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Surely the essential feature is the presence of a significant degree of mitral stenosis-that is to say, enough to raise left atrial pressure under various conditions such as exercise, emotion, pregnancy, or tachycardia from any cause. Operation for removal of clot is not an accepted procedure apart from valvotomy. The statement that valvotomy is indicated "provided the valve is suitable for it" is in our experience meaningless because what the surgeon will be able to achieve cannot by any method be predicted preoperatively. The unreliability of the signs of a so-called pliant valve have been previously stressed.5 An excellent valvotomy

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The Hamilton Rating Scale for Depression is in common use, particularly in drug trials. The authors compared this scale with a system of psychiatric assessment and recording designed by M. Sim. They found that there was closer agreement with the full assessment of the Sim method than with the single diagnostic area for depression. This suggests that the Hamilton Scale for depression is more general than specific in its application.

This investigation is concerned with the histological changes found in cerebral biopsy specimens taken from 59 patients with presenile dementia. We have defined the presenile dementias as organic dementing diseases occurring before the age of 65; although 5 of the patients were a few years older than this at the time of biopsy, in all cases there was unequivocal evidence that the dementia was established before the 65th year. The clinical findings in 56 of these patients are described in the preceding paper (Sim, Turner and Smith, 1966).