Throughout medical history we find evidence that hysteria has predominated over all other psychological disorders in attracting the attention of philosophers and physicians, yet despite the leading part which the study of hysteria has played in building up our present-day knowledge of psychopathology, it is remarkable how little we have advanced in acquiring an understanding of the cause of the hysterical syndrome itself. Even the wisdom of Freud has failed to offer us a readily acceptable explanation of hysteria, and to this day medical literature contains many theses suggesting that hysteria is related to disorders of the diencephalon, or to glandular dysfunction, and other such organic approaches to the problem. Seemingly we have no yardstick by which we can measure to what extent the hysteric is born, predestined by some elusive factor to develop the malady, and to what extent hysteria is imposed on persons by environmental circumstances. Much significant information on hysteria may be neglected by those who study it as an isolated phenomenon or disease entity, whereas it may well be that the truth of the matter is that at least a little bit of the hysterical reaction goes to form most of the neurotic syndromes met with in practice, and that the pure hysterical reaction is only an academic concept.

Introduced in 1933, Sakel's pharmacological shock treatment [Sakel (1935a, 1935b, 1938)] is now regarded as a valuable method of treatment in schizophrenia. The complications which may ensue during the treatment are, however, both numerous and dangerous, and may be classified according to the system predominantly affected as follows:

1. (1) The Respiratory System.

2. (2) The Cardiovascular System.

3. (3) The Nervous System.

“Fear is more pain than is the pain it fears.”

Sir Philip Sidney.

In the opening chapter of his Body and Mind (1873) the physician and philosopher whom these lectures commemorate wisely insists that our inquiries into human faculties should begin with the elementary and proceed only later to the elucidation of the complex. “Surely,” he says, “it is time that we put seriously to ourselves the question whether the inductive method, which has proved its worth by its abundant fruitfulness wherever it has been faithfully applied, should not be as rigidly used in the investigation of mind as in the investigation of other natural phenomena. If so, we ought certainly to begin our inquiry with the observation of the simplest instances …” In the chapters which follow he applies this principle, and—or so it seems to me—provides a number of healthy correctives to much modern thinking and writing, and not least to the opinions of those who have allowed too little or assumed too much in their appraisals of the body-mind relationship. If we have for too long separated psyche and soma, past and present, organism and environment, individual and society, in our attempts to fathom Man, may not an extension of interest in a primitive emotion such as fear, in which the interdependence of all of these is manifest, have value?

By time-honoured tradition one of the first duties of your newly-elected President is to inflict upon you a Presidential address. This is at once a very considerable responsibility and a privileged opportunity, but the feelings of awe and apprehension with which I face such a distinguished and erudite audience are mercifully lessened by the knowledge of the unwritten rule of our Association that no outspoken criticism of the subject matter of the address is permitted. I wish to ask you to bear with me, for a few minutes, whilst I put before you what I think may best be termed psychiatric reflections or ruminations, based on a certain amount of experience and, I can say quite sincerely, a true interest in the matters touched upon. I fear, however, that I have little or nothing original to offer you.

Since Alzheimer (1907) described the disease which bears his name there has been considerable controversy about its relationship to senile dementia and senility. In the course of years there has been little advance towards a solution of the problem.

I propose to explain the application to play therapy of a theory of family sexuality (Turner, 1947), upon which I have been working for some time.

When children are referred to me I see them individually and ask them to tell me, usually by their play (Lowenfeld, 1935), what real or imaginary thing could have caused their symptoms. I then follow the technique of Melanie Klein (1932) in that I straightway give an interpretation.

The usual leucotomy cut in this country, made through burr holes orientated by means of skull measurements, in the majority of cases enters the brain at about the middle of pars triangularis of the inferior frontal gyrus (Brodmann's Area 45), and if performed in a strictly coronal plane remains entirely within the prefrontal region. Intentionally or unintentionally cuts are not infrequently placed either anterior or posterior to this plane. That cuts made posterior to strictly prefrontal levels are often followed by an unfavourable post-operative course distinguished by particularly severe personality change, persisting incontinence, vasomotor, trophic and neurological disturbances has been demonstrated by Knight (1943), Meyer and Beck (1945), Ziegler and Osgood (1945), Reitman (1946) and others.

It is a very great honour to occupy the Presidential Chair of the Psychiatric Section of the Royal Society of Medicine; it is one which I appreciate most highly, and thank you warmly for.

Tridione (Abbott) is 3.5.5-Trimethyloxazolidine-2, 4-dione, and has been demonstrated clinically to have an inhibitory effect on petit mal, myoclonic and psychomotor seizures in epilepsy. Gibbs, Gibbs and Lennox first demonstrated a similarity between the cortical dysrhythmias in certain cases of schizophrenia and those of psychomotor epilepsy, whilst Kalinowsky and Putnam, as a result of these findings, gave the anti-convulsant dilantin as a successful sedative to 60 cases showing mental symptoms. Since tridione has a specific action against psychic equivalents in epilepsy, it was thought that its administration to patients showing chronic mental disturbances might result in at least a similar improvement.

Despite the precarious vulnerability of genetic theories to partisan distortion and abuse, a report on the progress of genetics in relation to mental disorders merits introduction on a fairly optimistic keynote. It seems that in quest of a better understanding of human behaviour deviations we have finally arrived at the threshold of the age of biology as a focal discipline. There are many indications that in searching for adequate methods of biological analysis, one of the key positions of science is held by human genetics.

Introduction.

The Admission of Aged Psychiatric Patients to Institutions.

