In bilateral prefrontal leucotomy inter alia the fronto-subthalamic, the fronto septal and fronto-hypothalamic (posterior) projections may be severed, together with reciprocally projecting tracts. These may represent the anatomical basis for the altered autonomic visceral disturbances observed following operations. The reports on bilateral leucotomy emphasize the post-operative “improvement in autonomic functions with a tendency to gain weight” (Vonderahe). After lobotomy transient visceral disturbances make their appearance, such as disturbed sphincter control and slightly but permanently decreased blood pressure, whilst vasomotor disturbances and sweating on the contralateral half of the body have been noted following unilateral lobotomy.

This paper should be considered a preliminary communication, tentative and suggestive. It is based on a psychiatric and electro-physiological study of 70 cases (children, adolescents and adults) referred for anti-social and/or criminal behaviour, and is an attempt to suggest more defined criteria for the assessment of a particular syndrome.

This paper describes an investigation into the significance of physique in effort syndrome.

I once knew a child psychiatrist who had two treatments: Boy Scouts for all symptoms except enuresis, for which he prescribed Sea Scouts; but that was before the war, when we had a seaboard.

There is great satisfaction to the human mind in reducing multiplicity to unity, diversity to simplicity, but this exercise can be carried too far, especially in dealing with such a complex creature as the child. In contrast there is the school of thought which believes in intensive analytic treatment, four to five sessions a week, for every child. How can one steer a middle course in a modern Child Guidance Clinic where numbers must be dealt with, without the sacrifice of the deeper approach, where short and long treatments must be fitted in, where diagnosis and consultations are essential, yet treatment must always be one of the fundamental aims?

Excepting hysteria, there is a wide divergence of opinion about the proportionate incidence of the various psychoneurotic syndromes. This is more extraordinary because there is general acceptance of the meaning of current terms. Thus, very roughly, in the sense of abnormality—

The purpose of this paper is to report some observations on the Rorschach test in two cases of severe concussional head-injury. Detailed studies of such cases in the Rorschach literature are relatively few, and none, so far as the present writer is aware, includes observations on the test during the more acute phases of the post-traumatic disorder. In addition, therefore, to placing further cases of head-injury on record, it is hoped that our observations may throw light on the psychological changes associated with remission of the post-traumatic confusional state and recovery of normal consciousness. It is further hoped that the Rorschach observations made at a later stage of recovery in these cases may have some bearing on our knowledge and assessment of the chronic post-traumatic condition.

Von Storch has induced headache by the sudden intravenous injection of minute amounts of histamine phosphate in three groups of persons—the first group consisting of those subject to migraine, the second group composed of those suffering from chronic recurrent non-migraine headache, and the third group consisting of those not subject to headache. He has found that in persons subject to migraine the headache produced by histamine is frequently similar in character to their habitual headache (though bilateral), while in those subject to chronic recurrent non-migraine headache the experimental headache is only occasionally similar to their usual headache. From the evidence presented by him, linking migraine and histamine, the latter would appear to be a useful drug for distinguishing migraine from other forms of recurrent headache. Using a technique similar to his, experiments were performed at this centre to determine the relation of histamine headache to post-contusional and psychogenic headaches, and the results are worth recording.

Abnormalities in the vestibular reactions in schizophrenics have been reported in the literature. Pekelsky (1921) observed transitory lack of caloric response in two cases of catatonic stupor. Rosenfeld (1926) described four cases of acute catatonia in which on calorization a slow deviation appeared instead of the physiological response. Claude, Baruk and Aubry (1927) examined four cases of catatonia, eight of hebephrenia and one of dementia paranoides. In one of the catatonic cases no caloric or galvanic response could be elicited, and in the three others the reactions were diminished. The other cases showed normal reactions. The authors stated that a diminution of the responses could sometimes be observed in hysteria. Claude, Bourguignon and Baruk (1932) found the Chronaxie of the vestibular nerves greatly increased in patients with catalepsy, but normal after the disappearance of that symptom. Joo and Meduna (1935) stated that in old-standing cases of schizophrenia a lack or a considerable diminution of the vestibular responses could nearly always be found. Sercl and Vinar (1937) examined the vestibular reactivity in twelve cases of hebephrenia and thirteen cases of paranoid schizophrenia. The responses to rotation were normal in all cases. The caloric responses were found to be diminished or lacking. Lack of caloric response was more frequent in the hebephrenic than in the paranoid cases. Löwenbach (1936), working on Gjessing's cases of periodic catatonia, carried out quantitative investigations taking into account the latency period of nystagmus, its duration and the number of oscillations. He examined thirty cases, each of them repeatedly, and attempted to correlate the results of the tests with the periodical changes in the clinical picture. He found that shortly before and during periods of stupor the vestibular reactivity dropped, and that sometimes only a slow deviation could be elicited. The lowering of the frequency was due to the prolongation of the slow phase. The abnormalities were independent of the duration of the illness, and in some old-standing cases the response was normal. Sometimes a temporarily diminished reactivity was noticed which did not coincide with a change in the clinical picture. Löwenbach noted frequent and often abrupt changes in individual cases, and in some he observed transitory complete loss of reaction. Angyal and Blackman (1940) studied vestibular reactivity to caloric and rotatory stimulation in 58 unselected male schizophrenics and in 20 normal controls. The response to caloric stimulation was found to be considerably lowered, the rotatory response only slightly reduced. There was no correlation to the duration of hospitalization or to the conventional subtypes of schizophrenia. However, in a group of five patients with extreme apathy, indifference and poverty of mental contents the reactivity was particularly low. In cases with a periodical course the vestibular reactivity was distinctly lower during the catatonic periods than during the intervals. The same authors (1941) investigated the nystagmic reactions to caloric stimulation under the influence of alcohol, hyperpnoea and CO-inhalation in schizophrenics and normal persons. While in normals alcohol intake results in an increase in the frequency of the nystagmus, in schizophrenics a decrease was observed. CO, which normally has a depressing effect on the nystagmic reaction, produced an increase in schizophrenics. Hyperpnoea, while causing an increase in normals, had the opposite effect in schizophrenics. Freeman and Rodnick (1942) studied the amount of sway induced by rotation in thirty schizophrenics and in an equal number of normal controls. The patients were found to be significantly less reactive than the normal subjects.

