informal research policy are clear: basic problems are located and adequate methods are developed for tackling them, theoretical systems become strongly linked with practical issues to the benefit of both, knowledge is more readily communicated because research workers have a common frame of reference, research findings become progressively more comprehensive, detailed, accurate and meaningful, and so on. Possible disadvantages are that originality may be curtailed and work may be duplicated, but it is doubtful whether the former is a real danger or the latter a real disadvantage. This report is not intended to specify particular research projects or programmes—this could be done only after discussion between members of research teams, their sponsors and advisers—the final choice of project depends very much on the interests and abilities of the team members and on the human ecology of the area in which they are working.

The fugue has received little recognition in the literature in recent years. Stengel (1941, 1943) defines the fugue state as consisting of “transitory abnormal behaviour characterized by aimless wandering, and more or less marked alteration of consciousness, usually, but not necessarily, followed by amnesia”, According to Henderson and Gillespie (1944) the patient in a true fugue suddenly leaves his previous activity and goes on a journey which has no apparent relation to what he has just been doing, and for which he has complete amnesia afterwards. William McDougall (1926) states: “Fugue is the name given to those instances in which a person suddenly disappears from his accustomed haunts and re-appears at some distant place, astonished and puzzled to find himself there, and unable to give any account of himself in the period between his disappearance and his re-appearance.” In a footnote McDougall adds: “This word is sometimes used in a wider sense to include wandering of a seemingly aimless kind for which the subject (generally a psychopath) can assign no adequate reason or motive, but of which, nevertheless, he can give some description.” In our cases the criteria for a fugue have been sudden onset of wandering with clouding of consciousness and a more or less complete amnesia for the event.

Over the past 3 years we have collected 37 cases, either from the hospital records or from cases personally seen by us. Interesting features have emerged which, as far as we can ascertain, have not previously been described. A control group matched for sex, age and clinical diagnosis has been studied to exclude fortuitous associations. In the 37 cases of fugue under review, 31 are men and only 6 women. This incidence in favour of males is in accordance with the findings of other workers who have dealt with mixed groups, but differs from Stengel (1941), who picked his cases mainly from the female wards of Bristol Mental Hospital.

In 1928 Symonds (1928) recorded a case of Schilder's encephalitis, the disease being remarkable for its familial incidence and the presence of a progressive double hemiplegia. Since this date other writers have fully confirmed his observations.

Familial forms of Schilder's Encephalitis have been described by Ferraro (1928) and Van Bogaert and Nyssen (1936) while Bouman (1934) has emphasized that in children quadriplegia is the usual clinical finding.

The present report deals with the clinical and pathological findings in a girl who was the second of thirteen children in the family studied by Symonds. Clinically, the case was remarkable for the very long period of survival and pathologically, by reason of the extensive degree of spinal cord degeneration with but little evidence of sclerosis in the cerebral hemispheres.

Disorientation in a new place (e.g. a hospital ward) and inability to remember a route after having been shown and having walked it several times, is a well known feature of senile dementia. These disturbances are a frequent practical cause of difficulty, since such patients are not uncommonly physically fit and active and unless allowed to wander about during some of their waking hours become irritable and unhappy. Yet their supervision and care places a great strain on those responsible for their welfare. If left to themselves they have a tendency to fall downstairs or to wander on to roads which renders them a menace both to themselves and to others. Some insight into the causes of spatial disorientation in the elderly, and ways in which it might to some extent be compensated for, would therefore be of considerable practical assistance. It may not lead to a cure of the defects, any more than a study of the reasons for getting lost in a fog will help to relieve the meteorological conditions. What it may do, however, is to discover the equivalent to senile patients of “cats' eyes” to the motorist, and help to relieve labour and prevent accidents.

A young Hessian physician, born in 1735, who had hoped for an academic career had to return home after his graduation in 1762 because of the death of his father, also a physician, and a fire which destroyed the major part of his home town including his paternal home and property. He put aside his original plans for research and became a general practitioner in his small town. His practice also encompassed the neighbouring Spa at Brückenau and the court of the neighbourhood prince. The medical biographies list him as an able and sage practitioner and credit him with several writings which were frequently used in his time for reference regarding the usefulness of Spas for various diseases. The least recognized of his works, however, is a book published in 1787, nine years before his early death. In the introduction, he designates this work as the “red thread” of his scientific occupation but one which he was only able to produce slowly because of the lack of physical and scientific means. This book, Die Leidenschaften als Heilmittel (The Passions as a Means of Cure), is the first systematic presentation of what we today call psychosomatic medicine.

