When you did me the very great honour of calling on me to deliver the Maudsley Lecture, I was told that it had been decided that these lectures should be devoted alternately to scientific psychiatry and to subjects of general popular interest, and that the subject of my lecture was to be scientific. I decided that with a year's notice the active preparation of the lecture might well be postponed for eleven months, and that during this gestation period I might hope to fix on one of the many aspects of pathological or physiological science of sufficient interest to justify a not too technical exposition to a mainly clinical audience.

Society's attitude towards those who commit crime is undergoing a fundamental change. Interest in criminals has changed from the moral and legal to the psychological and sociological aspects, with the result that the criminal to-day has acquired a new importance. In the old days the community set out to punish the criminal and did so with considerable severity. The Law still continues to keep as its first consideration the protection of the community, and the claims of society are considered greater than those of the individual. Nevertheless, intensive study of individual offenders is essential if we hope to be able to advise society as to the best methods of dealing with those members who will not or cannot obey its rules.

In this paper an account is given of the results of investigation of the use of the Columbian group test in a series of 10,000 male adolescent prisoners between the ages of sixteen and twenty-two years.

The hereditary aspect of mental disease is at the present time a preferential topic of research, and the importance of constitutional factors in the causation of neuroses and psychoses is generally admitted. In many instances the term “constitution” is merely a hypothetical “X” introduced because of the absence of other facts which could account for clinical symptoms. Constitution is given a positive meaning only if it is identified with hereditary equipment, which has to be assessed by the careful analysis of the clinical aspect of the disease as a whole, including its hereditary and familial aspects, as well as environmental and other exogenous causal factors. Unfortunately, psychiatric illnesses as a whole do not lend themselves readily to this type of investigation. It is usual, therefore, to apply the results of studies of heredity in non-psychiatric conditions to psychiatric illnesses themselves. As neurological conditions are the most closely allied to psychiatric ones, they are most commonly used. One of the most convenient types of illness to study from this point of view is Huntington's chorea, not only because of its psychiatric aspects, but also because of its striking symptomatology and course.

In availing myself of the invitation kindly extended to me by the Institute for the Scientific Treatment of Delinquency of speaking to you on “The Treatment of Mental Disorders and Mental Deficiency in Continental Criminal Law “, I have no intention to abuse this privilege by criticizing the corresponding English law or by making suggestions for its improvement. For the latter task I feel myself neither competent nor authorized, as I am only too well aware that every important legal change is dependent upon many considerations which the foreign observer—though possibly conversant with the external facts—can appreciate only inadequately. What I may safely do, however, is to summarize some outstanding features of modern continental law and to add a few personal experiences concerning the legal system under which I worked for nearly a quarter of a century. I intend to deal first with problems of insanity (including temporary insanity caused by drunkenness), secondly with other forms of mental disorders and with mental deficiency.

In a previous paper (1) the iron, copper and manganese content of the human brain were recorded, with special reference to the G.P.I. cortex, which in certain cases contained an excess of both total and “available” (i.e., non-hæmatin) iron.

My problem is to give you a short review of some investigations we have undertaken at Dikemark Mental Hospital on the disturbances of somatic functions in catatonia with a periodic course (1).

Among the mental symptoms associated with head injury the psychiatrist rarely happens to see those immediately following the trauma; he is principally concerned with those mental sequelæ that follow recovery of consciousness (E. Mapother). Neither is the neurologist much interested in “cases of simple concussion in which the concussion is usually of brief duration and there is no indication that the brain has been organically injured” (J. P. Martin). Thus they are generally only observed by surgeons, who are usually more interested in other aspects than the psychological or neurophysiological one. Yet these mental symptoms cannot be disregarded if a general view of the disintegration or re-integration of the nervous function after the traumatic impairment is to be formed.