Recent psychological investigations have left little doubt that considerable mental deterioration takes place with advancing age. The work of the United States Army Psychologists in the last war (22), of Beeson (1), Jones and Conrad (10), Weisenburg, Roe and McBride (21), Sorensen (18), Miles (11, 12, 13, 14), Ruch (17), Thorndike (19), Wechsler (20), Gilbert (7); Cleveland and Dysinger (3) and others makes it apparent that not only do the various mental abilities decline with age, but also that they decline at different rates.

In view of the success of E.C.T. in depressive states of the middle-aged it seemed worth while to take the risk of extending its benefit to patients over 60, whose clinical picture often differs very little from that of the next younger age-group. Since January, 1941, when E.C.T. was first used in the Crichton Royal, an increasing number of such patients has been treated. It is proposed to give a short, retrospective survey of these cases in order to assess if the therapy has justified itself by its results, and to find out the dangers and the limits of its application. Among over 500 patients treated were 76 over 60, 62 females and 14 males, with the following age distribution:

It is now three and a half years since the Navy opened Kielder Camp, and it has been suggested that some account might be given of its activities and of the results obtained there so far.

We wish to record a case of obsessional neurosis remarkable for its strange content and unusual form, and in doing so to draw attention to the comparative rarity of this condition as a primary diagnosis in Naval Psychiatry. Our observations on the last point may not be without interest in considering the aetiology of this condition.

This paper describes the case of a girl to whom certain mental tests were given while she was under hypnosis. The results of these tests are compared with the results obtained when she was in her normal state.

In a previous communication to this Journal, the author described the results of three years' experience of pharmaco-electrical shock-therapy in the schizophrenic and depressive psychoses, and presented clinical and experimental evidence for an organic basis of these conditions. It was shown, firstly, that there is convincing evidence for supposing that deranged oxygen-glucose metabolism of the cerebral neurones is the essential lesion; and, secondly, that all these conditions can be classified according to their response to shock-therapy into two groups—dysoxic encephalopathy, or cerebral dysoxia, in which oxygen-metabolism is principally at fault, and which responds to anoxic shock; and dysglycolytic encephalopathy, or cerebral dysglycia, in which glucose-metabolism is at fault, and which responds to hypoglycaemic shock. The former condition is synonymous with depressive states, and the latter with schizophrenic reaction-types in the orthodox terminology.

Ucko (1935) showed that the reaction time of the Takata test on serum can be reduced from 24 hours to 90 minutes by modifying the concentration and volume of the reagents. These reagents were applied with a further slight modification in the amount of the fluid tested and as a one-tube method for cerebrospinal fluid (Fleischhacker, 1938). 177 cerebrospinal fluids were examined, and the conclusion was drawn that the M.T.R. will indicate even very fine disturbances in the protein composition of cerebrospinal fluid. Later the test, together with others, was applied to another 165 C.S.Fs. from neurological and psychiatric patients and was found to give weak positive results in many psychoses of the so-called “non-organic” type (especially typical schizophrenics), while it remained negative in manic depressives and neurotic disorders (Fleischhacker, 1943).

In view of the many problems that are bound to arise in dealing with “displaced children” in Europe, we thought it might be useful to report the following cases, which illustrate the dangers in accepting accounts, however circumstantial, from children about traumatic situations which had occurred to them. The young child's difficulty in separating fact from phantasy is normally fairly pronounced. Under the impact of traumatic situations, such as personal injury, death or separation from the parents, this tendency to confuse fact and phantasy becomes still more marked.

The object of this paper is to present a brief review of nearly five years' experience of the schizophrenic group of psychoses as found in military practice, with particular reference to its treatment, and to important new facts which have recently come to light regarding the relative values of the convulsive and insulin therapies.