The problem set for this paper was to find out how many children who attended the Child Guidance Clinic at the Hospital for Sick Children, Great Ormond Street, London, during and shortly after the war, showed nervous symptoms caused or aggravated by war experiences or war circumstances; further, to follow up as many of these children as possible to get a picture of the prognosis of such disturbances. One of the main aspects was to investigate the possible relations between type of trauma, set-up of the child, type of disturbance and prognosis.

The Children's In-patient Department of the Maudsley Hospital has now been running for two years, and currently accommodates twenty to twenty-five in-patients of both sexes. These range through severe organic disabilities, early cases of delinquency or behaviour disturbances and emotional or psychoneurotic problems. In the under fives there are a high proportion of acute disturbances of behaviour and habits. It is believed that our experience in developing this unit and discussion of our problems solved and still to be met will prove of value to other hospitals planning similar accommodation.

These notes are divided into three sections. In the first, consideration is given to cases of aphasia occurring in childhood. In addition, the handedness of defectives is touched on, and there is a note on the influence of heredity. The section as a whole owes its existence to ideas set in motion by Brain's “Speech and Handedness” (Lancet, 2, 839, 1945). For that reason somewhat disparate elements are dealt with together. Section two is concerned with stammering; an endeavour is made to apply to this condition propositions put forward in the first section. Brief attention is given to bad spelling—or rather to that group of bad spellers in whom there is consistent discrepancy between their intellectual capacity and attainments, and their performance in oral and written spelling. The last section deals with “motor” or executive aphasia. A plea is put forward for the recognition of a dysarthric component in this condition. An anatomical configuration is suggested by which unilateral cortical dysarthria would become a possibility.

Youth is an elusive period of life, and although it has been considered from many points of view, it remains an intricate and unpredictable epoch, for which further study is needed to bring it into clearer perspective.

Electronarcosis was introduced as a new treatment of schizophrenia by Tietz and co-workers in 1946. They reported favourable results in a group of 47 schizophrenics and claimed that it was as effective as deep insulin therapy, in the treatment of schizophrenia.

For a few seconds after the convulsion has ceased, whilst the patient is cyanosed and the breathing forced, there is complete flaccidity of all the body muscles. The first sign of muscular activity is a contraction of the masseter muscle, which holds the mouth tightly closed. This is followed by rigidity of a definite pattern; in its complete form the neck is retracted, the mouth closed, the shoulder flexed and adducted, the elbow flexed and the forearm pronated, the hip, knee and ankle joint are extended. Wrists, fingers and toes are invariably flaccid, offering no resistance to passive movements. In the extreme forms of rigidity the extension in the lower limbs is so intense that it is impossible to overcome it by force.

Of the various pathological states mentioned as contraindications against convulsive treatment in mental disease, tuberculosis and other affections of the lungs rank among the most important. It may generally be considered less dangerous than insulin coma therapy (which has been observed to activate pulmonary tuberculosis), but many authors warn against it. Very few, how–ever, have actually published observations of exacerbations of the tuberculous process consequent to convulsive therapy.

Leucotomy studies are now commonplace and this preliminary report on the clinical aspects of our series has probably little to add to existing ideas on the subject. Neither the case material nor our initial approach to the problem differ fundamentally from the observations expressed by various workers at a meeting held at the Royal Society of Medicine on 9 April, 1946.

One can arrange the determinants of Rorschach responses in the following groups, according to the sense impression which they convey:

An optic sense impression only is given by the form-, colour- and vista-responses (F, C’, FC, CF, C, FK, K, k responses).

A kinaesthetic impression is conveyed in addition to the optic one by the movement responses (M, FM, m responses).

A tactile and optic impression is conveyed by the texture responses (c, CF, FC responses).

Mr. President, Ladies and Gentlemen: as my contribution to this morning's topic, “Legislation and Mental Health,” I had hoped to be able to give you the outlines of the proposals contained in a new Mental Health Bill under way in Northern Ireland. Time has not been on my side, as it just happens the Bill is being presented to-day for its first reading in the Northern Ireland Parliament, and as only after that will it be available for publication, I am not able to make use of it as the basis of my paper this morning.

The generalized foetal dysplasia known as mongolism is one of the most frequent causes of severe mental defect. It accounts for something like 5 per cent. of all institutional cases in this country (Tredgold, 1929). The incidence of the condition in the general population is difficult to estimate with accuracy because of the high mortality it carries, but an exact knowledge of the frequency would be useful both for biological and for administrative reasons.

Turpin and Bernyer (1947), working on the influence of heredity on the Arneth count (Cooke and Ponder's (1927) modification), found that in mongols it was shifted to the left, i.e., that their polymorphonuclears had fewer lobes and were therefore more immature.

Many writers on the subject of the treatment of addictions have suggested that for treatment to be efficacious, a period of detention legally enforced is necessary, and it is perhaps strange that a country which tends to regard personal failings and idiosyncrasies with a kindly eye has been probably the first to provide a method of enforcing it without recourse to a legal sentence.

Re-testing of the same individuals is a measure of the reliability of a test, a high correlation indicating that the results are consistent. Wechsler found the correlation for his test was ·94±·013 for 32 children aged 10–13 years re-tested from one month to one year later, and ·94±·018 for 20 adults aged 20–34 years re-tested after the same intervals of time. These figures indicate that the test itself is reliable.

Comparison of different tests performed on the same individual is of value in showing whether tests purporting to be testing the same properties are, in fact, doing so, and also in determining whether certain psychological characteristics tend to occur concurrently in the same subjects. Previous work (Rudolf, 1948) has shown that the accumulation of general knowledge based on the environment and excluding school work, as shown by the I.Q. obtained by the use of Kent's test, correlates highly with the I.Q. obtained by the use of the Stanford Revision of the Binet-Simon, the coefficient being + 0·7499 ± 0·019. With a test of reasoning, Raven's Progressive Matrices (Group), the correlation-coefficient of the Kent Test was less impressive, being + 0·2686 ± 0·038. These results suggest that the accumulation of knowledge of the environment is not markedly dependent on, or connected with, the powers of reasoning.

Brain and Strauss (1945) emphasize that a patient recovering from the immediate effects of rupture of a congenital intracranial aneurysm may show “some reduction of mental function, varying from impairment of memory and inability to concentrate to more serious disturbances.” They add, “The importance of these residual symptoms lies in the possibility that they may lead to faulty diagnosis if the patient is first seen some time after the leakage which produced them.” In view of the significance of this eventuality, the following case is of relevant interest. I saw the patient for the first time when the paranoid features were already the most prominent clinical manifestations of the case.

Courville (1945) remarks that: “It was almost a medical habit in England on the part of physicians with literary leanings in the first half of the nineteenth century to write an essay on ‘water on the brain’.” It was not, however, until the experimental work of Dandy (1917) was published that a dynamic and scientific approach to the problem became possible. To this day no generally effective and applicable method of treatment has been devised. This is possibly due in part to the tendency to lump together a variety of conditions of different aetiology and pathology under the one heading. To emphasize this point it is perhaps useful to publish the following case, which clinically seemed to be one of simple hydrocephalus, but post-mortem examination of which showed that the symptoms had quite a different origin.