The present description is based on a study of 168 men and 107 women (total 275), who have been admitted to the Rampton State Institution diagnosed as post-encephalitic.

Continuous narcosis is a method of treating psychiatric conditions by producing a state of narcosis or intoxication for a prolonged period. It was first adopted seriously by Klaesi (1921), and has proved to be a valuable therapeutic weapon. Klaesi used large doses of somnifaine by intramuscular injection, and these were repeated as often as was required to maintain unbroken sleep for 8–10 days.

The theory concerning the various types of nervous system in man, generally acknowledged by Russian neurologists, is based on the principles established by Pavlov in his investigations on conditioned reflexes in dogs. It was Pavlov and his collaborators who succeeded in establishing that all variations in the nervous types of dog are due to three main differences. These differences may consist in varying intensity in the essential processes (excitation and inhibition), peculiar to the nerve cell of the cerebral cortex, with the result that some specimens are of a stronger, others of a weaker nervous type. There may also be differences in the degree of equilibrium attained between the two processes, with the result that some specimens are well balanced, while others are unbalanced. Finally the differences may consist in the rate at which the nerve cell is able to pass from one state to the other, in the rate at which the concentration of the excitation or inhibition process is reached after the primary phase of irradiation, and in the rate at which the excitation process becomes extinct within a cell after the action of the stimulus has ceased. As a result of these latter differences some specimens may be more mobile, others more inert. At the same time it was established that the differences with respect to all these three functions could develop independently of one another, owing to which fact the resulting typologic combinations are extremely varied.

The harmonizing of legal administrative practice with the development of scientific concepts in the field of medicine is sometimes difficult. The law has to be understood by everybody, whereas scientific knowledge is too often considered the privilege of the educated few. Thus, the law must be simple and directly applicable, leaving for the expert, critical examination of causes and effects. When the definition of a situation depends upon physical findings, a decision can be made without very much difficulty as to how the law is to be interpreted; but in questions of behaviour interpretation of rules may be much more troublesome, and special care is required in drafting laws which define psychological concepts.

When I was invited to take part in this Conference it was suggested that I should speak on some aspects of the population problem in relation to poverty, social inefficiency and mental disorder, as illustrated by the Merseyside Survey. At first I confess I felt very hesitant about it, for I did not want to go over ground that might already be familiar to you. But then I reflected that the purpose of the Conference was, no doubt, to recall and discuss work done in the past having some bearing on the quality of the population—an aspect of the problem that is only beginning to receive the attention it deserves. Before replying I therefore consulted Dr. Blacker as to whether it might meet your purpose if I attempted to summarize quite simply a few of the conclusions reached in the course of the Merseyside Survey concerning certain subnormal types in the community. It was only after I had been fortified by his reassurance and that of Dr. Cook that I ventured to accept your kind invitation, and I make my apologies here and now to any of you who find it tedious to listen to a reproduction of what you may have read in the published account of the Survey.

Mr. Caradoc Jones this morning emphasized very clearly indeed the important distinction between high and low grade mental deficiency. He showed us some very striking figures suggesting, not that heredity is not involved in both, but that it is a different sort of heredity. It always seems to me that in considering this and related matters the analogy of stature is a helpful one. Many of us remember those posters of the last war but one, which said “Your King and Country Need YOU,” coupled with the statement that “You” had to be 5 ft. 4 in. high—a standard which went down afterwards. If one rejects for any purpose a segment of the population on a measurement of this kind one is rejecting people for very different reasons. The arbitrary standard cuts off, of course, the dwarfs; the achondroplasics, the midgets, the cretins, the rachitic dwarfs, and so on; but it cuts off far more of those who are simply short. In causation we can normally expect the dwarf's condition to be due to hereditary factors, actually a single factor in achondroplasia; or it may be something environmental, as in the rachitic dwarfs or the cretins, but when we come to the people who are just short, it has been shown fairly conclusively that in a civilized community in which the standard of nutrition is adequate, at least 90 per cent. of the differences are due to heredity; but it is a different sort of heredity. We have a whole host of genetic factors, each one of which has a small effect; but the effect is cumulative; some factors make for greater stature, some for smaller, and it is on the sum total received from the parents that the stature of the individual depends.

Gunshot and shrapnel wounds of the head during the war have produced various disabilities not commonly seen in the injuries of peace-time.

The symptom complex which usually appears subsequent to head trauma has become very familiar during the past few years. The resemblance from case to case of certain sequelae to head injuries has been grouped together in syndromes, variously labelled post-concussive syndrome, post-traumatic personality change, post-traumatic neurosis and post-contusional state, all indicating an oft-recurring persistent disability following concussion of the brain.

