Ten years have elapsed since the introduction by Meduna in 1934 of convulsion therapy, and five since Cerletti and Bini first described the use of electricity as a convulsant. A not unreasonable early prejudice finds a later echo in the comment of Critchley (1943) that convulsion therapy “is crude, dangerous and repellent to anyone who holds the central nervous system in respect.”

Although by now many papers have been published on psychiatric cases occurring in the Forces in this war, few follow-up studies are available of cases discharged to civilian life. Lewis (1943) and Ferguson (1943) found that a considerable proportion of discharged psychiatric patients had required further medical treatment and had difficulty in resettling to work.

Owing to the difficulties of investigating the sensory organization of the nervous system experimentally, for many years experimental neurologists tended to direct their attention rather to the motor mechanisms, for these can easily be studied and recorded objectively. During the last few years, however, research investigations have been more concentrated on the anatomical basis of sensation and, accordingly, this review will be mainly concerned with this aspect.

It is generally known that in recent years there has been a considerable increase of the elderly population. In addition, we assume that unless the birth-rate rises again, an increasing proportion of the population will be found in the involutional and senile periods of life. This development has already begun; whereas in 1901 7.6 per cent. of the population of Scotland were over 60 years of age, the percentage in 1941 has been estimated at 13.0. Men are less long lived than women, the figures being 6.6 and 8.-6 in 1901, and 12.1 and 13.8 in 1941.

The careful contribution on “Prisoner-of-War Mentality” by Major P. H. Newman (Brit. Med. J., vol. i, p. 8, 1944) has provoked this record of related psychological reactions. The men and women to be described, though not prisoners-of-war, were nevertheless imprisoned by psychological difficulties no less harassing than those material restraints, which, as Newman points out, operate mainly by frustrating or reducing to futility the accustomed interests, satisfactions and tasks of human beings. In the problems of prisoners-of-war a large part is played by retreat into phantasy. It is suggested below that, in human affairs and in clinical work, the scope of this particular reaction to frustration is very much wider than is commonly realized. The range is probably from what is colloquially called “uplift,” to mental states not very unlike psychoses (which have in fact been referred to as “pseudo-psychoses”), and, indeed, possibly to the psychoses themselves.

It is proposed in this review to deal only with those aspects of physiological psychology that have an immediate bearing on the problems of human behaviour. Here again two limitations must preclude consideration of much important work in this field, in that endocrinology and the study of cortical potentials have been relegated to the special articles dealing with this subject.

The following report is based on 150 men treated in hospital, and 300 patients, 50 of whom were women, seen at a diagnostic and advice centre.

As a rule, stresses and precipitating factors were more obvious or easily discoverable than in civilian life, adverse situations were more superficial, diagnosis and treatment were easier. Anyone who has conducted civilian clinics finds the change-over comparatively easy. Nevertheless, much of what follows is applicable to civilian work.

Paranoid delusional reactions have seldom been reported in chronic encephalitics, in contrast to the commonly occurring schizophrenia-like reactions. Apart from the cases described by Kwint (1), Ostmann (2), McCowan (3, 4), and a reference by Neustadt (5) to an undescribed case, there seem to be few, if any, references in the literature until a recent paper by Brody and Freed (6) describing a case where obsessive ideas became temporarily converted during oculogyric crises into a paranoid condition. The present case therefore seems worth putting on record, the more so in that the patient's unusual intelligence helped to throw some light on the relationship between oculogyric crises and post-encephalitic mental disorder, a subject which has been discussed by Stern (7), Jelliffe (8), and more recently by Wexberg (9) and by Brody and Freed (6).

“No man will be a sailor who has the contrivance enough to get himself into a jail, for being in a ship is being in a jail, with the chance of being drowned.”—Dr Johnson (1759).

