The purpose of this article is to review briefly a few of the many questions that have arisen directly or indirectly out of the interest taken of late years in the matter of the care and control of the feeble-minded, and to comment on some of the aspects of the legislative measure, known as the “Mental Deficiency Act,” which has ultimately resulted from that interest. Some reflections by the way on this subject, about which at the present moment there is necessarily but little practical activity, may, I trust, be regarded as not wholly inopportune. In offering to the readers of this Journal the following remarks on some difficulties that have been raised regarding the interpretation and working of the new Act, and in noting certain misconceptions and more or less irrelevant discussions that seem to have obscured the practical side of the subject, I have but the excuse of a long-continued interest in the matter of the due recognition of mental failure in all its varieties, and of my personal experience, gathered from the study of criminals, touching the part played by mental defect or disorder as a factor in the production of crime. These notes, which are at least meant to be practical, will therefore tend to circle chiefly round the questions of the actual diagnosis of such mental defect in persons of all ages as is now officially registered under the term “mental deficiency,” and of the relation that seems to exist between mental defect generally and criminality.

There is a class of individual loose upon society whose presence and significance in our midst seems, as yet, insufficiently and improperly appreciated. These people are usually of pleasant address, with all the outward show of civil social observance; they are fluent of speech, readily adaptable to circumstances, superficially in every way most plausible. How does it come, then, that on closer acquaintance they prove to be the scourge of their relations and friends; that many of them have a prisoner's acquaintance with the police courts; that they are frequently embezzlers of money; are guilty of theft, drunkenness, and immorality of every kind; that slander, with all its miserable train of disintegrating influences, emanates from them as a miasma? Punishment is no deterrent to their anti-social activities; they are supremely unaffected either by the teachings of past experience or the forewarnings of future suffering.

It is just forty years since I first ventured to call in question the accepted doctrines of the causation of nervous diseases. In an article in the British and Foreign Medical and Chirurgical Review, an excellent quarterly now long defunct, I likened the imagination of physicians in this respect to the imagination of that fortunate sailor to whom was granted (nowadays we should say who was given) the fairy privilege of having three wishes fulfilled. After he had secured all the rum in the world and all the tobacco in the world by his first two wishes, he could think of nothing further to desire than “a little more rum.” So physicians, after they had attributed every known nervous disease to sexual excess and syphilis, had no explanation of a new disease to offer beyond a little more sexual excess. The only nervous diseases that were not then attributed partly or wholly to syphilis were tabes and general paralysis. Some five-and-twenty years ago, when an eminent physician was about to lecture upon the causes of insanity, I hazarded the conjecture that we should hear a good deal about masturbation, and I had no reason to repent of my prophecy. We may be pardoned a little natural exultation when we contrast the present state of ætiological doctrine with that which prevailed in those dark ages. We had then no more reason for our belief than Aristotle had for the belief that all heavy bodies tend to the centre of the universe, but now we know that the mental diseases that we used fondly to ascribe to sexual excess and syphilis are, in fact, due to repressed complexes and infantile incestuous longings. How foolish were our predecessors! How enlightened are we!

In studying a case of insanity, the family history of the patient is a matter of considerable interest. But it is often difficult to obtain reliable information on the subject. In such researches one has to contend with ignorance and prejudice. Many people know very little about their ancestors or collateral relations. And further, the idea that insanity is a disgrace so pervades all classes of society, that a man is shy of speaking about the mental condition of his relatives, if it should chance to be, or have been, diseased.

In 1896 Kraepelin first introduced and defined his conception of the manic-depressive psychoses and dementia præcox. It has been fairly generally admitted that his was a brilliant piece of work, but since that time he has been led, in certain more or less minor respects, to modify his views. Briefly put, Kraepelin described in a very thorough and detailed way the symptomatology of these disorders, and then, according as the case was one of manic-depressive insanity or dementia præcox, the prognosis was held to be either good or bad respectively. Such a simple method of differentiation and of deciding on the prognosis seemed too good to be true, and although it must be admitted that in the main it holds good, yet in certain fundamental respects it fails. We all know that certain types of the manic-depressive psychosis do not get well, and on the other hand we all probably have seen cases which, symptomatologically, were cases of dementia præcox that recovered. In no group of cases has this been more clearly seen than in catatonia.

The first thing I wish to call to your attention is the distinction between the foot-pound and the cubic foot. The footpound is used to measure work, and when work is stored it is called energy. The cubic foot is used to measure material substances, or the space in which bodies are contained. What I have to say relates to things measured by the footpound or corresponding unit, and not to things measured by the cubic foot.

[We have received the following Address from Dr. Brush, who, knowing that we have had some difficulty in obtaining sufficient material for the Journal since the war began, kindly offered it for publication in our pages, while it will appear simultaneously in the July issue of the American Journal of Insanity, of which Dr. Brush is the Managing Editor. He is also the President of the American Medico-Psychological Association for the current year, and his views will no doubt be full of interest for his colleagues in the specialty on this side of the Atlantic.—Editor. Journal of Mental Science.]

