[In the physiology of the central nervous system, the hypothalamus has of recent years obtained a position of much enhanced importance. There is reason to believe that it has a determining influence on cortical function and evidence is not wanting that some psychotic conditions are associated with hypothalmic disturbance. It may well be that many forms of mental disorder are conditioned by a lesion of the hypothalamus. This close anatomical and physiological relationship between this area of the brain and the pituitary we think, therefore, cannot be over-emphasized. Dr. Max Reiss was asked by the Research Bureau to present a review of our present knowledge of the anterior pituitary, on which he is a recognized authority.]

The general object of the Criminal Justice Bill, now before Parliament, as set out in the explanatory Memorandum, is to improve the methods of dealing with persons found guilty of offences, including adolescent offenders and persons who commit repeated offences. It so happens that the Home Office has recently issued, as a Stationery Office publication, a Report on the Psychological Treatment of Crime which was made to the Secretary of State by Dr. Hubert and myself. The present position of psychiatry in relation to crime, therefore, seemed a fitting subject to discuss at this Conference.

The distribution of the blood-groups in persons suffering from mental disease has been widely investigated, but the literature is full of conflicting statements. It may fairly be taken that no one has yet demonstrated any statistically significant alteration of the blood-group distribution in any other disease, but there have been many claims for variation in mental diseases.

We have previously investigated the blood-group distribution in a series of normal persons and mental patients and shown that there is no significant difference between the two groups (Thomas and Hewitt, 1939). As an ancillary procedure in the investigation of any possible differences in the serological make-up of persons suffering from mental disease, we have determined the iso-agglutinin titres in a similar series of normal and mental patients. On prima facie grounds no difference is to be expected, and in the result, no difference was found.

Insulin shock treatment of schizophrenia is to-day a recognized part of our therapeutic armamentarium in mental disease, and with selected cases is yielding results which are more encouraging than those given by other methods. At the same time the method is largely empirical, and the theories of its mode of action are only equalled in number by the hypothetical causes of the disease itself.

In a social system where responsibility for the care and support of children rests with the parents, society is justified in imposing restrictions designed to prevent the births of children to a socially incompetent person who is unable to assume such responsibility. Owing to the overcrowded conditions of state institutions for the care of the mentally defective, it is certain that patients committed to such institutions are scarcely able to provide satisfactory care and support for themselves, and would not be able to provide adequately for any children that they might produce. On this basis, society is quite justified in enacting the regulation, as, according to Popenoe (1, 2), has been done in one State, that no patient who has been committed to a state institution for the care of the feeble-minded shall be allowed to leave the institution without having first been sterilized.

Although considerable attention has been devoted during the past years to the problems of the influence of heredity on mental deficiency, no final conclusions have yet been reached. It appears well established at the present time, first, that in a large percentage of cases, variously estimated at from 40 to 80%, mental deficiency is significantly determined by genetic mechanisms, and second, that recessive genes seem to play a considerable role in such mechanisms (Lokay, 1929; Brugger, 1930a; Smith, 1930; Luxemburg, 1931; Juda, 1934; Kreyenberg, 1935).

During the last twenty-five years it has come to be recognized that a fairly large amount of mental deficiency appears to coincide with or result from faulty intracranial myelination. In some such children little or no post-natal development occurs, in others recession is already occurring at birth; a few remain fairly normal for some years. Spastic contractures, especially of the legs, grow progressively worse, epilepsy may appear, the child goes steadily downhill and early death is the usual termination. In some cases choreoathetosis is present, and this may either, if the patient lives long enough, disappear spontaneously, or, more usually, become impossible when the spastic contractures have immobilized the extremities. Post-mortem one finds one of two conditions—demyelination of the brain (the status dysmyelinatus of Hallervorden-Spatz) or hypermyelination (the status marmoratus of the Vogts). In both forms there is much hypergliosis, evidently secondary to some irritating but slow myelin poison which finally produces anoxia. Clinically during life both varieties appear much the same, and that is all that is known about its nature at present. Cases were recorded by the Vogts in 1920, Hallervorden and Spatz in 1922, Kalinowski in 1927, Helfand in 1931, Spatz and Peters in 1938; in this country by Meyer and Cook in 1936, Meyer and Earl in 1936. By these authors the views of others are summarized—Bielschowski, Loewenberg and Malamud, Urechia and Michalescu, Bouché and Van Bogaert, Casper, Ammosow, Bostroem, Bodechtel and Guttmann. If epilepsy has been present, it generally disappears after some years. By no means all cases end up as helpless idiots; some learn to attend to their own wants, but few ever walk freely.

Attempts to find a function characteristic of schizophrenia which may be correlated with the electro-encephalogram have not been very fruitful. For example, in a group of 60 adult schizophrenics only a very slight positive correlation exists between the electrical activity of the brain and duration of illness (Rubin, unpublished observations). The same correlation obtains for duration of hospitalization. Although not systematically studied, there appears to be no correlation between the electro-encephalogram and diagnostic sub-type of schizophrenia.

Since the passing of the Mental Treatment Act, 1930, 135 patients have been admitted to St. Ebba's Hospital up to date. An analysis of the first 30 patients admitted on a temporary basis was made by Dr. Wootton and myself, and the results published in the Journal of Mental Science for July, 1937.

No problem in neurology has been approached from so many different angles as has the pathogenesis of the epileptic fit; yet it is far from being solved. Histological examination of the brains of epileptics, electric stimulalation of the human brain during operation, chemical analysis of the body fluids both in general and of the arterial and venous blood of the cerebral vessels in particular, measurements of the intracranial blood-flow, investigations into metabolic changes before, during, and after fits, electro-encephalographic studies, have produced an enormous wealth of data, which it has not, however, been possible to weld into a single theory. The most recent monograph on epilepsy—Kinnier Wilson's article on the subject in Bumke's Handbuch der Neurologie—speaks only of various “determinants” of the fit: the vascular, the humoral, etc.

This investigation attempts to determine what effect a sub-convulsive dose of triazol had on the individual patient as compared with a convulsive dose, and in addition to study and compare the reactions of a group of deteriorated schizophrenic patients with those of a heterogeneous group composed of mental disorders not schizophrenic. There were 12 patients in each group. The first group of schizophrenic patients was made up of individuals who showed marked emotional deterioration, with either a poverty of affective response or a definitely inappropriate affect. All these patients had had their mental disorder for many years. The average duration of the psychosis in the schizophrenic group was 9 years, and the average age of the group was 31 years. The heterogeneous group was composed of three patients classified as manic-depressive in the depressed phase, two depressed patients in a stuporous condition, three psychoneurotic patients with chronic anxiety states, and four with chronic obsessive states. The average age of the heterogeneous group was 33 years.

Since Meduna in 1934 introduced the treatment of schizophrenic states by induced epileptiform convulsions, a volume of literature has appeared on the use of cardiazol as convulsant. But although cardiazol proved immensely superior to the original camphor, it is not without some serious disadvantages. These led naturally to the search for further improvement in the convulsant agent, and it is with one of the successors to cardiazol, introduced by Walk and Mayer-Gross (1938), and known as azoman or triazol 156, that this record is concerned.