In 1895, as many people here are likely to know, Henry Maudsley combined two of his earlier books into his famous Pathology of Mind. Very near the beginning of this volume, he laid unusual emphasis upon the paramount importance of a study of social conditions in relation to human conduct in general and the varied forms of mental illness in particular. “The study of the individual as an element of social pathology,” he declared, “will plainly be a long, laborious, and difficult business of the future.” He was right. Fifty years have gone and, in spite of many notable contributions, it is a study still in its infancy.

The use of intravenous insulin in Sakel's shock treatment as an alternative to intramuscular insulin was first reported by Ventriglia (1939), whose findings may be summarized as follows:

(1) Hypoglycaemic symptoms appear more quickly than with intramuscular insulin, so that the pre-shock period is shortened.

(2) The coma dose of insulin is reduced by 50 per cent. on an average, but may be reduced by considerably more.

(3) In some cases the hypoglycaemic symptoms are more abrupt and violent.

(4) There is a greater tendency to tonic-clonic spasms and convulsions generally.

The present description is based on a study of 168 men and 107 women (total 275), who have been admitted to the Rampton State Institution diagnosed as post-encephalitic.

The origin of the term abreaction dates from the time of Breuer and Freud's (1) early studies in hysteria, when they observed that patients were helped by “just talking it out.” Later their technique was employed under hypnosis (2). Sadler (3) defined abreaction as “a process of reviving the memory of a repressed unpleasant experience and expressing in speech and action the emotions related to it, thereby relieving the personality of its influence.” Miller (4) quotes Freud as holding that experiences shall be recalled with emotional vividness. “Affectless memories are almost useless,” said Freud.

More than ten years have elapsed since insulin therapy was first introduced in this country as a treatment for schizophrenia. This should gradually enable us to form a more accurate opinion as to its value. An enormous literature has accumulated on the subject. Only some samples of it, representing the different views expressed, can therefore be mentioned. It is here attempted to apply some common criteria which are indispensable for the assessment of the effects of treatment, which it is hoped may lead to a clarification of the present position of insulin therapy.

Does convulsive therapy in the depressive states produce its effect by some action on the pituitary and hypothalamus? This is a question which we at Barnwood House and at the Burden Neurological Institute are trying to answer.

This is a field of knowledge which has been neglected unduly and which, should prove fruitful in view of the recognized importance of sex in psychology.

Pearse and Crocker (1944a), in their study of the family, that unit with which is associated suckling and coitus, leave out psychology, saying there is no normal psychology described.

Continuous narcosis is a method of treating psychiatric conditions by producing a state of narcosis or intoxication for a prolonged period. It was first adopted seriously by Klaesi (1921), and has proved to be a valuable therapeutic weapon. Klaesi used large doses of somnifaine by intramuscular injection, and these were repeated as often as was required to maintain unbroken sleep for 8–10 days.

This year marks the seven hundredth anniversary of the foundling of the House of Bethlem. Seven hundred years! It takes us back to the very beginnings of English culture. Much in our constitution that we hold dear dates from this thirteenth century, which saw the foundation of Bethlem. In 1215 King John signed the Magna Carta, and in 1265 Simon de Montfort summoned not only the knights of the shire, but for the first time two representatives from each of the chartered boroughs, the precursor of the House of Commons. It was between these two dates on the Wednesday after the Feast of St. Luke the Evangelist, which in the year 1247 fell on 23 October, that Simon FitzMary, a citizen of London, signed the deed-poll which founded this hospital. He had given and granted to God and the church of St. Mary of Bethlem all that land of his which he had in the parish of St. Botolph without Bishopsgate London, to wit, all that he had or might have there, in houses, gardens, orchards, fish-ponds, ditches, marshes and all other things appertaining thereto as defined by their boundaries. These extended in length from the king's highway on the east to that ditch on the west which was called Depeditch, and in breadth to the land which belonged to Ralph Dunning on the north and to the land of St. Botolph's church on the south. The gift was for the formation of a priory under the rule and order of the church of Bethlem, the brothers and sisters to wear publicly upon their copes and mantles the badge of a star. He further declared in the deed poll that: “For the greater security of this gift I have placed myself and mine outside the said property, and I have solemnly put in actual possession of it, and have handed over the possession of all things aforesaid to the lord Godfrey of the family of the Prefetti of the city of Rome, at this time bishop-elect of Bethlem (as by our lord the pope confirmed) and at this time actually in England, in his own name, and in that of his successors, and in the name of the chapter of the church of Bethlem. And he has received possession of the said property, and has entered upon it in the form prescribed.”