So little has been written in this country on Pseudologia Phantastica, or Pathological Lying, that Dr. George Robertson, Physician Superintendent of the Royal Asylum, Edinburgh, has urged me to report the following case of this disorder associated with hysteria and a certain degree of moral defect.

In this erudite article the author points out that Brunetière is wrong, when, in his study of La Pathologie Mentale des Rois de France, he states that Auguste Brachet invented a new science, having for its object the explaining of historical facts by biology and pathology. This method of studying history is almost as old as history itself, and the author supports this view by a formidable array of facts.

This question, the author says, cannot be treated from a theoretic or metaphysical point of view; it ought to be dealt with, on the contrary, by the positive method of observation and experience. One has been taught that psychological life is bound up with the presence of a nervous system. As we descend the zoological scale the nervous system gradually simplifies its structure and finally disappears. No one has demonstrated with certainty the presence of nervous substance in the protozoa. Are we, therefore, to conclude that there is no psychological life in these simple animals? The author considers that the continuity, which in zoology binds the most simple phenomena to the most complex, leads us to think that even among the infusoria there may be rudimentary psychological phenomena.

Questions were circulated by an Italian psychological society among psychologists, professors, and others concerning antipathy, its relation to other antagonistic states, its description and analysis, its various forms, its course and transformations. Something over a hundred replies were received, and many are here reproduced. They are often interesting and suggestive, but, as might be expected, sometimes contradictory. Gambara and others consider antipathy fundamental and instinctive. Stepanoff, on the other hand, who regards antipathy as chronic opposition, argues that acute opposition arises earlier than the chronic form, which is not known in young children, and presupposes so considerable a social education that it is not one of the first even of chronic psychic states. Assagioli regards it as a reaction of defence, derived from the instinct of conservation, and not easily distinguished from other states of opposition. Foà, however, believes that the oppositional states are easily determined, and are aversion, hate, repugnance, and antipathy; he regards antipathy as fundamental and primitive. Boncinelli and others believe that antipathy is simply a complex result of many mental states, and that it has no special function, while Vacca regards it as a purely artificial conception, and mainly negative.

The term, epilepsia tarda, is applied to the epileptic phenomena occurring in advanced age. A few authors distinguish between epilepsia tarda and senile epilepsy, understanding by the first that form of the disease which is said to appear about the thirtieth year, and by the second that which occurs after 60 years of age.

This is the second of the author's studies on the “feebly inhibited,” and in the preface he justifies the use of that term, on the ground that, while the term “mind” could doubtless be stretched to cover the emotional phenomena he is dealing with, it seems best to consider the hereditary basis of the emotions separately. “The chief problem in administering society is that of disordered conduct; conduct is controlled by emotions, and the quality of the emotions is strongly tinged by the hereditary constitution.”

The author here seeks to analyse the distribution in families of temperament, as expressed in mood, and to test the hypothesis that it is dependent on heredity. Mood is divided into two main clashes (as seen in manic depressive states): the hyperkinetic or exalted, and the hypokinetic or depressed. The hyperkinetic temperament is divided into two grades: a less developed called nervous (and sometimes sanguine), and a more developed called choleric. The hypokinetic temperament is likewise divided into two grades: a less developed called phlegmatic, and a more developed called melancholic. In some families there is a prevailing tendency to the first class of conditions, and in other families for the second class, while yet other families show a mixed state. How can we bring under one general scheme the inheritance of these various types of mood? After several trials the following hypothesis was selected to test. There is in the germplasm a fectot E, which induces the more or less periodic occurrence of an excited condition (or an exceptionally strong reactibility to exciting conditions), and its absence e, which results in an absence of extreme excitability. There are also the factor C, which makes for normal cheerfulness of mood, and its absence c, which permits a more or less periodic depression. Moreover, these factors behave as though in different chromosomes, so that they are inherited independently of each other and may occur in any combination.

The author's object in this paper is to emphasise afresh the fact that neurasthenic symptoms are in some cases the result of underlying disease, organic or other. Half a dozen cases are narrated in illustration of the thesis. The author summarises his conclusions under four heads: (1) Since the early symptoms of disease are often remote from the organ really affected, it is necessary always to make observations away from the point to which the patient calls atttention; (2) it is even yet more important to enter sympathetically into the patient's emotional attitude, in order to gain the knowledge that can only be acquired by tracing its multiform ramifications; (3) the acuteness of the neurasthenic symptoms is parallel to the gravity of the disease and on a different level from, for instance, the spes phthisica; (4) a very wide and broad view must be taken of the treatment.

After an extensive series of observations, of which he gives particulars, the author concludes that essential epilepsy is neither caused by intestinal putrefactions (abnormal fermentations, etc.) nor by intoxication by purins, nor by retention of, hypersensibility to, or intoxication from chloride of sodium.