The differential diagnosis of a presenting symptom is usually to be found as a section of an article on a disorder in which the particular symptom is common. Thus one learns a great deal about the widely different pathological processes responsible for epigastric pain in a description of peptic ulcer, and much about headache in descriptions of cerebral tumour or migraine. Amnesia is peculiar in this respect in that succinct expressions of its differential diagnosis are rarely found in the description of individual disorders.

Symptoms attributed to dysfunction of the ductless glands have long been noticed in the group of mental disorders formerly known as dementia praecox, now included in the wider designation schizophrenia. A variety of such abnormalities has been described, but without sufficient consistency or clarity to help in formulating a pathology of the disorder. From the first, the usual onset in adolescence or early adulthood, and the symptomatology, prompted investigation of the gonads. Papers have been published by Fränkel (1919), Mott (1919), Pézard (1920), Tiffany (1921), Lewis (1923), Morse (1923), Geller (1923), Münzer (1926), McCartney (1929), in which histological changes in the testis in schizophrenia are cited and discussed. The contributions of Mott, Lewis and Morse are the most important, for their material and histology are more accurately controlled and described. It appeared as if the very extensive work done by Mott had succeeded in establishing a direct relationship between gonadal failure and dementia praecox. Subsequently his findings were heavily criticised and the conclusions to a great extent rejected, for, like others, he had obtained material at post mortem, mostly from patients who had died of tuberculosis or other diseases liable to produce the very changes he regarded as specific; very few were young adults in the early phases of the mental disease. These objections constituted an apparently insuperable difficulty, and the whole question has remained virtually in abeyance ever since.

In recent years authoritative opinion in this country has decided that aged persons are less suited for magisterial duties in a juvenile court than justices who are younger.

In another paper in collaboration with Reiss and Taylor (1944) I have described and classified the state of testis function in schizophrenia, mental defect, and the common mental illnesses from an examination of specimens obtained by biopsy from 115 representative subjects, selected for adequate physical health and development. It was found convenient to classify all material in five grades according to the histological appearances. These have been fully described in our paper. In brief they indicate (1) complete normality, (2) normality with slight defects, (3) moderate atrophy, (4, 5) severe and very severe atrophy amounting in the worst cases to total loss of normal function. While we have regarded a Grade 3 specimen as significant in young subjects, it is probably not necessarily outside the normal expectation from the fourth decade upwards. Grades 4, 5 are, of course, indicative of a severe atrophying process at any age. In analysing the defects we noted and described degeneration of the seminiferous elements with changes in the tubular capsule. The basement membrane was affected first and principally, and underwent a form of hyaline degeneration. This, we felt, was the underlying cause of the atrophy of the seminiferous epithelium, and eventually led in many instances to complete destruction of lengths of the affected tubules. The interstitium was not subject to important change.

Psychosurgery consists in surgical operation on the anatomically intact brain for the purpose of relieving mental symptoms. It was first devised and named by Egas Moniz, the distinguished Portuguese neurologist, essayist and diplomat, following the Third International Neurological Congress in 1935, at which time a remarkable symposium was offered on the functions of the frontal lobes (1). Approximately a year later Moniz (2) published his monograph detailing results in his first twenty cases. We began our work in the Fall of 1936, reporting our experiences in preliminary fashion several times, later bringing them together in a monograph (3), presenting the “results” in 80 cases. Since that time we have persistently followed up these cases as well as all subsequent ones, and now, with a series of 204 cases in all, we are able to discuss the adjustment of 154 living patients over a period ranging from six months to seven years.

This most important subject, which is likely to affect the whole future of psychiatry, has so far made little progress. Enlightened individuals are beginning to show a way, handicapped by existing law and practice. Some of the most important possible developments are not under the control of those with mental hospital experience, and the diversity of approach and training of those who deal with the different aspects of the subject renders co-ordination still more difficult.

Few psychologists or psychiatrists would object to the statement that the whole field of personality and temperament study is in a state of acute conflict and dissociation. This is as true on the psychological side, i.e. in the field of experimental tests, questionnaires, ratings and so forth (69, 1), as on the psychiatric side, i.e. in the field of the diagnosis and classification of mental disorders (39, 9). In the present paper an attempt is made to locate the fundamental trait-vectors in terms of which personality and temperament can be most parsimoniously described, and to demonstrate that the results thus obtained from a detailed analysis of psychiatric ratings and experimental tests carried out on 700 neurotics can serve to integrate findings from a wide variety of sources, which at first glance seem confused and even contradictory.

