I wish to make it clear at once that for the purpose of this paper I am taking the definition of psychiatry as being synonymous with the term psychological medicine—in other words, the study of the subject as a whole.

The results of leucotomy in mental hospital practice are already well known and are familiar from the Board of Control's review of 1,000 cases published in 1947.

I am not aware that in mental deficiency institutions the operation has become a practice in application to cases presenting gross abnormality of conduct having its origin in mental disorder which, though not amounting to one of the insanities, has the characteristics of a psychopathic state.

At the beginning of the war part of the Maudsley Hospital moved to Mill Hill School, and a neurosis centre of 550 beds was established. During the six years of war some 20,000 neurotic patients, both forces and civilian, were treated at this centre. Within the centre a special unit for the study of Forces patients with effort syndrome (E.S.) was set up. This unit was in existence from 1939 to 1945, and during this period 2,324 cases of E.S. were treated. The writer was associated with this unit throughout, working in association with a cardiologist (Paul Wood (1)), and with other psychiatrists (Lewis (2), Guttmann (3), Gillespie (4)). Much of the material brought together in this thesis has already been published (Jones (3, 5, 6, 7, 8, 9, 10, 11, 12, 38, 43)). During most of the war years the writer was in receipt of a Medical Research Council grant.

Since the introduction of prefrontal leucotomy by Moniz in 1936, an ever-increasing number of psychotics have been subjected to this operation. Results have been very satisfactory in certain types of psychosis and psychoneurosis, especially in obsessional tension states, in agitated depression, and in patients with considerable apprehension and anxiety, while less favourable results have been reported in many cases of schizophrenia, hebephrenia, and others. Naturally, with the number of cases operated on, experience has grown, and psychiatrists, neurologists as well as psychologists are nowadays, to some extent, in a position to determine which case is likely to benefit from the operation, and where leucotomy should rather not be resorted to.

Though twelve years have now passed since the first prefrontal leucotomy was performed, the status of this form of therapy is still far from settled. There are some who would never perform the operation at all; and some who would reserve it for the chronic sick; while others (Fleming, 1944) would advise its use at an early stage in the illness in cases where there were reasonable grounds for believing that recovery would not otherwise occur. With opposition of a purely emotional kind, the profession as a whole need hardly concern itself; for appeals that the integrity of the nervous system be maintained at all costs are unlikely to impress those whose daily work brings them into contact with the personality degradation of chronic mental illness. It is difficult to see why interference with the brain in order to save sight or to save life in the case of tumour should be regarded as either more or less wicked than interference designed to save human reason.

The neuropsychiatrist presenting evidence before Court will sooner or later be asked the question, “Was the accused, at the time of committing the offence, labouring under such defect of reason as that he did not know what he was doing, or if he knew what he was doing, he did not know it was wrong?”

In recent years many attempts have been made to improve methods of temperament testing, and to show the validity of the results by comparing test-scores of groups of subjects known to be differentiated with respect to certain traits (Cattell (1), Eysenck (2), Himmelweit (5)). Thus there has been found a very significant correlation between degree of neuroticism and suggestibility, and a correlation almost as high between degree of neuroticism and persistence. These results have suggested the possibility of using tests of this kind in an attempt to measure the neurotic tendencies of individual subjects, and to screen the more neurotic from types of occupation likely to impose too great a strain on them (Eysenck (3)).

Tests of the indefinable quality known as intelligence are legion. Many have been standardized satisfactorily, others have not. The validity of some tests is high, but results of different tests used on the same individuals have seldom been published.