Electronarcosis is the term applied to a sleep-like condition produced by the passage of an electric current through the central nervous system.

Considerable material is available about the effect of leucotomy on intelligence. There are, however, few reports of objective measures of changes after leucotomy in the non-intellectual aspect of personality, those changes of temperament and character which are so striking to the clinician. In order to make a small contribution to filling this gap, at the suggestion of Dr. Desmond Curran an investigation has been carried out at St. George's Hospital and its In-Patient Unit at the Atkinson Morley Hospital, London.

The loss of consciousness in hypoglycaemia is generally regarded as a direct consequence of the fact that the brain cells are being increasingly deprived of glucose, their principal fuel. The prompt relief of symptoms by glucose administration led to a number of investigations on the effect of other substrates known to sustain the respiration of surviving brain slices in vitro. Amongst these are various mono- and disaccharides, and such acids as lactic, pyruvic, succinic or glutamic acid which may be formed from glucose in the course of its metabolism. It appeared, however, that, in contrast to their in vitro action, most of these substances, including glutamic acid, were unable to relieve the symptoms of hypoglycaemia in eviscerated or hepatectomized animals (Bollmann and Mann, 1931; Maddock, Hawkins and Holmes, 1939). Similarly, lactic and pyruvic acids were found to have no effect on the oxygen consumption of the brain or the comatose state of hypoglycaemic patients undergoing insulin shock therapy (Wortis and Goldfarb, 1940; Goldfarb and Wort is, 1941). It has been shown for several substrates, including glutamic acid, that their rate of diffusion from the blood stream into brain tissue was markedly slower than that of glucose, and that therefore the concentration necessary for the maintenance of nervous function was not reached (Klein, Hurwitz and Olsen, 1946; Klein and Olsen, 1947). In harmony with this are the observations of Fried berg and Greenberg (1947), and of Waelsch, Schwerin and Bessman (1949) that intravenously injected glutamic acid is not taken up by brain tissue. The differences between the in vitro and in vivo results seemed to be adequately explained by these experiments.

Mr. Cecil Gray, in his excellent study, Peter Warlock holds the view that Philip Heseltine's character only becomes understandable if he is regarded as an example of dual personality. Gray gives very clearly and, in my opinion, conclusively the evidence on which he bases this belief. The only question that is left unanswered is the clinical nature of the duality.

The assessment of a patient's bodily habitus has now become an important part of clinical investigation in many medical fields.

Re-testing of the same individuals is a measure of the reliability of a test, a high correlation indicating that the results are consistent. Wechsler found the correlation for his test was ·94±·013 for 32 children aged 10–13 years re-tested from one month to one year later, and ·94±·018 for 20 adults aged 20–34 years re-tested after the same intervals of time. These figures indicate that the test itself is reliable.

The finger-prints of mental defectives have been investigated by Bonnevie (1927), Poll (1935) and M⊘ller (1935). It was found that the frequency of whorls was less in the feeble-minded and imbeciles than in the general population but there was no correlation between intelligence quotients and quantitative values of patterns among defectives. Very little investigation has been carried out on the epidermal ridges of palms in mental defectives except in the case of mongoloid imbeciles, where Cummins (1939) and Workman (1939) have investigated the main patterns. Penrose (1949) has measured the angles subtended at triradius t by triradii a and b, and the present writer has counted the epidermal ridges between the a and b triradii.

Comparison of different tests performed on the same individual is of value in showing whether tests purporting to be testing the same properties are, in fact, doing so, and also in determining whether certain psychological characteristics tend to occur concurrently in the same subjects. Previous work (Rudolf, 1948) has shown that the accumulation of general knowledge based on the environment and excluding school work, as shown by the I.Q. obtained by the use of Kent's test, correlates highly with the I.Q. obtained by the use of the Stanford Revision of the Binet-Simon, the coefficient being + 0·7499 ± 0·019. With a test of reasoning, Raven's Progressive Matrices (Group), the correlation-coefficient of the Kent Test was less impressive, being + 0·2686 ± 0·038. These results suggest that the accumulation of knowledge of the environment is not markedly dependent on, or connected with, the powers of reasoning.

Hydén and Hartelius in a recent monograph (1) described nerve cell abnormalities which they consider to be characteristic of mental disease. Their investigations were based on biopsies obtained during prefrontal leucotomy carried out in 11 psychotic patients, 10 of whom belonged to the schizophrenic group. The biopsies were investigated by means of the ultraviolet microscope and the results compared with brain material from normal patients fixed a few hours after death. Two types of abnormal nerve cells were found in the psychotic patients: one type is narrow and shrunken with corkscrew-shaped apical process and appears dark in the photographs in contrast to the other type which is swollen and appears light in the photographs. Both these cells lacked polynucleotides in their cell bodies and contained only a small amount of other protein substances, as shown by the ultraviolet absorption spectra.

Communicated mental illness or “folie à deux” in which the parent appears to have influenced the child is a frequently found disturbance in general practice and Child Guidance Clinics. The child is especially disposed to such a disturbance because he lives during the first years of his life in almost complete identification with the parents' psyche. In a healthy environment his growing consciousness will gradually resolve this identity, and thereby develop his ego and individuality. If, however, one or both parents suffer from mental illness this process is liable to be disturbed, and the child will remain fixated to the disordered psyche of the parent.