In this paper are given the histories of ten patients who have been treated by means of leucotomy, particular attention being paid to the study of character and personality traits.

The records are compiled from the information given by a relative or relatives, supplemented in some cases by data supplied by the patient as well. This method undoubtedly has serious disadvantages, for the information must inevitably be dependent upon the informant's veracity, powers of observation and description, memory, and conscious and unconscious subjective bias. In every case the interview took place at the patient's home, so that the interviewer could obtain a personal impression of the patient's home environment. Furthermore, the information regarding the pre-morbid personality was only obtained after the illness, operation, and recovery, and in some cases it was difficult to ascertain when the morbid changes actually began.

The theory concerning the various types of nervous system in man, generally acknowledged by Russian neurologists, is based on the principles established by Pavlov in his investigations on conditioned reflexes in dogs. It was Pavlov and his collaborators who succeeded in establishing that all variations in the nervous types of dog are due to three main differences. These differences may consist in varying intensity in the essential processes (excitation and inhibition), peculiar to the nerve cell of the cerebral cortex, with the result that some specimens are of a stronger, others of a weaker nervous type. There may also be differences in the degree of equilibrium attained between the two processes, with the result that some specimens are well balanced, while others are unbalanced. Finally the differences may consist in the rate at which the nerve cell is able to pass from one state to the other, in the rate at which the concentration of the excitation or inhibition process is reached after the primary phase of irradiation, and in the rate at which the excitation process becomes extinct within a cell after the action of the stimulus has ceased. As a result of these latter differences some specimens may be more mobile, others more inert. At the same time it was established that the differences with respect to all these three functions could develop independently of one another, owing to which fact the resulting typologic combinations are extremely varied.

This article is a study of mental derangement in Kenya Africans, and is based on seven years' special experience as Medical Officer in charge of Mathari Mental Hospital and of H.M. Prison, Nairobi, and on nine years' previous general medical experience as a Government Medical Officer in various parts of the Colony.

Von Winiwarter, in 1879, published his pathological findings in a case in which there was obliteration of the vessels of the leg due, as he considered, to a proliferative process in the intima, that is to say, an “endarteritis obliterans.” Other views on the pathology came to be propounded, notably that of van Manteuffel, who considered that consequent upon arteriosclerosis of the popliteal artery a white thrombus formed, which, spreading peripherally and becoming organized, produced the picture of an obliterative endarteritis. Twenty-five years after Winiwarter's paper Buerger published his observations based on 30 cases, with pathological studies on the vessels obtained from eleven amputated limbs. He disagreed with the views of both von Winiwarter and von Manteuffel. He found that besides an extensive obliteration of the larger arteries and veins there was a varying degree of peri-arteritis and arteriosclerotic thickening of the vessel wall, and concluded that the condition was a thrombotic process occurring in the arteries and veins, followed by organization and canalization, and not an obliterating endarteritis. He absolved the intima from any “considerable role in the genesis of the thrombotic process,” and attributed the thickening of the intima and the cellular infiltration and vascularization of the media and adventitia to the agency producing the coagulation of the blood and to the changes in the thrombus itself. He saw the final lesion as a vessel obliterated by dense connective tissue, canalized, together with some residual cellular infiltration and capillarization of the media and greater or less thickening of the adventitia and periarterial tissues, the thrombus having disappeared in the course of the development of this final result. He proposed the term “thrombo-angeitis obliterans” for the condition, and with the general adoption of the term Buerger's name came to be linked with it.

The harmonizing of legal administrative practice with the development of scientific concepts in the field of medicine is sometimes difficult. The law has to be understood by everybody, whereas scientific knowledge is too often considered the privilege of the educated few. Thus, the law must be simple and directly applicable, leaving for the expert, critical examination of causes and effects. When the definition of a situation depends upon physical findings, a decision can be made without very much difficulty as to how the law is to be interpreted; but in questions of behaviour interpretation of rules may be much more troublesome, and special care is required in drafting laws which define psychological concepts.