It has recently been pointed out (Lewis, 1946) that between the years 1907 and 1937 the number of first-attack admissions of patients of 65 years and over, into the mental hospitals of England and Wales, differs considerably from analogous American figures. In Britain, using statistics supplied by the Board of Control for England and Wales, there was a marked tendency for the incidence of this group to decline, whereas in America, using statistics from New York Mental Hospitals Board, there was a marked increase. An explanation is found in the assumption that in England large numbers of cases which would be relevant to the statistics, were looked after in other institutions or at home, whereas in America less alternative accommodation was provided. It is doubtful, had the investigation been continued up to the present date, if the statistical divergence would have been found to continue. The incidence of first-attack admissions of those over 65 has, of course, a more subtle significance than a simple admission-rate for an age-group, or even a first-admission-rate, but the present impression in British Mental Hospitals is that admission of old persons—even first-attack admissions—has increased, especially during the war years. Post (1942) demonstrated this rising incidence of aged patients by analysing the admissions to Edinburgh Royal Mental Hospital from 1904 to 1942.

My interest in this subject was aroused during the first few weeks of the campaign in Normandy, when seemingly large numbers of these cases were known to be undergoing surgical treatment. At that time the rapid flow of psychiatric cases prevented a clear view of the significance of the situation as it was impossible to know accurately whether these wounded were in high proportion to the number of troops in action or to the total of battle casualties.

Pythagoras appears to have been the first to recognize “the profound effect of music upon the senses and emotions.” He tried to influence the mind and body with what he termed “musical medicine” (1).

He declared that the soul could be purified from its irrational influences, and he made detailed investigations into the therapeutic value of the seven different Greek keys. Pythagoras is said to have cured many mental illnesses “by having certain specially prepared musical compositions played in the presence of the sufferer.” For example, Iamblichus, in his life of Pythagoras, relates how he devised certain melodies against despondency, others against anger and still others against desires.

Cases showing alexia which is not part of a general visual agnosia or of a speech disorder (letter or word blindness, cécité verbale pure) are uncommon and deserve careful study for a variety of reasons. The conception of word blindness as loss of visual memories due to a localized cerebral lesion (Hinshelwood, 1917) has been challenged by later investigators who aimed at a more general analysis of impairment of cerebral functions. The application of the principles of Gestalt psychology has introduced new aspects into the study of word blindness. Investigations into acquired word blindness, apart from their psychological and neuro-pathological interest, are of value for the understanding of congenital word blindness which has been found to be a condition of considerable practical importance. It was the investigation of cases of acquired word blindness which led Hinshelwood to the first full description of the congenital disability.

This paper is based upon the data obtained in a survey undertaken to ascertain the incidence of mental deficiency in England and Wales. My observations will be restricted to those data that are of most interest to students of social medicine.

The cases reviewed in this paper were treated in Three Counties Hospital during the last seventeen years. The ages of the patients ranged between 15 and 44 years. Of the total 1,009 cases, 563 had insulin coma and convulsion therapies, while 446 received no such special treatment. Some had prefrontal leucotomy after failing to respond to insulin and convulsion treatments, but their number is small and they are not included here.

Amnesic aphasia has a peculiar position within the aphasic disorders, and it has always been found difficult to bring it into any aphasic scheme. The nearest to it in Head's (1926) classification of symbolic disorder is his nominal aphasia. This, however, is actually a sensory aphasia, in which the difficulty in finding words prevails; it has lost all the characteristics of the classical amnesic speech disorder. Goldstein (1926), on the other hand, while stressing the existence of the amnesic aphasia as a definite and well-circumscribed type of disorder, denies that it has anything to do with a speech defect—an opinion up to then held. According to him, it is fundamentally a defect in the thinking process in which the patients have sunk to a lower and more concrete level of behaviour. They have, according to Goldstein (1926), lost the categorical meaning and use of words; they may be able to name an object in a concrete situation, but are unable to generalize, to use the word in its class meaning. Since then this question has been critically examined by several authors (Hauptmann (1931), Isserlin (1936), von Kuenburg (1930), Lotmar (1933), Scheller (1938)) in the light of Goldstein's conception. In their conclusions, repudiating Goldstein's opinion, they reaffirmed the classical view of a basic speech disorder in the amnesic aphasia.

The pattern of the epileptiform fit produced by electric shock treatment is fairly uniform and constant. The four stages of the fit—the preconvulsive, tonic, clonic and post-convulsive phases—are characteristically expressed in postures and movements of eyes and head in each phase.

I am very grateful to the Committee of this Conference for giving me the opportunity to say a few words about the aims and methods of social surveys. I must, however, confess that I was somewhat astonished when I got the invitation, because everybody interested in this topic knows that the most eminent experts within this field are English. It would, therefore, seem unnecessary to ask a foreigner to read this paper, and after having heard the lectures of Dr. Lewis and Dr. Blacker I feel still more convinced that I shall not be able to add anything of importance to their excellent presentations.

Ever since Group Therapy became established as a scientific method for the furtherance of mental health, therapists have looked for ways of measuring the behaviour of the Group. It is clear, for example, that there are important differences in structure between a group of people newly assembled in a railway carriage and those who share the same dining table at the end of a long sea voyage. Interpersonal relations have been established in the latter company, and each member has himself achieved some kind of relationship to the group as a whole. It cannot be conceded that any purpose would be served in quantitatively measuring these relationships in the two kinds of groups which have been mentioned. This is because they are accidentally formed groups, lacking a basic purpose and without a pre-appointed leader. Membership of such a group may be interesting, boring or entertaining, but it cannot be said to play any great part in the life-plan of the individual.