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.

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 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.

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.

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?

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.

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).

Although much work has been done on the physiological concomitants of affective states, nothing is known of any objective bodily changes accompanying thought processes, and yet the most superficial observation of lip, facial and eye movements, of unconscious gesture and restlessness furnishes indications of some of the more obvious somatic accompaniments of non-emotional mental activity.

The range of psycho-pathological conditions for which the term “fugue” has been used has increased considerably and is still increasing. Originally the term was chosen to denote transitory abnormal behaviour characterized by aimless wandering and more or less marked alteration of consciousness, usually but not necessarily followed by amnesia. At present it is used for a variety of different symptoms, some of which have little in common; the psychiatrist using the term has to define what kind of fugue he means if he wishes to avoid misunderstanding and confusion. The reasons for the great popularity of the term are manifold. It is short, handy, vague, and has even a distinguished foreign flavour. But there are other reasons apart from those virtues. When the psychological mechanisms underlying abnormal behaviour were first studied two were regarded as responsible for the origin of fugues: dissociation and escape. From that time dates the tendency to describe as fugue nearly every condition of transitory alteration of consciousness which can be understood as the result of those mechanisms. Thus a remarkable change of conception has taken place; while the term “fugue” originally described a certain type of abnormal behaviour characterized by running away and wandering under a strong impulse and associated with clouding or narrowing of consciousness, it later came to be used, in addition, as the description of various results of the psychological mechanism of escape, without regard for the resulting behaviour. Obviously the fact that fugue means escape invited that change of conception. Considering the grèat number of neurotic and psychotic symptoms in the origin of which the two mechanisms mentioned above are supposed to play a part, there are hardly any limits to the use of the term. It is not intended to survey the whole literature on what has been called fugues; a few instances from current text-books and recent articles will demonstrate for how many conditions the term has been used in recent years.

Re-examination of the various problems arising from psychoses following childbirth is of interest for various reasons. Firstly, their place in the system of psychiatry is far from clear; their original description under the term “puerperal insanity” (Kraepelin) had given rise to the idea that they represented a clinical entity. According to Kraepelin the great majority of these psychoses take the form of catatonic states and only a few are of the manic-depressive group. More recent investigators, however, have shown that there is no psychotic reaction peculiar to childbirth (Clarke, Kilpatrick and Tiebout, Zilboorg, Saunders, James, Strecker and Ebaugh, Harris, Karnosh and Hope, and Piker). In these contributions the importance of the accompanying environmental and sociological factors has also received consideration.

In the early days of convulsion therapy many chronic psychotics were treated by this method in the hope of effecting a cure. While temporary improvement was achieved in most cases, results were disappointing, owing to the rapidity with which relapses occurred. With cardiazol as the convulsant, various complications, such as sclerosis of veins, tachycardia, vomiting and, most of all, aversion to the treatment on the part of the patient made its continued repetition impracticable.

The case about to be described showed during the 18 months when she was under close observation certain remarkable pathological endocrine features. These, viewed together and in retrospect, throw considerable light on the relationship between pituitary function and so-called anorexia nervosa, and introduce a broader conception of the latter somewhat misleading designation.

In the development of involutional melancholia a variety of causes have from time to time been implicated, ranging from glandular upset of ovarian or pituitary origin to the stress of air-raids. In the bulk of cases the pathogenesis would appear to depend on the interaction of a constellation of predisposing and precipitating factors. In the present study a tentative attempt has been made to indicate a possible ethnic element in the aetiology of this psychosis.

In the treatment of involutional melancholia the administration of oestrogenic substances has for years been a feature. The results achieved with this form of therapy have varied, some workers claiming unqualified success, and others recording no change, or even deterioration in their patients.

As a rule, in hospital practice there’ is little urgency for a rapid diagnosis in idiopathic epilepsy to be effected, and doubtful cases can be submitted to prolonged observation until an actual seizure has resulted. There are, however, certain occasions when the necessity arises for the establishment of a definite diagnosis as early as possible. In the average hospital case, the period of observation necessary will be a matter of days or, at the most, a week or so, but in cases of irregular seizures at infrequent intervals, this period may have to be extended into months before any opinion can be offered. It is with a view to curtailing this period of observation that an attempt has been made in this investigation to determine a method whereby the condition can be diagnosed with a degree of certainty in the absence of seizures.

Since the introduction of the electrically induced convulsion by Cerletti and Bini the history of this procedure has become too well known to record again; but certain clinical data have come to light that are worth noting, of which the most important is the now recognized fact that this treatment is of more value in the affective psychoses than in schizophrenia, for which it was early introduced. Most writers, e.g., Elfield, Metcalfe and Paul, are agreed upon this, and it would therefore seem worth while to examine the results of this therapy in one hundred such cases. Depressions are so much commoner than manias that it would take a long time to collect a sufficient number of the latter for reliable conclusions to be drawn. These remarks are thus confined to the depressive states.

The Takata reaction has hitherto been mainly applied as a serum protein test and has been claimed useful in the diagnosis of liver disease.

It has been modified and applied to the cerebrospinal fluid (Takata-Ara (1)). Preliminary investigators found positive results in syphilis of the central nervous system, and it was thought to be a characteristic of this condition. Subsequent workers, however, found that organic conditions other than neuro-syphilis produced similar positive reactions, with the result that the test fell somewhat into disrepute. Now, however, it seems to be established that the test is indicative of a change in the albumin-globulin (euglobulin) ratios in the cerebrospinal fluid. This condition is mainly found in syphilis of the central nervous system, but occurs, of course, in other conditions affecting the central nervous system, especially where degenerative processes are involved.