The concept of “orality” as used in this paper indicates a certain constellation of traits or habitual reactions which are, or are assumed to be, derivatives, whether direct or modified, of behaviour patterns characteristic of early childhood. The importance of the mouth as the first erotogenic zone and as the organ generating fundamental attitudes of giving or receiving, waiting or being impatient, and hoping or despairing, has been stressed by psychoanalysis. According to psycho-analytic theory, the oral phase, that is, the first period of libidinal development, plays a most important part for later character development in as far as gratification, or frustration, of the oral impulses is assumed to have a determining influence on character-formation in later life.

It is time the term “shock therapy “was dropped. Its meaning is not clear, we constantly attempt to avoid shock to our patients, it is not always therapy and the term does not do us much good in the eyes of our colleagues or the public.

The first object of this paper is to describe the clinical and pathological features of two cases of sub-acute sclerosing leuco-encephalitis (first distinguished by van Bogaert in 1945). A second object is to compare these features with those of the Dawson inclusion type of sub-acute encephalitis (Dawson, 1933, 1934; Brain, Greenfield and Russell, 1943, 1948; Greenfield, 1950; Malamud, Haymaker and Pinkerton, 1950), and the final object is to emphasize the importance of mental change, when associated with motor symptoms, in the diagnosis of both these forms of encephalitis.

In this paper I propose to describe three varieties of behaviour of patients under treatment by means of ether abreaction.

The a-b ridge count, called the a-b count for short, is the number of epidermal ridges crossing or touching a fine straight line drawn joining the triradii a and b on the palm. The triradial point, or the radiant when the former is absent, is not included in the count. It was pointed out in a previous work (Fang, 1949) that, on the assumption that university students are more intelligent than the general population, there is a consistent increase of the mean a-b count with intelligence. The results of the present study seem to agree with this finding.

It was recognized long before the birth of Freud and of psychoanalysis that the mental attitude of the patient has an important if not a decisive influence on the course of bodily disease. Milton expresses the almost universal striving for life in spite of the sufferings of illness when he says:

“And that must end us : that must be our cure—
To be no more. Sad cure ! for who would lose,
Though full of pain, this intellectual being,
Those thoughts that wander through eternity,
To perish rather, swallowed up and lost
In the wide womb of uncreated Night,
Devoid of sense and motion? ”

In more recent times, almost the whole of the work of Pavlov (1928), and particularly that of his pupil Bykov, is devoted to emphasizing the role of the cortex and higher brain centres in the determination of bodily reactions.

It is important, at the outset, to define the purposes which can be served by studying the subject of neurosis in animals, and they appear to be twofold. Firstly, animals display emotions in a simplified form, because their behaviour is not influenced by social conventions, and thus one can sometimes recognize vital underlying human feelings which are masked by other less important habits. A simple example of this is seen when two animals are given identical meals in separate feeding dishes; each animal is convinced that the other has a better meal, and they will not be happy till they have changed dishes: in human relationships, the feeling that the other person has something better often plays a major part in determining behaviour, but it is frequently disguised and seldom admitted by the person concerned. The second way in which animals can help in the study of human medicine is in controlled experimental work; for instance, the relative effects of heredity and environment can be studied comparatively easily in animals, and although it is important to remember that arguments based on animal behaviour cannot be applied directly to human behaviour, much can be gained by an exchange of information between workers in the two fields.

Our present state of knowledge concerning the changes brought about by shock therapy is such that the application of these forms of treatment is still largely empirical. This is due to the fact that we are not aware of the mode of action of these different modes of treatment and also because the classification of the various forms of mental disorders is still very unsatisfactory. This is particularly true when we are dealing with that heterogeneous group of mental illnesses lumped together as schizophrenia. Many cases of so-called schizophrenia will recover without and even in spite of shock therapy, and I very much doubt whether the concept schizophrenia has done anything to help us in choosing our cases. A diagnosis to have any value should give us (a) a clinical picture of the patient, (b) an indication of the course of the illness which would be helpful in giving a prognosis, and (c) some guidance as to the appropriate treatment for a particular patient. Most clinical psychiatrists will agree that the diagnostic label schizophrenia fails us in all these respects. I read with great interest in the booklet of the International Congress Dr. Meduna's article in which he divides schizophrenia into two groups (a) endogenous schizophrenia, and (b) symptomatic schizophrenia. He points out that shock therapy is of value only in cases of symptomatic schizophrenia, which is more or less identical with the confusional insanity and the exhaustion psychoses of the English Board of Control classification of mental diseases.

