The range and precision of clinical endocrinology in recent years have been increased by the introduction of more and better purified hormones, and by the use of hormone analysis and physiological tests for endocrine function.

Therapeutic convulsions were introduced by Meduna (1937) in 1934. After preliminary trial with intramuscular camphorated oil, Meduna soon discovered the great advantages of intravenous cardiazol (leptazol, metrazol), which remains the best of the chemical methods of fit production. Many descriptions of the various aspects of the cardiazol fit are available (Cook, 1938a; Ebaugh and Shanahan, 1939; Katzenelbogen et al., 1939; Strauss, Landis and Hunt, 1939; Dean, 1940; Hemphill, 1940).

SINCE Sakel (I) introduced treatment by insulin a vast literature has emerged from all countries. This was admirably reviewed by Wilson and Rees-Thomas (2) in 1938, so that consideration is given here to publicalions since that date. Even so, it has not been possible to incorporate all the publications, but a sufficient number has been drawn upon to present the essential position as it is to-day. Whatever may be the final judgment on the efficacy of insulin therapy, there is no doubt that its introduction has been an enormous stimulus to therapeutic endeavours. Its main interest has been to the psychiatrist, but the problems presented have attracted the atten tion and interest of workers in other branches of medicine. Ebaugh (3) has summarized this interest thus : “The physiologist has become interested in the mechanism which produces the coma; the biochemist is interested in studying the various chemical changes which take place during therapy; the neuro pathologist is concerned with the pathologic changes that occur during and after the therapy; the internist is concerned with the problem of ‘punishment’ that the body is furced to absorb during the actual treatment; the psychologist is absorbed in following the psychological changes which take place under the influence of the treatment; the orthopaedist desires to know the type of fractures occurring during insulin, electrical and metrazol therapy; the neurologist studies the influence of these therapies upon the organic nervous system; and the psychiatrist attempts to explain the manner in which the psychosis is altered.”

The operation of prefrontal leucotomy or, as some call it, prefrontal lobotomy, is one of the most startling of modern therapeutic procedures. It was introduced in Portugal by Moniz (1936)—the actual operation being performed by Lima—and was subsequently developed in Italy and in America. In this country it was first carried out at the Burden Neurological Institute in Bristol on December 11, 1940. At the time of writing (May, 1943) some 350 leucotomies have been performed in Great Britain. In 1942 Freeman published his book, Psychosurgery, dealing with the work done up to the end of 1941. Most of the work dealt with in the present review has been published since then, although for the sake of completeness Freeman's book will be referred to.

This article deals with legal happenings, actual or prospective, in so far as they have a bearing on psychiatry. Both civil and criminal law are included, but no reference is made to juvenile delinquency, which is included in the article in this series contributed by Dr. Norwood East. No attempt has been made to deal with foreign literature or any changes in the law of foreign countries.