Mechanism of Memory

SIR,-Dr. P. Glees's plea (Jan. 29, p. 193) for co-operation between neurosurgeon and psychiatrist could not be better illustrated than in the problem of prefrontal activity. It is fairly certain that leucotomy by the standard or orbital approach, or by any other approach, is not the final answer tQ the surgical treatment of mental diseases. In all neurophysiological research the task of solving a particular problem often draws the attention and interest of many investigators, and the literature of to-day is full of their now discarded claims. A new approach is useful for giving a different line of thought, and its recognized weaknesses and dangers can only give stimulation for further research. The work of Freeman has followed on " older methods " of bilateral section and may possibly lead to further observations and experiments which will ultimately cause rejection or modification of the original. I consider that prefrontal activity can be controlled by regulation of local blood supply and that this procedure in the hands of the neurosurgeon may become the operation of choice. Whatever method is adopted or is subsequently fashionable, the selection of patients is best left to the psychiatrist, who will have the advantage of observing them for many years afterwards. Too often the experience of the neurosurgeon is limited to the post-operative sequelae. His interest in the patients ceases with their discharge from the ward. Neither is the psychiatrist fully equipped for their accurate study, as he has no knowledge of the exact pathways that have been severed in each case. Only when we have a precise method of interrupting clearly defined pathways will he be able to give a clear interpretation of its value.-I am, etc.,