About 15–20 per cent. of cases of head injury of moderate or severe degree are followed by persisting intellectual impairment, causing loss of efficiency often increased by psychoneurotic symptoms arising from such incapacity. Deterioration of powers of sustained attention, of recent memory and of emotional control are characteristic of post-traumatic states after severe head injury, but ignorance of the patient's previous capacity and personality makes it difficult to assess psychological and physical factors—to distinguish between the patient who is ineffective because he is neurotic and the one who is neurotic because he is ineffective—as a result of cerebral damage. Therefore any reliable index of damage to the “matrix of the mind” will be helpful in prognosis and in deciding disposal.

The patients forming the subject of the following paper were natives of East, West and South Africa. The South African group are mainly Basutos, mostly non-English speaking, and hence interviews had to be carried out with the aid of an interpreter. To obtain correct perspective of their types of illness it is of course necessary to know thoroughly their customs, beliefs and mode of living. For the sake of brevity illustrations are given only from the Basuto tribe, although it must be borne in mind that there is considerable difference between this and the other groups in this respect.

The observation of cases of narcolepsy does not to-day constitute a rarity worthy of notice. There are references in the literature to some hundreds of these cases, and we ourselves possess several observations which do not differ from the type described in monographs and text-books. However, in recent months there has come to our notice a case which presents rather peculiar characteristics. The truly remarkable amount of detail in the clinical picture, the rapid evolution of the disease, its combination with a syndrome of very marked oneiric manifestations at night, make the case in question worthy of note.

Workers in psychiatric genetics are, with some notable exceptions, psychiatrists first and geneticists second. Neither their medical nor their psychiatric training equips them with an appreciation of scientific method, and their narrow specialization prevents them from keeping abreast of advances in the general field of animal genetics. As things are, this is an important source of weakness; for the general geneticist, whose science is in a much more advanced state, has accumulated facts and theories that have an immediate application in our special field. One has therefore to notice comprehensive reviews of the present position in genetics in relation to the theory of evolution which have recently been provided by Dobzhansky (1941) and Huxley (1942). In what follows the work of Huxley has chiefly been drawn upon, and it is intended to provide a brief summary of the most important of these ideas.

In spite of the voluminous literature on the shock-therapies which has appeared in recent years, there is as yet little unanimity of opinion among psychiatrists as to the value of the anoxic and hypoglycaemic shock-therapies, and their indications, possible scope and limitations in the treatment of psychoses. Most potent in perpetuating this unsatisfactory state of affairs have been the too-rigid reliance on masses of statistics in evaluating results of treatment, the oft-repeated statement that the therapy is purely empirical, and last, but not least, the unfortunate publicity which it received at its inception, the result being that lately there has been a tendency to discredit the therapy, and a growing scepticism as to its efficacy.

Recent observers have differed considerably as to the incidence of neurosis among dyspeptics in the services. Whereas Hinds-Howell (1) only found about 8 per cent. of neurotic dyspepsia in a group of cases, Hartfall (2) considered that 60 per cent. of his cases, with or without ulcers, had a neurotic basis. A leading article in the Lancet on June 20, 1942 (3), stated that dyspepsia is often a manifestation of neurosis, that anxiety neurotic features are frequently associated, and that most patients are constitutional neuropaths.

In a previous article (1) the writer gave the results of a scale of 25 mental tests on a group of 20 senile patients. When that investigation was completed the scale was administered to a second group of seniles (Group b), who were considered to be in a more advanced state of dementia than the first group.

Ten years have elapsed since the introduction by Meduna in 1934 of convulsion therapy, and five since Cerletti and Bini first described the use of electricity as a convulsant. A not unreasonable early prejudice finds a later echo in the comment of Critchley (1943) that convulsion therapy “is crude, dangerous and repellent to anyone who holds the central nervous system in respect.”

Although by now many papers have been published on psychiatric cases occurring in the Forces in this war, few follow-up studies are available of cases discharged to civilian life. Lewis (1943) and Ferguson (1943) found that a considerable proportion of discharged psychiatric patients had required further medical treatment and had difficulty in resettling to work.

It is generally known that in recent years there has been a considerable increase of the elderly population. In addition, we assume that unless the birth-rate rises again, an increasing proportion of the population will be found in the involutional and senile periods of life. This development has already begun; whereas in 1901 7.6 per cent. of the population of Scotland were over 60 years of age, the percentage in 1941 has been estimated at 13.0. Men are less long lived than women, the figures being 6.6 and 8.-6 in 1901, and 12.1 and 13.8 in 1941.

Owing to the difficulties of investigating the sensory organization of the nervous system experimentally, for many years experimental neurologists tended to direct their attention rather to the motor mechanisms, for these can easily be studied and recorded objectively. During the last few years, however, research investigations have been more concentrated on the anatomical basis of sensation and, accordingly, this review will be mainly concerned with this aspect.