The following report is based on 150 men treated in hospital, and 300 patients, 50 of whom were women, seen at a diagnostic and advice centre.

As a rule, stresses and precipitating factors were more obvious or easily discoverable than in civilian life, adverse situations were more superficial, diagnosis and treatment were easier. Anyone who has conducted civilian clinics finds the change-over comparatively easy. Nevertheless, much of what follows is applicable to civilian work.

Paranoid delusional reactions have seldom been reported in chronic encephalitics, in contrast to the commonly occurring schizophrenia-like reactions. Apart from the cases described by Kwint (1), Ostmann (2), McCowan (3, 4), and a reference by Neustadt (5) to an undescribed case, there seem to be few, if any, references in the literature until a recent paper by Brody and Freed (6) describing a case where obsessive ideas became temporarily converted during oculogyric crises into a paranoid condition. The present case therefore seems worth putting on record, the more so in that the patient's unusual intelligence helped to throw some light on the relationship between oculogyric crises and post-encephalitic mental disorder, a subject which has been discussed by Stern (7), Jelliffe (8), and more recently by Wexberg (9) and by Brody and Freed (6).

“No man will be a sailor who has the contrivance enough to get himself into a jail, for being in a ship is being in a jail, with the chance of being drowned.”—Dr Johnson (1759).

The history of electro-encephalography contains both triumphs and disappointments. The most profound of the disappointments is the relative failure to elucidate any of the important problems which concern the psychiatrist. It was hoped that some real electro-physiological alteration would be seen in patients whose mental condition suggested something bordering on the organic, but the negative findings even in the most profound mental disorders are almost as striking as if they were positive. Before considering the published work it would be well to review in a few words the nature and significance of electro-encephalographic records.

In recent years important additions to the knowledge of the symptomatology in cases with involvement of the parietal lobe have been made. Both constructional apraxia (Kleist, 1922) and Gerstmann's syndrome, consisting of finger-agnosia, disturbance of right-left orientation, agraphia and acalculia (1924) have been related to lesions of the angular gyrus of the dominant hemisphere. Before the description of those symptoms, a loss of spatial orientation had been described in cases with lesions of the same localization. Balint (1910), Riddoch (1917), and others had observed that symptom in single cases, but the most comprehensive description was given by Gordon Holmes (1918), who studied it in a case-material of war injuries. When Holmes and his co-workers published their observations, constructional apraxia and Gerstmann's syndrome were still unknown. Loss of spatial orientation as a fully developed symptom is rare, while the other two disorders are not uncommon. For this reason the psychopathological relationship of those symptoms is still insufficiently understood. The following case offers an opportunity for studying the problem:

The case about to be described presented a problem of some complexity in neurological diagnosis. The attempt here made to unravel the problem is set forth with the full realization that some quite different explanation may be the true one. The true explanation, however, is incapable of proof and the view offered here is only suggestive, though of some interest because of the rarity of lesions of the superior cerebellar peduncle in man.

Biochemical research has continued in spite of the war and considerable advances have been reported during the period under review. While the task of applying this new biochemical knowledge in the field of psychiatry has hardly yet begun, the underlying chemical mechanisms concerned in nervous activity are becoming considerably clearer and a few beginnings in this direction have been made.

A state of vitamin deficiency arises (i) when inadequate amounts of a vitamin (or vitamins) are ingested, (ii) when absorption from the alimentary canal is defective or interfered with, (iii) when storage mechanisms are at fault, e.g. liver disease, and (iv) when the tissue cells themselves are unable to utilize the vitamin (i, 2). With war rationing the first factor is likely to be commoner than heretofore, especially in alcoholics (3), patients maintaining a strict “peptic ulcer diet” over long periods (4), diabetics (2), mothers sacrificing their rations for the family, food faddists, and in people living alone and doing their own cooking (5). Nowadays many exist on a “borderline” diet, in whom any stress such as pregnancy, infection, surgical procedure, fracture, hyperthyroidism, etc., will precipitate a deficiency state; moreover, in chronic gastro-intestinal disorders the available vitamins may be lost or destroyed (6-14).

