Sleep-walking, which is a fairly frequent symptom in children, is less common in adults, and, though fascinating, this subject has not yet received as much attention as its importance deserves. In the Text-Book of Medicine edited by Price there is no mention of this symptom. In the medical and legal literature one often comes across the same case-histories quoted by successive writers, some of whom consider somnambulism a hysterical dissociated state, while others maintain that it is an epileptic phenomenon. A correct diagnosis is essential not only for the purpose of treatment, but also for assessing criminal responsibility. Unfortunately, the features stated to be characteristic of somnambulism would seem really to be due to more than one condition.

This paper deals with the presence of insanity and allied mental disorders only in so far as found in adult defectives. The subject of psychotic states in defectives during infancy and childhood seems to demand a separate treatment.

In the relatively short period which has elapsed since the important findings about personality changes after encephalitis epidemica became known, those findings have been mainly responsible for the enormous advance in our knowledge of the sub-cortical direction of man's emotional and volitional life. This advance in psychopathology subsequently gave rise to the question whether similar sequelae could be found in the personality structure of those who had suffered from other forms of post-infectious encephalopathies. Chorea, which had already offered the puzzling problem of why the rheumatic virus becomes “neurotropic” in certain cases, was amongst the first to be considered, whereas 25 years ago no psychiatrist would have seen a special problem in the personality structure after choreic illness. The first investigations which dealt with entirely new problems in chorea minor were those of E. Straus, (1927), who found that hyperkinetic symptoms are frequently found, either in a generalized form, or as localized tics as sequelae of chorea minor, and of E. Guttmann (1927) and Schulz (1928), who both showed that hereditary predisposition of the brain plays an important role in persons who fall ill with chorea minor. A follow-up study of chorea cases with regard to personality development had not been undertaken until the present author's first publication on chorea (1934).

The life of those sailors who are called to tasks of special peril under the sea is recognized as being strange, unnatural, full of hazard, and of necessity involving considerable strain. It is hardly remarkable, therefore, that the infrequency of mental breakdown among submariners has given rise to comment and conjecture by various authorities. Colonel Cutler (1944) of the U.S. Army, in a lecture entitled “A Surgeon Looks at Two Wars,” states that the lack of neurotic illness amongst submariners is due to the fact that there is no escape route. He points out that “there are statistical data to support the fact that where there is no escape route, these psychological casualties do not arise, or arise but rarely. Thus they are not reported for crews of submarines, and surely this might be thought of as a place for psychological strain …” This view is not accepted by all, and quite different explanations have been put forward. Surgeon-Captain Curran, R.N.V.R. (1944) believes that effective pre-selection and early elimination of the unsuitable are the two principal reasons for the small number of submariners who reach naval psychiatrists.

The Retreat is now 150 years old. Some of you, perhaps, come from hospitals older still. Bethlem, looking back over 5 1/2 centuries, might well wonder, “Why such a fuss about a mere 150?” But it is quite a respectable age, and all old people are fond of reminiscing, so will you indulgently allow this elderly gentleman, through me, to talk for a few minutes about his past life and his old friends, and will you forgive him if he seems to emphasize the triumphs, and gloss over the difficulties and failures? It has all been said before, we know, but we hope you will find something of interest in it.

Numerous writers, doctors, psychologists and laymen interested in the cure of speech defects have discussed stuttering, a condition also known by various other names. Literature on this subject has been published by Kussmaul (1877), H. Gutzmann (1911), Froeschels (1925), Brown (1932), Hahn (1943), among others.

Fractures of the dorsal vertebrae remain one of the chief complications of convulsion therapy; and the problems of their mechanism and significance have not yet been completely solved. The present investigation has been developed with the intention of throwing fresh light on these matters by a comparative study of similar lesions in 27 patients suffering from the convulsions of idiopathic epilepsy, 21 of whom have also been treated by electrical convulsion therapy. A control group of 30 patients suffering from non-convulsive psychoses has also been examined, and in all cases the spine has been examined both clinically and radiologically, attention being focused, for the sake of clarity, on the dorsal region only.

