It is generally agreed that the occurrence of marked clinical dementia and accompanying cortical pathological lesions is rare in cases of idiopathic paralysis agitans. Cases which show this association have been described by Jakob (1923), and by Critchley and Greenfield (1937.). The name “Jakob's disease “has been assigned to this clinico-anatomical syndrome by the latter authors. Our case is clinically a typical one of this syndrome, and possesses some unusual pathological features which make it worthy of record.

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.

In this short paper I hope to present to you some of the problems attendant on the employment of the epileptic. In so doing I shall rely as far as possible on my personal experience of the problem as it has presented itself in my routine work as medical officer for the London district of the L.M.S. Railway, which covers a large area of our system, with some 44,000 workers employed on a wide variety of occupations.

Anodontia is a physical anomaly which may present itself in varying degrees, and although cases of partial anodontia occur with comparative frequency, the condition of complete anodontia is rare.

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.

Attention was drawn to the important work of Putnam and Merritt by an annotation in the Lancet last year. The results of their studies were published in two papers entitled “A New Series of Anti-convulsant Drugs Tested by Experiments on Animals” and “Sodium Diphenyl Hydantoinate in the Treatment of Convulsive Disorders”.

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.

Although the subject of this contribution is somewhat narrow, it is hoped that points raised will have some bearing on matters wider than pure therapeutics.