Jung wrote his Type Psychology in 1914, but does not seem to have developed any further its general thesis. The terms “introvert” and “extravert”, however, have slipped into everyday language, and experimental studies and questionnaire inquiries on introversion-extraversion continue to be published in psychological journals. Ink-blots, ambiguous figures, and even knee-jerks are called upon to measure this fundamental tendency of man; inventories and self-rating sheets are employed widely to estimate it; and yet it appears to evade capture. There is as yet little or no evidence anywhere that a coherent tendency of the kind looked for does in fact exist.

I am deeply conscious of the high honour which has been bestowed on me in having been granted the privilege of delivering this year's Maudsley Lecture. It is an honour which I value very highly, and I trust that the subject I have chosen for your consideration may prove in some degree worthy of the occasion.

The choice of my subject for this address has been determined by two factors: firstly, the precedent set by many Presidents of the Royal Medico-Psychological Association, when, as medical superintendents of modern mental hospitals which have emerged from ancient asylums, they spoke fascinatingly of their institutions' more remote past. Secondly, it has always been a cause for regret that I was not able to complete the centennial cycle in a book which I published eight or nine years ago entitled, A Critical Review of the Mental Hospitals in the Punjab from 1840 to 1930. It would be possible now, in this year of grace 1939, to hold a psychiatric centenary and to publish a new, revised and up-to-date edition, but the contents of a volume cannot be conveniently condensed into a few pages of typescript. All that can be done is to indicate retrospectively some of the ups and downs of the past century, to paint rapidly some of the high-lights and shadows which have alternately illuminated and darkened the history of psychiatry in this province. So if my recital seems disjointed, if there is little logical connection between one silhouette and the next, if there appears to be a flight of ideas, I beg that you will not regard this address as more maniacal than chairmaniacal.

I chose the title “Watchman, What of the Night?” because I hope to show that “the night is departing, the day is approaching”.

When I was thinking, with considerable anxiety, how I should start this address to you I was at the same time listening to the anthem by Brahms: “Blesseadre they that mourn”. Surely this omen was a good omen. How ever I may mourn to fall short of the high standard you are accustomed to, you will I trust bless and comfort me by your kind-hearted and friendly reception of my effort.

Since early times interest has centred round the problem of whether special virtue or taint is attached to the first-born child. Some recent workers, like Pearson (1914), have believed the first-born child to be liable to physical and mental handicaps. Still (1927) focuses attention on certain diseases which appeared to be more frequently manifested in the first child in a family than in children born later in that family. He also realized that maternal age might be a significant factor in other conditions. A summary of a good deal of the work done on these problems was published by Thurstone and Jenkins (1931). These writers drew attention also to parallel studies in animal genetics. Wright (1926 and 1936), by his analysis of Polydactyly and coat colour in guinea-pigs, laid a foundation for genetical work on maternal age. The effects he observed were due to alterations of characters in early offspring. Unfortunately, experimental animals rarely live long enough to make possible the corresponding study of maternal age effects at the end of the reproductive period. Evidence that birth order of itself is of significance in animal genetics has been scanty. Recently, however, Goetsch (1937) reported that the first eggs of the queen ant (Pheidole pallidula) give rise to small and physically feeble workers. In the present communication the results of some of the writer's recent researches on the effects of maternal age and birth order in human genetics are discussed. A multitude of human malformations are relevant to this study. Investigations of their respective ætiologies is of interest from the point of view of elucidating the effects of natural selection in man as well as from the standpoint of preventive medicine.

Experiments were performed to answer the elementary question whether cardiazol, after intravenous injection, has time to reach the central nervous system before the fit occurs. The question is not entirely superfluous for two reasons: first because several workers have reported convulsions occurring immediately after the injection, or even before the injection is completed, whereas in normal persons the average time taken for blood to circulate from the antecubital veins to the carotid sinus under resting conditions is 15·6 seconds (East and Bain (1936)), and from the carotid artery to the brain probably 1 second (Wolff and Blumgart (1929)); second, because it is important to decide whether the carotid sinus plays a part in the mechanism of the fit, since it is known that stimulation (by digital pressure) of the hypersensitive human carotid sinus will cause unconsciousness and convulsions (Weiss and Baker (1933)).

Pelizaeus (1885) described a family of which five members exhibited a rather uniform clinical symptomatology, consisting of tremor of the head, nystagmus, spastic paraplegia, etc. He thought he was dealing with an atypical familial form of disseminated sclerosis. Twenty-five years later Merzbacher (1910) investigated the same family and found the symptoms in twelve members, representing four generations. Symptomatology and clinical course of the condition was, in all patients, approximately identical: onset within the first months of life, rapid progression within the first six years, slowing down later considerably, death after twenty to thirty years due to intercurrent disease. The symptoms were tremor of the head, nystagmus; later paraplegia, ataxia, visual and auditory disturbances, involuntary movements, etc. The emotional and intellectual sphere remained comparatively unimpaired. The heredity was found to be recessive: the mothers, though themselves spared by the disease, pass it on to their sons (though among the twelve cases of Merzbacher there were also two females). In the one case investigated histopathologically by Merzbacher a diffuse demyelinization was found, particularly marked within the occipital region, distributed symmetrically in both the hemispheres and characterized by the persistence of myelin islands, often around vessels, which gave the condition the appearance of a tiger's skin. Merzbacher thought he was dealing with an hereditary aplasia of axis cylinders and myelin fibres, and called the condition aplasia axialis extra-corticalis congenita.

