This report consists of a follow-up of 22 cases of psychiatric and neurologic disability requiring prefrontal leucotomy. The follow-up covered cases operated on in the years 1947 to 1950 inclusive. In all cases at least six months were allowed to elapse before an assessment was made. The criteria of the follow-up were those used by Strom-Olsen and McDonald Tow at Runwell Hospital, Essen. In our group 45.5% of cases were successfully relieved and 13.6% of cases were partially successful in terms of these criteria. The results compare favourably with the comparable Runwell group. In three cases a second leucotomy was performed after the first had previously failed, with excellent results. The operation has a definite and valuable place in the treatment of chronic psychosis with severe behaviour disorder and chronic intractable obsessional and depressive states with prolonged and total incapacity. In all cases it must be used with discretion.
A case of Brucella melitensis infection presenting as an arthritis of the hip joint is descriptionbed. A review of the literature reveals it to be an uncommon form of presentation, but Brucellosis should be borne in mind in considering the differential diagnosis of arthritis of the hip joint. The immediate therapeutic response to Aureomycin alone was satisfactory, but relapse followed, and this responded satisfactorily to a combination of Dihydrostreptomycin and Aureomycin.
In the vast majority of cases of deaf-mutism, the aetiology is genetic in origin. The mutism is secondary to the deafness. In a minority of cases, the aetiological factor is an early postnatal acquired infection. Maternal rubella in the first four months of gestation may be followed by congenital deafness in the child, apparently due to defective development in the organ of Corti. Maternal rubella however, plays a relatively insignificant role in the causation of deaf-mutism in general. The diagnosis is difficult to make in early life, and deafness often simulates mental deficiency or behaviour disorder. Aphasias should be differentiated from deafness, as hearing aids are useless in these cases. True mental deficiency or microcephaly is not infrequently associated with post-rubella congenital deafness. Post-rubella deaf-mutism is usually bilateral, and may be complete or partial, sometimes being associated with other congenital defects, notably cardiac lesions. Unilateral or bilateral cataract or ocular defects may be associated with deafness, particularly if the mother had contracted rubella during the first two months of pregnancy, but fortunately the association occurs not too commonly. Many post-rubella deaf-mutes are undersized and dystrophic. Instruction in lip-reading, individual tuition, and the use of hearing aids should be commenced as early as possible in deaf-mutes. Social adjustment within the family should be aimed at.