The deep pleasure with which I received the invitation to deliver this lecture was tinged with dismay, for as a physiologist I am only too frequently reminded that the contributions which psychiatry has received from physiology are, in fact, almost negligible. I was therefore bound to ask myself very seriously whether I could honestly accept the honour without committing myself to stray far beyond the confines of my own subject. Finally, I satisfied my conscience by deciding that the invitation was issued in the spirit of hope rather than satisfaction, and I trust that I shall not be misinterpreting the intentions of this Royal and learned body if I feel encouraged to develop a speculative rather than a purely empiric theme. My aim is to outline the manner in which the study of brain physiology may conceivably enable us to define the physical parameters of mental experience, and the title which I first suggested for the lecture was “The Frame of Reason.” Vivid though the image may be for me, I admit that the more laconic title is better, for it does at least give us a landmark and a limit to our exploring.

There is still no agreement on the aetiology of schizophrenia, or general acceptance of its definition as a “functional psychosis.” There is agreement only on the complexity of the problem presented by an illness which involves every aspect of the personality, and is precipitated by a multiplicity of internal and external causes. This complexity suggests that an approach from many angles, clinical, genetic, sociological, statistical, or even a more remote biological or physiological approach may yield some information of value.

Prefrontal leucotomy as an operative method of treatment for mental disease greatly stimulated research into the functions of the frontal lobes. The operation was a direct result of the observation of Fulton and Jacobsen (1935) that rage reactions seen in monkeys in the course of increasingly difficult experimental tasks do not occur after extirpation of the frontal lobes.

There has recently been a plethora of new methods of psychosurgery. This has, we believe, created considerable bewilderment in the minds both of the clinical psychiatrists who have to decide which of the methods to choose and of the neurosurgeons who have to practise them. The aim of the present paper is to clarify and disentangle the situation as far as this can be done from the anatomical angle.

From time immemorial man has tended to classify his fellow beings into physical types associated with specific disease susceptibilities or characteristic mental or moral qualities. The ancient Hindus described three types of human physique likened to the elephant, the bull and the deer. Hippocrates formulated a dichotomy in build with a narrow type, the habitus phthisicus as one extreme and a broad type, the habitus apoplecticus, as the other.

1. It may be well to begin by delimiting the term psychotherapy; to me it has two aspects:—

(a) It is a procedure of verbal interchange between patient and doctor in which the phenomena presented by the patient to the doctor during interview are interpreted by the doctor to the patient—to the end that the patient's mental pain shall be relieved (by the interpretation) and he shall have an increased understanding and mastery of the impulse-laden, unresolved, emotional conflicts in his own personal past experience, and a better insight into his own personality.

This study is part of an investigation into the physical and mental status of a small series of patients with duodenal ulcer undertaken at Guy's Hospital. Each patient in this series had a routine biophysical and biochemical investigation, a clinical interview and the Rorschach test. In addition, information about the patient was gained from other sources, such as his relatives and employer, and his behaviour while in hospital was kept under review. In a majority of the patients examined, phases of activity of the ulcer dyspepsia were correlated in time with crises in the patient's personal life. The Rorschach patterns from the records of these patients are presented here for comparison with those found in other disorders, and for the assessment of certain features common to this series.

In a previous paper (Early, 1946) I reported and commented on the preliminary mass radiography survey in the Bristol Mental Hospital in December, 1944. Each year since then the entire patient population has been subjected to mass radiography and in this paper the results of this work will be reported.

It is perhaps not too fanciful an analogy to compare the expanse of psychiatric symptomatology to an expanse of sea scattered with a small and determinate number of islands.

Concentration changes of blood constituents other than glucose occurring during hypoglycaemia, and particularly during insulin shock therapy, have been studied by several authors (e.g., Harris, Blalock and Horwitz, 1938; Katzenelbogen et al., 1939) though not always with concordant results. One of the most constant features of insulin hypoglycaemia is a decrease in the level of inorganic phosphate during the phase of blood-sugar fall and a gradual return to normal after the blood-sugar curve has reached its lowest value. This fact which was described soon after the discovery of insulin (see Cori (1931) for a review of the older literature) is generally attributed to the increased phosphate esterification consequent upon the enhancement of glucose utilisation and is in harmony with the current concept that the function of insulin is primarily that of a promotor of glucose phosphorylation.

This paper is chiefly concerned with the recent developments in industrial selection techniques at these works. However, below its chocolate covering, I hope you will find that its centre, although still recognisably confectionery, contains ingredients, varied in origin and possible other use, possessing, if properly masticated and adequately digested, fundamental values not specific to chocolate.