The history of electro-encephalography contains both triumphs and disappointments. The most profound of the disappointments is the relative failure to elucidate any of the important problems which concern the psychiatrist. It was hoped that some real electro-physiological alteration would be seen in patients whose mental condition suggested something bordering on the organic, but the negative findings even in the most profound mental disorders are almost as striking as if they were positive. Before considering the published work it would be well to review in a few words the nature and significance of electro-encephalographic records.

In recent years important additions to the knowledge of the symptomatology in cases with involvement of the parietal lobe have been made. Both constructional apraxia (Kleist, 1922) and Gerstmann's syndrome, consisting of finger-agnosia, disturbance of right-left orientation, agraphia and acalculia (1924) have been related to lesions of the angular gyrus of the dominant hemisphere. Before the description of those symptoms, a loss of spatial orientation had been described in cases with lesions of the same localization. Balint (1910), Riddoch (1917), and others had observed that symptom in single cases, but the most comprehensive description was given by Gordon Holmes (1918), who studied it in a case-material of war injuries. When Holmes and his co-workers published their observations, constructional apraxia and Gerstmann's syndrome were still unknown. Loss of spatial orientation as a fully developed symptom is rare, while the other two disorders are not uncommon. For this reason the psychopathological relationship of those symptoms is still insufficiently understood. The following case offers an opportunity for studying the problem:

The case about to be described presented a problem of some complexity in neurological diagnosis. The attempt here made to unravel the problem is set forth with the full realization that some quite different explanation may be the true one. The true explanation, however, is incapable of proof and the view offered here is only suggestive, though of some interest because of the rarity of lesions of the superior cerebellar peduncle in man.

Biochemical research has continued in spite of the war and considerable advances have been reported during the period under review. While the task of applying this new biochemical knowledge in the field of psychiatry has hardly yet begun, the underlying chemical mechanisms concerned in nervous activity are becoming considerably clearer and a few beginnings in this direction have been made.

A state of vitamin deficiency arises (i) when inadequate amounts of a vitamin (or vitamins) are ingested, (ii) when absorption from the alimentary canal is defective or interfered with, (iii) when storage mechanisms are at fault, e.g. liver disease, and (iv) when the tissue cells themselves are unable to utilize the vitamin (i, 2). With war rationing the first factor is likely to be commoner than heretofore, especially in alcoholics (3), patients maintaining a strict “peptic ulcer diet” over long periods (4), diabetics (2), mothers sacrificing their rations for the family, food faddists, and in people living alone and doing their own cooking (5). Nowadays many exist on a “borderline” diet, in whom any stress such as pregnancy, infection, surgical procedure, fracture, hyperthyroidism, etc., will precipitate a deficiency state; moreover, in chronic gastro-intestinal disorders the available vitamins may be lost or destroyed (6-14).

This condition, in which severe confusion, disorientation, and restlessness are the principal features, appears to have been first clearly described by Bell (1845), who noted that about 2½ per cent. of the patients admitted to his asylum showed a particular syndrome: they were normal people who were admitted after about a week's acute illness; their appearance and speech suggested fever and delirium like a typhoid state; understanding was limited; they were apprehensive, with distressing but confused delusions; they disliked and suspected their food, and were not sensible enough to be thirsty; they tried to get out of bed, were sometimes violent, and struggled strongly when held. The course of the illness was rapidly downhill, but about a quarter of the patients suddenly made a complete and permanent recovery at the end of two to three weeks, the remainder dying in the same time. There were no specific post-mortem findings.

Two previous publications have been devoted to the behaviour of various reflex phenomena, and of the grasping phenomenon in particular, during the post-convulsive stage of the electrically produced seizures in man (1942, 1943).

This paper deals with eye movements in the shock procedure, and experiments planned to influence these movements.

In recent years our views of the interaction between the nervous system and the ductless glands have been gradually more defined. In the present review, for descriptive reasons the subject has been classified as follows with reference to the main elements of the neuro-hormonal inter-relation: (1) The influence of the nervous system on the pituitary itself and, through the pituitary, on the other ductless glands.