The problem of tuberculosis amongst mental hospital patients is of importance from both the psychiatric and public health point of view. Most of the active methods of psychiatric treatment must be abandoned or discontinued when physical illness intervenes. The problem is even more far-reaching from the standpoint of public health. Wingfield, Trail, Banks and McDougall (1942) have estimated that there is probably a reservoir of 250,000 infectious cases recognized and unrecognized in England, Scotland and Wales, and several authors have pointed out that mental hospitals contribute a disproportionate number to this reservoir. Modern methods of mental hospital administration with parole and leave privileges applied to the maximum number of patients lend importance to the public health aspect, not only the patients themselves and hospital staff being menaced, but also patients' visitors and relatives and other contacts outside hospital. The incidence of tuberculosis in mental hospitals has been variously estimated at 5 to 10 times and the mortality in peace-time 8 or 9 times that of the general population. These figures are sufficient to justify all efforts to bring the problem under control.

The idea of trying to replace the irregular major fits of epilepsy by convulsions, artificially induced under controlled conditions of time and place, is an eminently reasonable one; but there has so far been no systematic investigation of the therapeutic possibilities of this procedure. The present work, which has been carried out over a period of two years, is intended to clear the ground for such a study; and this report includes an account of the effect of electrical convulsion therapy not only on the frequency of the fits, but also on the psychotic symptoms which were associated with the epilepsy in many of the patients.

Kretschmer, in his Psychology of Men of Genius, drew attention to the frequent association of psychopathy in the mental make-up of individuals so gifted and so able as to be readily included in the class of “men of genius.” Of all the individuals whom Kretschmer discusses, Dostoievski is the only one who is known for certainty to have been epileptic. Both the prophet Mohamet and the apostle Paul are mentioned as being traditionally regarded as having suffered from this malady, but for obvious reasons it is impossible to be certain of this. That an individual who ranks amongst the world's greatest novelists should, throughout his life, have suffered from epilepsy is in itself a remarkable and possibly unique thing. It is therefore of some interest to inquire in what manner epilepsy manifested itself in Dostoievski, how it influenced his work, and what light, if any, the manifestation of this condition in an individual of such intellectual power, throws on the nature of the epileptic state itself.

Fly-bombing is not always concentrated, for isolated explosions may occur at any time. There are also numerous if uneventful alerts. Thus there is a state of continuous uncertainty which might be expected to affect psychoneurotics considerably. I therefore set out to investigate the reactions of my patients during approximately ten weeks' concentrated fly-bombing. There were 620 soldiers—9 male officers and 121 auxiliaries—a total of 750 cases, all stationed in the London district. They were referred to me for various psychiatric reasons, by no means on account of anxiety due to bombing; nor was referral on account of fear of bombs necessarily indicative of special apprehension on the part of the patient—in some cases indeed it obviously only indicated anxiety on the part of those making the referral!

Intracranial aneurysms are not uncommon, but those that are described are usually interesting because of the signs and symptoms associated with them. Aneurysms which have had evident leakages and yet, owing to their lack of neurological signs, are diagnosed from their symptoms as neurasthenia, effort syndrome or even malingering are fortunately rare. Correct diagnosis is important in these cases because of their medico-legal importance.

Since the work of Sakel, v. Meduna and Moniz, a large number of papers have been published on physical methods of treatment. Statistical studies of the results of these forms of treatment have been most commonly used and have demonstrated their usefulness.

In recent years the mining industry as well as the miner himself have to an increasing extent become subjects for public discussion. In addition to problems of mechanization and industrial organization, the importance of the human element has found growing recognition, and an investigation into psychiatric disorders occurring in miners should form a useful contribution in this field.

