Periodicity as a phenomenon in nature has been known and studied from time immemorial, Astronomy and other sciences have built up a large body of knowledge which goes a long way towards explaining periodicity in the spheres with which they concern themselves. As it appears in the animal kingdom, however, the mechanisms underlying the phenomenon are still largely unrevealed. Of late years the hypothesis has been advanced that many of the periodic happenings in the human economy are subserved by the hypothalamus. Thus menstrual periodicity is held to be due to the hypothalamus acting in conjunction with the endocrine system. This paper is a small contribution to this hypothesis, maintaining as it does that the periodicity observed in certain psychoses is due to the influence of the hypothalamus on the prefrontal cortex. So far no similar report has been made in the large literature dealing with leucotomy and it therefore seemed worth while to give our results in some detail.

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.

We need no longer dally over theories of the mind-body relationship; we need not even speak of the integration of body and mind, for that integration is not just the combining of parts to form a whole; the unity of any organism has existed from its first beginnings, evolutionary or individual. Myers (13) and Russell (18), by introducing a concept of “the directiveness of organic activities,” have defined this essential and intrinsic unity even more cogently than the many other exponents of the same theme. The unicellular amoeba, at one end of the evolutionary ladder, has all the biological capacities of man at the other end. The fertilized ovum develops from within itself all the specialized parts and functions of the higher animals. The unity, then, has been there from the beginning. The complexity of man is not an integration, but is a delegation of functions. As Russell says, the directiveness and creativeness of mind are but a specialized development of the directiveness and creativeness inherent in all living matter.

In 1872 Wm. Ireland, of Scotland, attempted a classification of mental deficiency based on pathological conditions. His twelve group's were: Genetous, Microcephalic, Hydrocephalic, Eclampsic, Epileptic, Paralytic, Traumatic, Inflammatory, Sclerotic, Syphilitic, Cretinous and Deprivative.

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.

The Hospital System.—In all three Scandinavian countries there are two main types of hospital catering for psychiatric patients, the mental hospital proper resembling closely in its style and function the institutions of that name to which we are accustomed in Great Britain and the psychiatric clinic, a department of a general hospital. All three countries also have institutions for the mentally defective, Denmark and Sweden ones for criminal psychopaths and Sweden ones for the treatment of alcoholic addiction.

Allen's work (1, 2, 3, 4) in this series has dealt with the test performance of the brain injured and brain diseased patients. Results of the two groups on the Bellevue Intelligence Scale, Form 1, have been adequately reported both separately and comparatively. The purpose of this paper is to combine the two groups in order to analyze the test results as one group, i. e. encephalopathic group. The study of these test results includes an item analysis of subtest results obtained by this group, and a comparison of verbal with performance scores to ascertain a valid basis for scatter analysis.

Many authors, examining personality changes after brain injury, have observed that lesions of the orbital surface of the frontal lobes are more frequently accompanied by emotional changes than lesions in any other part of the cortex. Amongst others, Schuster (1902), Berger (1923), Kleist (1931) and Rylander (1939), have called attention to this fact, and experimental work by Fulton and Ingraham (1929) on cats has established confirmatory evidence. Freeman and Watts (1942), in their study of leucotomized patients observed that, if only the lower quadrants of the white matter in the prefrontal area were cut, the results of leucotomy were better than when the cut was placed in the upper quadrants only. Groups of cases, in whom only the lower quadrants were sectioned, have also been reported on by Dax and Radley Smith (1943 and 1946), Reitman (1946) and Hofstatter et al (1945).

Clinicians often assume, in a somewhat casual manner, that injury to the brain at birth has been the cause of this or that case of defect. Cerebral diplegia, hemiplegia, hydrocephaly and numerous types of cerebral maldevelopment have been attributed to this cause. Some American psychologists have tended to ascribe to birth injury every case of defect with plegia (Doll, Phelps and Melcher, 1932). Equally categorical denials of the influence of birth trauma in the aetiology of mental defects have been expressed (Berry, 1933). The decision between these opposing points of view involves the examination of some difficult questions. There are two rather obvious principles to be applied. First, any case in which birth injury is diagnosed must present symptoms or signs, which could reasonably be attributed to this cause. Secondly, a history of events at the time of birth must be ascertained and the evidence carefully weighed with a view to finding out whether conditions likely to produce injury were present. A third point to be kept in mind is that, even when proof of cerebral injury at birth is reasonably complete, the effect of such injury on the intelligence level has still to be assessed. In any given case of defect with a possibility of birth injury, we must ask ourselves what the intellectual level would have been in the absence of such injury.

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.

The close relation of aphasia to lesions of particular brain areas may be responsible for the fact that factors other than lingual in their effects upon aphasic reactions have long been neglected. Pierre Marie (1906) came to the conclusion that in true aphasia the defect in language is regularly accompanied by a general intellectual defect. This opinion found little recognition; his statement was too general, and was not found to be in agreement with clinical experience. Head (1926) made a more elaborate attempt to break with the traditional ideas when he introduced the conception of symbolic expression and formulation, and viewed the clinical pictures of aphasia which came under his observation from a more general angle. Goldstein (1924, 1926), in applying the Gestalt conception to aphasic disorders, brought the brain function as a whole into the picture. He found the basis of aphasie disorders in the inability of figure-background formation and categorical behaviour. Such extra-lingual factors have consequently been considered in the analysis of particular cases by several authors (Woerkom, 1925, 1931), Bowman and Gruenbaum (1925), Klein (1929, 1931, 1932). Demonstrated on two aphasic patients, they are also the subject of this paper.

During several years of service at Broadmoor and in the prisons the writer saw a number of cases of criminal paranoia, and was impressed by the importance of external situations in the aetiology of the psychosis. The purpose of this short paper is to draw attention to the environmental stresses to which some of these patients have been subjected, and to try to show that criminal paranoia may sometimes be a reaction to an intolerable and inescapable predicament.

The following article is derived from a preliminary report made by the. writer while attached to the Habitability Sub-Committee of the Royal Naval Personnel Research Committee of the Medical Research Council. The observations were made in India and Ceylon during 1945.

Psychiatric disorder, according to the recently published statistical report on the Health of the Army, constituted one of the most common medical causes of discharge of A.T.S. from the Army, and was among the most frequent causes of admission to hospital.

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.

Electronarcosis is considered in some places to be as good as insulin in the treatment of schizophrenia (1, 2, 3, 4). One publication on the subject emphatically states that electronarcosis is only equivalent to E.C.T. as a therapeutic measure (5). There is such a marked difference of opinion in these preliminary reports that one wonders if we are dealing with the same procedure.