This paper reports the results of a series of psychological tests and behavioural scales obtained upon psychotic patients who were given prefrontal lobotomies at the Palo Alto Veterans Administration Hospital during the years 1947 through 1954. Psychological testing procedures were administered both before and at given intervals following operation, and comparisons were made of the pre-operative measures to degree of improvement. Also, an evaluation was made of changes in the measures over time following lobotomy.

Tranquillizing drugs have become widely accepted as a major form of treatment in psychiatry. However, reports in the literature on these drugs have frequently been conflicting, with a marked tendency for the results of uncontrolled studies to be much more favourable than those obtained in studies where some method of control has been adopted. Sargant (1956) has emphasized many of the social, economic, and moral implications inherent in the extravagant and indiscriminate use of tranquillizers in general and has stressed the need for the proper evaluation of their therapeutic effects. In view of this need, we undertook a controlled comparative study of the effects of two of the phenothiazine compounds, promazine (“Sparine”) and chlorpromazine (“Largactil”), in the treatment of chronic psychosis.

This is a reply to a critique by Karon and Saunders (9) of the Eysenck and Prell work on the inheritance of neuroticism (6). This paper is a curious combination of sophisticated statistical analysis and argument by irrelevant association. Thus the authors mention the fact that we found a strong heredity predisposition but go on to say that “the results are so much at variance with general clinical experience that doubts arise in the minds of many psychologists … particularly those who have investigated, in a therapeutic situation, the source and development of neurotic reactions”. The authors do not indicate how it is possible through general clinical experience or in the therapeutic situation, to find an answer to one of the most difficult and complex problems in the whole field of psychology. Whether neurotic predisposition is largely inherited or has little hereditary basis, would not seem to be capable of being discerned simply by giving psychotherapy to a few neurotics.

In Part I of this communication the theoretical basis for the investigation was outlined. Details of a statistical study were given and it was suggested that these confirmed a greater incidence amongst schizophrenics than normals of subjects excreting an excess of indole substances. In addition the question of hepatic dysfunction was investigated in 48 schizophrenic patients using the Cephalin-Cholesterol Flocculation Test. The results of this investigation were essentially negative.

An examination of recent catalogues of tests published by the Australian Council for Educational Research, the Psychological Corporation of America and the National Foundation for Educational Research, has shown that few well-standardized and validated tests of personality are available for use with children.

Since its introduction in 1938 electroshock therapy (E.C.T.) has become probably the most widely applied form of physical treatment in psychiatry, despite the fact that its method and site of action are still not precisely known. Numerous investigations have been undertaken to delineate more clearly the indications for its use; notwithstanding broad agreement as to its value in depressive states and some schizophrenic syndromes there is still a paucity of evidence on which firm criteria for the prediction of outcome to treatment can be based. Most prognostic studies appeared in the first decade following the introduction of E.C.T. and were based largely on empirical clinical observations during the course of routine psychiatric practice, whereas later investigations have included more intensive and precise researches into possible psychological, physiological, biochemical and pharmacological indices of capacity to respond to electroshock.

During an investigation of the morbid anatomy of pituitary and adrenal glands of an unselected series of mental hospital patients (1), it was noted that adrenal sudanophilic material and birefringence were reduced in many cases of schizophrenia. It was therefore decided to make a statistical study of such cases in order to determine if any significance could be attached to the findings and if so, to consider how the facts might be related to present knowledge of schizophrenia.

The present report deals with two effects of movement variability as a function of practice in the drawing from memory of visually presented patterns. The first effect is found in initial practice stages only and appears to be related to the neurotic dichotomy of hysteria/dysthymia. The second effect is specific to late practice stages and related to schizophrenics as against neurotics and controls. Results are mainly discussed to illuminate the problem of score complexity in motor learning. The aim is to show how, in learning involving motor activity, the extent and variability of movement components may affect the validity of learning scores in their relation to personality.

