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816 presence, and then he goes on to suggest many ways in which this knowledge could be increased. There are now societies of electro-encephalography in several countries and a journal will appear next year. But Jasper has found-and others in the States and in England will agree with him-that the volume and quality of original work has been disappointing. " Instead of representing.a stimulus to more intense fundamental investigation, clinical applications have drawn us away from basic research.... The outcome has been a number of pseudo-scientific clinical investiga- tions which have served only to burden editors and readers of scientific journals without providing a great attraction to more serious minded investigators con- cerned with the fundamental aspects of brain function." There appears, therefore, to be danger of criticism from two sides-the clinical and the physiological-presumably because the subject has a difficult position within both fields of work. The solution may lie in the use of a team, consisting of physicist, physiologist, and clinician, as well as the group of technicians. Such a unit would be far beyond the needs of most institutions, but it is necessary if the standard of work is to be maintained at a high level and if knowledge is to be increased. Even if most units are necessarily smaller than this, each should include a well-trained clinical worker who has knowledge of physiological method and who at least can work in close touch with academic physiologists. CEREBROVASCULAR ACCIDENTS IN HYPERTENSION THE precise nature of vascular accidents to the brain in hypertension is sometimes certain and at other times obscure. With the classical cerebral hemorrhage or thrombosis the clinical picture is usually unmistakable, and the pathogenesis beyond question. A larger group of cases is characterised by transient paralysis, paresis, aphasia, or amaurosis. Such a syndrome, now known by the generic title of hypertensive encephalopathy,l may take an acute or chronic form. Acute encephalopathy occurs with the hypertension of acute nephritis and of toxsemia of pregnancy, and with acute exacerbations of chronic hypertension. The attacks, consisting of severe headache, drowsiness, vomiting, and convulsions, may be preceded or followed by focal cerebral signs which usually leave no stigmata in those who survive. Volhard’s original suggestion that the immediate cause is acute oedema of the brain is now generally accepted ; but it is still undecided whether this oedema is due to excessive or defective arteriolar constriction. The principal features of encephalopathy in chronic hyper- tension are its brief duration and the completeness of recovery from motor or sensory disturbances ; there is, as a rule, no 10s&bgr; of consciousness. It has long been held that the disturbance is due to localised spasm of the cerebral arterioles. Pickering,2 however, now postulates that it is the outcome of embolism or thrombosis. Cerebral arteries, he points out, have exceptionally thin walls, and the media of cerebral arterioles contain relatively little muscle tissue. This anatomical evidence against contractility is supported by physiological evi- dence of difficulty in producing vasoconstriction by either adrenaline or stimulation of the cervical sympathetic fibres. Pickering draws attention to the similarity of the cerebral syndrome in hypertensive encephalopathy with that in cerebral embolism due to mitral stenosis and auricular fibrillation. In both, he suggests, the mechanism is the same--namely, sudden organic occlu- sion. In hypertensive encephalopathy the eventual state varies between complete recovery and persistent paralysis. At the latter end of the scale thrombosis or 1. Oppenheimer, B. B., Fishberg, A. N. Arch. int. Med. 1928, 41, 264. 2. Pickering, G. W. J. Amer. med. Ass. 1948, 137, 423. embolism has always been acknowledged as the cause, He believes that the termination of transient disturbances is due to dislodgement of the embolus from a main artery ; where the disturbance, though still temporary, is more protracted the embolus or thrombus may become canalised or collateral circulation develop. Pickering’s explanation-like others- is still largely based on hypothesis. But he is on firm ground in claiming that his suggestion " violates no cardinal principle in vascular physiology and is in harmony with the pathology of hypertensive disease." THE CRIMINAL AND THE BENCH " WRITE and tell him what you think of him, by all means," was the advice of an editor to a junior, and angry, member of his staff ; " but don’t send the letter." The same principle might be followed in courts of justice. Mr. Claud Mullins, giving the Maudsley lecture of the Royal Medico-Psychological Association on Nov. 12, con- sidered it a weakness of our judicial system that sentences are usually passed within a very few minutes of the verdict being reached. Judges should be beyond emotion, yet some crimes, notably sexual offences, excite unreason- able anger in many people ; and though it is unforgive- able, he said, to pass a sentence in anger, some criminals appear so unrepentant and defiant that magistrates, recorders, and even judges may be forgiven if they find them hateful. With even a smattering of psychiatric knowledge, however, judges could recognise such behaviour as a defensive reaction. The judge who forms his opinion of a prisoner by watching his conduct at the trial could hardly engage, Mr. Mullins suggested, in a more dangerous practice ; and the lawyer who says " I can tell a rogue as soon as I see him " is deceiving himself : it simply cannot be done. The rule of passing sentence directly after the verdict has another drawback : it gives the magistrate no opportunity of getting further information about the prisoner-unless, indeed, such information is obtained before the trial starts. Since the prisoner is presumed innocent until he is proved guilty this too presents difficulties. Children and young people convicted of crimes are remanded while inquiries are made ; and it might be wise to remand adult prisoners in the same way. Early in his career as a magistrate, Mr. Mullins began to have doubts about our traditional methods of dealing with criminals ; and he took the trouble to learn some- thing of abnormal psychology, and to arrange for psychiatric treatment of convicted criminals who were willing to accept it. He has even managed to persuade some who had been acquitted for lack of evidence to accept treatment. The results were encouraging, especially with some sexual offenders, notably exhibi- tionists. He realises that such patients are not necessarily cured by psychiatric treatment : but they often give up behaving in a manner which is dangerous or annoying to others and so brings them into conflict with the law. Psychiatric treatment is not necessarily an alternative to punishment, he considers ; indeed, wise punishment can satisfy a criminal’s unconscious needs, and should have his approval. Unfortunately in a high proportion of cases the punishment is related to the crime, not the criminal. The new Criminal Justice Act gives express powers to the courts to arrange for a medical inquiry into the prisoner’s case, provided he consents ; but this is a practice which has been followed in enlightened courts for a long time. Whether or not the Act will bring better conditions depends on the willingness of the courts to use their powers. Psychiatrists, he suggested, must do what they can to form a body of public opinion favouring methods more likely to induce a change of attitude in the prisoner, and hence greater protection for the public. He quoted the case of a child sent to an