Perhaps more than any other conditions, allergic diseases during recent years have been the subject of studies demonstrating the interplay of mind and body. In numerous papers on asthma, migraine and urticaria the psychological aspects of these disorders have been discussed. In these conditions the emotional origin of single attacks is generally admitted, but it is still a controversial subject whether, or to what extent, asthma, migraine and urticaria can be considered as part manifestations of a general psychopathological constitution. Hay-fever, since it is a purely seasonal disease, although of clean-cut allergic origin, has so far been excluded from such studies; and yet if in allergic diseases the biological over-reaction, the allergy, is in fact correlated in some way to the mental make-up of the patient, no other disease seems more appropriate than hay-fever as a crucial test of the importance of psychosomatic relationships in allergic disorders. Consequently, with the kind permission and support of Dr. Freeman, I set out to investigate the mental make-up of a number of hay-fever patients in the Inoculation Department of St. Mary's Hospital.

For some years following the war the number of patients admitted to mental hospitals whose illnesses were associated with alcohol definitely decreased, but recently the number again appears to be on the increase. During the past eighteen months 50 patients whose illnesses were the result of alcoholic excess were admitted to St. Ebba's Hospital. As this hospital is set aside for recoverable cases, it is possible that the number is in excess of that admitted to other mental hospitals, owing to the fact that many alcoholic psychoses such as Korsakov's disease and delirium tremens have a good prognosis. Nevertheless, in my capacity as consultant to an observation ward I have found that many patients who are suffering from delirium tremens, “pathological drunkenness “, etc., are admitted to such wards, who rapidly clear up and are discharged without being admitted to a mental hospital, and the impression gained is that the number of alcoholics is steadily increasing. It is not proposed to discuss the symptomatology of the various forms of alcoholic psychoses, which are well known, but to discuss various points of interest which arose during the investigation of these patients.

The estimation of vitamin C in the urine has recently been undertaken on a fairly large scale on patients suffering from physical disturbances. Harris (1) and his co-workers investigated 74 hospital patients at Cambridge, and found that 62 (84%) excreted less than the minimum standard, or 13 mgrm. per day. Excluding 19 on special diets, 43 excreted less than 13 mgrm. per day, and the average excretion of 55 was 10 mgrm. per day.

The hippuric acid excretion test (after benzoate administration) has been used by previous workers, with the general result that it affords a reasonably accurate and satisfactory test for determination of parenchymatous hepatic damage and of various hepatic involvements. The test is also known to be indicative of hepatic disorder, even where no clear clinical signs of hepatic or renal derangements are observable. A series of 67 cases of mental disorder has been examined by the test, 45 of which belonged to the schizophrenic group; 18 of these were classed as catatonics. The average value of hippuric acid eliminated in the non-catatonic schizophrenic group, expressed in terms of benzoic acid, in 4 hours after administration of 6 grm. of sodium benzoate, was 3.4 grm. with an average deviation from the mean of ± 0.4 grm. This value agrees well with the values obtained by previous workers for normal cases having no hepatic damage. The average value of hippuric acid eliminated under the same conditions by catatonic patients was 2.2 grm. with an average deviation from the mean of ± 0.5 grm. All the catatonic patients studied, without exception, showed a diminished ability to excrete hippuric acid at a normal rate. It is inferred that a metabolic disturbance of the liver affecting benzoic acid detoxication may be a characteristic feature of catatonic patients.

Work on benzoic acid detoxication in catatonic patients before and after various shock treatments for schizophrenia is in progress.

Originally the conception of disturbances of the cerebral circulation was closely associated with that of gross arterial and venous disease, and it was in these conditions that the typical pictures of hæmorrhages, hæmorrhagic and anæmic infarctions (softenings), scars and cysts as their sequelæ were first studied. These sequelæ are in all essentials the same in the brain as in other organs with similar vascular arrangements, such as the kidney and the spleen, with the exception of some peculiarities due to special structure or special staining reactions. Recent ischæmic necrosis of the grey matter appears in Nissl-stained specimens as areas of pallor, and examination under high magnification often reveals a special type of ganglion-cell change called ischæmic by Spielmeyer (16), which so far has maintained its reputation as being highly specific. A further peculiarity is provided by the activity of the glia in all processes of breakdown and repair. In vascular disease especially, a type of mobile glial-mesodermal activity is met with (Spielmeyer (16)), that is to say, the glia acts jointly with the mesenchymal tissue in the production of scavenger-cells and of fibres.