The presenile psychoses have been the subject of intensive study in recent years. Both Alzheimer's and Pick's disease can now be regarded as well-defined clinico-pathological conditions. However, there occur cases with dementia developing in middle age or in early senium which do not fit into any of the established clinical types. A small group of cases characterized by dementia, extra-pyramidal symptoms and involvement of the spinal cord has been described by Jakob (1920) and Creutzfeldt (1920) independently. Similar cases have since been reported by Meyer (1929), Davison (1932), Jansen and Monrad-Krohn (1938), Davison and Rabiner (1940), and most recently by Jervis, Burdum and O'Neill (1942). McMenemy (1940), in a review of dementia in middle age, stated that the number of cases of that type reported in the literature did not exceed 14. Though all of them had the syndrome mentioned above in common, they varied considerably in respect of the leading symptoms. While in some the clinical picture was dominated by dementia associated with a variety of psychotic features, in others the extrapyramidal and in a few the spinal symptoms were predominant. Nothing definite is known about the etiology of that condition, though the hypothesis has been expressed that it may represent an atypical form of encephalitis. Josephy (1936) suggested that it might be a deficiency disease. No agreement has been reached on a suitable terminology. Jakob's original description of the condition as spastic pseudosclerosis has been found to be misleading. K. Wilson (1940) proposed to call it “cortico-striato-spinal degeneration.” Davison and Rabiner (1940) speak of “diffuse encephalomyelopathy.” Other authors advocated the provisional term Jakob-Creutzfeldt disease. In view of the scanty knowledge of the symptomatology and pathology of the disease, this term seems at present to be the most acceptable.

In a previous investigation it was found that the incidence of schizophrenia in a group of 627 British N.C.Os. was much lower than in the average O.R. admissions to hospital. Two questions at once arose: Why was the incidence of schizophrenia low? and How does the disease incidence of British N.C.O. psychiatric casualties compare with other groups admitted to this Base Psychiatric Hospital? The answer to the first may become apparent when we have found the answer to the second.

It is likely to be contended that climatic conditions, jungle warfare, distance from home, long separation from wife and family, difficulties in obtaining leave in the United Kingdom, delay in the receipt of mail, close association with members of different races and problems in regard to evacuation contributed to the incidence of psychiatric illness in Burma. It will be interesting to note in due course, when the total figures of psychiatric casualties from all theatres of war are available, whether or not conditions in Burma were in fact relatively more productive of psychiatric illness than they were, say, in North Africa or Italy. Then only will it be possible to conjecture on the relative effects of one type of climate as compared with another, or jungle warfare as compared with desert fighting, and so on.

Psychiatrists constantly observe pathological attitudes towards mental and physical illness among their cases. At one end of the scale there are the hypochondriacal patients, with their increased awareness and over-emphasis of discomfort and deficiency; at the other end there are those who make light of, or even ignore, their disabilities. The psychiatrist is often faced with the task of modifying such abnormal attitudes. This aim can, in many cases, be achieved by psychotherapy, while in others physical treatment such as shock therapy or prefrontal leucotomy may prove successful. Both the abnormal attitudes towards illness and the success of treatment are as yet little understood. Possibly observations such as those on which we are going to report in this article may contribute to that problem. We refer to the symptoms of imperception and unawareness of gross physical disabilities in certain cases with lesions of the nervous system.

A discussion of the use of prolonged narcosis in mental disorder might seem to be something in the nature of a valedictory address. The ease of application of electric convulsion therapy (E.C.T.), and the excellent effects of its use (1, 2, 3, 5, 11, 25, etc.), particularly in melancholia, have tended to overshadow the benefits to be obtained from an efficient narcosis clinic.

Comparatively little attention has been devoted to schizophrenia in the extensive psychiatric literature which has accumulated during the War. While man-power was more important than Man, it could hardly be otherwise, for those who succumbed to this illness were usually invalided even in the event of full recovery. But there was perhaps another reason to be found in the belief that schizophrenia was merely an old friend of peacetime interjecting itself inconveniently into wartime medicine, but not having any special or unusual qualities save perhaps an acuter onset or a better prognosis.