More than a thousand years ago a Japanese writer, we are told, came to the conclusion that specialism was the curse of every subject in connection with which it had been developed.

The investigations reported in this paper owe their origin to a systematic research on the fibrous glia in various groups of mental defectives. A preliminary note on this subject has already been published by A. Meyer and L. C. Cook (1937). For technical reasons the full report on these findings will be delayed. A special publication on the findings in mongols seemed to be desirable, not so much because they are thought to constitute the substrate of the mental defect in mongolism, but because they are so unusual that they deserve special mention. In addition, they throw some light on the findings and interpretations of previous workers.

[In the physiology of the central nervous system, the hypothalamus has of recent years obtained a position of much enhanced importance. There is reason to believe that it has a determining influence on cortical function and evidence is not wanting that some psychotic conditions are associated with hypothalmic disturbance. It may well be that many forms of mental disorder are conditioned by a lesion of the hypothalamus. This close anatomical and physiological relationship between this area of the brain and the pituitary we think, therefore, cannot be over-emphasized. Dr. Max Reiss was asked by the Research Bureau to present a review of our present knowledge of the anterior pituitary, on which he is a recognized authority.]

The influence of the endocrines on the excretion of creatine and on the urinary creatinine level has become increasingly recognized of recent years. It has, of course, long been known that hyperthyroidism is accompanied by creatine excretion. A recent investigation by Sohval, King and Reiner (1938) found that the creatine tolerance test was positive in 90% of patients with active Graves' disease, but only in 10-18% of controls. Shelton and Tager (1937) showed that four out of five slightly hypothyroid children had an increased creatine tolerance.

There is already a comprehensive literature on the convulsion treatment of schizophrenia, and it is not the purpose of this paper either to attempt to assess these results, or to claim therapeutic success, or failure, in the cases mentioned here.

It has been recognized for many years that in certain cases of mental disorder there is a demonstrable disturbance of carbohydrate metabolism. Among early observations may be mentioned those of Raimann (1902), Schultz and Knauer (1909) and Laudenheimer (1898). These workers reported the presence of sugar in the urine of patients suffering from depressive and anxiety states, and noted that the glycosuria often varied with the severity of the mental disturbances and disappeared with them. They remarked, however, that the phenomenon was of little diagnostic importance, inasmuch as it could be found in depressive states associated with many different types of mental illness. Such observations were of value as an indication for further research, but until it was established that the glycosuria was not due to a derangement of the renal mechanism of sugar excretion, it could not be claimed that the findings indicated such a fundamental metabolic disturbance as is now known to exist. Although Santenoise and Tinel (1923) stated that the renal threshold varies according to the mental state of the patient, many more recent workers have shown that the increased sugar excretion is always associated with a greater or less degree of hyperglycæmia, and, although agreement on this point is not complete, the balance of evidence favours the belief that such hyperglycæmia is alimentary in origin, and not spontaneous. As the earliest workers appeared to recognize, the metabolic disturbance is found mainly in states of depression, which may be retarded or agitated, and in certain cases of schizophrenia, which, too, may be stuporose or restless. Some investigators are of the opinion that the same disturbance may be found in states of mania as well as or even to the exclusion of depressive states, but this is a view which is held only by a minority.

The general object of the Criminal Justice Bill, now before Parliament, as set out in the explanatory Memorandum, is to improve the methods of dealing with persons found guilty of offences, including adolescent offenders and persons who commit repeated offences. It so happens that the Home Office has recently issued, as a Stationery Office publication, a Report on the Psychological Treatment of Crime which was made to the Secretary of State by Dr. Hubert and myself. The present position of psychiatry in relation to crime, therefore, seemed a fitting subject to discuss at this Conference.

In many theories concerning the development of psychological illness, stress has been laid upon the difficulties encountered during the earliest period of life. The problems of feeding in infancy and early childhood have, in particular, been believed to colour if not actually to determine certain neurotic and psychotic behaviour.

I would first like to thank you for the honour and privilege of addressing you on this subject of co-operation between special departments of a general hospital.

The opportunity I have of speaking to you is for me both a pleasure and a privilege, but it is also, I fully appreciate, a responsibility.

The field of psychiatry to-day is not unfruitful and not a few discoveries of lasting worth appear to have been made, while certainly claims to progress of more doubtful value, both as regards letiology and even more with regard to treatment, are so numerous as to be rather bewildering, particularly when they become the subject of articles in the popular press, whereby relatives are enabled to make a diagnosis and decide on a line of treatment without any reference to the medical man.

Various complications to convulsant drug therapy in mental diseases have been stressed in recent reports. These complications have consisted of fractures, dislocations, cardiac irregularities, the development of abnormal neurological signs, etc. Little comment has been made on the behaviour of the patient or the mental state following the use of such treatment, except to say that there was or was not improvement. The fact that patients frequently pass through interesting and perhaps significant stages in their recovery, or failure to recover, is worthy of comment.

The problem of devising scientific means of assessing and describing the personal characteristics of an individual has been attacked along a number of lines, of which the principal, perhaps, has been the attempt to separate independent variables by the use of tests, which, it was expected, might be the subject of progressive refinement through study of the intercorrelations of scores obtained with them. So, starting with the admittedly imprecise categories of common discourse, and the adjectives commonly used in the description of individuals, it was hoped that by degrees it would be possible to disentangle the basic variables to which personality and character are subject, and to provide the means of assessing each by the use of a particular test. It can scarcely be said that these hopes have been realized. The categories in question have eluded the refining power of test score factorization.(1)