The multiplicity of classifications of the psychopathic personality shows how important it is that a definite effort should be made to limit the syndrome, and to prevent a number of indefinite conditions being classified under this heading. The greatest danger appears to be to allow any prepsychotic state to be labelled with this diagnosis. If there is slight but definite evidence of an abnormal psychotic state, this diagnosis should be made. As pointed out the inclusion of the milder cyclothymic cases and early schizoid cases under the heading of psychopathic personalities complicates and confuses a type of psychiatric work already vague and indeterminate.

Returns have been available since the early days of the war of naval cases diagnosed as suffering from neuropsychiatric disorders admitted to the various R.N. hospitals and sick quarters in Great Britain. The following table gives an indication of the relative frequency of the different diagnostic groupings for the year 1940. These figures are in certain respects misleading. For example, uncomplicated cases of head injury would seldom be included.

The term narcoanalysis may be applied to a technique whereby psychotherapeutic principles are applied and analytical investigations are conducted with the patient under treatment in a mild narcotic state.

This paper reports an attempt to determine the nature of dementia by analysing the results of mental tests applied to groups of patients clinically estimated to be demented in varying degree.

Previous investigations.—The relevant literature concerns the results of mental tests in psychosis and in normal senility. These topics having been recently fully surveyed elsewhere (Brody, 1942a), they need occupy no space here.

The operation of prefrontal leucotomy presents many aspects; to select one in preference to another would, we feel, do the subject an injustice. We have therefore decided to treat the subject as a whole, and thus avoid limiting the scope of the paper or of any subsequent discussion.

The therapeutic procedure of electrically induced convulsions provides a rare opportunity of studying experimental convulsive states in man and their accompanying reflex phenomena, many of which are of great importance in neurological diagnosis. Among the many interesting motor manifestations appearing during the post-convulsive stage is the grasping reflex, which has previously been observed only in certain structural disorders of the brain, usually of the frontal lobes.

That three brothers and their mother should be admitted to a mental hospital on the same day is sufficient cause to be put on record.

The demonstration by Zondek (1936), subsequently confirmed by Cramer and Horning (1936), Gardner (1937), Collip (1936), Noble (1938), Deanesley (1938, 1939), Pybus and Miller (1938), that large doses of oestrone will impair and partly suppress the functions of the pituitary anterior lobe, especially the gonadotrophic and the growth hormone production and will produce partial degeneration of the acidophil cells, led Kirklin and Wilder (1936) to adopt this method of treatment for patients suffering from acromegaly. Their series consisted of eight patients, four men and four women, and their results may be briefly summarized as follows: There was a general improvement in three patients; headache which was originally present in six cases disappeared in four, but returned in one case, though this may have been due to a discontinuance of treatment; in three patients there was a decrease in size, in one a smaller hat was required and her dental plate became loose, in one the hands became smaller, and in one shoes became looser; the visual fields were originally altered only in three of the eight patients, and in one of these the fields returned to normal, in one there was no change, and in the third a progressive hemianopia accompanied by erosion of the sella turcica developed during treatment; hyperidrosis and intolerance of heat, originally present in two, disappeared in both; finally there was loss of libido in three cases.

The estimation of the amount of neutral 17-ketosteroids excreted in the urine has attracted considerable attention, since the level of excretion (usually expressed as mgm./24 hours) can be fairly well correlated with the output of androgenic substances determined biologically (Callow et al., 1939a, b). What constitutes the normal range of daily output is still somewhat uncertain; 1.7 to 12.6 mgm. for females, 3.5 to 15 mgm. for males (Callow, 1939), 40 to 15 for normal women (Friedgood and Whidden, 1939), 4.3 to 21 mgm. (Chou and Wang, 1939), 3.5 to 14.6 mgm. for females, 9.4 to 20.4 for males (Patterson, McPhee, Greenwood, 1942) have been quoted. We have conducted investigations in a large number of cases of each sex in the last two years, and have come to regard 6 to 15 mgm. daily as the range for normal adults, females as a rule being lower in the scale than males; after middle age a somewhat reduced output is to be expected. It has been suggested (Patterson et al., 1942) that among normals higher values are related to larger body size, but we are unable to confirm this.

During the past three years some clinical applications of corticotrophic hormone have been studied, and in this paper is described a form of involutional melancholia in which hypopituitarism and secondary hypoadrenalism are factors. Nine such cases were treated with corticotrophic hormone; in addition two cases of pituitary cachexia in young women were similarly treated.

G. A. Levvy in 1940 (Biochem. J., 34, 73) published from the Department of Pharmacology, University of Edinburgh, a new method for the estimation of barbiturates in blood, claiming that his technique gave results accurate to a 20 per cent. error or less for quantities of 1.0 mgm. or more in 20 c.c. of blood. After studying this method at first hand we have carried out a number of estimations in cases undergoing prolonged narcosis with somnifaine, and studied the blood levels of barbiturates in patients under medication with soluble barbitone and phenobarbitone, a total of 200 estimations having been made.

It is now generally agreed that a fuller understanding of psychotic conditions associated with alcohol can only be achieved by taking into account the whole of the psychosomatic make-up of the individual, rather than by emphasizing any specifically poisonous properties of alcohol.

Meduna introduced the cardiazol treatment of schizophrenia, following an observation of the supposed rarity of the coexistence of epilepsy and schizophrenia and an observation of improvement in two schizophrenics who developed convulsions. Since then other drugs akin to cardiazol have been introduced, and recently electrically induced convulsions have been tried. It is generally agreed that there are certain complications and many objections to the use of cardiazol as a convulsant. Extreme apprehension and fear of treatment are present in almost every case. In some cases the patients' apprehension is so great that they decline treatment, saying that their dread of it makes them worse. It is a great obstacle preventing co-operation in the treatment. The other complications are the dislocation of the jaw, shoulder or hips, fractures of the arms or leg, sometimes the thigh, fracture of the spine and decalcification; cerebral haemorrhage and rarely lung abscesses and embolism have been reported.

By thiocyanate compounds is meant a group of salts of thiocyanic acid (HCNS). Together with compounds of glycuronic and sulphuric acids, these salts are products of several detoxication processes. In the urine they are the end-products of the detoxication of substances formed during the breakdown of protein.

The evaluation of suicide varies with the number of specified aspects employed. Yet none of them is able to offer a predictability of the suicide. Psychiatry acknowledges the fact that suicide is a non-specific symptom, accompanying certain mental disorders, and consequently uses precaution without selective prediction. Psychopathology looks upon the suicidal individual as one who identifies himself with his love object and directs reproaches and aggression against the introjected love object; in the suicidal act he kills the introjected person (Schilder). This only gives the structure analysis of the individual case, and the prediction “the greater the aggression the greater the danger of suicide” does not enable a generalized predictability. Sociological studies offered explanation for statistical coincidences (Durkheim) but failed in construction of a prediction.