Commenting on the different symptoms produced by disturbances of the left hemisphere (aphasia, apraxia, etc.) and of the right (dreamy states, hallucinations, etc.), Hughlings Jackson on many occasions pointed out that there exists a “duality” of the brain; the anterior parts of the left hemisphere serving more controlled and objective purposes, the posterior parts of the right more subjective† and the anterior parts of the right serving more automatic purposes. Consequently, quoting Bastian and Rosenthal to support him, he tendered the suggestion that “mental” symptoms might be indicative of a disturbance particularly of the posterior parts of the right hemisphere (in right-handed people).

Now that more than six years have elapsed since the introduction of leucotomy in this country, it is becoming possible to assess more accurately its remoter effects. The increasing use that is being made of the operation bears witness to the beneficial results that have been obtained by it, but the justifiable enthusiasm occasioned by the dramatic improvements it has produced in some cases apparently resistant to all other present-day methods of treatment must be tempered by a sober consideration of all the sequelae of section of the prefrontal fibres. While it is undoubted that after it many cases are sufficiently recovered to resume a full and satisfactory social life, and an even larger number are either freed from intense misery or from hostility and aggressive impulses and enabled to take a more co-operative part in the sheltered life of a hospital community, there are a few whose behaviour following the operation is definitely less satisfactory than it was even at the height of their illness. Furthermore, even in the successful cases, certain undesirable traits have often been noted.

This study of retrograde amnesia of brief duration is based upon information furnished by 117 persons who had undergone, according to their statements, one or more terrifying incidents. All were men on full military duty, with the exception of three civilians, included as being of particular interest. In many investigations the information has been obtained from patients in whom motives other than accuracy could have taken a part in their descriptions. A patient may invent, distort or exaggerate his amnesia for psychological, or material and pecuniary, aggrandisement. In this series 99 of the cases were voluntary applicants for officer-training.

In recent months most of us have seen patients who have been in the Services and who now present features of psychiatric illness. Many of them are in the ordinary run of our experience, and we have no difficulties—other than the usual ones—of understanding the origins and pattern of their present distress. By and large, the ordinary clinical breakdowns occurring in the Services were of a kind familiar to us before the war, while during the war we became familiar with most of the disturbances of behaviour and feeling produced by specific stresses of service life. Many patients with difficulties of these two kinds were discharged the Services in the past, and others have since been demobilized. The large and compelling problem of their treatment and effective rehabilitation should not blind us to another newer problem—that of ex-servicemen who made satisfactory adjustments to civilian life before the war, and to service life during the war, but who are now in severe difficulties under the stresses presented to them by their return to civilian life. In a manner unexpected by the majority, they have become ill-at-ease in familiar surroundings, phobic, depressed or irritable, asocial, confused, retarded, aggressive, antisocial or restless. There is a mass of evidence to show that in addition to the clinical symptoms which lead some of them to seek help from medical men, their damaged attitudes disrupt other aspects of their lives—social, domestic or industrial—in serious and subtle ways.

Some 640 men and 170 women patients are detained in Broadmoor. The following account of the diversional therapy applied to their different types of mental disorder may be of interest.

The conscious involuntary immobility of which recognition has been described elsewhere (Rudolf, 1946a) appears to be a cataleptic or trance-like state. The psychological aspects have also been described (Rudolf, 1946b).

As you probably know, in January, 1944, the Provisional National Council for Mental Health were asked by the Board of Control to provide a Social After-Care Service for men and women discharged from Service Psychiatric Hospitals. For the purposes of this work an experienced psychiatric social worker, known as Regional After-Care Officer, was appointed to each of the Civil Defence Regions to undertake and organize this service. The psychiatric social workers visited the Psychiatric Service Hospitals in their areas, obtaining a full history and recommendations from the psychiatrist referring the case, and interviewing each patient to discuss his needs and plans. These reports were then sent to the Regional After-Care Officer in the patient's home area and formed the basis of our work.

During the six years of the war, from the opening of the hospital in September, 1939, until the end of September, 1945 (to choose a convenient end-point), 13,556 soldiers, sailors and airmen of non-commissioned rank were admitted to the wards of Sutton Emergency Hospital. From this number have been excluded all women, all foreign troops and prisoners of war, Dominions troops, foreign nationals in the British Army, and also a half dozen or so men of whose religious affiliation no record was kept. Apart from these few accidental exceptions, all men on admission to the hospital gave to a nurse particulars which included their religious affiliation, and which were subsequently entered on the Hospital's Admission Register. From this Register the data which will be discussed below have been obtained. It is to be noted that the religious classification is based solely on the men's own statements; and these may at times have been lacking in precision, or have implied a distinction which does not exist. It is doubtful, for instance, whether there is any real difference between “Wesleyans” and “Methodists”; but as this distinction was made by the men themselves it has been retained.

The following method of rapidly establishing the diagnosis of Bacillary Dysentery has been used at this hospital for the past sixteen years. It is reliable and simple. The technique allows for the transfer of material direct from the infected person to the laboratory medium and obviates waiting for specimens of patients' excreta to become available.

In a recent communication Andrews(1) claims that smears made from the end of the urethra of sexually immature or impotent males differ markedly from the smears obtained from a normal potent male.