The adolescent psychoses are amongst the most rewarding subjects for study in all psychiatry, not only on account of the considerable clinical interest of these patients, but because no other group affords the psychiatrist quite such an advantage by reason of age alone, an age that covers the peak phase in maturation. The juvenile is young enough for childhood environment to be vividly recalled, the responses to the stresses of puberty are already evident, and in a short space of time the writing of the future adult life pattern will be on the wall. Furthermore, owing to the more likely presence of parents or guardians, sometimes lost or dead by the time one deals with adult disorders, a more comprehensive view of the hereditary influences, and a relatively adequate account of the early formative years, is generally possible.

Although Külpe (14) used only three subjects in his original experiment on tachistoscopic memory in 1904 his classification of them into colour, form and intermediate types has initiated a substantial amount of psychological research all over the world. Thus investigations into both normal and abnormal personality correlates of reaction to colour and form have been carried out in France (8), Poland (1), Italy (5), (18), Japan (17), Britain (6), (9), (16), America (4), (23), Sweden (2), (15), and Germany (20), (21) to quote but a representative sample.

Although described as far back as 1898, the Ganser state is still a subject of controversy and causes discussions regarding its existence as a clinical entity, its psychopathology and its incidence. Lately, Goldin and Macdonald (1955) endeavoured to clarify the meaning of the Ganser state after a critical review of the literature. They provided an illustrative case report with some hitherto unreported features and psychological test results. Although their paper presents a wealth of valuable material, there are still some points which need further discussion and elucidation.

I want to thank you, Mr. President, and the members of this Society for the privilege of appearing before you.

You are all familiar with the fact that headache, dizziness and mental disturbance occasionally persist for a long time after closed head injuries. These symptoms are usually grouped together under the title, “Postconcussional Syndrome“. The question whether or not there is an organic lesion at the root of this syndrome has engaged many minds for many moons. I think the majority of observers would agree with the text which I have taken for this discourse. You will find it in the tenth chapter of the last book of Mayer-Gross, Slater and Roth, page 408. There it is written, “Although predisposition and psychological factors would appear to play a predominant role in its causation, the probability is that some degree of organic change plays its part in most cases.”

My purpose in this paper is to analyse the attitudes of people toward their own hallucinations and the attitudes of other people toward people who have hallucinations in our own and other cultures. It will, however, be helpful first to present a phenomenological classification of hallucinations.

Many current textbooks fail to place sufficient emphasis on the occurrence of psychological symptoms in cysticercosis. The case reported gives point to the contention of Bickerstaff (1955) that clinical manifestations other than epileptic convulsions are not widely recognized.

Familial dysautonomia, first described as a distinct entity in 1949 (Riley et al., 1949), is considered to be a comparatively rare disease, only some 48 cases being so far recorded (Riley et al., 1954). But as its features become more widely known it is likely to be increasingly recognized. It occurs in children of Jewish parentage, the majority of cases being reported from the U.S.A., with one from South America (Tyndel, 1955), and some from Montreal (Riley, 1955).

The constant symptoms comprise: defective lachrymation (“crying without tears”); symmetrical, blotchy erythema following emotional disturbances or eating; excessive sweating; sialorrhoea; emotional lability; poor motor coordination; relative indifference to pain; and hypo- or areflexia. Inconstant symptoms are: intermittent hypertension; periodic vomiting which may threaten life; liability to respiratory diseases; frequent unexplained bouts of pyrexia; attacks of apnoea during the first year of life; corneal ulceration; orthopaedic changes (scoliosis, pes cavus); and epileptiform convulsions (Riley, 1952).

The condition is familial, apparently being inherited as a simple recessive trait (Riley et al., 1954), though an irregular dominant is a possibility (St. Martin, 1953).

In a pioneer work, Faris and Dunham (1939) studied the distribution of mental disorders in Chicago. Essentially their findings were that the incidence of schizophrenic cases was highest in the central areas of low social and economic status and lowest in the affluent residential districts on the periphery; that the differential distribution of cases of senile and arteriosclerotic dementia was similar to but less marked than that of schizophrenia; but that cases of manic-depressive psychosis were much more evenly distributed throughout the city though with a tendency to higher rates in better-class areas. They concluded that “social isolation”—the fact that in the central area of the city a person tended to be cut off from intimate and lasting emotional relations with other people—was a causal element in schizophrenia and that this accounted for the observed difference of incidence. Their findings have been confirmed in nine other American cities (Clark, 1949) but there have hitherto been no reports of similar studies outside the United States. The aim of the present study was to test, in an English city, the observations of Faris and Dunham on the urban distribution of mental disorders, and, by relating the distribution to various indices of social and economic status, to determine whether any additional evidence could be found for the hypothesis that social isolation is a factor in causing schizophrenia.

In earlier articles from 1939, the results of treatment with amphetamine preparations have been discussed. In this paper, a comparison of the results of treatment by means of electric convulsive therapy with those from methyl-amphetamine will be made.