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.

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)).

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.

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 published reports on convulsant drug therapy of the psychoses have stressed the favourable results of such treatment, with only an occasional reference to the undesirable or unfavourable sequelæ other than such complications as fractures, dislocations, cardiac arrhythmias, etc. It seems worth while to survey the results of a series of patients so treated, and point out that psychotic patients receiving convulsant drug therapy may show undesirable mental sequelæ.

As the title suggests, this paper is a review of insulin therapy in our hospital, and as such we shall discuss only actual cases with their results.

The title of this paper may seem over-ambitious in the scope which it predicts, for it is obvious that much more space would be required to cover all the ground. It should be made clear that we are concerned here mainly with the administrative side of child guidance, which has of late years become a vital concern to the members of this Association. During the past few years there has been growing in the minds of all those interested in the promotion and preservation of mental health a belief that a co-ordination of existing mental health services should be carried out. At present these services are too sporadic and are uneven both in distribution and efficiency. London and the great cities are rich in mental health services of all kinds, but in the counties and smaller towns there are but meagre provisions. This is well illustrated by the voluntary societies concerned with the treatment and prevention of mental illness. There is, for example, the Home and School Council, which works on the principle that a better relation between parents and teachers constitutes a creative force in mental health, and further provides a unique channel through which mental health knowledge can be brought before the general public without the risks attached to indiscriminate propaganda. Another society, at the other end of the scale, is the Mental After-Care Association, which attempts to bridge the difficult gap which patients experience between leaving a mental hospital and taking up life in the ordinary world again. Yet another society is the National Council of Mental Hygiene, whose broad aims are to educate the public in mental health matters, to promote closer association between psychiatry and general medicine, to further the early treatment of mental disorders, etc. The Central Association for Mental Welfare was, at its inception, mainly interested in the problems of mental defect, but now has a wide range of activities, such as the organization of training courses for medical officers, teachers and mental welfare workers, co-ordinating local activities in many areas and making provision for cases which fall outside the scope of smaller authorities, and undertaking public activities relating to propaganda and the promotion of legislation. In a more limited field the Child Guidance Council attempts to encourage the provision of skilled treatment for children showing behaviour disturbances or early symptoms of nervous and mental disorder and, in general, to further the practice of child guidance. In addition to those societies which are directly concerned with mental health, there are many others, such as the British Social Hygiene Council, the National Association of Probation Officers, the R.S.P.C.A., the Howard League, the National Institute of Industrial Psychology, whose work lie on the borders of this field. It is obvious that there is a great deal of overlapping, and the need for co-ordination is being attained through a temporary reconstruction committee under the chairmanship of Lord Feversham, which will shortly publish a report.

In spite of Freud's great discoveries tracing back the origins of adult psycho-neurosis to the mental conflicts of early childhood, until comparatively recently little was done by psychiatrists generally to investigate and treat directly the mental problems of difficult and neurotic children. Though a few clinics had been established for a considerable time in Vienna and elsewhere as a result of the work of Adler and his pupils, the “Child Guidance “movement obtained its greatest impetus from America. Here it arose, however, out of social problems rather than medical; more particularly from Healey's studies of delinquent children. Partly on account of its origin in this way, and partly no doubt influenced by the behaviourist psychology so much in evidence in U.S.A., the tendency there from the beginning was to stress the importance of the child's environment and the remedial effect of altering harmful influences found in it. The psycho-analytic schools, on the other hand, have emphasized the endogenous nature of neurotic conflict, i.e., localized the trouble wholly in the child's mind; which has led them to concentrate on treatment of the child itself to the exclusion of the material surroundings.

The stimulus behind this investigation was created by various factors which can only be enumerated briefly. In the course of routine sero-diagnosis of syphilis in psychiatric work at the Institute during the last five years, it became evident that, of the three flocculation tests employed, the Kahn (Kahn, R. L., 1928), Müller-Ballungs reaction (Müller, R., 1929), and Meinicke Klarungs reaction (Meinicke, E., 1929), the Meinicke original extract gave results superior in sensitivity. This feature was shown particularly in very early infections and treated cases. Three Wassermann tests, the standard method for psychiatry (Mann, S. A., and Partner, F., 1931), the Wyler drop technique (Wyler, E. J., 1929), and the Browning and Kennaway methods (Browning, C. H., and Kennaway, 1924), run concurrently, could not claim to be as good in this respect, and further, were liable to give non-specific results. The explanation of some of the anomalous reactions of one or another of the three hæmolytic systems seems to lie chiefly in the fact that sera from psychotic and mentally defective patients contain in larger degree elements that are prone to disturb specificity.

This method appears first to have been used in the U.S.A. by Kunde, Hall and Gerty (1927) and then by Mackenzie (1927) in this country. Later Driver and Shaw (1933) gave divided doses of typhoid vaccine, and Schnitker (1934) gave typhoid H antigen. T.A.B. vaccine, containing one thousand million dead B. typhosus and seven hundred and fifty million each dead B. paratyphosus A and B per c.c., has been used here since July 6, 1928.

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.

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.