The keen pleasure I felt when I was invited to deliver this lecture arose not only from the honour which it conferred, but also because it offered an opportunity to link again the lecture founded in Henry Maudsley's memory with the hospital which is the living witness to his wisdom and generosity. The first Maudsley Lecture was given by Sir James Crichton Browne, a contemporary and friend of Maudsley; the second was given at the Maudsley Hospital by Sir Frederick Mott, who had seen much of him during the last decade of his life. Since then very few of those called to give this lecture had had any personal contact with him, and it seems appropriate that now, a hundred years after Maudsley entered University College Hospital as an apprentice, when he has become for most of us a shadowy figure of the Victorian past, I should attempt to revive the memory of what he did during his life and consider how his work lives on after him—most of all in the hospital and school where I, and so many more, have the privilege of working. Before I do this I would like to recall that on the list of Maudsley lecturers there is the name of Edward Mapother, a man singularly close to Maudsley in temperament and outlook, who carried forward the Maudsley Hospital in the spirit of its Founder's intention, and who would have been ideally fitted, in the 1939 lecture entrusted to him, to deal with the theme I am entering upon; unfortunately the war and his failing health came between, and Prof. Mapother never delivered the lecture. Sir James Crichton Browne compared Maudsley with Mercier; I compare Maudsley with Mapother, and recognize that in each generation there are men of rare gifts, severe in self-discipline, with strong and consistent purpose, who, in psychiatry as in other fields, accomplish much good and leave behind a lasting memorial.

The endocrine system is one of the foremost links in the psychosomatic relationship, and its special significance in the study of mental disease needs no emphasis. Compared with our knowledge of the chemistry and basic functions of the hormones very little is known about their more intimate mechanisms of action. It has been possible to assign to some hormones the function of controlling the rate of specific metabolic processes, but whether they do so by a direct reaction with a component of one or more enzyme systems or indirectly by influencing the mutual accessibility of enzyme and substrate is still a matter of discussion. The latter mechanism would depend on a spatial organization involving membrane barriers, phase boundaries or similar discontinuities and, in fact, many hormonal effects which can be demonstrated in vitro with the aid of intact or sliced tissues disappear when the structural organization of the cell is destroyed. It is, however, well to remember that synthetic and other energy-consuming reactions were believed until recently to depend on the integrity of the cellular organization, but when some insight was gained into the mechanism of biological energy transformation and the function of labile phosphate bonds in these processes, it was possible to demonstrate many such reactions in homogeneous systems. Similarly, the interactions of hormones and enzymes may require the intervention of unstable mediators, and control of these factors might allow their reconstruction in cell-free extracts. In any case, it is more satisfying to account for the great specificity of hormonal action on the basis of a chemical reaction with specific enzymes than by a mechanism leading to predominantly physical changes.

It is commonly believed that heredity plays a considerable part in the determination of an individual's personality. If we accept the well-known definition of personality as “the integrated organization of all the cognitive, affective, conative and physical characteristics of an individual as it manifests itself in focal distinctness to others,” we might expect that much research endeavour would have been dedicated to the discovery of hereditary influences on the cognitive, affective, conative and physical characteristics of the individual. A certain amount of such research there has been, but its emphasis has been curiously lopsided; we have some studies into inheritance of physical characteristics, and numerous studies into the inheritance of cognitive characteristics, but there has been little worth-while research into the conative and affective sides of personality.

The purpose of this article is to illustrate the value, especially over the five colder months, of the peripheral vasodilator, benzyl imidazoline (Priscol, Ciba) in the care of the circulatory disorders of the aged.

In a previous article—” A Study of Mental Derangement in Africans “—the writer described primitive African culture, thinking and attitude to life, and the types of mental derangement seen in Kenya over a 5-year period, and endeavoured to explain the peculiarities in the incidence and nature of African mental derangement on the basis of cultural factors.

The following experiments on glutamic acid were carried out in view of the conflicting reports of Price, Waelsch and Putnam (1943), Waelsch and Price (1944), and Goodman et al. (1948) on its effect in epilepsy. A number of preliminary experiments were made which suggested that there was an apparent difference between the effects of glutamic acid and sodium glutamate. Such a difference does not appear to have been considered by most other investigators. It was decided therefore to try to determine whether a possible reason for the difference was the effect of the sodium ion on water balance, since this is known to be related to the tendency to seizures (McQuarrie et al., 1932, Swinyard et al., 1946, and Weinland, 1949). For comparison potassium glutamate was given in a way to be described below. The experiments will be reported under the following headings:

1. 1. The acute E.E.G. and clinical effects of intravenous sodium glutamate.

2. 2. The short term (one week) E.E.G. and clinical effects of glutamic acid, its sodium and potassium salts and a placebo.

3. 3. Longer term clinical effects in out-patients.

4. 4. Biochemical studies of the blood and urine levels of glutamic acid by paper chromatography of 7 epileptic patients and 5 non-epileptic control subjects, including salt and water balance studies of patients and controls.

