I have been fortunate in having the opportunity of studying several of the 15 patients treated by prefrontal leucotomy in connection with the Burden Neurological Institute. I do not propose to discuss the clinical results; it is much too early as yet for any authoritative opinion to be given, and a brief review of the literature and of the early results of the first 8 cases in this series was recently published in the Lancet. It may be mentioned, however, that the results are such as to justify the cautious adoption of this operation for therapeutic purposes. Although obviously any procedure of this kind is only justifiable on therapeutic grounds, its value for psychological medicine is far more than the mere addition of another effective therapeutic method, since for the first time in history an opportunity has been presented for the study of changes in personality produced by a relatively standardized local lesion of the brain, enabling us to investigate as never before the role of the frontal lobe in normal and abnormal mental states. This investigation involves the study and correlation of both neurological and psychological data, and encounters all the difficulties inherent in such correlation.

I am only too well aware of the extremely hypothetical nature of much that follows, and of the crying need for experimental evidence to confirm or refute the view here propounded, but I believe that our knowledge of mental disorders would be immeasurably advanced could we but discover the rationale underlying our present empirical methods of therapy.

The operation of prefrontal leucotomy first performed by Moniz (1) in 1936 in Lisbon will be by now more or less familiar to most psychiatrists, on paper if not in actual practice.

At first sight the operation would appear to be a revolutionary proceeding; and so it is in some ways. It is, however, no more drastic than the convulsion or insulin treatments in which the patient is near enough the line which separates life and death.

This paper is devoted to investigations into the resistance of the skin to a direct current, measured daily in normal and mental subjects. These investigations arose out of special studies in the endocrinology of mental disease, and revealed some correlation between the diurnal resistance and endocrine functioning.

The resistance of the body to the passage of a direct current is not a true resistance, being a complex phenomenon in which ohmic resistance and polarization are concerned. It has usually been referred to by other workers as the DC resistance of the skin, and has been expressed in ohms when measured with the type of apparatus used in this study. With apparatus of this sort, various workers have reported fluctuations. In this paper, although fluctuations are referred to as changes in diurnal resistance, they are in reality an effect, and not in the strict sense a resistance change. It is with the alterations in this effect in a variety of psychiatric and endocrine conditions that this paper is concerned.

The measurements described in Dr. Hemphill's paper are nominally of resistance to a direct current, but in view of the well-known variations in resistance according to the frequency used, it seems most probable that the actual phenomena reported are due not only to changes in resistance proper, but also to fluctuations in the E.M.F. generated by the superficial tissues, as a result of the small steady polarizing current used in the Wheatstone bridge circuit.

The strong association between psychosexual anomalies and mental illness was first brought out by the work of Krafft-Ebing (1902) and Freud (1905). Freud (1911) demonstrated the existence of a latent homosexual element in the structure of the paranoid reaction. He also held the view that, to some extent, every person is psychologically bisexual. A preponderance of instincts concordant with physical attributes of sex, however, would be expected in normally developed adults. The experimental analysis of masculine and feminine traits, carried out by Terman and Miles (1936) with an attitude—interest test, led to conclusions which were in accordance with this viewpoint. Terman and Miles were also able to show that frankly homosexual males and females had mental preferences which corresponded with those of the simulated sex. Thus, from the psychological standpoint, sex is a graded character with a bimodal overlapping distribution. That is to say, although most males and most females have mental attributes which are in agreement with their sexes, many also are mentally intermediate and lie between the two normal modes. Furthermore, some are excessively masculine, some excessively feminine, and a few, who can be said to be “inverted,” possess mental attributes, which belong normally to the other sex. No mental disability has so far been shown to be associated with excessive mental masculinity or femininity, though Terman and Miles found that “supermales” were, on the whole, poorly developed physically. On the other hand, a marked degree of sex inversion is known to be unfavourable to mental stability. Indeed, a significant trend towards sex inversion as measured by the Terman and Miles test has recently been demonstrated by Bosselman and Skorodin (1940) in psychotic patients. A somewhat similar result was obtained by Neal and Penrose (1941), who used a classification test.

Hitherto two methods have been commonly used to measure dementia—by means of numerical measures of scatter, and by means of the discrepancy between scores on vocabulary and other tests. In the present investigation the value of the most popular techniques with both methods was examined, and a new short measure of dementia was evolved.

Subjects taking the Stanford Binet and similar tests rarely pass abruptly from complete success at and below a certain M.A. level to complete failure at the next and subsequent levels. For example, a subject with a total M.A. of eleven years may succeed in all the subtests at and below the VIII year level and fail all the subtests above the XIV year level, while between these two levels he succeeds in some and fails others. The range of partial success and failure is called the “scatter.” Many psychometrists believe that unusually wide scatter indicates psychopathy or intellectual deterioration. The various methods for measuring scatter are conveniently summarized by Harris and Shakow (1937).

A long-standing observation on the results of intelligence tests in dementia is that vocabulary ability remains comparatively unimpaired until a late stage when the subject is unable to solve other tests. Therefore, it has been claimed, vocabulary score may be taken as a measure of the subject's pre-morbid intelligence, and the discrepancy between his vocabulary ability and ability on other tests as a reflection of the difference between his former and present intelligence, thus providing a measure of his dementia. The Babcock test is the best known of several techniques, based on this principle, for the measurement of dementia.

This paper is concerned with a group of cases presenting certain psychiatric symptoms following exposure to the detonation of a nearby high-explosive bomb. These cases show features and present problems which appear from the current literature in this country to have received insufficient attention, or none at all. The cases to be presented are not all of equal significance, but in each there are certain common features which, from the psychiatric angle, have a definite and unmistakable organic stamp, and indicate a relationship, direct or indirect, of the syndromes to structural changes in the brain. These symptoms are characteristic in fact of a slight or moderate degree of cerebral trauma. This relationship is prone to be too easily overlooked. The reasons for this are :

(1) The absence in many cases of a definite history of head injury.

(2) The absence as a rule of at least a long period of unconsciousness.

In consequence, when the patient is seen perhaps some considerable time later this possibility is not considered, and the reaction is dismissed as psychogenic. That this can be done even by trained observers was demonstrated in three of the cases about to be described. All the patients except one were Naval personnel who were exposed to blast in air-raids either ashore or at sea.

Partial agenesis of the olfactory apparatus or arhinencephaly is usually associated with other gross manifestations of cerebral malformation. The subject has recently been discussed by Stewart (1939), who described the rare variety in which absence of the olfactory bulbs and tracts constituted the main abnormality. Intermediate between this, the mildest form of arhinencephaly, and the cyclopian brain in which the endbrain fails to divide into hemispheres and cranial nerves other than the first are also affected, comes a transitional group in which a partial separation of the hemispheres has taken place and arhinencephaly is present in varying degree. The present case is an example of this intermediate variety, and owing to the rarity of the condition we have thought it worthy of record, though a lack of reliable clinical and post-mortem information somewhat reduces its value. The brain was found amongst a number at the Hereford County and City Mental Hospital.