The automatic repetition of words heard (echolalia) and actions seen (echopraxia) has long been known to occur in certain psychotic states in cases of aphasia and in low-grade mental deficiency. Echographia was established as a sub-type of echopraxia (Pick, 1924). The similarity of the pathological echo-reactions with phenomena occurring normally in childhood during the early period of speech development was pointed out by Wyllie (1894) and Pick (1902), who studied them in aphasia. The most recent study dealing with echo-reactions is that of D. E. Schneider (1938), who described the syndrome echolalia, echopraxia, grasping and sucking. Most previous writers investigated echo-reactions either from the neurological or psychiatric point of view and not enough attention has been paid to the comparative aspect and to the question of a common underlying mechanism. In this study an attempt has been made to investigate that problem.

Section I.—Introduction.

Interest in the psychological concomitants of flying was greatly stimulated by the outbreak of war in 1939. The rapid increase in size of the Royal Air Force and the ever-increasing “airmindedness” of the general public led to a far wider realization of the growing importance of this comparatively new field of enquiry.

From time to time in the Middle East, cases were admitted into hospital bearing the diagnosis of Mepacrine Psychosis. This was a label which one hesitated to accept because, for one thing, the cases presented no single clinical type, and for another, they showed, with few exceptions, little or no evidence of symptoms of an organic reaction type such as might be expected in a toxic psychosis. It was, moreover, important, in view of the widespread use of mepacrine both as prophylactic against malaria and in the treatment of it, that the occurrence of a psychosis during the exhibition of mepacrine should not be ascribed to it, except on the irrefutable evidence of a causal connection between the two. Though I have no figures to indicate the incidence of mepacrine psychosis relative to the number of cases of malaria treated with the drug in the M.E.F., I believe the ratio to be very small indeed. Kingsbury mentions 12 cases among several thousand cases of malaria treated with mepacrine; Allen et al. quote Greene as having encountered 2 cases in a series of 750 so treated, in Malay. Hoops had 1 case of mental excitement among 1,207 cases; Briercliffe 15 cases of delirium among some hundred persons taking mepacrine. Field estimated the incidence of mepacrine psychosis to be less than 01 per cent. of cases treated. Gaskill and Fitz-Hugh noted 35 cases of toxic psychosis in 7,064 cases of malaria treated with mepacrine in an army hospital during the recent war; Mergener reports 1 case in 1,000, and quotes Udalagama, who recorded 7 such cases in a series of 644, and Bispham, who noted only 1 case in 7,915 cases that came under his personal supervision, and who up to 1941 found only 35 instances in the literature. Burnham quotes Dove as having noted no case of alarming reactions (presumably including psychotic reaction) in a series of 30,000 cases treated with mepacrine.

Depersonalization, or feeling of unreality, is a symptom which may occur as part of several psychiatric conditions, such as hysteria, anxiety and obsessional states, and some forms of schizophrenia and endogenous depression. The true derealization-depersonalization syndrome, however, in which the unreality symptom is the primary disturbance, is a quite peculiar and distinctive condition, which has received scant attention in most psychiatric textbooks and which appears to be becoming increasingly common in practice.

The observation and treatment of neurotic patients in groups has attracted much attention in recent years. Schizophrenics have occasionally been included in such therapy groups, and favourable results with them have been reported by Blackman, Foulkes and Lewis, Schilder, Wender and others.

When I was invited to take part in this Conference it was suggested that I should speak on some aspects of the population problem in relation to poverty, social inefficiency and mental disorder, as illustrated by the Merseyside Survey. At first I confess I felt very hesitant about it, for I did not want to go over ground that might already be familiar to you. But then I reflected that the purpose of the Conference was, no doubt, to recall and discuss work done in the past having some bearing on the quality of the population—an aspect of the problem that is only beginning to receive the attention it deserves. Before replying I therefore consulted Dr. Blacker as to whether it might meet your purpose if I attempted to summarize quite simply a few of the conclusions reached in the course of the Merseyside Survey concerning certain subnormal types in the community. It was only after I had been fortified by his reassurance and that of Dr. Cook that I ventured to accept your kind invitation, and I make my apologies here and now to any of you who find it tedious to listen to a reproduction of what you may have read in the published account of the Survey.