This condition, in which severe confusion, disorientation, and restlessness are the principal features, appears to have been first clearly described by Bell (1845), who noted that about 2½ per cent. of the patients admitted to his asylum showed a particular syndrome: they were normal people who were admitted after about a week's acute illness; their appearance and speech suggested fever and delirium like a typhoid state; understanding was limited; they were apprehensive, with distressing but confused delusions; they disliked and suspected their food, and were not sensible enough to be thirsty; they tried to get out of bed, were sometimes violent, and struggled strongly when held. The course of the illness was rapidly downhill, but about a quarter of the patients suddenly made a complete and permanent recovery at the end of two to three weeks, the remainder dying in the same time. There were no specific post-mortem findings.

Two previous publications have been devoted to the behaviour of various reflex phenomena, and of the grasping phenomenon in particular, during the post-convulsive stage of the electrically produced seizures in man (1942, 1943).

This paper deals with eye movements in the shock procedure, and experiments planned to influence these movements.

In recent years our views of the interaction between the nervous system and the ductless glands have been gradually more defined. In the present review, for descriptive reasons the subject has been classified as follows with reference to the main elements of the neuro-hormonal inter-relation: (1) The influence of the nervous system on the pituitary itself and, through the pituitary, on the other ductless glands.

In recent years the scope of various physical psychiatric treatments has been defined more clearly. Broadly speaking, continuous sleep for acute and subacute anxiety reactions, electro-convulsive treatment for depressions, insulin comas for schizophrenia with or without fits, malaria for G.P.I., and so on. In 1941 my colleagues, Drs. Sargant and Craske, described a modification of insulin shock therapy for treatment of war neuroses in the Services. In 1944 we find the method maintaining its effectiveness, its indications more definite, its scope widened through trial in various psychiatric states, and checked by control experiments. From the 850 odd patients so treated at Sutton I have selected some 320 as the basis of this paper, whose courses of insulin I have given personally. The great majority of this number are civilians, and the forms of their illnesses do not differ materially from those familiar in peace time. In properly chosen cases the results are as satisfactory as with Service personnel. The treatment is free from the potential dangers of other physical methods.

Parotid gland secretion is one of the most easily observable manifestations of autonomic activity, and a study of the secretion of this gland should be helpful both in the elaboration of the theory of autonomic activities and perhaps also in practical diagnosis (1, 2, 3). Strongin and Hinsie have shown that whereas normal subjects secrete on the average.07 c.c. per 5-minute period, varying from 02 c.c. to .15 c.c., none of a number of manic-depressive patients studied by them secreted more than .01 c.c. per 5-minute period (4, 5).

Increased use of mental tests for the study of psychoses and allied disorders is conspicuous in recent psychiatric practice. This increase is most prominent first in the use of Rorschach's ink-blots; second, in the investigation of conceptual thinking with methods originated by Goldstein; third, in the study of psychometric pattern; fourth, in the diagnosis and measurement of intellectual deterioration; fifth, in assessing prognosis and the effects of treatment. It is partially attributable to sharpening of interest, due to the war, in the prediction of break-down under stress, in the stability and social potentialities of border-line groups, and in estimating the effects of head injury. Another factor is that popular modern treatments such as shock therapy and prefrontal leucotomy appear to involve cerebral areas intimately associated with intelligence. The greatest advances, however, have been made by the followers of Rorschach and of Goldstein and their contributions began before these factors arose. Their methods are also much applied in investigations under the fourth and fifth headings. Their influence, too, is discernible in a change now developing in the way of using mental tests. Whereas in most early investigations tests were used quantitatively as instruments for studying how intelligence level affects and is affected by psychosis, the modern tendency is to use tests not as measuring instruments, but as standard interviews or situations in which the quality rather than the level of the subject's behaviour is studied. On the other hand, perhaps it was growing recognition of the unsuitability of most quantitative tests for application to adults, and of the additional difficulties of interpreting results in psychoses, that first induced search for other techniques.