Many problems concerning Alzheimer's disease and Pick's disease are still awaiting clarification. In this country Henderson was the first to draw attention to the considerable importance of Alzheimer's disease in clinical psychiatry. Valuable work has been contributed by various writers in recent years (Grunthal, 1936; Critchley, 1929, 1930, 1931, 1938; Schottky, 1932; Thorpe, 1932; Rothschild, 1934; Malamud, Lowenberg and co-workers, 1929; Mayer-Gross, 1938; Kasanin and Crank, 1933; Jervis and Soltz, 1936; McMenemy, a.o., 1939). While Pick's disease has retained its position as a clinical entity based mainly on the characteristic anatomical picture, the position of Alzheimer's disease in the system of psychiatry has become more complicated; for instance atypical cases have been described presenting the anatomical characters of Alzheimer's disease, though not fitting into the original clinical conception of that disease. Lowenberg and his co-workers (1929) are inclined to regard Alzheimer's disease as a syndrome rather than a clinical entity. Many contributors have directed their main interest to the pathological changes. The knowledge of the symptomatology of those conditions is still incomplete. Further intensive study may enable us not only to base the diagnosis and differential diagnosis of Alzheimer's disease and Pick's disease on more solid clinical knowledge than hitherto, but also to recognize the early stages of those diseases before advancing cerebral degeneration effaces their characteristic clinical features. Unfortunately, most of the cases come under the observation of the psychiatrist only in the later stages of their illness, and it seems that the comparatively small proportion of the mental hospital population they represent does not reflect the incidence of those diseases. It is very likely that many patients die from intercurrent illnesses before their mental condition is recognized or sufficiently advanced to make admission to a mental hospital necessary. The differential diagnosis of those conditions offers considerable difficulties which often may prove insuperable. Alzheimer's disease and Pick's disease have to be distinguished not only from each other but from conditions of vascular origin, from senile dementia and various atypical conditions which occur at the same age period during which Alzheimer's disease and Pick's disease usually develop. Only careful collection and analysis of clinical observations and their scrutiny by pathological investigations can increase our still limited knowledge in this important field of psychiatry.

The frontal lobes form the latest stage in the evolution of the brain. There has been much speculation as to their functions, and they have been described by some as biological luxuries and parasitic growths. It is, however, inconceivable that an organ appearing so late in the scheme of evolution should be completely devoid of function. Since the introduction of pre-frontal leucotomy evidence as to their function has been growing, and it may be said that the consensus of opinion now is that the frontal lobes are concerned with imagination, the social sense, self-consciousness, and the projection of the self into the future; these functions are synonymous with Freud's super-ego, so that, in fact, we may regard the frontal lobes as the seat of the super-ego.

Problem.

The writer undertook to try out a number of mental tests on a group of senile patients and to submit a tentative battery for a further investigation of senescence.

The purpose of this paper is to present the results of treatment by prefrontal leucotomy in 30 cases of mental disorder. In view of the fact that this procedure is not only comparatively new, and uncertain in its ultimate effects, but is also after all a destructive operation, its trial was only felt to be justified, in the first instance at any rate, in a selected number of chronic patients with an apparently hopeless or very poor prognosis.

The purpose of this paper is to illustrate and discuss by case-records the affective responses of a number of patients with a schizophrenic reaction type of mental illness. Recently the energies, time and attention of neuropsychiatrists have been focused on the newer methods of treatment of the schizophrenics. As a result of such intensive and extensive study, interest in other problems of schizophrenia has been rekindled. The “shock therapies” have seemed to crystallize certain factors for us. They have tended to bring out into clear relief certain old factors and have produced many new facts so that we have been forced to re-orient ourselves in many diverse ways. Prognosis has been altered, and this fact has led to a minute scrutiny of the patients who have been treated to determine what factors are operating for or against a favourable outcome. One of these is the affective factor. Patients that have retained a good affective response may still be able to combat reality and its ever-present problems of adjustment and re-adjustment. They may recover spontaneously, or they may do so quicker with the help of the “shock therapies.”

The problem of estimating objectively the value of any new form of treatment is constantly presenting itself in all branches of medical work. In the case of shock therapy applied in the treatment of mental disease, the task is especially difficult. Standards of initial severity and degrees of improvement in mental diseases are subject to very wide interpretations. Disagreement on questions of diagnosis is common even among psychiatrists who employ the same terminologies. Thus, it is not surprising to find that widely divergent claims have been made about the value of shock treatment in mental diseases. In most of the large surveys, patients have been classified as (i) Recovered, (ii) Much improved, (iii) Improved, or (iv) Unimproved after shock treatment, but little unanimity about the results has emerged. In Table I, the figures given by Malzberg (1938) and Pollock (1939) for New York State and those for Ohio, given by Bateman and Michael (1940), are compared with figures obtained in a survey of the Ontario Mental Hospitals in 1941.

In March, 1939. there was admitted under my care at the St. Pancras Hospital Mental Observation Unit a case of torulosis of the nervous system. This is a very rare disease in this country and the present case is only the third recorded in British medical history (Greenfield et al., 1938; Smith and Crawford, 1930), and the first one to have come under mental hospital supervision. Although such a rarity here, torulosis is more common in the United States, and cases have been reported from nearly every part of the world.