Control of micturition by day should ordinarily be acquired in the second year of life and by night in the third, and enuresis comprises repeated involuntary micturition after this age if not due to organic disease. If the latter is responsible the symptom is termed incontinence of urine (Hubble, 1950).

Geographically, Iran is for the most part a plateau at an average altitude of about a thousand metres; the terrain—the near-jungle conditions of the Caspian littoral excepted—is arid semi-desert and the typical landscape one of limestone mountain ranges between which lie flat plains. It is bordered by Iraq, Turkey, the U.S.S.R., the Caspian Sea, Afghanistan, Pakistan and the Persian Gulf. Except during spring the vegetation in most areas is sun-shrivelled on the bare treeless earth; after five months of burning heat the winter rainfall washes off the topsoil, and river-beds, dry throughout the summer, overflow with muddy torrents. Although the soil is dry and powdery there are abundant watercourses below the surface and with irrigation the land is very productive. The country has great mineral resources; apart from the oil-fields they are un-exploited due to lack of coal and road and rail communications. The people are mainly feudal villagers or nomadic tribesfolk but Tehran is a modern city of a million population and the provincial capitals are also semi-Westernized.

During the past ten years varying degrees of prognostic value have been claimed, directly or indirectly, for a number of specific factors in connection with the treatment of depressive illnesses by E.C.T. These have included the blood pressure responses to adrenaline and methacholine (Funkenstein et al., 1948, 1950); the “sedation threshold” to intravenous sodium amylobarbitone (Shagass, 1954; Shagass and Jones, 1958); EEG changes under thiopentone following electroshock (Roth, 1951; Roth et al., 1957); and psychological tests based on items derived from the Minnesota Multiphasic Personality Inventory (Pearson, 1950; Feldman, 1957, 1958; Welsh, 1952). Other studies have been made on the prognostic value of adrenocortical activity (Faure et al., 1957); serum calcium levels (Gour and Chaudhry, 1957); the “amytal test” (Kahn et al., 1956); and the administration of methylamphetamine (“methedrine”) (Rudolf, 1956). Some of the techniques employed appear too complicated or unreliable in their interpretation to be of any practical clinical value, although a few are of great theoretical value in the contributions to further knowledge of the rationale of E.C.T.

The value of a rating scale for assessment in psychiatric disorders is that it facilitates the investigation of patterns of symptoms and their response to treatments. In a previous paper, Hamilton (1959), describing the construction and use of a rating scale designed for assessing the condition of patients suffering from depressive disorders, certain findings were described. In brief, it was found that much of the information given by the 17 variables of the rating scale could be given by four “index numbers” (dimensions, or factors). The nature of these factors was determined in two ways. In the first, the weights given to the symptoms which constituted the factors were examined. It was found (Table I) that the highest weights in the first factor were given to Depressed Mood, Guilt, Retardation, Loss of Insight, Suicide and Loss of Interest, in descending order. On this basis it was decided that the first factor corresponded to the classical clinical description of Retarded Depression. Examination of the weights given to the symptoms in the second, third and fourth factors, showed that these factors had no obvious correspondence with clinical syndromes.

May I begin by qualifying the title of this paper? I can only illustrate some broad principles and a few of the methods that are used in epidemiology today—there is no attempt to be comprehensive.

One of the most important questions in dealing with psychopaths is the prognosis. In 1948 two of us made a study (Stafford-Clark, Pond, Lovett-Doust, 1951) of a number of criminal psychopaths and a control group of ordinary criminals in prison by clinical and EEG methods, with the object of revealing the characteristics which most significantly distinguished psychopaths from others, and which were, therefore, most crucial in diagnosis. The psychopaths were carefully chosen in collaboration with two experienced prison medical officers. The later criminal behaviour of these psychopaths and controls is equally interesting, however, if we are to understand what the diagnosis implies (Gibbens, 1951). The third author (T.C.N.G.) has therefore been conducting a continuous follow-up, with the collaboration of the Prison Commission and Criminal Records Office. The results of the first follow-up, from 1948–1953, have been published (Gibbens, Pond and Stafford-Clark, 1955), and were reproduced in the transactions of the Royal Commission on the Law relating to Mental Illness (1957). The present paper deals with a further period of study, so that the follow-up is now from 1948-June, 1957.

