I am proud to have become your President for the year, and I trust that your confidence in me will be justified by events. It is with some regret that I step into the place of your immediate Past President, and I am not willing to do so until I pay my tribute to his work as President of the Association. Together with your Honorary Secretary he has carried the Association through a period of great strain: he has left it with an enhanced reputation for, I might say, charm and sweet reasonableness. That is in tune with what we preach, and accords well with the beliefs of most of us who know that Psychiatry has a place on the map, and it gives to us an assurance of its value to the world of mankind.

Comparable with the misconceived diagnoses of shell shock (1) and D.A.H. (2) which were current in Army practice in the World War of 1914–18 were the terms Flying Stress (3), Aviators Fatigue (4), Aviator's Neurasthenia and the American Aeroneurosis (5), of aviation medicine. With all, a convenient label covered unjustified assumptions about pathogenesis.

In the following pages the use of electricity as an anaesthetic agent for man and animals is discussed. An attempt is made to assess the existing state of knowledge, but the issue is a complex one, and there are many gaps and contradictions in the story. Attention is later given to the now familiar use of electricity for the supposedly humane destruction of animals, in particular the pig, dog and cat, and these practices examined in the light of the reliable evidence.

The most important contribution the psychiatrist could make to the selection of officer candidates or of applicants for comparable leading or managerial positions would be the exclusion of potential neurotics. The Report on the Work of Psychologists and Psychiatrists in the services acknowledges and commends the contribution made by psychiatrists to the selection of officers in the Army; but evidence has not yet been published to enable the extent of their particular contribution to the efficiency of the whole procedure to be assessed in measured terms. Other services have not followed the example of the Army. The Admiralty and Civil Service Selection Boards, which were created after the War Office Selection Boards, and have adapted many features of the Army procedure for their own requirements, have decided against employing psychiatrists for this purpose; and the extent to which the War Office Selection Boards make use of psychiatric services for selection has been reduced. The effectiveness of existing psychiatric methods for this kind of work may thus be felt still open to some doubt.

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.

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).

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.

In the usual procedure of electronarcotic treatment, the electrodes are placed bitemporally and an initial electric current of 180 m.a. is applied for 30 seconds. During this period a tonic extension of the skeletal muscles occurs, accompanied by strong contraction of the pupils, which in the majority of cases are reduced to pin-point size. Slight convergence of the eyes may accompany the contraction. The contraction relaxes somewhat when clonus ensues, but usually becomes slightly more marked in the following stage when the electric current applied is between 60 and 80 m.a.

The subject of this contribution to the knowledge of reflexes is not the discovery of a new reflex or a new modification of an old one. On the contrary, the reflex at issue was described for the first time as far back as 1896 in the Lancet by W. Overend, who called it the “frontal reflex.” As has often happened with many other reflexes, it was overlooked and rediscovered many times after, and each of the authors gave to it another name. However, in spite of all these numerous contributions its practical clinical value remained of no importance, and it is scarcely mentioned in text-books dealing with nervous disorders.

Tashiro (1922) showed that the isolated frog nerve liberates ammonia on stimulation, and Richter and Dawson (1948) have recently found that ammonia is liberated on stimulation by the brain. Ammonia is very toxic to the brain, on which it has an irritant action; but the brain may be protected to some extent by the enzyme system described by Krebs (1935), which can detoxicate ammonia by combination with glutamic acid to form glutamine. Sapirstein (1943) obtained evidence that this system is active in vivo by showing that glutamic acid increases the resistance of animals to convulsions produced by injecting ammonium chloride. The toxic action of ammonia on the brain is also of interest in connection with the view that it may be concerned in certain forms of epilepsy (Harris, 1945). This view is supported by the observations of Price, Waelsch and Putnam (1943) on the inhibitory action of glutamic acid on petit mal attacks.

The adrenal cortex is the pivot of the body's reaction to stress. To this gland converge most of the varied effects of shock and stress, and from this gland diverge the steroids which, in ways but partly known, enable the body to withstand the stress. No apology is therefore needed for a study which contributes to an elucidation of the actions of these steroids.

Electronarcosis is the term applied to a sleep-like condition produced by the passage of an electric current through the central nervous system.

The assessment of a patient's bodily habitus has now become an important part of clinical investigation in many medical fields.

Hydén and Hartelius in a recent monograph (1) described nerve cell abnormalities which they consider to be characteristic of mental disease. Their investigations were based on biopsies obtained during prefrontal leucotomy carried out in 11 psychotic patients, 10 of whom belonged to the schizophrenic group. The biopsies were investigated by means of the ultraviolet microscope and the results compared with brain material from normal patients fixed a few hours after death. Two types of abnormal nerve cells were found in the psychotic patients: one type is narrow and shrunken with corkscrew-shaped apical process and appears dark in the photographs in contrast to the other type which is swollen and appears light in the photographs. Both these cells lacked polynucleotides in their cell bodies and contained only a small amount of other protein substances, as shown by the ultraviolet absorption spectra.

Out of 95 leucotomy cases of which the brains and clinical records have been collected at this laboratory, 45 were cases with post-operative survival of over 5 months, and more than 20 of these showed some degree of clinical improvement. Such numbers now make worth while an attempt to ascertain whether or not any attribute common to the lesions is a prerequisite to clinical improvement; whether or not the degree of improvement tends to vary with any qualitative or quantitative feature of the lesions; and whether or not any such relationship between lesions and improvement which is revealed holds good in equal degree for each of the main types of functional-psychosis. Over 20 of the same 45 cases had a recorded post-operative change of personality, so that relationship of post-operative personality change to the leucotomy lesions can conveniently be investigated in the same group of cases. Only some general findings concerning the personality change will, however, be touched on in the present paper.

The operation of transorbital leucotomy recently described in the Lancet by Freeman (1948) was originally devised and carried out by Fiamberti in 1937 very soon after Moniz had introduced the original operation of leucotomy. Meyer, Beck and McLardy (1947) have shown that degeneration of the central portion of the pars parvicellularis of the dorso-medial nucleus of the thalamus was correlated with a lesion involving areas 9, 10 and 46 in the middle frontal gyrus. The transorbital method might now be said to follow almost logically on the work being done at the Columbia Presbyterian Medical Center and at the Greystone State Hospital, New Jersey, by a team of 96 (!) collaborators. Brodmann areas 9 and 10 and in some cases part of area 46 of the cerebral cortex are removed by an open bone-flap operation. This work is still in its infancy, and is not yet published apart from a summary by Nolan Lewis (1948). The entire project is to be described in a volume, The Human Frontal Lobe, to be published at an early date.

Although chess sets are usually to be found in the games cupboards of the male wards of a mental hospital, it is a rare sight to see two patients indulging in this game. Nevertheless, it may be a humiliating experience for any medical officer to challenge a patient to a match unless he is a fairly good player.