The following findings apply to 50 cases who were operated upon in the last six months of 1942. The very short time which has elapsed since the operations were performed makes it necessary to treat the results with the greatest reserve. It is therefore hoped that this account will be regarded as a progress report.

Malarial therapy as a subject for a paper may well have lost the sparkle that it once owed to novelty, but it should still be acceptable if only because the passing of time and the accumulation of experience provide an opportunity of confirming some of the tentative conclusions originally advanced, of emphasizing what has often passed almost unnoticed, even of disproving opinions hastily formed on insufficient data.

When Dr. Cook, who has the thankless task of organizing the papers and discussion of this meeting, told me I had let him down because I had not secured one of the most distinguished surgeons in the country, Mr. Jefferson, he put it to me that the least I could do was to fill in the gap. I was puzzled as to what to say until Prof. MacDonald gave me a clue, and instead of talking on physiology and anatomy, which, after all, you probably know better than I do, I propose to give you a few general considerations which seem to make for the defence of an operation such as this against Prof. MacDonald's criticism.

In the Tomlinson report on rehabilitation the definition of this form of treatment is given in its strictly medical sense as the process of preventing or restoring the loss of muscle tone, restoring the full function of the limbs, and maintaining the patient's general health, strength, etc. This is apart from such rehabilitation treatment as is required for particular diseases such as tuberculosis. The process should begin as soon as possible after injury or operation or, in the case of acute prolonged illness, as soon as the patient's condition permits, and should continue not only throughout the period of hospital treatment, but also during the subsequent stages of convalescence, whether that takes place in hospital or is provided in a separate centre. Continuity of treatment is essential to achieve the aim of restoring the patient's mental and physical capacity at the earliest possible date, and to the fullest extent possible.

Conscientious objection is a problem involving both personalities and society. It has important military, political, ethical, religious and sometimes psychiatric aspects. It is only where conscientious objection arises in a person who shows signs of psychiatric disorder that the psychiatrist has to take an active professional interest. He has sometimes to treat patients struggling with the problem of conscientious objection and sometimes has to report on them to the Recruiting Medical Boards. Thus this aspect of conscientious objection becomes a part of war psychiatry. My own interest in the problem was aroused by seeing a number of psychiatric patients who were objectors.

Since psychiatry is that branch of medicine which deals with disorders of the psyche, it must inevitably include in its study the nature and activities of that which is thus disordered; it will therefore be granted that advances not only in scientific, but also in metaphysical, aesthetic and religious knowledge, must be of prime importance for the psychiatrist, since these are indubitably concerned with the activities of the psyche.

I have been briefed to address you for half an hour on what must be a rather uninteresting subject to an audience composed mainly of physicians, namely the technique of the operation the results of which we have learnt this morning. May I congratulate this audience on showing such interest in the technicalities of the surgeon's art?

The following story was written by a woman writer while convalescing from an attack of melancholia. She had written it for publication as a short story for children.

When I read it, I was certain that it was a deliberate piece of autobiography, written in the form of a fantasy. I was therefore much surprised on putting this to the1 author to be told that it was not supposed to have any reference to herself whatever. Without any attempt at serious analysis it was not difficult to convince her of the real significance of her story, and it is such a good example of the part the subconscious plays in the writing of such stories that it seems worth recording.

The group of mental disorders classified at present under the name of “schizophrenia” or “dementia praecox” offers a number of symptoms of not entirely “psychological” nature, and a more organic line of approach to the examination of these signs.

For many years the need has been felt for a means of measuring in a reasonably accurate manner the amount of deterioration present in mental patients.

The old criterion of saying that a patient is well because he is capable of working well in the laundry or garden or doing skilful work in the handicrafts department, combined with giving an impression of recovery to the doctors and relatives, is not accurate enough for modern standards.

May I apologize in advance for the many deficiencies of the paper I am about to read. I have not had the time that I would have wished to spend upon its preparation, nor the opportunity to make myself more than superficially conversant with the increasing literature, and I trust that you will excuse such imperfections as will appear.

The value of electrical shock therapy is becoming increasingly recognized and used by psychiatrists in the treatment of depressive states, particularly of the involutional period, states of depersonalization, and to a lesser extent in schizophrenia. One of the major objections to its use, however, has been the complication of fractures, generally crush fractures of the bodies of the mid-dorsal vertebrae (thoracic 4-8), and uncommonly that of limb bones, such as the femur. Another aspect of this problem arises with the occasional case in which the use of shock therapy is desirable, but a previous fracture of the spine or limb bones, or marked bone disease with an increased liability of fracture resulting during treatment, acts as a deterrent to the physician. Even more so is the question of continuing treatment without further damage to the patient, should a fracture have unfortunately resulted before the full course of convulsions is completed. Various methods have been introduced to minimize or abolish the muscular pull producing fractures, including intravenous injections of curare, of concentrated magnesium sulphate solution, or of beta-erythoidin hydrochloride; spinal anaesthesia has been similarly employed.

Seven hundred Progressive Matrices records of male neurotic military patients admitted to Sutton Emergency Hospital between April and November, 1942, were compared with a control group (1). The distribution of the patients' scores shows a negatively skewed curve with a clustering of scores below the control median (Fig. 1).