Since the introduction of leucotomy by Lima and Moniz in 1936 numerous authors have reported their experiences with this form of treatment in mental disorders (Freeman and Watts, Fleming, Mayer-Gross, Hemphill et al.). Although leucotomy has stood the test of time well, and all workers agree that in selected cases its application is well justified, so that it has become an established form of treatment, there are many obscure clinical aspects which require elucidation. It is obvious that the collection of observations from as many angles as possible is necessary in order to further research in this promising field. It is hoped that a report on the results of leucotomies performed in this Hospital will be a contribution to that end.

It is well known that occupational therapy plays an essential part in the rehabilitation of psychoneurotic service patients. The usual occupations are carpentry, arts and crafts, gardening, and the like. At Mill Hill E.M.S. Neurosis Centre, marked success attended a supplementary scheme wherein selected patients underwent four-week courses at a nearby technical institute in mechanical and commercial subjects.

Generalized xanthoma is a cholesterol disturbance of the cells, coincident with a normal lipoid content of the blood serum.

The case described involves the skull, dura mater, brain, pleura and gallbladder.

It has been said that when a psychiatrist is appointed to a general hospital the staff only by stages come to make use of his services. The first phase is that in which he is called upon to dispose of those patients suffering from severe mental illnesses, whose behaviour is disturbing to the rest of the ward. In the next phase he may be called upon to deal with psychotics and severe psycho-neurotics. The third phase comes when surgeons and physicians refer to him all those patients they have investigated for whose symptoms no organic basis can be found. A fourth phase is when the psychiatrist is asked to co-operate in the treatment of such psychosomatic cases as asthma, colitis and migraine—and in the last phase, when the psychiatrist has proved his worth, he may be asked to advise on the handling of patients suffering from “wear and tear diseases,” frank organic diseases, such as gastric ulcer and hyperpiesia (1).

Military psychiatry is a large subject with widespread ramifications. The general scope of the work at home has been well reviewed in J. R. Rees's paper, “Three Years of Military Psychiatry in the United Kingdom”; I need not, therefore, try to describe what he has described so well. Even in the overseas field, I must unwillingly avoid the fascinations of detailed discussion of the aetiology and treatment of “battle neurosis” in forward troops; there is already a wealth of papers on this subject, including the valuable symposium at the Section of Psychiatry of the Royal Society of Medicine last November, in which Palmer, Kenton, Craigie and Main took part. Kenton's contribution, being based on work in North Africa and Italy, outlines some of the experience on which my remarks to-day are based.

This paper deals with the presence of insanity and allied mental disorders only in so far as found in adult defectives. The subject of psychotic states in defectives during infancy and childhood seems to demand a separate treatment.

The Retreat is now 150 years old. Some of you, perhaps, come from hospitals older still. Bethlem, looking back over 5 1/2 centuries, might well wonder, “Why such a fuss about a mere 150?” But it is quite a respectable age, and all old people are fond of reminiscing, so will you indulgently allow this elderly gentleman, through me, to talk for a few minutes about his past life and his old friends, and will you forgive him if he seems to emphasize the triumphs, and gloss over the difficulties and failures? It has all been said before, we know, but we hope you will find something of interest in it.

Intracranial aneurysms are not uncommon, but those that are described are usually interesting because of the signs and symptoms associated with them. Aneurysms which have had evident leakages and yet, owing to their lack of neurological signs, are diagnosed from their symptoms as neurasthenia, effort syndrome or even malingering are fortunately rare. Correct diagnosis is important in these cases because of their medico-legal importance.

In recent years the mining industry as well as the miner himself have to an increasing extent become subjects for public discussion. In addition to problems of mechanization and industrial organization, the importance of the human element has found growing recognition, and an investigation into psychiatric disorders occurring in miners should form a useful contribution in this field.

It is likely to be contended that climatic conditions, jungle warfare, distance from home, long separation from wife and family, difficulties in obtaining leave in the United Kingdom, delay in the receipt of mail, close association with members of different races and problems in regard to evacuation contributed to the incidence of psychiatric illness in Burma. It will be interesting to note in due course, when the total figures of psychiatric casualties from all theatres of war are available, whether or not conditions in Burma were in fact relatively more productive of psychiatric illness than they were, say, in North Africa or Italy. Then only will it be possible to conjecture on the relative effects of one type of climate as compared with another, or jungle warfare as compared with desert fighting, and so on.

Innumerable attempts have been made to define pain by physiologists, by pathologists, by clinicians and by philosophers, who all see the problem from a different angle, and who discuss it each according to his own particular mode of expression and training. The distinguished writers of the past centuries devoted much attention to the subject of pain, but wrote largely on its origin and on the various types rather than on its actual nature.