Holzinger set up his equations to show the combination of the factors—nature (A), nurture (B), and error(E)—which go to make up a score obtained by a particular twin on a particular test. If iX1 and iX2 are the twins in an identical pair and fX1 and fX2 are the twins in a fraternal pair then: —

Effects of substances on the respiration of unstimulated portions of mammalian brain have been used in the past as aids to understanding or suggesting their actions on the brain in vivo. The present paper gives data with respect to glucose and glutamic acid, which show some of the limitations of such interpretations. It also describes the application of new experimental means of examining the metabolic effects of added substances in relation to the functional activity of the brain.

Mental deficiency and its synonym “oligophrenia” are terms interpreted very differently in various countries; this has made it almost impossible to compare the statistical data of these countries. The concept the lay person in this country has of mental defect applies with few exceptions to individuals with intelligence quotients below 60 per cent., i.e., idiots, imbecile and obvious simpletons. When a person with this conception of mental defect—and we must admit that it corresponds fairly closely to the legal interpretation of the Mental Deficiency Acts in this country—is told that mental deficiency is a major social problem, the statement is received with some measure of incredulity. There is some justification for this incredulity. The statement is ambiguous and is based upon some rather muddled thinking. If we accept this legal and administrative interpretation of mental defect only about 1 per cent. of the population can be said to be mentally defective. Probably no other 1 per cent. of the population has such a high proportion of decent, docile and law-abiding citizens. If so, what meaning can we give to the statement that mental deficiency is a major social problem ?

In 1933 Potter expressed the opinion that a careful psychiatric study of patients in institutions for mental defectives “might demonstrate that schizophrenia in children is not as rare as is now generally believed.” Similarly in 1938 O. Lay wrote: “It is possible that many cases exist in institutions for the feebleminded, in which the disorders have been assumed to have existed from birth, and that a close examination would reveal that in the earliest years the patient's development was normal.”

Modern psychiatry has developed in Western Europe, largely under French and German aegis, and latterly in the United States. It is pertinent to ask, since it deals with human behaviour in all its variety, if the concepts, working principles and empirically derived conclusions of psychiatry possess universal validity, wherever it might be practised. As one instance of the influence of cultural environment on psychiatric symptomatology (and also psychiatric practice), we may point to the “hysterogenic points “so often found in French hysterics by the Salpêtrière school of neurologists, who could provoke an hysterical attack or sometimes abort one by pressing on these points. Just across the Channel in England, among English hysterics, these phenomena could not be reproduced; they were, of course, special features of the disease, exhibited only in the atmosphere created by Charcot and his colleagues at that period. The psychiatrist in cultures farther removed from the civilization of Western Europe may well have reason to pause and ask if the principles and practice of orthodox psychiatry possess the same degree of truth or usefulness elsewhere than in Western Europe or America.

Three is no branch of neuro-surgery in which the assessment of results is more difficult than in psycho-surgery. The main sources of uncertainty are:

1. (a) Mental impairment or improvement cannot yet be measured as precisely as neurological disorders, such as visual field or motor defects.

2. (b) Spontaneous recovery and the influence of the incidental psychotherapy and drugs involved in any form of surgical attention cannot be evaluated with certainty in many cases.

3. (c) Most of the cytoarchitectural fields of the frontal cortex cannot yet be defined during life by any physiological test or anatomical measurement.

4. (d) Finally, from a technical point of view the surgeon is liable to produce many incidental lesions which cannot be ascertained during the patient's life.

The possibility of using the Rorschach test to predict outcome of insulin coma treatment of schizophrenia has been investigated by Piotrowski (1938, 1939 and 1941).

This paper is based on 66 child guidance cases. Children under 7 years were excluded because my Rorschach experience with them is too slight. All had psychotherapeutic treatment, mainly analytical, some had purely permissive play therapy, some combined this with analytical treatment. A few were treated indirectly through therapy of the parents. I have included some adults, parents of clinic cases, and one teacher.

Phenylpyruvic oligophrenia is a syndrome in which mental deficiency is accompanied by the excretion of phenylpyruvic acid in the urine.

It was noticed that, during the performance of the Kohs Blocks Test, a few patients would in some cases make the model correctly, but misoriented. Illustration i gives an example of such a phenomenon. The patient had to reproduce the design shown with four Kohs Blocks. His reproduction is shown. The pattern has been correctly reproduced, but has been misoriented by 45°. The pattern was never in fact misoriented to a greater extent than this.

The widespread use of group treatment as one of the modern methods of psychotherapy has provided us with an opportunity to study psycho-social phenomena in a fairly uniform social setting.

Written language is a complex function; being built on the spoken word it has to draw on a variety of subsidiary functions which have to be unified in one particular skill. Moreover, the subsidiary functions are not the same for reading and writing; in reading, visual-gnostic factors are of major importance, in writing, special skill of hand and finger is required.