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All this reflects the increasing availability of public and private funds for mental retardation research. In view of the many years of neglect of the field there is urgent need for acceleration of this research activity on all fronts.

In the medical field the importance of environmental factors whether inherent in the physiology of the mother herself, or upon the circumstances and situations in which she finds herself, can undoubtedly be clarified by epidemiological studies, particularly longitudinal studies of the prospective type. Many forms of retardation are due to congenital malformation of the central nervous system; more accurate classification of these malformations is a necessary step.

The recent discoveries relating to "inborn errors of metabolism" of genetic origin point up the need for further studies of the nature of gene action and interaction with the prenatal or postnatal environment, especially where manipulation of this environment can lead to the suppression of undesirable characteristics to which a genetic defect may predispose the individual.

Such studies of both genetic and environmental factors are basic to attempts to identify the specific causes of the various clinical entities such as mongolism and microcephaly. The discovery, in England and France, of an abnormal chromosome complement in mongoloid children (47 as against the normal 46 chromosomes) undoubtedly will lead to greatly accelerated research activity into this particular condition.

Those causes of mental retardation associated with the birth process which appear to require particular emphasis at this time fall in three classifications. First, the relation between prematurity and mental retardation, although positive, is not understood. Secondly, the possible damage to the brain due to delays or other interference with the infant's proper breathing in the first minutes and hours of independent life also require considerably more study. Finally, there is substantial evidence that abnormalities in the composition of the blood in the neonatal period are important determinants of permanent damage resulting in mental retardation.

Among the possible sources of damage to the brain after birth diseases of the circulatory system require more study. A number of common and uncommon childhood diseases may result in inflammation of the immature nervous system of the child which will leave permanent residual damage. Many different viruses may produce such effects, but do not necessarily do so. This fact very much complicates the research picture, while at the same time pointing up the importance to the field of mental retardation of the study and control of many types of viruses.

Such a broad program of medical research reemphasizes the need for parallel activity in sociological and psychological areas. Yet, remarkably little attention has been given to the fact that all cases of mental retardation, regardless of etiology, present a continuing social problem. This problem is multiplied when one recognizes the compelling factor that mental retardation poses a severe social problem not only for the retardate himself but for the entire family group, and in many ways the problem extends into the community at large.

This is well exemplified by a question that has been posed in the literature and in practice with increasing frequency in recent years: on what grounds can the physician (or other counselor) base his recommendation as to how a family should handle a problem of retardation once it has been diagnosed, particularly with regard to institutionalization? In this regard Bernard Farber's study "Effects of a Severely Retarded Child on Family Integration", published in 1959, has produced important findings of areas of sensitivity in the interpersonal relations of families so affected. From one point of view his findings can be used presently with appropriate caution in considering the question whether residential care should or should not be recommended in particular cases of severely retarded children or not. However, seen from another angle his findings and those of further more refined studies he has suggested, should provide important leads for community planners. If we can identity a growing number of tension producing situations involving the retarded child and his family we need not necessarily accept these passively as indicators for institutionalization but can proceed to consider and plan for appropriate community services which would tend to bring specific relief to families in these situations. Thus we would receive important clues as to needed functions, structure and administration of day care services, clinical consultation, leisure time programs, temporary residential care facilities and similar supportive programs for families with retarded children and young people.

There is needed a social and psychological appraisal of differentials in parental attitudes toward the problem of mental retardation as such, toward their own retarded child, toward treatment (in the broader sense, including medical, social, and educational measures) and the agencies providing the treatment, and toward their own continuing responsibility to plan for the future of this mentally retarded child during their own lifetime.