I am indebted to you for giving me this opportunity to put before you certain tentative conclusions at which I have arrived as a result of working at the problem of physiological instability on a group of 525 children between the ages of 6 and 14. Like so many investigations of this type, it began on a presumption that was not borne out by further experience, and because of this it caused me to revise certain views I held on the subject.

Brain and Strauss (1945) emphasize that a patient recovering from the immediate effects of rupture of a congenital intracranial aneurysm may show “some reduction of mental function, varying from impairment of memory and inability to concentrate to more serious disturbances.” They add, “The importance of these residual symptoms lies in the possibility that they may lead to faulty diagnosis if the patient is first seen some time after the leakage which produced them.” In view of the significance of this eventuality, the following case is of relevant interest. I saw the patient for the first time when the paranoid features were already the most prominent clinical manifestations of the case.

Out of 95 leucotomy cases of which the brains and clinical records have been collected at this laboratory, 45 were cases with post-operative survival of over 5 months, and more than 20 of these showed some degree of clinical improvement. Such numbers now make worth while an attempt to ascertain whether or not any attribute common to the lesions is a prerequisite to clinical improvement; whether or not the degree of improvement tends to vary with any qualitative or quantitative feature of the lesions; and whether or not any such relationship between lesions and improvement which is revealed holds good in equal degree for each of the main types of functional-psychosis. Over 20 of the same 45 cases had a recorded post-operative change of personality, so that relationship of post-operative personality change to the leucotomy lesions can conveniently be investigated in the same group of cases. Only some general findings concerning the personality change will, however, be touched on in the present paper.

In my student days, after the first world war, teachers and text-books still used the term dementia praecox. It was looked upon as a disease sui generis, and descriptions were entirely in terms of clear-cut asylum cases with the usual classification into simple, hebephrenic, katatonic and paranoid. There was no psychopathology worth noting, and no anticipation of the immense gap waiting to be explored between “normality” and complete mental breakdown. In effect this meant that there was no half-way house in diagnosis: it was either dementia praecox or nothing. The revolutionary change in diagnostic approach began with Bleuler's highly original conception of the disorder as a progressive splitting of the psyche, indicated by the name schizophrenia which he gave to it, and which now holds the field. Added to this there are the researches of the psycho-analytical schools (the Jungians in particular) which have succeeded in opening up a huge and fascinating borderland on the fringe of normality, with a corresponding enlargement of our notions of schizophrenic disorders.

This paper presents an example of the depersonalization syndrome as experienced and described by an intelligent patient. Considering the frequency of its occurrence, this syndrome has not been as often recognized nor as adequately described as would be expected. The syndrome was first described by Mayer-Gross (1935), later by Gordon (1936), Shorvon (1946, 1947) and Tayleur Stockings (1947). The psychopathology of depersonalization was given in analytical terms by Oberndorf (1935, 1936) and Feigenbaum (1937); Galdston has recently discussed this aspect (1947). As a symptom of organic brain disease, depersonalization offers an interesting field in the long-disputed question of body-mind relationship. Reidl (1942) described this symptom in a case of carbon monoxide poisoning, and Brock and Weisel (1942) discussed its occurrence in organic cerebral disease. Guttman and Maclay (1936) described the interesting relationship between mescaline intoxication and depersonalization. Cerebral anatomical localization was discussed in an anatomico-clinical study by Dide (1938).

Courville (1945) remarks that: “It was almost a medical habit in England on the part of physicians with literary leanings in the first half of the nineteenth century to write an essay on ‘water on the brain’.” It was not, however, until the experimental work of Dandy (1917) was published that a dynamic and scientific approach to the problem became possible. To this day no generally effective and applicable method of treatment has been devised. This is possibly due in part to the tendency to lump together a variety of conditions of different aetiology and pathology under the one heading. To emphasize this point it is perhaps useful to publish the following case, which clinically seemed to be one of simple hydrocephalus, but post-mortem examination of which showed that the symptoms had quite a different origin.

The operation of transorbital leucotomy recently described in the Lancet by Freeman (1948) was originally devised and carried out by Fiamberti in 1937 very soon after Moniz had introduced the original operation of leucotomy. Meyer, Beck and McLardy (1947) have shown that degeneration of the central portion of the pars parvicellularis of the dorso-medial nucleus of the thalamus was correlated with a lesion involving areas 9, 10 and 46 in the middle frontal gyrus. The transorbital method might now be said to follow almost logically on the work being done at the Columbia Presbyterian Medical Center and at the Greystone State Hospital, New Jersey, by a team of 96 (!) collaborators. Brodmann areas 9 and 10 and in some cases part of area 46 of the cerebral cortex are removed by an open bone-flap operation. This work is still in its infancy, and is not yet published apart from a summary by Nolan Lewis (1948). The entire project is to be described in a volume, The Human Frontal Lobe, to be published at an early date.

Although chess sets are usually to be found in the games cupboards of the male wards of a mental hospital, it is a rare sight to see two patients indulging in this game. Nevertheless, it may be a humiliating experience for any medical officer to challenge a patient to a match unless he is a fairly good player.