My first words must necessarily be an expression of sincere thanks to the Association for the great honour they have done me in electing me their President for the ensuing year. In the interval since this was proposed I have often reflected on the number of eminent men who have filled the Presidential chair with great distinction, only to become more conscious of my inadequacies to reach the standard they have set.

It has become increasingly apparent in recent years that perception may afford a valuable approach to the study of personality. In this growing awareness several converging trends may be distinguished, which have their origin in different branches of study.

I am very grateful for the invitation of the Association to speak about the work I have been doing with twins, as it is an opportunity to thank the very many members who have helped in it. Without your kindness and co-operation the work would not have been possible. Medical Superintendents have put themselves out to make it possible for me to see patients and examine records; medical officers have discussed cases with me; I have been able to see the invaluable reports on family visits by social workers, and P.S.W's. have even made special inquiries on my behalf; hospital secretaries have made visiting books and other records available, and have rummaged through dusty files for ancient case-notes, and they have added to their labours routine inquiries about twinship which have considerably enlarged my series. This help has been given not only to me personally, but also to other workers collaborating with me. For all this and more, which I have no time to mention, I want to say thank you very much.

Extensive lesions of the frontal lobes are followed by pronounced personality changes. This has been shown beyond doubt by the effect of neuro-surgery performed for the removal of brain tumours or for the relief of mental illness. To identify such changes and the lesions responsible for them at least four conditions seem necessary: (a) Knowledge of the limits, variations and connections of the main pre-frontal areas.—In this field the researches of Professor Alfred Meyer and his associates, Mrs. Beck and T. McLardy, are of primary importance (1950).

The term “premenstrual tension” was applied by Frank (1931) to a syndrome developing during the second half of the menstrual cycle and clearing up soon after the onset of the menses.

Hurler's disease is characterized by chondro-dystrophic skeletal changes, corneal opacities, hepatosplenomegaly and mental defect. The skeletal changes are such that the patient presents a large head, grotesque facies, deformed limbs and kyphosis.

Tics are involuntary, repetitive or stereotyped movements which apparently lack purpose and which, with adults, tend to be permanent or long-term abnormal aspects of the individual's motor behaviour. The question arises whether certain basic psycho-motor and personality traits characterize persons who develop tics. No previous experimental work on this problem has been reported. In the present research, therefore, a preliminary attempt was made to describe precisely, by the use of psychological tests, certain aspects of the motor behaviour and some of the personality characteristics of tic patients and to compare the results with a similar examination carried out on matched, but non-tic, control patients.

The relations between Psychiatry and Occupation are considerable and complex. This is the case whether we consider psychiatry as limited (Curran, 1952) and thus approach the problem through the individual patient and his work, past, present and future, or less limited and thus concerned with industry and group adjustment. In reality both approaches deal with essentially the same basic problem which is the biological adaptation of man to his occupation, or to earning a living. Such work phases form an integral part of man's very existence, whether he works to live, or lives to work. Interest in the maintenance of health through prevention of occupational hazards has developed rapidly in this century, stimulated by war stresses, defence programmes and economic cataclysms. The struggle for our industrial survival has focused more than our interest, as psychiatrists; but extravagant offers of industrial consultancy, of trying to teach where little knowledge is yet available are patently dangerous. Industry, like society, has often been led to expect too much, and too soon, from our as yet embryonic facts, experiments and principles in this field.

Clouding of consciousness is a common feature of organic psychoses. It may be of any degree of severity from acute delirium to some diminished capacity for clear thinking and impairment of retention for recent experiences. However, such a diminution in the level of awareness also occurs occasionally in “functional” mental disorders; severe and rapidly evolving attacks of mania or depression may be associated with some degree of clouding of consciousness, and Meduna in some recent papers (Meduna and McCulloch, 1945; Meduna, 1950) has redirected attention to “oneirophrenia,” an acute psychotic disorder originally described by Mayer-Gross (1924) in which clouding of consciousness is the general rule.

Prolonged cerebral electrostimulation of subconvulsive intensity has been employed as an experimental procedure at this hospital during the past year, and the indications for this technique in the treatment of mental disorders are being investigated. Preliminary tests in conjunction with Dr. H. Weil-Malherbe showed that electrostimulation, when applied to normoglycaemic patients under pentothal anaesthesia, caused a pronounced increase in the concentration of adrenaline-like substances in the blood during the passage of the current. The same current was therefore applied to a series of patients in hypoglycaemic coma to determine whether the effects obtained after injection of glutamic acid—and considered by Weil-Malherbe (1949) to be adrenergic in origin—could also be obtained after electrostimulation. The results of these investigations are presented in this report. The stimulating current employed for this purpose was of the “square wave” (interrupted galvanic) type, which was first applied as a cerebral stimulus by Leduc (1902) in his pioneer demonstration of electrical anaesthesia and sleep. More recently Liberson (1945) has investigated this type of current in relation to E.C.T., subsequently utilizing it in his Brief Stimulus Technique (Liberson, 1947, 1948). This latter technique is also under investigation here at the present time, the same stimulator being used for both convulsive and sub-convulsive therapies; the results obtained with the Brief Stimulus convulsive therapy will be presented in a later report.