Head injury, whether single as in an accident, or recurrent as in boxing, may on rare occasions be followed by a form of insidious dementia (Bowman and Blau, 1940). The post-mortem study of such long-standing cases however is seldom undertaken, and although various pathological processes may have been postulated during life they have rarely been looked for after death. The findings in the following case are therefore reported in some detail.

Certain drugs apparently alter the focus of attention. This paper deals with attempts to confirm and extend knowledge about drug influences on the focus of attention, and to relate the concept of the focus of attention to the concepts of extraversion and introversion used by Eysenck and his co-workers.

Smallness of the cranium is one of the commonest findings in severe mental defect. Ashby and Stuart (1933 and 1934) found a correlation between brain weight and mental age of +0.15, but they regarded this as part of the more general positive correlation of +0.24 which they observed between body weight and mental age. In discussing this subject elsewhere (Hilliard and Kirman, 1957), Crome and Kirman have taken a more definite stand on this matter in so far as idiocy and imbecility are concerned and regard reduced brain weight, which is so often associated with a small cranium, as one of the major factors in reduced intelligence. Crome (1957) found marked reduction in size to be the commonest abnormality in brains of low-grade defectives.

Because of the importance of the serum lipids in the pathogenesis of atherosclerosis, much information is available on the serum lipoproteins of adults in health and disease (Adlersberg et al., 1955; Chapin, 1956; Dangerfield and Smith, 1955; Jencks et al., 1956; Kanabrocki et al., 1958). The lipoproteins in childhood have been studied less extensively. Rafstedt (1955) has reported lipid and lipoprotein values for normal infants and children. More recently, Salt and Wolff (1957) have found that paper electrophoresis of the lipoproteins is of value in a number of diseases of infancy and childhood involving lipid metabolism primarily or secondarily. These authors detected abnormalities in the serum lipoproteins in gargoylism and the severe form of hypercalcaemia of infancy, conditions associated with mental defect. Using the ultra-centrifuge, Simon et al. (1954) had earlier demonstrated an increase in the level of certain low density lipoproteins in patients with mongolism, and work in this department (Stern and Lewis, 1957, 1958a) indicated that lipid metabolism is disturbed in children with mongolism and some other mentally retarded children. Paper electrophoresis was chosen as the method for a further study of the serum lipids in mental deficiency. Of particular interest was the possible relation of abnormalities in the serum lipoproteins to the disturbance responsible for the mental defect.

In a recent paper Slater and Meyer (in press) have pointed out that the nature of Robert Schumann's final psychiatric illness has never been satisfactorily explained. Moebius (1906) diagnosed it as dementia praecox, while Gruhle (1906) favoured an organic disease of the brain, probably paretic dementia. Subsequent opinion has been evenly divided between these two diagnoses but recent writers have inclined more to a diagnosis of schizophrenia. Slater and Meyer, however, on critically re-examining the available evidence, have definitely come down on the side of Gruhle.

In Oxford, all psychiatric cases among undergraduates are referred by their general practitioners and therefore tend to be selected by them. There is no group they are more ready to pass on to the psychiatrist than the student complaining, in whatever guise, of homosexuality. It is not therefore surprising that homosexuals form a high proportion of the 100 Oxford students referred on psychiatric grounds and studied in the research underlying this paper (the mode of selection is described in Davidson et al., 1955 and Spencer, 1957, p. 93). Opportunity was afforded also for the examination of 100 freshman controls from three Oxford Colleges (for mode of selection, see loc. cit.). These students agreed to answer questions about their sexual development, including possible homosexual practices or interests.