An extensive review of recent advances in the aetiology and treatment of neurosyphilis was published in this journal by one of us, E. L. Hutton (1941). While it is mainly the later manifestations with their crippling disabilities that present themselves to the psychiatrist in the mental hospital, it is becoming increasingly obvious that early treatment is imperative to obtain good results, and that neurosyphilis itself must be regarded as a preventable disease.

A critical review of work covering a period of years, in three of which war has reduced papers from the Continent almost to nil, must necessarily be incomplete. Lines of investigation, however, follow a pattern which has suggested the following arrangement for this review: (1) Normal development of the child, including the important studies of Gesell (1940, 1942) and Valentine (1942).

The modern usage of the word “delinquency” lacks precision, and some writers use it to connote all types of offences, however serious, and whatever the age of the offender, whilst others restrict its use to minor offences committed by children and young persons. A crime is described legally as an act or omission forbidden by law under pain of punishment (Harris and Wilshere, 1919), and may be regarded as conduct which the State considers to be opposed, at the time, to the welfare of the community. Kenny (1909) stated, “Crimes are wrongs whose sanction is punitive, and is remissible by the Crown, if remissible at all.”

A scrutiny of the papers published during the years 1940-42 and, indeed those published in 1939 and 1943, reveals an increasing trend towards clinical inquiry. Few articles are to be found in which it is assumed that mental deficiency is itself a simple concept, about which little remains to be discovered, and writers are now more cautious in suggesting the best methods of control and treatment than they were wont to be ten or twenty years ago. It is even realized that there are no fully satisfactory methods of describing what is meant by mental defect. Kuhlmann (1941) gives this definition: “Mental deficiency is a mental condition resulting from a subnormal rate of development of some or all mental functions.” The specific functions which are weak or strong in a given case are determined by tests and other observations. As Doll (1941) points out, there seems to be no escape from basing the diagnosis of mental deficiency upon a variety of different criteria, the main symptom still being social incompetence. Standards of social behaviour at different ages have been incorporated by Doll (1942) in the Vineland Social Maturity Scale; he recommends its use in classifying cases for training. The problem of deciding what constitutes mental defect is acutely brought out when differences in education or culture have to be considered. Sparling (1941), for example, showed that American Indian children, whose mean Binet I.Q. was on the borderline between normality and defect, had a mean I.Q. of 108 on the Porteous Maze test. In New York State, Malzberg (1943) found that even allowing for educational differences, mental defect was commoner among negroes than among whites. Nevertheless, as shown by Zubin and Scholz (1941), recognized mental defect (judged by the number of admissions to institutions) is commoner among whites than among negroes in the Southern States. This effect is partly due to the fact that more attention is paid to problems of mental defect in predominantly white than in predominantly coloured populations. Conversely, prisons contain unduly high proportions of coloured inmates according to both North American and South African statistics (Penrose, 1943). The question as to how far mental defect is a contributory factor in cases of crime has received attention from Frankel (1939), who reported that 15 per cent. of 1,000 murderers came into this category, and that the mean mental age for 722 of such criminals was 11 years. Among 309 adolescent delinquents, Stefanescu-Goanga (1939) found 99, of 32 per cent., mentally defective; 47 per cent. of the children committed for homicide were in this category, and 34 per cent. of those committed for theft. Selling (1942) has investigated the degrees of intelligence in offenders under Road Traffic Acts, and finds that although uncomplicated defect is compatible with safe driving, many accidents are caused by emotionally unstable cases with subnormal intellectual capacity, and that such people should not be allowed to drive motor vehicles.

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.