The problem set for this paper was to find out how many children who attended the Child Guidance Clinic at the Hospital for Sick Children, Great Ormond Street, London, during and shortly after the war, showed nervous symptoms caused or aggravated by war experiences or war circumstances; further, to follow up as many of these children as possible to get a picture of the prognosis of such disturbances. One of the main aspects was to investigate the possible relations between type of trauma, set-up of the child, type of disturbance and prognosis.

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.

Those responsible for these lectures took their courage in both hands when they chose me to follow in the line of the eminent doctors and lawyers who preceded me. For I am in no way a Very Important Person. I held the lowest of judicial offices, though in my opinion one of the most important. But while emphasizing your courage, I want to assure you very sincerely that I am fully conscious that it is a great honour to be selected for this task. Indeed, I am somewhat overawed, but I can only try my best.

For the use of the term “affective disorder” there is good literary warrant. Shakespeare, writing in the last decade of the sixteenth century, or just before it, uses the word thus:

Electroshock therapy, first introduced to this country by Fleming, Golla and Grey Walter in 1939, has long passed its period of probation and is now universally accepted as active and effective. Yet its mode of action is still unknown. The variety of theories propounded to explain its action establishes only the degree of our uncertainty. To advance our knowledge of its mode of action has been the aim of the work described in this paper.

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.

The Children's In-patient Department of the Maudsley Hospital has now been running for two years, and currently accommodates twenty to twenty-five in-patients of both sexes. These range through severe organic disabilities, early cases of delinquency or behaviour disturbances and emotional or psychoneurotic problems. In the under fives there are a high proportion of acute disturbances of behaviour and habits. It is believed that our experience in developing this unit and discussion of our problems solved and still to be met will prove of value to other hospitals planning similar accommodation.

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.

It is perhaps of some small interest that the President of the Section of Neurology delivered last week in this building an address on “The Borders of Neurology,” and that for to-night I had chosen to speak on what is obviously a related topic, the “Tasks of Psychiatry.” It is, of course, possible that behind this choice of our titles there may simply be a geriatric problem, for the President of the Section of Neurology and I worked together as members of the same Field Ambulance in the Battle of the Somme, just over 32 years ago. On the other hand, there may be more than this in it, and perhaps we really do need to define our fields rather more clearly and to make sure what our tasks are, and how we are best to meet them. In fact, I think that the question of the actual borders of psychiatry, as apart from its tasks, was dealt with quite convincingly in the Joint Report of the Royal College of Physicians, the B. M. A. Psychological Medicine Group and the Royal Medico-Psychological Association.

This investigation is not concerned with the clinical indications or results of prefrontal leucotomy, but attempts to re-examine changes following the operation, especially in regard to the impairment of some of the manifestations of the highest integrative psychophysiological functions of the central nervous system that may bring about such alterations. Amongst these we were primarily interested in cognitive changes, but the interpretation of apparent cognitive changes led to the consideration of orectic alterations as well. Such changes have so far been impossible to localize exactly, but are considered to be partly related to the phylogenetically more recent parts of the cerebral cortex. Masserman (1946) compared the mechanism of shock treatment and leucotomy with the effects of alcohol and states that “its main actions are those of a cortical depressant,” as manifested by impairment of finer perceptions and discriminations and a “constriction of the integrative field.” He believes that shock therapies and leucotomy partly produce their results by temporary or permanent decorticating effects, “rendering the individual no longer capable of fine spun fantasies or elaborate delusions.” These decorticating effects can be assumed to be reflected in cognitive, conative and emotional alterations following the operation. The interpretation of change following leucotomy presents many difficulties, one of them being that only dysfunction can be related to structural damage of the frontal lobe and not function. Another is that psychotics or severe neurotics operated upon usually do not have a sufficiently intact pre-operative personality to draw conclusions about the normal functions.

These notes are divided into three sections. In the first, consideration is given to cases of aphasia occurring in childhood. In addition, the handedness of defectives is touched on, and there is a note on the influence of heredity. The section as a whole owes its existence to ideas set in motion by Brain's “Speech and Handedness” (Lancet, 2, 839, 1945). For that reason somewhat disparate elements are dealt with together. Section two is concerned with stammering; an endeavour is made to apply to this condition propositions put forward in the first section. Brief attention is given to bad spelling—or rather to that group of bad spellers in whom there is consistent discrepancy between their intellectual capacity and attainments, and their performance in oral and written spelling. The last section deals with “motor” or executive aphasia. A plea is put forward for the recognition of a dysarthric component in this condition. An anatomical configuration is suggested by which unilateral cortical dysarthria would become a possibility.

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.

In 1939 an inquiry was begun into the late results of the type of head injury which results from collisions on the roads, from accidents in industry and from falls in the home. Since penetrating injuries resulting from civilian accidents are extremely rare, the examples that were encountered have been eliminated from the final reckonings and so the following account is concerned entirely with the so-called closed type of injury. It must, of course, be realized that compounding and infection are common even in this type of injury, because cranial fractures frequently run across and open into the paranasal air sinuses.

Delinquency is one of those vague but fashionable words that are becoming very difficult to define. Originally it appears to have been used to describe minor infringements of the social, moral or legal code, with special reference to acts of omission rather than acts of commission. It is now often used to describe any kind of anti-social conduct, whether trivial or serious, while some use it as a harmless euphemism for crime, although the word crime, in its technical meaning of an act or omission punishable by law, is inoffensive, and has no reference to the question of moral guilt or culpability. It is therefore perhaps advisable for me to say what meaning I attach to the word to-day. For the purpose of this paper I am using the word in the general sense of criminality, that is to say, I am confining my remarks to the more serious types of anti-social conduct shown by mentally defective persons.

Youth is an elusive period of life, and although it has been considered from many points of view, it remains an intricate and unpredictable epoch, for which further study is needed to bring it into clearer perspective.