I am deeply conscious of the honour you have done me in asking me to serve as your Chairman for the coming year. I feel this promotion is somewhat premature and that there are others better qualified for this responsible task. But I bow to your wishes and will do my best to serve you.

I carried out 2,443 treatments by electro-narcosis on 152 patients, between 29 January, 1948, and 19 February, 1949, without fatality, and without any adverse personality change attributable to the treatment. Of these patients 105 were schizophrenics, whose treatment was completed before 29 January, 1949. This series alone is considered in detail here, but the experience gained from the treatment of the remaining patients is taken into account, especially in relation to difficulties and dangers.

In a previous article (Rudolf, 1949) an account was given of the results of treatment of 90 defectives with 3 mgms. of aneurin daily for a period of six months. The patients had been resident in Hortham Colony for periods of from 3 to 17 years. None had shown any improvement for at least one year prior to the beginning of the treatment.

Although one of the important objects of a mental deficiency colony is the return of patients to the general population, the number of cases on licence, or discharged from the provisions of the Mental Deficiency Acts, is not an accurate indication of the improvement-rate. Cases proceed on licence because their behaviour is sufficiently satisfactory for the houses to which they go. A defective may show no change whilst in the colony, but the environment to which he goes may be better than that which he left before entering the colony. Alternatively, the defective may return to the same home circumstances which he left, but he may have improved. All gradations of combinations of change of environment or of defectives occur.

Fifty years ago in a discussion on the pharmacology of cannabis indica, Dixon (1899) said, “Hemp therefore exerts its effect differently according to the preparation used … In fits of depression, mental fatigue, nervous headache, and exhaustion a few inhalations produce an almost immediate effect, the sense of depression, headache, feeling of fatigue disappear and the subject is able to continue his work feeling refreshed and soothed. I am further convinced that its results are marvellous in giving staying power and altering the feelings of muscular fatigue which follow hard physical labour … It is to be feared, however, that cannabis indica can never become popular until its active principle has been isolated, that is, the isolation of a compound of fixed strength.”

Concurrence of the above-named symptoms does not appear to have been reported in the literature. Congenital double athetosis and deaf-mutism usually occur independently of one another. Out of about 1,500 patients at this institution there are 14 with the former condition and 25 with the latter. The relation of the syndrome to its chief constituents may be clarified by a preliminary account of this larger context out of which 3 of the 5 cases here reported are drawn.

This paper is concerned with two schizophrenic patients showing unusual complications of Sakel's insulin coma therapy. The first had a series of attacks of spontaneous hypoglycaemia apparently uninfluenced by the temporary withholding of insulin; the other developed diabetes mellitus a short time after finishing his treatment.

Results of a previous investigation of manic-depressive psychosis with a continuity of cycles of short duration (Klein and Nunn, 1945) seemed to justify further study of this group. As such cases suitable for investigation are rare, we are again reporting observations on a single case, although the cycles were not as short and regular as in the earlier case. The patient at the time of his last admission to this hospital (in 1944) was aged 40, married, had a healthy child of 16, and was an employee of a tobacco factory. He was said to have been always very quiet and reserved, and had no history of mental illness before joining the Army in 1941. He went to the Middle East in July, 1942, and began to feel listless, tired and sleepless for the first time at the beginning of 1943. After spending four weeks in a military hospital he still felt low on returning to his unit, but soon afterwards was full of life; in his own words, “I could tear anything down.” A fresh period of depression set in later, and he was sent to a military mental hospital for six months, during which time he apparently changed several times from a depressive state into a manic one in which he felt “overstowed with vitality,” “with the energy of ten men.” From this hospital he was returned to England and invalided from the army in October, 1943, at which date he first became a patient in this hospital. An initial depression of about three weeks was followed by a manic condition, and on becoming more settled he took his discharge (at the beginning of December, 1943). In February, 1944, he was readmitted in depression, but went out again whilst in moderate mania in April. Whilst at home he continued his work in the factory, but in September, 1944, was once more admitted to hospital and has since remained. From the latter date till October, 1948, depressive periods have alternated with manic conditions. Wide variations have been noted in the duration of the two phases; at the beginning of the observation period of 21 cycles the manic state lasted longer than the depression, whilst in the last year the reverse was usually true. Manic periods varied between one week and 35 days, with an average of 18 days, while the variation shown by depressive phases was between 6 and 24 days, with an average of 13 days.