Psychotic states due mainly, but not exclusively, to unusual external circumstances are well known, and are commonly exemplified by such mental disorders as are occasionally met with in persons in prison, or those morbidly homesick, or suffering under the strain and stress of advanced deafness. In the great majority of these instances, however, the external conditions represent only an additional, precipitating aetiological factor which is operating as a trigger mechanism to a mental derangement of non-specific character already present in a latent state. It may therefore be of some theoretical and practical interest to report on a group of acute and subacute psychotic states whose history, features, course and outcome characterize them as constituting a readily recognizable clinical entity of purely psychological, situational origin.

The problems of the interdependence and unity of the brain and body have been put on a scientific basis by Pavlov and his successors. Bykov (1947) has, for example, been able to demonstrate that the cortex plays a leading part in the regulation of somatic processes, such as secretion of urine, blood pressure, peristalsis and metabolism. It is therefore reasonable to argue that lesions of the central nervous system will be reflected in the pathogenesis and course of morbid processes in the body. It does not follow, however, that this influence will necessarily be in the direction of greater lability, more rapid pathogenesis or more extensive destruction. The outstanding feature of the central nervous system is its plasticity and power of compensation. It is therefore possible and probable that those parts of the nervous system which remain intact will take over and compensate for the function of the lost ones. Emotion may, for example, lead to polyuria, but it does not follow that urinary secretion will be impaired in a leucotomized patient. The brain may well play an important part in the infective processes of a normal person, but the defence against infection in a microcephalic idiot may remain perfectly adequate, and may even be more effective than in a normal person, provided that the mechanism of the immunity and phagocytosis had been more fully mobilized in the course of his previous life.

The study of dreams is a study of a group of epiphenomena associated with states of diminished awareness. No matter whether such dreaming occurs in natural sleep, in states of reverie interspersing normal levels of consciousness or in pathologically or pharmacologically induced aberrations of consciousness, it would appear that the principle that dreams do not occur other than at levels of lessened awareness is generally accepted. From the point of view of neurophysiology, it also seems reasonably clear that the formation of the visual and auditory hallucinations, illusions and delusions forming the manifest formal content of dreams is dependent upon fairly precise cerebral localization, the temporal lobe and Brodman's area 19 being especially important in these respects (Penfield and Erickson, 1941). Psycho-physiologically a number of attempts have been made to assess the nature and quality of stimuli normally inciting dreams. From Maury (1861) onward the effects of various physical stimuli (Klein, 1930), of auto-suggestion (Arnold-Forster, 1921), of post-hypnotic suggestion (Prince, 1939) and of projection phantasies (Malamud and Linder, 1931) have been noted. Psychologically the dynamics underlying the mechanisms of the dream instinct have been investigated especially by Freud and his followers. Freud's opinion that the dream represents an attempted wish fulfilment has been modified by Jung, who emphasizes its compensatory function, by Adler, who conceived of the dream as a method for testing possible future situations in phantasy, and by Stekel (1943), for whom the dream was a symbolic manifestation of the “internal conflicts” of the individual. Finally, the observations of Monge (1929) concerning the increased incidence of disturbing dreams when dwellers at high altitudes suffer from chronic mountain sickness, and of McFarland (1937) on the changing dream habits of a party of mountaineers in the Chilean Andes as they ascended steadily to ever-increasing altitudes (and hence to progressively greater degrees of anoxic anoxia), are of immediate interest. They are in direct line with the findings of anoxaemia in sleep (Lovett Doust and Schneider, 1951), and suggest a positive relationship between the manifest content of dream patterns, emotional tension, reduced awareness and anoxaemia.

Shorvon and Sargant (1947) have given a full account of the history and development of the use of ether in relation to excitatory abreaction. They have shown how valuable its use can be to rid patients of emotional tension which has occurred as a result of some particular battle experience, such as being blown up, buried alive, torpedoed, etc. They propound various theories as to the mechanism of excitatory abreaction, and they give a full description of the technique they employed, illustrated by examples from the numerous cases with which they dealt.

The object of this study is to investigate the extent to which the MMPI reveals personality changes following prefrontal leucotomy, and how these compare with personality changes as shown in the results of intelligence testing.

A multiple channel electroencephalograph permits the simultaneous recording of several leads in electrocardiography. In order to utilize for this purpose the electroencephalograph installed in this hospital, a method has been worked out to record in groups of three the 3 standard leads, the 3 augmented unipolar limb leads, and 3 unipolar precordial leads consecutively, changing over from one group to the other simply by turning a switch. The technique here described is used in connection with a four-channel Marconi electroencephalograph.