Since the treatment of juveniles as in-patients in a special unit is somewhat unusual in mental hospital practice, a brief introduction may not be out of place. These units might be considered as another development in a trend which has been progressing for the past 25 years. Until 1930 certification of all admissions to mental hospitals and a mainly custodial régime ensured the majority of patients being largely the end-results of psychiatric illness. Since 1930 the steadily increasing use of the voluntary system has brought many patients to hospital at a stage when their illness can be favourably influenced by modern therapeutic methods. An associated development was the increased provision of wards or units separate from the chronically disturbed cases, or even, as at this hospital, a complete villa system of detached and semi-detached wards for mainly voluntary adult patients.

Difficulty occurs at times in the diagnostic differentiation between the manifestations of organic cerebral disease and those of hysteria, particularly in patients who suffer from symptoms which are largely subjective in nature, and which are not accompanied by physical signs. An attempt is made in this paper to discuss behaviour reactions which are characteristic of organic cerebral disease, and which, if present, exclude the possibility of the disease being “hysterical” in nature.

The pictorial work of art bears witness, above all else, to the process of creation. Whatever it is that differentiates a work of art from mere skilled productivity—(and aesthetic theories rage about this issue)—it would appear that only in the case of the former is the spectator made conscious of that heightened scale of perception, at once purposive, integrated, and whole, which is the distinguishing feature of creative activity. And if we admit the principle of creativity in artistic expression, then we must seek in paintings something more than a reproduction of external appearance. The visible world indeed is the raw material of art, but it is moulded and fashioned by the artist according to his own purposes and, it is now suggested, by certain qualities of reminiscence. As a consequence of the relation which exists between his own emotional life and these qualities he creates in pictures a world of reality which has for him a compelling intensity—an irradiance in which he finds meaning and justification for his work. It is the embodiment of some new state of comprehension, bringing order, coherence and purpose to what otherwise would be formless and lacking in meaning. This world re-born, founded in experience, is invested with conviction and validity. The making of such an extra-sensory world is at the heart of creativity, for only so can the artist create the conditions for a communicable experience. A purely private world is mysterious and incommunicable, and does not provide the conditions in which schools of art can develop.

Acute porphyria is a rare disease in this country. Although a typical case was described in the Journal of Mental Science over 50 years ago (Campbell, 1898), Petrie (1948) could find only three cases reported in Britain between 1940 and 1948; since then at least six more cases have been reported. The disease is relatively common in Scandinavia and, to a less extent, in North America—a distribution for which Discombe (1948) has suggested an explanation in terms of relative emigration rates.

It is probable that the incidence of vertebral fractures during E.C.T. is greater than was formerly thought to be the case. Meschan, Scruggs and Colhoun (1950) found vertebral compression fractures in over 35 per cent. of 212 cases treated with E.C.T. Plattner (1949), in a series of 500 cases (200 men and 300 women), found fractures in 58 (37 men and 21 women). In 20 of his cases E.C.T. had to be abandoned on account of the fracture.

The use of muscle relaxants as a help in minimizing the hazards of E.C.T. has been reported by a number of workers (Hobson and Prescott, 1947; Davies and Lewis, 1949; Shepherd and Watts, 1949; Smith and Thomas, 1951; and Thompson and Norton, 1951). From these observations the value of such substances in reducing the muscular force of electrically-induced convulsions is clear. Nevertheless the trial of a new substance was embarked upon in order to establish whether it approaches more closely the ideal drug for the purpose.

The present investigation covers a series of 110 treatments with electroplexy in which RO/3/0386 has been used as an ultra short-acting relaxant. This is a heteropoly-methylene-bis-trimethylammonium diiodide, Me3N + (CH2)4. S. S. (CH2)4N + Me3. 2I in aqueous solution which, being related to the decamethonium compounds, acts by depolarizing the motor end plate, and results in similar clinical effects to those produced by succinylcholine as described recently by Richards and Youngman (1952), Mayrhofer (1952), Bourne Collier and Somers (1952), and others.

Celastrus paniculata (c. multiflora and c. mutans) is a large climbing shrub found in the hilly districts of India, Burma and Ceylon. The seeds, leaves and an oil extracted by distillation are used in Ayurvedic medicine and are believed to increase intelligence. The Sanskrit name Jyotishmati or “light-bringer” is an allusion to this reputed property. Other members of the family Celastraceae, notably Gymnosporia deflexa Sprague and Catha edulis Forsk, are favoured by the natives of Africa as mental stimulants (Watt and Breyer-Brandwijck, 1932).